Burn injury

Burns are tissue damage that results from heat, overexposure to the sun or other radiation, or chemical or electrical contact. Burns can be minor medical problems or life-threatening emergencies. The treatment of burns depends on the location and severity of the damage.

1. PREPARED BY: SAMBAD JAGDISH M.SC NURSING –M.S.N BURN INJURY

2. INTRODUCTION Burn injuries occurs when energy from heat source is transferred to the tissues of the body. Heat may be transferred through conduction or radiation. A scald is burn injury caused by contact with hot liquid or steam but the term ‘burn’ is often used to include scald. Most burns only affects skin. Disruption of skin can lead to increased fluid loss, infection, hypothermia, scarring, changes in appearance and body image.

3. DEFINITION Injuries that results from direct contact with or exposure to any thermal, chemical, electrical, or radiation sources are termed as BURNS . Damage to skin or tissues caused by heat, flame, or steam.

4. TYPES: TYPES PRIMARY INJURY SECONDARY INJURY

5. CAUSES: CAUSES INHALATION INJURY THERMAL CHEMICAL RADIATION BURN ELECTRICAL BURN

6. CLASSIFICATION: ACCORDING TO BURN DEPTH:

7. FIRST DEGREE BURNS: It involves only epidermis. Tissue will blanch with pressure. It produces pink to reddish colour on burned skin. Involves minimal tissue damage. S&S: redness, pain, swelling Healing time: 3 to 6 days. Ex, sunburn

8. SECOND DEGREE BURNS: It involves epidermis and portion of dermis. Often involves other structures such as sweat glands, hair follicles. bright red and Blisters are produced. Oedema, decreased blood flow to tissue can lead to third degree burn S&S: severe pain, swelling, blisters Healing time: depend on severity, usually 1 to 3 week.

9. THIRD DEGREE BURNS: It involves epidermis, dermis and hypo-dermis. Both dermis and epidermis are destroyed. They produce deep scars. Sometimes nerves ending also may destroyed. S&S: charred skin or translucent white skin with coagulated vessels, pain may or may not present. Healing time: depend on severity. It needed to be treated with grafts.

10. FOURTH DEGREE BURNS: It involves deep injuries to muscle, bone, tendons. These may occur with deep flame, electrical or chemical injuries. S&S: wound may become blackened, depressed and sensation is absent. If extremity is involved, amputation is required.

11. ACCORDING TO BURN SEVERITY:

12. ACCORDING TO EXTENT OF BODY SURFACE AREA: THE RULE OF NINE:

13. LUND AND BROWDER METHOD:

14. PALM METHOD:

15. JACKSON’S BURN MODEL:

16. PATHO-PHYSIOLOGY:

17. Thermal Burn Injury Inflammation Histamine release Vasoconstriction Increased Capillary Permeability Increased Blood Pressure Fluid Loss From Injury Site Increased Blood Flow To Injury Decreased intravascular fluid HYPOVOLEMIC SHOCK

18. DIAGNOSTIC STUDIES IN BURN: DIAGNOSTIC STUDIES -CBC -ABGs -CO Hb S.ELECTROL-YTES S.GLUCOSE S.ALBUMIN -ECG -ALKALINE PHOSPHATE PHOTOGRPHS OF BURNS -CHEST X-RAY -FIBEROPTIC BRONCHOSCOPY -LUNG SCAN -BUN/Cr -URINE -RANDOM URINE SODIUM

19. MANAGEMENT OF BURN: MANAGEMENT IMMEDIATE PHASE INTERMED- IATE PHASE LONG TERM PHASE

20. SUBSEQUENT MANAGEMENT FIRST AID PREVENTION OF SHOCK AND RESPIRATORY DISTRESS WOUND ASSESSMENT AND WOUND CARE PREVENTION OF COMPLICATIONS AND INFECTION NUTRITIONAL SUPPORT REHABLITATION FUNCTIONAL AND COSMETIC RECONSTRUCTIONS

21. FIRST AID FOR BURN INJURY: If the skin is not broken, run cool water over the burned area or soak it in a cool water bath. Reassure the victim and keep calm. Cover the burn with sterile non-adhesive Bandage. Protect burn from friction and pressure. Over the counter pain medications may be used to help relieve pain , that also help to reduce inflammation and swelling. Make sure that victim is breathing. If the breathing has stopped or the victims airway is blocked then open airway and if necessary begin CPR. Do not use blanket and towel. Avoid breaking blisters.

22. DO NOT: Do not apply ointment, butter, medications, fluffy cotton dressings, ice, adhesive bandages, cream, oil, or any household remedy to burns. Do not allow the burn to become contaminated. Avoid breathing and coughing on burned area. Do not disturb blisters or dead skin.

23. AIRWAY MANAGEMENT: Persons who are burned on face and neck or those who inhaled flame, steam or smoke should be observed closely for laryngeal oedema and airway obstruction. For mild pulmonary injury, inspired air is humidified patient is encouraged to cough so that secretions removed by suctioning. For severe injury, it is necessary to remove secretions by bronchial suctioning and to administer bronchodilators , mucolytic agents. Early management may required intubation and ventilation. Elevation of head and chest by 20-30 degree to reduce oedema. Early escharotomy is needed in circumferential chest and limb burns when circulatory and respiratory disturbances is observed.

24. HYPERBARIC OXYGEN THERAPY(HBOT): It is non-invasive mode of medical treatment. In which the patient is entirely enclosed in a pressure chamber filled with oxygen at a Pressure greater than atmosphere.  Topical hypererobic oxygen therapy techanique includes delivering 100% oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure through special devices.  It is specially used in also used in the treatment of smoke inhalation. CO has a high affinity to hemo-globin and when it is inhaled it will bind to hemo-globin forming compound called carboxy-hemoglobin , this will lead to hypoxia and decreases oxygen delivery to tissues.

25. FLUID MANAGEMENT: Fluid loss is best immediately replaced through two large caliber peripheral intravenous catheters. An indwelling foley catheter is inserted to monitor urine output accurately. Adult with >15% of burns and child with >10% of burns  BSA requires fluid resuscitation. *All resuscitation formulae should be delivered as a goal directed therapy to prevent the complications of hypovolemic shock and over-hydration.

26. WOUND MANAGEMENT: The wound is one of cause of morbidity and mortality of burn injuries. Until the wound is healed, patient remains at risk of complications. GOALS of wound care: Cleanse wound & eliminate dead tissues and debris. Prevent further destruction of viable skin. Provide for patient comfort. Wound dressings.

27. SURGICAL MANAGEMENT: SURGERIES DERMABRASION SKIN GRAFTS

28. DERMABRASION: It is the surgical procedure to improve appearance of scars, restore function and correct disfigurement of injury. It is used to smooth scars tissue by shaving or scarring off the top layers Scars are permanent but their appearance will improve. The procedure may be performed in a dermatological surgeon’s office or in a out-patient facility.

29. SKIN GRAFTS: It is a surgical procedure in which piece of skin from one area to another area. Skin from another person or animal is used to cover only large burned areas. The skin is taken from donor’s site, which was healthy skin implanted at damaged recipient site. That is performed under general sanesthesia . This time may be 3 weeks or few months. Within 36 hrs new blood vessels begin to grow from recipient site implanted.

30. ROLE OF NURSE IN BURN MANAGEMENT: RESTORING NORMAL FLUID BALANCE PREVENTION OF INFECTION MAINTAIN ADEQUATE NUTRITION PROMOTING SKIN INTEGRITY RELIEVING PAIN AND DISCOMFORT PROMOTING PHYSICAL MOBILITY STRENGTHENING COPING STRATEGIES SUPPORTING PATIENT AND FAMILY

31. NURSING MANAGEMENT: NURSING ASSESSMENT: Assess airway, breathing, circulation, disability, exposure and need for fluid resuscitation. Assess severity and conscious level. Assess for associated injuries. Assess for any pre-existing illness, drug therapy, allergies. Establish patient’s tetanus immunization Body surface area burned: rule of nine. Depth of burn Circumferential extremity burns

32. NURSING DIAGNOSIS: BY LEAFLETS

33. ROLE OF NURSE IN REHABILITATION: Promoting activity intolerance Schedule care in a way that each person has a periods of uninterrupted sleep. A good time is planned for rest, after the stress of dressing changes and exercise. Improving body image and self concept Assess the patient concern about body images and can refer to support group. Help patients practice their responses to people who may stare or inquire about their injury once they are discharged from the hospital.

34. CONTINUE... Monitoring and managing potential complications Contracture may main complication which may come after the recovery of burns. It may be minimized by doing or applying range of motion exercises. Although there is a procedure escharotomy to make patient relieve from scars.

35. PREVENTION OF BURN INJURY: IN GENERAL: Keep matches, lighters, chemicals and lit candles out of kid’s reach. Put child’s safety covers on all electrical outlets. Make sure especially when using irons and curl irons. Prevent house fires by making sure you have smoke alarm in every level of your home and in each bedroom. Check these monthly and change it. IN BATHROOM: Set thermostat in your hot water heater to 120 degree farenheit , or use low medium setting. Always test bathwater with your elbow before use. Turn kids away from fixtures so they are less likely to play with them and turn it on.

36. CONTINUE... IN KITCHEN: Turn pot handles toward the back of the stove. Never let child use walker in kitchen. Avoid using tablecloth that can pull hot drink or plate on them. Keep hot drinks and foods out of reach of children. Never drink hot beverages when child is sitting in your lap. Never hold baby while cooking. OUTSIDE/IN THE CAR: Use playground with caution. If it’s very hot outside, use equipment only in morning. If you leave your car seat and stroller in sun then when you are using cover it with blanket or towel. Don’t forget to apply sunscreen when going outside. Use product with SPF 15 or higher.