BURN INJURY

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BURN INJURY

• Burns are wounds produced by various kinds of
  agents that cause cutaneous injury and
  destruction of underlying tissue.

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ETIOLOGY OF BURNS

• THERMAL
• CHEMICAL
• ELECTRICAL
• RADIATION

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BURN CLASSIFICATION BY DEPTH

• Superficial
• Partial-Thickness
• Partial-thickness superficial
• Partial-thickness deep
• Full-Thickness
• Deep Full-Thickness

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BURN CLASSIFICATION BY EXTENT

• Rule of Nines
• Re-evaluate 2-3 days post burn
• Burns of face, hands or feet
• Burns complicated by fractures, respiratory tract
  injury or major soft tissue injury

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PATHOPHYSIOLOGY OF BURNS Emergent Phase - First
48 hrs. Post Burn

• Plasma-to-Interstitial Fluid Shift
• Generalized Dehydration
• Oliguria
• Hyperkalemia
• Hyponatremia
• Metabolic Acidosis
• Hemoconcentration
• Water Loss

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PATHOPHYSIOLOGY OF BURNSFluid Remobilization
Phase Starts 48 hrs. Post Burn - Lasts 2-3 days

• Interstitial Fluid-to-Plasma Shift
• Hemodilution
• Increased Urinary Output
• Hyponatremia
• Risk for Pulmonary Edema

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PATHOPHYSIOLOGY OF BURNSRehabilitative
PhaseStarts 4-5 days Post Burn

• Hypokalemia
• Negative Nitrogen Balance
• Anemia
• Hypocalcemia

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INITIAL PATIENT ASSESSMENT

• When did burn occur?
• Nature of burning agent?
• Length of exposure?
• Prior Medications?
• Was burn sustained in an enclosed area?

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INITIAL PATIENT ASSESSMENT(Continued)

• Any pre-existing illnesses?
• What is normal pre-burn height and weight?
• Is pain present?
• Any drug/food allergies?
• Any other injuries?

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INITIAL BURN MANAGEMENT

• Establish an Open Airway
• Support Circulation
• Maintain Urinary Output
• Prevent GI Distress
• Administer Medications
• Determine Burn Depth Extent

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ESTABLISH AN OPEN AIRWAY

• Etiology of Respiratory Burns
• SS of Resp Burns
• ET Tube/Trach
• Monitor for ARDS
• Ventilator/ABGs

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SUPPORT CIRCULATION

• IV Access
• Fluid Replacement
• Invasive Cardiac Monitoring

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MAINTAIN URINARY OUTPUT

• Foley Catheter Hourly Outputs
• Increased Urinary Specific Gravity
• Urinary Output - Most Reliable Index of Adequacy
  of Fluid Replacement

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PREVENT GI DISTRESS

• NG Tube to Suction
• Ileus
• Keep NPO Initially
• Curlings Ulcer

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ADMINISTER MEDICATIONS

• IV Route
• Opioid Analgesics
• Tetanus Prophylaxis
• Antibiotics ?

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CONTINUING CAREWOUND CARE MANAGEMENT

• Infection
• Debridement
• Escharotomy
• Hydrotherapy
• Open Method
• Closed Method
• Topical Drug Therapy

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CONTINUING CARESkin Grafting

• Purpose
• Homograft (Allograft)
• Heterograft (xenograft)
• Amniotic Membranes
• Autograft
• STSG
• Mesh Graft

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CONTINUING CAREImpaired Physical Mobility

• Contractures
• Prevention
• Pressure Dressings

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CONTINUING CARENUTRITIONAL THERAPY

• Factors which necessitate optimal nutrition
• Tissue destruction
• Tissue catabolism
• Increased metabolic demands
• Tissue regeneration
• Skin grafting

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CONTINUING CARENUTRITIONAL THERAPY (Contd)

• Principles of Diet Therapy
• High Protein (150 - 400 Gm)
• High Calories (3500 - 5000 Cal)
• High Vitamin (1 - 2 Gm Vitamin C)
• High Carbohydrate
• Normal Fat