burn injury-acute burn course

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Information about burn injury-acute burn course
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Published on December 6, 2008

Author: rhun18

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burn injury acute burn course

BURN INJURY--ACUTE BURN COURSE A burn injury is a type of injury that may be caused by heat, cold, electricity, chemicals, light, radiation, or friction. Burn Size: 1. Small burns: Localized burn to the injury area. 2. Large burns: Consist of 25% or more of the total body surface area, and the response is systemic means all of the major systems of the body is affected. Burn Classification by Depth: 1. Superficial-thickness Burn It is similar to first-degree burn. There is mild to severe erythema but no blisters. Burn is painfull, and is ceased by cooling. It heals in 3 -7 days. 2. Partial-thickness Superficial Burn It is similar to second-degree burn. Large blisters cover an extensive area and edema is present. Mottled red base and broken epidermis with a wet, shiny, and weeping surface. Burn is painful and sensitive to cold air. Superficial partial thickness burn heals in 2-3 weeks while the deep partial thickness heals in 3-6 weeks. If the healing process is prolonged, the grafts may be used. 3. Full-thickness Burn It is similar to third-degree burn. A deep red, black, white, yellow or brown area are present with edema. Burn causes tissue disruption with fat exposed and spontaneous healing will not occur. There is little or no pain of burn area. It requires removal of eschar and split or full thickness skin grafting. The healing will be weeks to months. 4. Deep Full-thickness Burn It is similar to fourth-degree burn. It involves injury to the muscle and bone. The injured area appears black, no edema, no pain and no blisters. The eschar is hard and inelastic, and healing take weeks to months. Graft are required. Types of Burn Injuries There are four major types of burns: thermal burns, chemical burns, electrical burns, and radiation burns. Thermal Burns Thermal burns are caused by exposure to flames, hot liquids, steam or any hot objects. Chemical Burns Chemical Burns are caused by contact with strong acids, alkalis, or organic compounds. Electrical Burns Electrical burns are caused by an exogenous electric shock that passes through the body. Muscle and tissue damage will be occurred particularly in high-voltage electrical injuries. The voltage, type of current, contact site, and duration of contact are important to identify JUOCATE 1

the quick action. Just to be remembered that alternating current is more dangerous than direct current because it associated with cardiopulmonary arrest, ventricular fibrillation, titanic muscle contraction and bone fracture. Radiation Burns Radiation burns are caused by exposure to ultraviolet light (sun exposure), x-rays, or a radioactive source. Sun exposure is the most common burn, specifically two wavelength of light UVA and UVB that may more dangerous. INHALATION INJURIES There are four types of inhalation injury that most occurred: Smoke inhalation injury, carbon monoxide poisoning, smoke poisoning, and direct thermal heat injury. Smoke Inhalation Injury Smoke inhalation injury is occurred when the person is trapped in an enclosed, hot, smoke filled space. Patient with smoke inhalation might be have facial burns, erythema, swelling of oropharynx and nasopharynx, flaring nostrils, hoarse voice, stridor, wheezing, dyspnea, sooty (carbonaceous sputum), cough and tachycardia. Carbon Monoxide Poisoning Carbon monoxide is a colorless, practically odorless, and poisonous gas formed by the incomplete combustion of carbon; its toxic action is due to its strong affinity for hemoglobin, myoglobin, and the cytochromes, reducing oxygen transport and blocking oxygen utilization. Oxygen molecules are displaced and carbon monoxide reversibly binds to hemoglobin to form carboxyhemoglobin that tissue will be hypoxia. The signs and symptom of carbon monoxide poisoning are depended on the level of carbon monoxide in blood. It will be from impaired visual activity, headache, nausea, vomiting, dizziness, syncope, tachypnea, tachycardia, until coma or death. Smoke Poisoning Smoke poisoning is injury result when the victim inhales by-products of combustion. The localized inflammatory reaction occurs that causing a decrease in bronchial ciliary action and decrease in surfactant. The victim will have mucosal edema and wheezing. Direct Thermal Heat Injury Direct thermal heat injury can occur to the lower or upper airways by the inhalation of steam or explosive gases. Mucosal edema can lead to upper airway obstruction especially during the first 24 hours. Rule of Nines This method is used in calculating body surface area involved in burns. Here are Rule of Nines (Adult):  Head and nect: 9%  Anterior trunk: 18%  Posterior trunk: 18 %  Arm (9% each): 18% JUOCATE 2

 Legs (9% each): 18%  Perineum: 1% We can estimate the body surface area on an adult that has been burned by using multiples of 9. For example, if both legs (18% x 2 = 36%), anterior trunk (18%) and both of arm (18%) were burned, this would involve 72% of the body. BURN INJURY MANAGEMENT: There are four phases of Burn Injury Management: Emergent phase, resuscitative phase, acute phase, and rehabilitative phase. Emergent Phase  It includes pre-hospital care and emergency room care and begins at the time of injury till the restoration of capillary permeability.  Usually 48-72 hours following burn injury.  The management is to prevent hypovolemic shock and preserve vital organ functioning. Resuscitative Phase  The resuscitative phase begins with the initiation of fluids until capillary integrity returns to normal level.  Administration of fluid is based on the body weight and extent of injury, and the formulas are calculated from the time of injury and not from the time of arrival at the hospital.  Management of this phase is to prevent shock by maintaining adequate circulating blood volume. Acute Phase  This phase begins when the victim is hemodynamically stable, capillary permeability is restored, and diuresis has begun and continues until wound closure is achieved.  Usually 48-72 after the time of injury. JUOCATE 3

 Management of this phase focus on infection control, wound care, wound closure, nutritional support, pain management, and physical therapy. Rehabilitation Phase  This is final phase of burn management.  It focuses that the patient can gain independence and achieve maximal function BURN INJURY MANAGEMENT PHASE 1. EMERGENT PHASE The emergent phase begins at the time of injury and ends with the restoration of capillary permeability (fluid resuscitation): 48-72 hrs following the injury. Key point is to prevent hypovolemic shock and preserve vital organ functioning. It includes prehospital and emergency room care. Pre-hospital Care  Remove source of the burn  Assess airway, breathing, and circulation,  Conserve body heat  Cover burns with sterile or clean cloths  Remove jewelry and clothing  Intravenous fluid (if needed)  Quick transport Emergency Room Care It is a continuation of care administered at the scene and implemented as the hospital policy or standard procedures. For Major burns:  Assess the degree and extent of the burn area  Ensure a patent airway and administer 100% oxygen, assess for respiratory distress, blisters and edema on oropharynx  Check arterial gases and carboxyhemoglobin level  Peripheral intravenous access  Monitor vital sign closely  Keep NPO  Insert nasogastric tube as prescribed  Tetanus Toxoid and Pain medication as prescribed  Escharotomy or fasciotomy as prescribed For Minor Burns:  Pain medication (morphine sulfate or meperidine)  Oral analgesic and Tetanus toxoid as prescribed  Wound Care 2. RESUSCITATIVE PHASE It begins with the initiation of fluids and ends when capillary integrity returns to near normal. Keys point is to prevent shock by maintaining adequate circulation blood volume and vital organ perfusion. And the successful fluid resuscitation is evaluated by stable vital signs, adequate urine output (30-50 mL/hr) palpable peripheral pulses, and a clear sensorium. JUOCATE 4

Fluid replacement is calculated from the time of injury not from the time of arrival at the hospital. The amount of fluid given is based on the body weight and extent of the injury. Common Fluid Resuscitation Formulas (24 hours after burn injury) Parkland (Baxter) Formula:  4 mL/kg per percent TBSA burned.  Half is given in first 8 hours  One-quarter each next 8 ours  Solution: Lactated Ringer’s Modified Brooke Formula:  2.0 mL/kg per percent TBSA burned  Half is given in first 8 hours  Half in next 16 hours  Solution: Lactated Ringer’s 3. ACUTE PHASE It begins when the client is hemodynamically stable, capillary permeability is restored, and diuresis has begun, usually 48-72 hours after the time of injury. Key point is on infection control, wound care, wound closure, nutritional support, pain management, and physical therapy. JUOCATE 5

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