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BURN INJURY

Sonny M. Moreno, RN, USRN, MAN

Coverage
Preventive and Safety Measures Assessment and Classification Management During:
Emergent (Prioritization) 1st Phase (Fluids, Electrolytes & ABG) 2nd Phase (Fluids, Electrolytes & ABG) 3rd Phase (Rehabilitation)

Fire Hazards
MAJORITY OF BURN CASES ARE DUE TO
Due to

NEGLIGENCE!

Childs curiosity

MNEMONIC IN THE EVENT OF FIRE R-A-C-E

R ESCUE remove
client

A LARM activate
fire alarm, report

C ONFINE close
doors and windows

E XTINGUISH fire

Things to do..
Drop to the floor Cover face with wet cloth Look for the fire exit DONT PANIC!

Caught inside a burning building!

POSSIBLE INJURIES!

Most fatal!

Indication of Smoke Inhalation Injury


Fainting Fire or smoke present in a closed area S/sx respiratory distress or upper airway obstruction Presence of soot and singed hair Burns around the face, neck and chest

Consider CO poisoning

ASSESSMENT
A B C D E
IRWAY
REATHING

IRCULATION
ISABILITIES

XPOSE

Types of Burns
Chemical acid or alkali Electrical most fatal Mechanical friction or abrasion Radiation sunlight Thermal dry flames, moist and heat

Radiation

Thermal

Mechanical

Chemical

Electrical

Understanding the degree of burn injury.

Epidermis Only
1st degree superficial thickness painful, no blisters, pink and red, NSG

All Skin Layers


2nd degree partial thickness, deep partial thickness very painful, with blister/weep, (+) blanch:whitish, epidermis and dermis STSG

Skin, SQ, Fascia and Muscle


3rd degree full thickness painless, leathery, SQ, fascia and muscle, F&E imbalance FTSG

4th Degree
4th degree full thickness, black painless bones and visceral organs are affected FTSG

Factors Determining Burn Severity


Extent Depth Age Body Part

Burn Category
Minor Burn Injury
15-30% , 1st and 2nd degree 10%, 3rd degree

Major Burn Injury


30%, 2nd degree 10% , 3rd degree Face, neck, chest and genetalia Other disabilities Inhalation and electrical injuries

Bring to the nearest hospital

What is your Priority? 1. Airway 2. Hypovolemia 3. Hypothermia 4. Continuing burn injury 5. Pain 6. Compartment Syndrome

Emergency Room
ABCDE assessment Airway and fluid resuscitation (priority) Strict I and O monitoring (foley catheter) Prevent hypothermia (heat loss) Give TIG/TAT (passive) and TT (active) Prophylactic antibiotic Silvadene Silver Nitrate (may lead to Acidosis)

Fluid Replacement
LRS

Choose?
A. Isotonic B. Hypotonic C. Hypertonic

How to compute for fluid replacement?


Estimate TBSA (area of burn injury) Use the Rule of Nines TBSA x 4ml (constant) x BWkg

Parkland Formula
(TBSA x 4ml x BWkg) 1st 8H give 2nd 8H give 3rd 8H give

Case: Burnt Area: Head/neck, chest, and left lower extremity ___? BW: 60 kg Formula: TBSA x 4ml x BWkg 36% x 4ml x 60kg

Computation
= 36% x 4ml x 60kg = 36 x 4 x 60 = 8640 ml/24h 1st 8h = 4320 ml () 2nd 8h = 2160 ml () 3rd 8h = 2160 ml () Note: (Parkland) Use LRS fluid Given in the 1st 24h only Start the infusion at the time of injury

st 1

Phase

Hypovolemia tissue perfusion Hyponatremia Hyperkalemia Circumferential edema Rhabdomyolysis Myoglobinuria Oliguria

nd 2

Phase

Hypervolemia Hypokalemia Hyponatremia Infection Diuresis

Renal Failure

st 1

and

nd 2

Phase

First Phase
Hypovolemia tissue perfusion Hyponatremia Hyperkalemia Circumferential edema Rhabdomyolysis Myoglobinuria Oliguria

Second Phase
Hypervolemia Hypokalemia Hyponatremia Infection Diuresis

3rd Phase to Rehabilitation Period

Infection Anemia Nutrition

3rd Phase to Rehabilitation Period


Scar and Keloid
Psychological Problems Contractures Compartment Syndrome

Debridement
1. Wet to dry dressing 2. Occlusive dressing 3. Chemical dressing 4. Sharps

Circo-electric bed Circulo-electric bed

Debridement using scalpel

Wound debridement in a water tank

Wet to dry dressing debridement

Pressure Garment Daily for One Year

SPLIT THICKNESS, FULL THICKNESS

Skin Grafting

Donor site

Recipient site

Unsuccessful Management!

Escharotomy

Compartment Syndrome (6 Ps)

The other side of the story.

RECAP
Emergent Phase 1st Phase or Fluid Accumulation 2nd Phase or Fluid Remobilization 3rd Phase or Rehabilitation

Devastating and debilitating effects!

It can be prevented!

Only if Inday is prudent enough...

Thank you!

Dei Belen 2nd-degree burn, Combustion.. ALARM!

Noel Go partial thickness burn(anu itsura), mgmt: burning pt(anu gagawin), electricution(anu gagawin?), pt(sa wheelchair): "ano gagawin ko pag ako nasunog?"

Neyz Intalan wat if burning pt?? u cover wid blanket? or tell him to stop first then roll saka blanket?

Marvin Tablisma burning pt (roll at blanket) partial thickness (mas mababaw ung burn mas masakit) yan po sagot ko hehehe ewan ko lng kung tama

Mgjerika Olumor Deep partial thickness po yung given... Ang pagpipilian kung Charred, blanch, with blister, at namumula yung isang option ata...

The nurse see a reddened area on the client's skin but no lesions. The nurse's best action is to: A. Put gauze on the reddened area to prevent any further injury.

A nurse is preparing to care for for a burn client scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn, the nurse understands that the anticipated therapeutic outcome of the escharotomy is: A. brisk bleeding from the site B. formation of granulation tissue C. decreasing edema formation D. return of distal pulses ***********************************

A burn may be an injury caused by:

C old C hemicals
H eat E lectricity F riction or Radiation
Its a form of heat converted to an energy

Lets have a review of ABG


Simple if:
pH is normal HCO3 is normal CO2 is abnormal ORAYT! pH is normal CO2 is normal HCO3 is abnormal

Ph 7.46 upalkalosis HCO3 29 up alkalosis CO2 33 downalkalosis Interpret it!


Look at the arrows of HCO3 and CO2 What did you observe?

Opposing arrows, right?


You would interpret this as? Mixed Alkalosis

Compensation can be?


Compensated if pH is normal Uncompensated if pH is abnormal Co2 and HCo3 same arrowsexample

CO2 48 upacidosis+3
HCO3 30 upalkalosis +4 Ph is 7.40 ..normal Check! Compensated!!! NEXTTT

If its compensated check the difference The one with higher difference will be the primary problem Fully if ph is at 7.40

Uncompensated
Ph is always abnormal CO2 and HCO3 will have the same arrows Example!

Co2 33 downalkalosis

HCo3 21 downacidosis pH 7.34 down acidosis

Interpret this
pH 7.40 normal CO2 49 upacidosis + 4 HCO3 31 upalkalosis + 5 Same arrows? Compensation Is it compensated or uncompensated? What is the primary problem? The one with higher difference

Lets review fluids


Pt is dehydrated following major operation. What fluids will u give? A. hypotonic B. isotonic C. hypertonic Final answer? Isotonic! Why? To prevent shifting of fluids from IC to IV

This fluids will allow movement of water from IC to IV? A. hypotonic IV B. isotonic C. hypertonic

IC

ratio
Hypertonic has high solutes thereby creating an osmosis ORAYT!

FVD
Osmolality of plasma is? A. High B. low

Essential output is?


A. feces B. sweat ]C. urine D. vapor

electrolytes
Effects of giving D5W and insulin adminstration? A. K excretion via feces-KAYEXALATE B. K moves out from the cell-INCORRECT C. creates PISO-Na HCO3 po D. K moves inside the cell-CORRECT

Calcium tayo hehehe


Parathormone, SATA select all that apply? A. triggered by low serum Calcium-check B. promotes bone demineralization-check C. may predispose px to kidney stone-check D. is opposite to the effects of calcitonin-check E. produced from the thyroid gland-no F. is opposite to estrogen-