BURNS management in peadiatrics and adults

burns

1. BURNS
PRESENTER
O. MALIYAMA

2. OBJECTIVES
•Define burns
•List causes of burns
•Discuss classification of burns
•Outline the incidence of burns
•Explain the Pathophysiology of burns
•Discuss management of burns

3. Definition of burns
•Burns occur due to the effect of thermal
energy upon the skin and other tissues. In
burns, tissue damage begins when the
temperature reaches 44 degrees cercius and
the rate of injury increases when the
temperature rises

4. causes
•Dry heat
•Hot liquids
•chemicals

5. Classification of burns
•Burns are classified into 3 major categories. This
is done according to the depth of tissue injury
1.First degree burns
•They only involve the epithelium eg sun burns
2. Second degree burns
•Involve the destruction of the epithelium and
part of the corium but spares the dermal
appendages (hair roots and sweat glands)

6. Classification of burns ct…
3. Third degree burns
•The entire thickness of the dermis is
destroyed
NOTE: As the extent of burns increases the
complication increases and the mortality rate
rises

7. Classification of burns ct…
Part of body burned Percentage of surface area
Head 18
Neck 2
Arm (each) 9
Chest & Abdomen 18
Back 18
Buttocks 3
Perineum 3
Legs (each) 9
Feet 4

8. Incidence of burns
•Burns are the second leading causes of death
•In children, burns contribute to 30% of total
deaths. The deaths are common in children
aged 1 to 4 years and below 15 years
•Burns are the leading type of accidental
deaths in the home

9. Pathphysiology of burns
•After a burn there is a rapid development of
haemodynamic, autonomic, cardiopulmonary, renal
and metabolic disturbances
•Following severe thermal injury, within seconds of a
burn, cardiacoutput falls because of the exaggerated
reflex responses and decreased venous return
•This occurs because soon after a burn, the permiability
of the entire vascular tree increases as a result water,
electrolytes and proteins are lost from the vascular
component into interstitial tissues of injere and non
injured sites

10. Pathphysiology of burns ct…
•Within minute after a burn renal plasma flow and
glomerular filtration rate decreases. This results
to oligulia and urine output is concentrated
•There is 10% or more destruction of red blood
cells in circulation immediately after a burn (Old
blood cells are lysesed, some are lost in
glomenulation tissues). This may result in anamia
development in 4 to 7 days after a burn

11. Emergency management
NOTE: Children with burns should be admitted according to
the assessors judgment
Emergency management of severe burns
1.Establish a patent airway especially in a child with facial
burns or a child who has inhaled smoke (can obstruct air
way) can have laryngeal oedema due to smoke inhalation
2.Perform rapid assessment to inspect the wound
3.Examine trauma to the head, skeleton or nervours system
4.Begin intravenous dehydration to correct deficits and
concurrent fluid and electrolytes losses

12. Reason for fluid therapy
•During the first 24 hours after a burn the
reason for fluid therapy are as follows:
-To correct hypovolemia
-To maintain the vascular volume
-To prevent abnormalities in plasma
electrolytes, protein or pH
-To minimize oedema

13. Reason for fluid therapy ct..
•If blood must be transfused it should be 0.5mls
per kg body weight x surface area burned
•Intravenous infusions should be 1.5mls per kg
body weight Ringers lactate or Normal saline x
Surface area of the body burned (Normal
maintenance needs). Give half of the total
culculated fluids in the first 8 hours and the
remained fluids in the next 16 hours
• If Hypoglacaemia is suspected add 100mls of
50% dextrose in 1000mls of intravenous infusion

14. Other management
•Proper positioning depending on the area burnt
•Bed cradle could be used to avoid pressure of
linen on the wound and also for infection
prevention
•Strong analgesics could be given pethidine 1mg
per kg body weight or morphine 0.5mg per kg
body weight the route and frequency is
determined depending on the severity of the
burn and pain assessment by the doctor or care
giver

15. Other management ct…
•Employ infection prevention measures at all
times to prevent cross infection
•Antibiotics are used only if the child has
developed sepsis
•Analgesics is given to manage pain
•Always give analgesic 30 minutes prior to
wound dressing to minimize pain

16. Other management ct…
•Vaseline gauze is used when dressing the
wound
•If the wound is not infected dress it on
alternate days but if the wound is infected it
should be dressed on daily basis
•If burns are extensive may be dressed in
theatre

17. Other management ct…
•High protein diet to repair worn out tissues
•Exercises should be started early to prevent
contractures
•Advice the guardian measures to employ at
home to prevent further burns in future

18. Other management ct…
•Debridement may be done to remove dead
tissue in order to facilitate healing
•When the wound is clean skin grafting may be
done for cosmetic purposes in extensive burns

•All other basic nursing care are applied
depending on the child’s condition and
presenting signs and symptoms

19. Reference
•Electronic Books
•Margaret, C., Haegarty, Wiliam, J. & Moses.
Peadiatrics
•Phillips, J., A. & Kazembe P., N., et al. A
Peadiatric hand book for Malawi