BU R N INJURIES

4/1/2011
& ITS
MANAGEMENT

By-
Dr. Surya Teja Nakka
1 M.Sc. MS CTVS (ONACOLOGY)
EXUCUTIVE Director CUM PROFESSOR
KIRAN COLLEGE OF NURSING.
 BURNS
WOUNDS CAUSED BY EXPOSURE
TO:
1. EXCESSIVE HE AT
2. CHEMICALS
3. FIRE/STEAM
4. RADIATION
5. ELECTRICITY

4/1/2011
 BURNS
 RESULTS IN 10-20 THOUSAND
DEATHS ANNUALLY
 SURVIVAL BEST AT AGES 15-45

 SURVIVAL BEST BURNS COVER

LESS T H A N 20% OF TBA

4/1/2011
 TYPES OF B U R N S
 THERMAL
EXPOSURE TO FLAME OR A HOT OBJECT
 CHEMICAL

EXPOSURE TO ACID, ALKALI OR ORGANIC

SUBSTANCES
 ELECTRICAL

RESULT FROM THE CONVERSION OF

ELECTRICAL ENERGY INTO HEAT.
(EXTENT OF INJURY DEPENDS ON THE
TYPE OF CURRENT, THE PATHWAY OF
FLOW, LOCAL TISSUE RESISTANCE, AND
DURATION OF CONTACT)
 RADIATION

RESULT FROM RADIANT ENERGY BEING

TRANSFERRED TO THE BODY.
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 CHEMICAL B U R N

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 ELECTRICAL B U RN

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 B U R N WOUND ASSESSMENT
 CLASSIFIED ACCORDING TO DEPTH OF
INJURY A N D EXTENT OF BODY SURFACE
A R E A INVOLVED
 B U R N WOUNDS DIFFERENTIATED

DEPENDING ON T H E LEVEL OF DERMIS

A N D SUBCUTANEOUS TISSUE
INVOLVED
1.SUPERFICIAL (FIRST-DEGREE)
2.DEEP (SECOND-DEGREE)
3.FULL THICKNESS (THIRD A N D
FOURTH DEGREE)

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8
 BURNS
(FIRST
DEGREE)
 EPIDERMAL TISSUE ONLY AFFECTED
 ERYTHEMA, BLANCHING ON PRESSURE,

MILD SWELLING NO VESICLES OR

BLISTER INITIALLY
 NOT SERIOUS UNLESS LARGE AREAS

INVOLVED
 I.E. SUNBURN

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 D E E P (SECOND DEGREE)
*INVOLVES THE EPIDERMIS AND
DEEP LAYER OF THE DERMIS
FLUID-FILLED VESICLES –RED, SHINY,
WET, SEVERE PAIN HOSPITALIZATION
REQUIRED IF OVER 25% OF BODY
SURFACE INVOLVED
I.E. TA R BURN, FLAME

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 FULL THICKNESS
(THIRD/FOURTH DEGREE)
 DESTRUCTION OF ALL SKIN LAYERS
 REQUIRES IMMEDIATE

HOSPITALIZATION
 DRY, WAXY WHITE, LEATHERY, OR H ARD

SKIN, NO PAIN
 EXPOSURE TO FLAMES, ELECTRICITY

OR CHEMICALS CAN CAUSE 3RD DEGREE

BURNS

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 Calculation of B u r n e d
B o d y Su r f a c e Area

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TOTAL BODY SURFACE
AREA (TBSA)

 SUPERFICIAL BURNS ARE NOT INVOLVED IN

THE CALCULATION
 LUND AND BROWDER CHART IS THE MOST

ACCURATE BECAUSE IT ADJUSTS FOR AGE

 RULE OF NINES DIVIDES THE BODY – ADEQUATE

FOR INITIAL ASSESSMENT FOR ADULT BURNS

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LUND BROWDER CHART U S E D FOR
DETERMINING BSA

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RULES OF NINES
 HEAD & NECK = 9%
 EACH UPPER EXTREMITY (ARMS) = 9%

 EACH LOWER EXTREMITY (LEGS) = 18%

 ANTERIOR TRUNK= 18%

 POSTERIOR T R UN K = 18%

 GENITALIA (PERINEUM) = 1%

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 24
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PALM METHOD

IN PATIENTS WITH SCATTERED BURNS, A METHOD

TO ESTIMATE THE PERCENTAGE OF BURN IS THE
PALM METHOD.
THE SIZE OF THE PATIENT’S PALM
IS APPROXIMATELY 1% OF TBSA.

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

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 CHANGES
RESULTING FROM
BURN INJURIES
 CIRCULATORY DISRUPTION OCCURS AT T H E B U R N
SITE IMMEDIATELY AFTER A B U R N INJURY
 BLOOD FLOW DECREASES OR CEASE DUE TO
OCCLUDED BLOOD VESSELS
 DAM AGED MACROPHAGES WITHIN T H E TISSUES
RELEASE CHEMICALS T H AT CAUSE CONSTRICTION
OF VESSEL
 BLOOD VESSEL THROMBOSIS M AY OCCUR
CAUSING NECROSIS


MACROPHAGE: A TYPE OF WHITE BLOOD T H AT INGESTS (TAKES IN)

FOREIGN MATERIAL. MACROPHAGES ARE KEY PLAYERS IN
THE IMMUNE RESPONSE TO FOREIGN INVADERS SUCH AS INFECTIOUS
MICROORGANISMS.
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 FLUID SHIFT
 FLUID SHIFT OCCURS AFTER INITIAL
VASOCONSTRICTION, T H E N DILATION
 BLOOD VESSELS DILATE A N D LEAK FLUID

INTO T H E INTERSTITIAL SPACE

 KNOWN A S TH I RD SPACING OR CAPILLARY

LEAK SYNDROME
 CAUSES DECREASED BLOOD VOLUME A N D

BLOOD PRESSURE
¢ OCCURS WITHIN T H E FIRST 12 HOURS AFTER
T H E B U R N A N D CAN CONTINUE TO U P TO 36
HOURS
¢ [MAJOR BURNS >30%TBSA]

4/1/2011
 FLUID IMBALANCES
 FLUID IMBALANCES OCCUR A S A RESULT
OF FLUID SHIFT A N D CELL DAMAGE
 HYPOVOLEMIA

 METABOLIC ACIDOSIS

 HYPERKALEMIA

 HYPONATREMIA

 HEMOCONCENTRATION (ELEVATED BLOOD

OSMOLARITY, HEMATOCRIT/HEMOGLOBIN)
DUE TO DEHYDRATION

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 FLUID REMOBILIZATION
 OCCURS AFTER 24 HOURS
 CAPILLARY LEAK STOPS

 SEE DIURETIC STAGE WHERE EDEMA FLUID

SHIFTS FROM T H E INTERSTITIAL SPACES INTO

T H E VASCULAR SPACE
 BLOOD VOLUME INCREASES LEADING TO

INCREASED RENAL BLOOD FLOW A N D

DIURESIS
 HYPOKALEMIA OCCUR

4/1/2011
 CURLING’S ULCER
 ACUTE ULCERATIVE GASTRO DUODENAL
DISEASE
 OCCUR WITHIN 24 HOURS AFTER BURN

 DUE TO REDUCED GI BLOOD FLOW

AND MUCOSAL DAMAGE

 TREAT CLIENTS WITH H2 BLOCKERS,

MUCOPROTECTANTS, AND EARLY

ENTERAL NUTRITION
 WATCH FOR SUDDEN DROP IN

HEMOGLOBIN

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M U C O P R OT E C TA N T S - SALIVATION INDUCING AGENT

4/1/2011
 MANAGEMENT:-
PHASES OF B U R N CARE
 EMERGENT (24-48 HRS)
 ACUTE

 REHABILITATIVE

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EMERGENT OR IMMEDIATE FROM ONSET OF INJURY TO • FIRST AID
RESUSCITATIVE COMPLETION • PREVENTION OF SHOCK
OF FLUID RESUSCITATION • PREVENTION OF RESPIRATORY
DISTRESS
• DETECTION AND TREATMENT
OF CONCOMITANT INJURIES
• WOUND ASSESSMENT AND
 INITIAL CARE

ACUTE FROM BEGINNING OF DIURESIS • WOUND CARE AND CLOSURE

TO NEAR • PREVENTION OR TREATMENT
COMPLETION OF WOUND OF COMPLICATIONS, INCLUDING
CLOSURE INFECTION
• NUTRITIONAL SUPPORT

REHABILITATION FROM MAJOR WOUND CLOSURE • PREVENTION OF SCARS AND

TO RETURN CONTRACTURES
TO INDIVIDUAL’S OPTIMAL LEVEL • PHYSICAL, OCCUPATIONAL,
OF PHYSICAL AND VOCATIONAL
AND PSYCHOSOCIAL REHABILITATION
ADJUSTMENT • FUNCTIONAL AND COSMETIC
RECONSTRUCTION
• PSYCHOSOCIAL COUNSELING

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

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PLASTIC SURGERY
WHAT IS PLASTIC SURGERY?
 THE NAME IS TAKEN FROM THE GREEK WORD
“PLASTIKOS”, WHICH MEANS TO FORM OR
MOLD!
 PLASTIC SURGERY IS A SPECIAL TYPE OF
SURGERY THAT INVOLVES BOTH A PERSON'S
APPEARANCE AND HIS OR HER ABILITY TO
FUNCTION.
 IT INTENDS TO IMPROVE PATIENTS'
APPEARANCE, SELF-IMAGE, AND
CONFIDENCE THROUGH BOTH
RECONSTRUCTIVE AND COSMETIC
PROCEDURES.
WHY DO PEOPLE GET PLASTIC SURGERY?

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
THERE ARE TWO MAIN KINDS OF PLASTIC
SURGERY:
1. RECONSTRUCTIVE SURGERY - IS USUALLY EMPLOYED FOR
MEDICAL PURPOSES, AND SOME COMMON EXAMPLES
INCLUDE:
*CLEFT LIP SURGERY
* BREAST RECONSTRUCTION SURGERY FOR THOSE WHO
HAD MASTECTOMY
* CONTRACTURE SURGERY FOR BURN SURVIVORS

2. COSMETIC SURGERY - IS DONE MOSTLY FOR AESTHETIC

3. ENHANCEMENT AND INCLUDES: *
- DIFFERENT TYPES OF COSMETIC SURGERY INCLUDE:
• TUMMY TUCK (ABDOMINOPLASTY)
* LIPOSUCTION
* BREAST LIFT
* CHEEK AUGMENTATION
* BREAST REDUCTION/ENLARGEMENT (AUGMENTATION
MAMMAPLASTY)
WHICH ARE THE MOST COMMON PLASTIC
SURGERIES ?

1. TUMMY TUCK
2. EYELID SURGERY
3. LIPOSUCTION
4. BREAST AUGMENTATION
 BREAST RECONSTRUCTION
 BREAST IMPLANT
 BREAST LIFT
 BOTOX
GETTING A TUMMY TUCK
 TUMMY TUCK (ABDOMINOPLASTY) HELPS TO
REDUCE THE APPEARANCE OF A PROTRUDING
ABDOMEN, LOOSE SKIN.
 STRETCH MARKS IN THE ABDOMINAL AREA.

 MANY PEOPLE TURN TO A TUMMY TUCK AS A

RESULT OF PREGNANCY.
 THE ALSO TURN AS E RESULT OF AGE OR
OBESITY.
EYELID SURGERY

 IS PERFORMED ON ADULTS OF ANY AGE TO CORRECT

PROBLEMS ASSOCIATED TO AGING OR TO RECEIVE
TREATMENT FOR INHERITED TRAITS.
 THEY MAY HAVE LOOSE SKIN HANGING DOWN FROM THE
UPPER EYELIDS AND POSSIBLY IMPAIRING VISION
 A PUFFY APPEARANCE TO THE UPPER EYELIDS THAT MAKE
THE EYES LOOK TIRED
 EXCESS SKIN AND FINE WRINKLES OF THE LOWER EYELIDS,
 DARK CIRCLES UNDER THE EYES
 EYELID SURGERY CAN NORMALLY FIX THESE TYPES OF
PROBLEMS, BUT SOMETIMES AN EYELID SURGERY MAY BE
NEEDED IN COMBINATION WITH ANOTHER TREATMENT.
GUIDE TO GETTING LIPOSUCTION
 LIPOSUCTION (LIPOPLASTY) IS THE ELIMINATION
OF UNWANTED FAT.
 EVERY YEAR, HUNDREDS OF THOUSANDS OF
AMERICAN MEN AND WOMEN UNDERGO
LIPOSUCTION PROCEDURES TO ELIMINATE
UNWANTED AND PERSISTENT POCKETS OF FAT IN
THE:
 ABDOMEN
 HIPS
 THIGHS
 BUTTOCKS
 ARMS
BREAST AUGMENTATION

 BREAST IMPLANTS ARE USED DURING

AUGMENTATION TO INCREASE THE SIZE
OF THE BREAST.
 TO INCREASE SHAPE OF THE BREAST.

 TO RESTORE BREAST VOLUME LOST

AFTER WEIGHT REDUCTION OR
PREGNANCY.
 PLASTIC SURGERY

BENEFITS DRAWBACK

 COSMETIC SURGERY IS  LEAVES SOME MARKS OR SPOTS ON THE

BODY WHICH CAN BE RECTIFIED BY
PURSUED TO ENHANCE PERFORMING ANOTHER PLASTIC
THE MAGNIFICENCE OF SURGERY
THE PERSON.  RISKS DEPEND ON THE TYPE OF PLASTIC
 PLASTIC SURGERY IS TO SURGERY. (BREAST AUGMENTATION,
LOOK ENERGETIC AND BLEEDING OF GEL)
TO PLEASE HIMSELF.  THE RISKS OF LIPOSUCTION INCLUDE
DISCOLORATION, DEPIGMENTATION,
 THERE IS A NUMBNES S, BRUISING AND PAIN.
DEVELOPMENT OF  FACELIFT PLASTIC SURGERY INVOLVES
SELF-ESTEEM IN THE VARIOUS SIDE EFFECTS: NERVE DAMAGE
PERSON IF THE PLASTIC WHICH MAKES THE PERSON’S FACE
INSENSIBLE.
SURGERY IS
SUCCESSFUL  THE PATIENT ALSO SUFFERS FROM MILD
SIDE EFFECTS: FEELING PAIN IN THE
AFFECTED PART AND INFLAMMATION.
THEREFORE, PLASTIC SURGERY HAS TWO
SIDES – ONE IS BENEFIT SIDE AND THE
OTHER ONE IS THE DRAWBACK SIDE AND
THE PATIENT HAS TO EXPERIENCE BOTH
THE SIDES.
THANK YOU!