Burns And Scalds
Burns are form of traumatic injury caused by thermal, electrical, chemical or radioactive agent.
A burn injury usually results from energy transfer from a heat source to the body.
Type of burn injury may be flame/flash, contract, scald (water, grease, etc) chemical, electrical, inhalation or any thermal source.
1. Fire accidents
2. Electrical injures
3. Chemical injury ( acids)
Signs and symptoms:
1. Many factors alters the response of the body tissue to these sources of heat.
2. Local tissue Conductivity - bone is most resistant to the heat source accumulation. Lesser resistance is seen in nerves, blood vessels and muscle tissue. Adequacy of peripheral circulation
3. Skin thickness, insulating material of clothing or dampness of the sun.
4. Physiologic reaction to a burn is similar to inflaming process.
5. Adjacent intact vessels dilate, causing redness and blanching with pressure.
6. Platlets and leukocytes being to adheres to the vascular endotheliuem, as an early event in the inflaming process.
7. Increased Capillary permeability produces wound edema.
8. Burns may be partial or full
9. Respiratory Distress Syndrome (ARDS).
It depends upon the severity of burns determined by.
5 Area of the body burned
6 Inhalation injury.
7. Obtain arterial blood gas analysis.
8. A chest x-ray should be obtained as a base line.
Treatment of burns :
Management of acute burns injury includes.
1. Hemodynamic stabilization
2. Metabolic support
3. Wound debridemens
4. Use of topical antibacterial therapy.
5. Biological dressing and would closing
The goal is to give sufficient fluid to allow perfusion of vital organs without over hydrating the patient.
1. Immediate intravenous (IV) fluid resuscitation is indicated.
2. First day a crystalloid (RL) solution is used and on the second day a colloid is used.
3. Several formulas may be used to determine the amount of fluid to be administered in the first 48 hrs.
@ Parkland formula:First 24 hrs - 4 ml of RL x wt in Kg
X % TBSA burned.
One half amount of fluid is given in the first 8 hours calculated from the time of injury
Boluses of any colloid may be necessary to keep a urinary output of 0.5 m1 to 1 ml / kg/ hour.
All nonviable tissue is removed down to a viable base.
Fluid may be titrated to achieve a urinary output of
30.50 ml/hr (0.5 ml to 1. mg / hr in adult)
An indwelling urinary catheter is needed to monitor response to fluid therapy.
Weigh the patient on admission and then daily.
Monitor peripheral pulses
Administrator humidified oxygen through a nasal canula, mask or endotracheal tube.
Metabolic supports :
1. Keep the patient by naming by month status. However small amount of (5 to 10 ml/hr) Isotonic enteral tube feedings are often started within 24 hrs to help maintain a functioning of gastrointestinal system.
2. When bowel sounds normal, administer oral fluids
3. Provide 3 gm protein / kg body weight 20% of needed calories inform of fats remainder in carbohydrates.
4. When calorie requirements, cannot be met by external feeding it may be necessary to initiate total parental nutrition (amino acids, carbohydrates, and fat emulsion)
Provide potassium and vitamin and mineral supplements (zinc, iron, vitamin C)
Wound cleansing and Debridment. ( refer racticals)
Treatment of true burns would include daily or twice daily would cleansing with debridement, or hydrotheraphy and dressing changes.
Burn must be cleansed with a mild antibacterial cleansing agent and saline solution or water.
Burn slough will be removed through daily or twice daily dressing changes and use of forceps and scissors at time of wound cleansing.
Hydrotheraphy is the bathing of the patient in a tub of water or a water shower to facilitate cleansing and debridement of the burned area.
1. Adherent dressing are more easily removed
2. Provide patient to practice range of motion exercises.
1. Loss of body heat, sodium loss
2. Uncomfortable to the patient and at times painful.
Topical medications are used to cover burn areas and to reduce the number of organism.
Surgical management :
Early excision and grafting is the basic goal
Burn wound covering :
Biological Dressing are used to cover large surfaces of the body. Usually they are split thickness grafts harvested either from human cadavers or other mammalian donors such as pigs. Human amnion may also be used.
An Allograft is a graft of skin taken from a person other than the burn victim and applied to a burn would temporarily ( a cadaver is a most common source)
A. Kenograft or is a segment of skin taken from an heterogfart animal, such as a pig. It is useful in preparing debrided area for grafting and is really a biologic dressing.
1. 1.Achieving adequate oxygenation and respiratory function
a. Provide humidified 100% oxygen
b. Asses for sign of hypoxemia
c. Asultate chest and note the breath sounds.
2. 2.Promoting Peripheral Circulation
a. Remove all jewellary and clothing
b. Elevate extremities.
c. Maintain intake of output accurately
d. Weight the patient daily
e. Administer diuretics as ordered.
3. Promote skin integrity
4. Maintain body temperature.
5. Avoid infection
6. Administor antibiotics as prescribed
7. Promote optimal personal hygiene
8. Initiate passive and active range of motion and breathing exercise during early post burn period, provide back care.
9. Administer analgecis as prescribed
1. Infection and stock
2. Pulmonary damage.