Burns

burns
introduction
causes
types
depth
fluid calculation
risk factor
management
escharotomy
flaps
graft
rule of nine
palmar rule
evans formula
parkland formula
brokers formula
complications
curlens ulcer
marjolin ulcer

1. BURNS

2. A ANATOMY AND PHYSIOLOGY OF SKIN

3. A A LAYERS OF EPIDERMIS

4. BURNS A  burn  is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn).

5. Fire. Hot liquid or steam. Hot metal, glass or other objects. Electrical currents. Radiation, such as that from X-rays. Sunlight or other sources of ultraviolet radiation, such as a tanning bed. Chemicals such as strong acids, lye, paint thinner or gasoline. Abuse. CAUSES

6. PHASES OF BURNS INJURY EMERGENT PHASE – UPTO 72 HRS HYPOVOLEMIC SHOCK EDEMA FORMATION ENDS WITH THE FLUID MOBILIZATION OCCUR AND DIURESIS OCCURS 2.ACUTE PHASE (WEEKS TO MONTHS) MOBILIZATION OF EXTRACELLULAR FLUID SUBSEQUENT DIURESIS

7. REHABILITATION PHASE ( 2 WEEKS TO AS LONG 7/8 MONTHS) WOUNDS ARE HEALED RESUME FUNCTIONAL ROLE REHABILITATION FROM FUNCTIONAL AND COSMETICPOST BURN

8. ZONE OF INJURY

9. TYPES

10. FIRST DEGREE BURNS SECOND DEGREEBURNS THIRD DEGREE BURNS DEPTH OF BURNS

11. THICKNESS OF BURNS

12. FIRST DEGREE BURNS

13. SECOND DEGREE BURNS

14. SEVERITY OF BURNS

15. BURNS ASSESSMENT RULE OF NINE

16. Rule of Nines for Establishing Extent of Body Surface Burned Anatomic Surface % of total body surface Head and neck 9% Anterior trunk 18% Posterior trunk 18% Arms, including hands 9% each Legs, including feet 18% each Genitalia 1%

17. RULE OF NINE

18. PALM RULE Palmar hand surface is approximately 1% TBSA

19. FLUID CALCULATION

20. PARKLAND FORMULA

21. Fluid of Choice  Lactated Ringer’s (RL)  NS can produce hyperchloremic acidosis NEXT 24 HRS  Total volume ½ of first day  Colloids ( 0.5 ml / kg / % )  5 % glucose to make up the rest

22. Brooke Army formula( Modified) Colloids – 0.5 ml x kg body weight x % TBSA burned Electrolytes – 1.5 ml x kg body weight x % TBSA burned Glucose (5% in water) – 2,000 ml for insensible loss DAY 2 :0.25ML OF COLLOIDS 0.5MLKG% OF ELECTROLYTE SOLUTION

23. Evans formula Colloids – 1 ml x kg body weight x % TBSA burned Electrolytes – 1 ml x kg body weight x % TBSA burned Glucose (5% in water) – 2000 ml for insensible loss Day 1 – half to be given in first 8 hours, remaining half over next 16 hours Day 2 – half of previous day’s colloids and electrolytes Maximum of 10,000 ml over 24 hours

24. MEDICATION TAB. AMOXYCLAV CAP. TRAMADOL TAB. BCOMPLEX TAB. FE/FA TAB. PANTOP TAB. DICLO

25. 1. SILVER SULFADIAZINE 1% 2. SULFAMYLON 5% 3. SILVER NITRATE 0.5% 4. PROVIDONE IODINE TOPICAL AGENT USED IN BURNS

26. CLINICAL FEATURE

27. CLINICAL FEATURE

28. CLINICAL FEATURE

29. INVESTIGATION HISTORY COLLECTION PHYSICAL EXAMINATION VITAL SIGN BLOOD STUDIES USG HRCT SCAN CULTURE SENSITIVITY

30. COMPLICATI ON EARLY: SHOCK INFECTION & SEPSIS ASPHAXIA TOXAEMIA FLUID & ELECTROLYTE DISTRUBANCES

31. LATE: DISFIGUREMENT CONTRACTURES CHRONIC ULCER THAT MAY BE COMPLICATED BY MALIGNANCY PSYCHOLOGICALFLUID & ELECTROLYTE DISTRUBANCES MARJOLINS ULCER CURLING ULCER

32. CONTRACTURE PREVENTION SPLINTS

33. COMPRESSION GARMENTS

34. POSITIONING

35. Phase 1: Treatment at the scene P hase 2: Assessment and stabilization at initial care facility and transfer to burn ICU. MANAGEMENT

36. PRE HOSPITAL MANAGEMENT Rescuer to avoid injuring himself Remove patient from source of injury Stop burn process Burning clothing; jewelry , watches, belts to be removed Pour ample water on burnt area (not ice/ ice packs – skin injury & hypothermia) DON’T APPLY ICE / ICE WATER

37. Chemical burns: Remove saturated clothing Brush skin if agent is powder Irrigation with copious amount water to be started and continued in hospital Electrical burns: Turn off the current Use non-conductor item to separate from source

38. Immediate care Dry clean wound ,apply non adherent gauze Tetanus prophylaxis Foleys catheterization in case needed Small blister left intact Large blisters are debrided and covered with a topical agents. Aseptic dressing W ound care

39. SURGERY Plastic surgery Reconstructive Cosmetic

40. Z plasty

41. ESCHARATOMY Surgical incision through a burn eschar

42. GRAFT A skin graft is a tissue of epidermis and varying amount of dermis that is detached from its own blood supply and placed in a new area with a new blood supply

43. 1. Allograft- use of Another person 2. Xenograft – non human sources 3.Autograft – Patient own skin

44. FLAPS Skin  flap  is a surgical procedure in which a healthy skin and its underlying subcutaneous tissue is taken from an area very close to the wound to be covered, the  flap  remains partly connected to its original site via its blood supply.

45. NURSING DIAGNOSIS Acute Pain related to skin and tissue destruction secondary to release of toxins as evidence by facial rating scale. Impaired Physical Mobility related to pain and discomfort secondary to neuromuscular impairment as evidence by limited range of motion, decreased muscle strength. Disturbed Body Image related to disfigurement secondary to traumatic event as evidence by negative feeling about body. Impaired Skin Integrity related to disruption of skin surface as evidence by viable tissue. Self care deficit related to burn injury as evidence by observation.

46. 6. Risk for Infection related to destruction of skin barrier secondary to inadequate secondary defenses like suppressed inflammatory response. 7. Risk for Deficient Fluid Volume related to hypermetabolism state loss of fluid from burnt wound site. 8. Risk for Ineffective Tissue Perfusion related to hypovolemia reduced or interrupted blood flow. 9.Deficient Knowledge related to lack of information as evidence by request for information 10.Anxiety related to threat of death as evidence by expressed concern regarding change in life.