Burns powerpoint presentation on burn classification

burns powerpoint presentation on burn wound management and classification

1. BURNS 5 CAUSES? BMM

2. What you should know about burns Definition Causes Classification Pathophysiology Management Complications

3. A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Definition

4. Causes Chemicals Friction Electricity Radiation Heat.

5. Classification:3 ways By depth; 1 st degree (Superficial) 2 nd degree partial thickness(superficial and deep) 3 rd degree full thickness 4 th degree. By severity : Major Moderate Minor By surface area: Rule of Nines Lund & Browder charts Palm trick.

6. Classification by Depth

7. Superficial burn injury 1 st degree burn Limited to the epidermis Presents with erythema and minimal swelling Mild discomfort Commonly treated on outpatient basis

8. Superficial partial-thickness burns Superficial 2 nd degree burns Involves the epidermis and superficial portion of the dermis Often seen with scalding injuries Presents with blister formation and typically blanches with pressure Sensitive to light touch or pinprick Commonly treated on outpatient basis; heal in 1-3 wks

9. Deep partial-thickness burns Deep 2 nd degree burns Involves the epidermis and most of the dermis Appears white or poorly vascularized; may not blister Less sensitivity to light touch and pinprick than superficial form Extensive time to heal (3-4 wks) Patients often require excision of the wound and skin grafting

10. Full-thickness burns 3 rd degree burns Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue Appears dry, leathery, and numb, often without blisters Can be difficult to differentiate from deep partial-thickness burns Commonly seen when patient’s clothes caught on fire/ skin directly exposed to flame Usually require referral to burn surgeon; need skin grafting to heal

11. Fourth degree burns Full-thickness burn extending to muscle or bone Common result of high-voltage electric injury or severe thermal burns Requires hospital admission

12. Classification on basis of severity .

13. Major Major burns are defined as: Age 10-50yrs (adults): : partial thickness burns >25% of total body surface area Age <10 or >50 (Children and elderly) partial thickness burns >20% of total body surface area Full thickness burns >10% Burns involving the hands, face, feet or perineum Burns that cross major joints

14. … Circumferential burns to any extremity Any burn associated with inhalational injury Electrical burns Burns associated with fractures or other trauma Burns in infants and the elderly Burns in persons at high-risk of developing complications These burns typically require referral to a specialised burn treatment center

15. Moderate Moderate burns are defined as: Age 10-50yrs: partial thickness burns involving 15-25% of total body surface area Age <10 or >50: partial thickness burns involving 10-20% of total body surface area Full thickness burns involving 2-10% of total body surface area Persons suffering these burns often need to be hospitalised for burn care

16. Minor Minor burns are: Age 10-50yrs: partial thickness burns <15% of total body surface area Age <10 or >50: partial thickness burns involving <10% of total body surface area Full thickness burns <2% of total body surface area, without associated injuries These burns usually do not require hospitalization

17. Classification by surface area .

18. Palm trick Palm size to represent approximately 1% TBSA

19. LUND AND BROWDER Age in years 1 5 10 15 Adult Head (back or front) 9½ 8½ 6½ 5½ 4½ 3½ 1 thigh (back or front) 2¾ 3¼ 4 4¼ 4½ 4¾ 1 leg (back or Front ) 2½ 2½ 2¾ 3 3¼ 3½

20. RULE OF NINES Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% Each palm = 1% Groin = 1% Each leg = 18% total (front = 9%, back = 9%)

21. PATHOPHYSIOLOGY OF BURNS .

22. . Once the burn reaches 30% of TBSA, cytokines and other inflammatory mediators are released at the site of injury. These inflammatory mediators have systemic effects affecting almost all body system as described in the following slides .

23. Cardiovascular changes Capillary permeability is increased , leading to loss of intravascular proteins and fluids into the interstitial compartment. Peripheral and splanchnic vasoconstriction occurs. Myocardial contractility is decreased but the rate increases causing reduced cardiac output. There is also fluid loss from the burn wound All these result in systemic hypotension , hyperviscosity and end organ hypoperfusion NB/24 hours after burn injuries, cardiac output returns to normal if adequate fluid resuscitation has been given.

24. Respiratory changes Inflammatory mediators cause bronchoconstriction , and in severe burns respiratory distress syndrome can occur. Gross edema of the throat causing airway obstruction. May have an increased respiratory rate as a result of pulmonary edema and as an attempt to compensate the increased metabolic rate.

25. Metabolic changes The basal metabolic rate increases up to three times its original rate. This, coupled with splanchnic hypoperfusion , necessitates early and aggressive enteral feeding to decrease catabolism and maintain gut integrity. Muscle mass may also decrease due to increased catabolism.

26. Digestive system Decreased blood supply Risk of curling’s ulcer (duodenal ulcer that develops 8-14 days after burns. (first sign is vomiting of bright blood). Nervous system Pain depending on the degree of burns

27. Endocrine System Increased secretions of catecholamines ( adrenaline and nor-adrenaline) in response to the injury may lead to increased body temperature and increased cell metabolism

28. Lymphatic System Inflammation increases as a result of damaged tissue, which results in greater strain on the lymphatic system and pitting oedema

29. Urinary The kidneys compensate for the hypovolemia by decreasing urine output. There is potential for kidney damage as a result of poor perfusion as well as by excessive myoglobin.

30. Immunological changes Non-specific down regulation of the immune response occurs. Burns area removes the first line of infection defense.

31. . MANAGEMENT OF BURNS

32. POINTS TO REMEMBER 1 st 48hrs: Hypovolemia 48-72 hrs: Circulatory overload After 72 hrs: would healing Burns greater than 15% in an adult, greater than 10% in a child, or any burn occurring in the very young or elderly are serious

33. Management ABC Monitor Serum creatinine and BUN) RF ECG, pulse, B.P(Cardiac failure) Assess for infection of the wound( erythema,odor,green yellow exudate . Do regular wound culture and sensitivity tests I.V fluid administration. To determine the amount Parkland formula can be used. Total volume of the first 24 hours with Ringer= 4mL x (percentage of total body-surface-area sustaining non-superficial burns) x (person's weight in kgs ) Half the volume is given in the first 8 hours the remaining volume delivered over 16 hours

34. Management cont… Adequate nutrition(increased protein, calories and vitamins) via NGT to support repair of damaged tissue as well as to decrease catabolism. Give small frequent feedings of high calorie, high protein, low volume. Monitor nutritional intake by daily weight, serum electrolytes and serum albumin Control pain-intravenous opioids in small frequent doses Relieve anxiety

35. Management cont.. Prevent infection; Use protective isolation/reverse barrier nursing principles and also use topical and systemic antibiotics. Wound care; Dress the wound aseptically at least once daily, provide range of motion that prevents contractures. Debridement and grafting may also be done depending on the degree of burns. This prevents infection and promotes healing.

36. … Positioning-bed cradle. This helps to lift the weight of the bedding off the wound and also prevents direct contact between the wound and the beddings. Keep room warm and humid. This prevents loss of body heat and water via the traumatized skin. Grafting and care of the graft-promotes healing and prevents infection

37. Complications Shock Infection; haemolytic streptococcal, Pseudomonas aeruginosa Multiple organ dysfunction syndrome Electrolyte imbalance Respiratory distress Heart failure Renal failure Contractures Curlings ulcer- a duodenal ulcer that develops 8-14 days after severe burn injury. Because of decreased perfusion Paralytic ileus

38. The end.