Burn Injury Management

8/12/2019 Burn Injury Management

1/27

Describe the methodology for demonstration thatwill allow observation skills 25

S clear statement

Measurable Attainable

R identified the details

It is congruent

List the equipment/supplies necessary tostimulate the learning activity w25

Effective presentation skill 25


2/27

Objective

At the end of the discussion the learners will beable to:

1. Define what is BURN INJURY?

2. Identify the causes of BURN

3. Classify the severity, depth and extent of BURNas to 1st, 2nd,3rddegree.

4. Demonstrate competence in handling orrendering initial assessment and management

of burn injury.

Given a situation or real scenario the students willdemonstrate competence in managing or handling

a burn patient.


3/27

BURN INJURYMANAGEMENT

ROSECHELLE SIUPAN-ELARCO,RMT, RN,MAN

BURN INJURY

MANAGEMENT


4/27

BURN

Is an injury caused by an exogenous agent

that produces a characteristic reaction to local

tissues which may vary from mild erythema to

full thickness destruction of the skin anddeeper tissues.


5/27

CAUSES

THERMAL

DRY HEAT- CONTACT BURN

FLAME BURNS

MOIST HEAT

FLASH BURNS


6/27

ELECTRICITY

LOW VOLTAGE

HIGH VOLTAGE


7/27

CHEMICALS

ACIDS

ALKALI


8/27

RADIATION

IONIZING

NON IONIZING


9/27

Management of Burns


10/27

Degrees of Burn Injury


11/27

NamesLayers

involvedAppearance Texture Sensation

Time of

healingComplications Example

First degree EpidermisRedness

(erythema)Dry Painful 1wk or less

Increased risk

to developskin

cancerlater in

life

Second degree

(superficial

partial

thickness)

Extends into

superficial

(papillary)

dermis

Red with

clearblister.

Blanches with

pressure

Moist Painful 2-3wks

Local

infection/

cellulitis

Second degree

(deep partial

thickness)

Extends into

deep (reticular)

dermis

Red-and-white

with bloody

blisters. Less

blanching.

Moist Painful

Weeks - may

progress to

third degree

Scarring,contractures

(may require

excision

andskin

grafting)
http://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Blisterhttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Blisterhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Erythema


12/27

Names Layers involved Appearance Texture SensationTime of

healingComplications Example

Third

degree(full

thickness)

Extends throughentire dermis

Stiff andwhite/brown

Dry,leathery

Painless Requiresexcision

Scarring,contractures,

amputation

Fourth

degree

Extendsthrough skin,

subcutaneous

tissueand into

underlying

muscle and bone

Black;charred

with eschar

Dry PainlessRequires

excision

Amputation,

significantfunctional

impairment,

possible

gangrene, and

in some cases

death.
http://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Escharhttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Escharhttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Subcutaneous_tissue


13/27


14/27


15/27

Management : FIRST-DEGREE

BURN

A first-degree burn is confined exclusively to

the outer surface and is not considered a

significant burn. No barrier functions are

altered. The most common form is a Sunburn which

heals by itself in less than a week without scar.


16/27

A second-degree burn that does not cover more than 10percent of the skin's surface can usually be treated in anoutpatient setting. Treatment depends on the severity of theburn and may include the following:

antibiotic ointments dressing changes one or two times a day depending on the

severity of the burn

daily cleaning of the wound to remove dead skin or ointment

possibly systemic antibiotics

Wound cleaning and dressing changes may be painful. Inthese cases, an analgesic (pain reliever) may need to begiven. In addition, any blisters that have formed should not beburst.


17/27

MANAGEMENT

Management of the acute burn injury includeshemodynamic stabilization, metabolic support,wound debridement, use of topical antibacterialtherapy, biologic dressings, and wound closure.

Prevention and treatment of complications,including infection and pulmonary damage, and

rehabilitation are also of major importance.

The patient will also require physical andoccupational therapy and psychiatric andnutritional support.


18/27

Management: Second Degree

Burn Second-degree burns are defined as those burns in which the

entire epidermis and variable portions of the dermis layer areheat destroyed. A superficial second-degree (partialthickness) burn is characterized by heat injury to the upperthird of the dermis leaving a good blood supply

Characteristics:

Confined to upper third of dermis

usually caused by hot liquids

Blisters, wet pink, painful

low risk of infection

Heals in 10-12 days without scarring


19/27

Superficial 2 burn caused by hot water: a scald burn Superficial burn with plasma leaking into wound (note

blisters)

Treatment:

Clean, remove small blisters; apply grease gauze and soft gauze dressing (occlusion,

absorbent dressing, changed daily)

On face, perineum, apply bacitracin or neomycin ointment, applying several times a day.

Excellent alternative is the use of a synthetic skin substitute which seals the wound and

decreases pain.

Use a water-soluble topical antibiotic if the wound is grossly contaminated or if one isunsure if the wound is superficial or deep.

Prophylactic systemic antibiotics are not needed.


20/27

Superficial Partial ThicknessBurns Covered with Synthetic

Skin Substitute

Closed Dressing ApproachThe soft gauze over the primary dressing willprotect the wound and help soak up fluidleaking from the surface


21/27

Essential Management Points

- Stop the burning

- ABCDE

- Determine the percentage area of burn (Rule

of 9s)

- Good IV access and early fluid replacement.


22/27

The severity of the burn is determined by:

- Burned surface area

- Depth of burn

- Other considerations.


23/27

Serious burn requiring hospitalization

- Greater than 15% burns in an adult

- Greater than 10% burns in a child

- Any burn in the very young, the elderly or theinfirm

- Any full thickness burn

- Burns of special regions: face, hands, feet,perineum

- Circumferential burns - Inhalation injury

- Associated trauma or significant pre-burn illness:e.g. diabetes


24/27

Burn Management (continued)

Wound care

First aid

If the patient arrives at the health facility without first aidhaving been given, drench the burn thoroughly with coolwater to prevent further damage and remove all burnedclothing.

If the burn area is limited, immerse the site in cold water for30 minutes to reduce pain and oedema and to minimizetissue damage.

If the area of the burn is large, after it has been doused withcool water, apply clean wraps about the burned area (or thewhole patient) to prevent systemic heat loss andhypothermia.

Hypothermia is a particular risk in young children.

First 6 hours following injury are critical; transport the patientwith severe burns to a hospital as soon as possible


25/27

Initial treatment

Initially, burns are sterile. Focus the treatment on speedy healingand prevention of infection.

In all cases, administer tetanus prophylaxis.

Except in very small burns, debride all bullae. Excise adherent

necrotic (dead) tissue initially and debride all necrotic tissue overthe first several days.

After debridement, gently cleanse the burn with 0.25% (2.5 g/litre)chlorhexidine solution, 0.1% (1 g/litre) cetrimide solution, or anothermild water-based antiseptic.

Do not use alcohol-based solutions.

Gentle scrubbing will remove the loose necrotic tissue. Apply athin layer of antibiotic cream (silver sulfadiazine).

Dress the burn with petroleum gauze and dry gauze thick enoughto prevent seepage to the outer layers.


26/27

Daily treatment

Change the dressing daily (twice daily if possible) or as often as necessary toprevent seepage through the dressing. On each dressing change, remove any loosetissue.

Inspect the wounds for discoloration or haemorrhage, which indicate developinginfection.

Fever is not a useful sign as it may persist until the burn wound is closed. Cellulitis in the surrounding tissue is a better indicator of infection.

Give systemic antibiotics in cases of haemolytic streptococcal wound infection orsepticaemia.

Pseudomonas aeruginosa infection often results in septicaemia and death. Treatwith systemic aminoglycosides.

Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is

the cheapest, is applied with occlusive dressings but does not penetrate eschar. Itdepletes electrolytes and stains the local environment.

Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It haslimited eschar penetration and may cause neutropenia.

Mafenide acetate (11% in a miscible ointment) is used without dressings. Itpenetrates eschar but causes acidosis. Alternating these agents is an appropriatestrategy.


27/27

Treat burned hands with special care to preservefunction.

Cover the hands with silver sulfadiazine andplace them in loose polythene gloves or bags

secured at the wrist with a crepe bandage; Elevate the hands for the first 48 hours, and

then start hand exercises;

At least once a day, remove the gloves, bathe

the hands, inspect the burn and then reapplysilver sulfadiazine and the gloves;

If skin grafting is necessary, consider treatmentby a specialist after healthy granulation tissueappears.

Burn Injury Management

Documents