RECONSTRUCTIVE SURGERY AND WOUND CARE MANAGEMENT OF BURN final.pptx

BURN

1. GOOD MORNING

2. RECONSTRUCTIVE SURGERY AND WOUND CARE MANAGEMENT OF BURN

3. A burn is an injury to the tissues of the body caused by heat, chemicals, electric current or radiation.

4. PHASES OF BURN

5. EMERGENT PHASE The emergent (resuscitative) phase is the time required resolve the immediate, life threatening problems resulting from the burn injury, Lasts upto 72 hours from the burn occurred

6. MANAGEMENT OF EMERGENT PHASE PRE HOSPITALIZATION MANAGEMENT: Some of the initial activities that are to be performed: At first, ensure safety of the rescuer rescue the affected person by extinguishing the fire if unresponsive, assess circulation, airway and breathing If responsive, monitor circulation, airway and breathing

7. while rescuing the client & so as for the client also Remove the clothes & other belongings of the patient very gently (if possible) Pour plenty of water (of room temperature) Cover the client with blanket to prevent contamination of wound Ensure the safety of yourself is of great priority

8. AFTER HOSPITALIZATION MANAGEMENT For detailed treatment, admit patient to the hospital as soon as possible An immediate history of the burn incident patient is to be take Stabilize the cervical spine Assess the burn through TBSA Assess the pain
ET intubation & assisted ventilation with 100%
oxygen are to be done
Monitor vital signs, level of consciousness, 02
saturation & heart rhythm

9. Check the pulses distal to burn
Establish IV catheter if bum > 15% TBSA
Begin fluid replacement
Foleys catheter & NG tube placement
Elevate the burned limbs above heart to
decrease edema
Administer Tetanus prophylaxis through IM

10. Obtain ABGs carboxyhemoglobin level and chest x ray . Give IV analgesics & assess the effectiveness frequently Identify & treat other associated injuries ( eg. fractures, pneumothorax, head injury) Cover the concurrent burned areas with dry dressings or clean sheet Monitor urine output

11. For chemical burns: a)Brush dry chemicals from skin before irrigation . b) flush chemical from wound with copious amounts of saline solution or water c) for chemical burn of eyes, flush from the inner to outer corner of eye with water or lactated ringer’s d) monitor pH of eye if exposed to chemicals

12. DETAILED MANAGEMENT OF EMERGENT PHASE The possible management of the patient in emergent phase are the followings: AIRWAY MANAGEMENT: 1.Early endotracheal intubation within 1-2hrs after injury. 2.After intubation , put on ventilator support with o2 concentration based on ABGs.

13. 3.Escharotomies (surgical division of the nonviable eschar , the tough , inelastic mass of burnt tissue)of the chest to relieve respiratory distress. 4.Extubation may be done when edema resolves. 5.Provide high fowler’s position. 6.Encourage deep breathing and chest physiotherapy. 7.PEEP(positive end-expiratory pressure )is indicated. 8.Provide Bronchodialators . 9.Co poisoning is treated by giving 100 pecent o2

14. FLUID THERAPY: 1.Two large-bore i.v. must be placed for client with 15% TBSA or more. 2.A centre line must be placed for client with more than 30% TBSA. 3.PARKLAND (BAXTER)FORMULA is used for fluid replacement. 4.Assess for hourly fluid resuscitation using clinical parameters i.e.(urine output:0.5 to 1ml/kg/hr. ,cardiac parameter: mean arterial pressure[map]>65mmHg,SBP>90mmHg,HR<120beats/min.)

15. WOUND CARE: 1.At first , perform cleansing and gentle debridement. 2.Extensive surgical debridement is done on operation room. 3.Two approaches to burn wound treatment: open method , closed method or multiple dressing change method. 4.check client’s eyelashes are not turned inward towards the eyeball(for facial burn).

16. 5.Ear should keep free from pressure. 6.raise client’s head using a rolling towel under the shoulders. 7.keep client’s perineum clean. 8.encourage ROM exercise.

17. DRUG THERAPY: 1 . Analgesics and sedatives: Morphine , Fentayl etc. 2 .Tetanus immunization. 3.Antimicrobial agents : silver sulfadiazine 4.etc.

18. NUTRITIONAL THERAPY: 1.Begin the feedings slowly at 20-30 ml/ hr through NG feeding. 2.Assess the bowel sounds every 8 h. 3.Give calorie containing nutritional supplements. 4.Give protein rich diet.

19. ACUTE PHASE The acute phase of burn care begins with the mobilization of extracellular fluid and subsequent diuresis . It concludes when Partial thickness wounds are healed or full thickness burns are coverd by skin grafts . This may takes weeks or months. Begins 48 to 72 hours after the burn injury In this phase the extracellular fluid start mobilize and start diuresis. This phase is completes when wound is covered by skin grafts or the wound healed. This may takes weeks or months.

20. COMPLICATIONS OF ACUTE PHASE Bacterial injection , which may lead to a bloodstream. Inflammation Hypovolemia Hypothermia Scar or ridged areas caused by an overgrowth of scar tissue called keloids. Hyponatremia hyperkalemia

21. MANAGEMENT OF ACUTE PHASE Infection control : 1.Use PPE , gloves, cap. 2.Use clean technique. 3.Antimicrobial therapy. Wound cleaning: 1.Hydrotherapy(37.8 degree or 100 degree centrigrade , time not more 20 or 30 min , not break the blister on the skin , maximum mobility)

22. Topical Antibacterial therapy: 1.silver nitrate 2.silver sulfadine 3.mafedine acetate Wound depridement : remove nonviable tissue(natural , mechanical , surgical) Grafting : autografting , homografting , hetarografting , bysynthetic and synthetic dressing. Nutritional support : 1.High protein and high caloric diet. 2.Often requiring various supplement. 3.route should oral.

23. REHABILITATION PHASE TIME PERIOD: The formal rehabilitation phase begins when the patient's wounds have healed and he or she is engaging in some level of self-care. This may happen as early as 2 weeks or as long as 7 to 8 months after a major burn injury. PURPOSE : work toward resuming a functional role in society and (2) rehabilitate from any functional and cosmetic postburn reconstructive surgery that may be necessary. COMPLICATION : skin and joint contracture and hypertrophic scaring.

24. MANAGEMENT : 1.Encourage care giver or patient to participate in care. 2.Give return demonstration of proper dressing changes to patient or care give. 3.Assess some free hand exercise and device to do own work. 4.Give advice scar management moisturizing ,sun protection , suggest using water based cream to use. 5.Advice to take proper nutrition. 6.Advice to take medication properly.

25. PLASTIC SURGERY The name is take from the Greek words “PLASTIKOS” which means to from mold. PURPOSE : 1 .To improve the appearance. 2.some people are addicted to cosmetic surgery. 3.To correct a physical defect or to alter a part of the body that makes them feel uncomfortable. 4.To feel better about the way they look.

26. Escharotomy An escharotomy is defined as a surgical incision through burn eschar (necrotic skin). This procedure is usually performed within the first 24 hours of burn injury. Burn eschar has an unyielding, leathery consistency and is characterized by denatured proteins and coagulated vessels in the skin, which are the result of thermal, chemical or electrical injury.

27. There are two kinds of plastic Surgery Reconstructive Surgery – Reconstructive surgery is usually employed for medical purposes and Some Common examples are – - Cleft Lip surgery -breast reconstruction surgery for those whohad mastectomy. - contracture surgery for burn survivors.

28. Cosmetic surgery - It is done mostly for aesthetic enhancement which include- Tummy Tuck (abdominoplasty) Liposuction Breast lift Check agumentation Breat reduction/enlargement ( Agumentation Mammoplasty)

29. Techniques are used in Reconstructive surgery : Reconstructive Surgery is a technical specialy with the aim of achieving repair and this repair is generally brought by moving tissues. Skin graft Tissue expeasion Flap surgery

30. Skin graft: A skin graft involves taking a healthy patch of skin from one area of the body known as the donar site and using it to cover another area where skin is missing or damaged. Surgical procedure in which skin is placed over a non healing wound/burn purposes. 1. To provide wound covering. 2. Permanently replace damaged or missing skin.

31. Types of skin grafts: There are 3 basic types of skin grafts: 1. Spilt-thickness skin graft 2. Full thickness skin graft 3. Composite graft

32. Spilt-thickness skin graft: Just a few layers of outer skin ( closest to the surface) are transplanted.This is most commonly used type of skin graft. Removes only the epidermis and part of the dermis. Taken by shaving the layers of the skin.

33. Depending on how much of the dermis is included,on STSG may be – Thin Intermediate Thick Donor sites for STSG are usually thigh, buttocks and abdomen.

34. Full-thickness skin graft: Often used to treat relatively small defects. All layers of skin are used. The common donor sites includes the groin and the medical aspects of the arm because the residual scar is hidden.

35. Full-thickness skin graft Split-thickness skin graft Spilt-thickness skin graft Full-thickness skin graft

36. Composite graft : A graft composed of two or more tissue types, such as skin and cartilage or skin and subcutaneous fat. Requires well vascularised bed .

37. Other skin grafts used for burn injury:

38. Tissue Expansion: This is accomplished by inserting an instrument known as a “balloon expander” under the skin near the area in need of repair. Procedure that enables the body to “grow” extra skin for use in Reconstructive procedure. Once enough extra skin has been grown,it is then used to correct/reconstruct damaged part. Little scarring.

39. Flap surgery: Flap= Partially or completely Isolated segment of tissue Perfused with its own blood supply. May consist of skin,subcutaneous fat,fascia,muscle,bone or viscera. There are three main types of flap- Local flap Regional flap Free flap

40. Special needs Of Nurses: Warm, trusting, and mutually satisfying relationships frequently develop between burn patients and nursing staff, not only during hospitalization but also during the long-term rehabilitation period. Peer support groups (eg can serve a similar purpose by helping you cope with difficult feelings experienced when caring for burn patients. Because burn nursing is physi cally, psychologically, and intellectually demanding, it has many challenges and inherent rewards.

41. Conclusion: Caregiver and patient support groups may be beneficial in meeting the patient's and caregiver's emotional needs at any phase of the recovery process. Speaking with others who have experienced burn trauma can be beneficial, both in terms of confirming that the patient's feelings are normal and in sharing helpful advice.

42. Thank you