BURNS

Occurs when there is injury to the tissues of the body caused by heat,
chemicals, electric current, or radiation

Thermal
Chemical
Management:
remove pt from burning agent and begin to quickly remove the
chemical from the skin
Dry chemical should be brushed from the skin
Areashould be flushed with tap water
Any clothing with chemical should be removed
Smoke and inhilation
Types:
Carbon monoxide poisoning
Inhilation injury above the glottis
Electrical
Radiation
Cold thermal

Classification (Severity)
A. Depth of Burn
Superficial (first degree)
Deep (second degree)
Full thickness burn (third and fourth degree)
B. Extent of body surface are injured
Rules of nine
Head and neck
9
Arms (each) 18
Ant. Trunk 18
Post. Trunk 18
Legs (each) 18
Perineum
1
TOTAL
100%
Lund and Browder Method
Head 7
Neck 2
Ant. trunk
13
Post. Trunk 13
R buttocks 2
L buttocks 2
Genitalia
1
R U arm
4
L U arm
4

R L arm
3
L L arm
3
R hand
2
L hand
2
R thigh
9
L thigh
9
R leg
7
L leg
7
R foot
3
L foot
3
TOTAL
100%
Palmer method size of pts palm is approx 1 % of the TBSA
PHASES OF BURN MANAGEMENT

1. Emergent/ Resuscitative Phase

- From onset of injury to completion of fluid resuscitation
- May last from time of the burn to 3 more days but usually 24-48 hrs
Interventions:
Check if scene is safe
Remove pt from the source of the burn
Small thermal burns(10% TBSA) cover with clean,cool,tap waterdampened towel
Assess ABC and need for cervical spine immobilization
Assess for pulse and bp
Neuro status
Establish airway and humidified 100% O2
No food or fluid given by mouth
Place in a position that prevent aspiration
Do total body assessment
Encourage to cough
ET intubation may be done
All clothing and jewelries are removed
Insert IV (PLR)
Indwelling cath may be inserted
Administer tetanus toxoid, pain meds
Fluid restriction important for the first 24 hrs, goal: 0.5 to 1.0 ml/kg/h
Fluid requirements
-combination may be used= colloids + crystalloids/electrolytes
-<20% TBSA oral or enteral
-<20 to 25% - IV
-half of calculated total should be given over the first 8 hrs and the
other half should be given over the next 16 hrs
-General formula: 2-4 ml/kg/% TBSA (isotonic)
2. Acute/ Intermediate / Wound healing

-from beginning of diuresis to near completion of wound closure

-48 to 72 hours after the burn injury

Interventions:
Removal of ET to prevent route of pathogens
Cautious administration of fluids and electrolytes continues
Administer acetaminophen and hypothermia blankets following fever
due to bacteremia
Prevent infection
Wound cleaning
Hydrotherapy, 37.8 C
Topical antibacterial therapy
Silver sulfadiazine
Wound dressing
Light dressing on joints
Burns in face mat be left open
Occlusive dressing- impregnated dressings left up to 3-5 days
Wound debridement
FOUR types:

a. Natural
b. Mechanical
c. Chemical
d. Surgical
Wound grafting
TYPES:
a. Biologic dressing
b. Biosynthetic and synthetic dressing
c. Skin substitutes
d. Autografts

3. Rehabilitative/ Restorative
- From major wound closure to return to individuals optimum level of physical and
psychosocial adjustment
Interventions:

Promoting activity intolerance

Schedule care that has periods of uninterrupted sleep
Promote rest and sleep
Improving body image and self-concept
Nurse must take time to listen and provide realistic support
Promoting home and community-based care
Teaching pt on self-care