Burn injury
J.A.K.E
BURNS
- Causes:
• Thermal – hot objects or substances
• Chemical – strong acids, alkali
• Electrical – electrical appliances and sources
• Radiation – excessive exposure to sunlight
- Classifications:
• 1st Degree – Superficial thickness burn - epidermis,
reddish, painful
• 2nd Degree – Partial thickness burn - dermis, moist
surface, with vesicles, painful
• 3rd Degree – Full thickness burn - epidermis, dermis
and other underlying structure, subcutaneous layer,
pearly white, no pain
• 4th Degree – Deep full thickness burn - muscles &
bones, blackish or charred, no pain
Stages of Burns
First Stage
- Shock/ Fluid Accumulation Phase
- first 48 hours (1-2 days)
- avoid oral fluids – decreased peristalsis
- NGT for decompression
- generalized dehydration
- hypovolemia – plasma loss, decrease BP
- oliguria – no urine output
- hyponatremia, hyperkalemia (fluid shifting)
- CBC results = hemoconcentration - increase hematocrit
(because liquid blood component is lost)
Second Stage
- Diuretic/ Fluid Remobilization Phase
- after 48 hours (3-4 days)
- hypervolemia
- diuresis – increased urine output
- Hyponatremia, hypokalemia
- CBC results – hemodilution, decrease hematocrit
Third Stage
- Recovery (5th day onwards)
- Hypocalcemia
- utilized in granulation tissue formation
- Negative Nitrogen balance
- increase CHON intake
Management of Burns
• Stop the burning process
a) immersed affected part in cold water/running water
b) advised client to roll on the ground if clothing is
flaming
c) throw a blanket over to the client to smother the flame
d) neutralized the chemical
• Promoting respiratory function
a) establish airway
b) oxygen therapy
• Promoting fluid, electrolytes, acid base balance
a) Colloids – blood, plasma expanders
b) Electrolytes – Lactated ringers
Burn Injury 1 of 1
NCMB 312 RLE
c) Non-electrolytes – D5Water
• Promoting comfort
a) Morphine SO4 – to relief pain
b) Bed cradle – to relieve pressure from topsheet
• Preventing infection
a) Asepsis
b) Reverse-protective isolation
c) Tetanus-toxoid immunization
d) Sterile NSS to irrigate the area
• Maintaining adequate nutrition
a) Avoid oral fluids – decreased peristalsis
b) Diet – increase CHON, increase CHO, low Fat,
increase vitamins and minerals
• Wound care
- Antimicrobials - Mafenide acetate 10% (Sulfamylon)-
good choice as penetrate in the eschar
• Skin grafting
- Isograft / Syngeneic graft – identical twin
- Homograft / Allograft – another human being
- Autograft – self
- Heterograft / Xenograft – animal (temporary)
- Skin grafting is a surgical procedure that involves
removing skin from one area of the body and moving it,
or transplanting it, to a different area of the body. This
surgery may be done if a part of your body has lost its
protective covering of skin due to burns, injury, or
illness. STSG – Split Thickness Skin Grafting
% of Burns (Rule of Nine)
Head, face, neck = 9%
Anterior trunk = 18%
Posterior trunk = 18%
Upper extremities (each) = 9%
Lower extremities (each) = 18%
Genital = 1%
100%
Parkland Formula
- A calculation used to calculate the total volume of fluids
that a patient is going to need about 24 hours after
receiving a severe burn
- widest and easy to use to immediately initiate replace
fluids and electrolytes losses
- Volume LR = 4mL x BSA % x kg
- Common solution used: Lactated ringers- is an isotonic
solution that will help expand the intravascular
compartment
- 4ml x 63% x 83 kg = 20,916 ml
• 1st 8hrs (half) VLR x .50 = 10,458 to run for first 8
hours with drop factor of 20 = 436 - 437gtts/min
• 2nd 8hrs VLR (one fourth) x 0.25 = 5,229 ml
flow rate: 5229 to run for second 8 hours x drop factor
of 20 = 218 - 219 gtts/min
• 3rd 8hrs VLR (one fourth) x 0.25 = 5,229ml, flow rate:
5229 to run for third 8 hours x drop factor of 20 = 218 –
219 gtts/min
• 20,916 ml for the first 24 hours