2. Burn Injuries
• Cell destruction of the layers of the skin and
the resultant depletion of fluid and
electrolytes
• Mortality rates are higher for children less
than 4 years of age, particularly in the birth to
1-year age group and for clients over the age
of 65 years
3. Burn Injuries
• Debilitating disorders, such as cardiac,
respiratory, endocrine and renal disorders
negatively influence the client’s response to
injury and treatment
• Mortality rate is higher when a client has a
preexisting disorder at the time of burn injury
4. Burn Injuries
Burn Size:
1. Small burns-
2. Large or extensive burns
Burn Depth
1. Superficial thickness burn
2. Partial thickness superficial burn
3. Full thickness burn
4. Deep full thickness burn
13. Types of Burns:
1. Thermal Burns
- Caused by exposure to flames, hot liquids, steam
or hot objects
2. Chemical Burns
- caused by tissue contact with strong acids, alkalis
or organic compounds
3. Electrical burns
- caused by heat generated by an electrical energy
as it passes through the body
14. Types of Burns:
4. Radiation burns
- caused by exposure to ultraviolet light, x-rays or
radioactive source
5. Scalding
- caused by hot liquids (water or oil) or gases (steam),
most commonly occurring from exposure to high
temperature tap water in baths or showers or spilled
hot drinks.
6. Inhalation Injury
Steam, smoke, and high temperatures can cause
inhalational injury to the airway and/or lungs
15. Classification of burns by severity (American Burn
Association)
Major burns are defined as:
• Age 10-50yrs: partial thickness burns >25% of total
body surface area
• Age <10 or >50: partial thickness burns >20% of total
body surface area
• Full thickness burns >10%
• Burns involving the hands, face, feet or perineum
• Burns that cross major joints
• Circumferential burns to any extremity
• Any burn associated with inhalational injury
• Electrical burns
16. Major burns:
• Burns associated with fractures or other trauma
• Burns in infants and the elderly
• Burns in persons at high-risk of developing
complications
Moderate burns are defined as:
• Age 10-50yrs: partial thickness burns involving 15-
25% of total body surface area
• Age <10 or >50: partial thickness burns involving 10-
20% of total body surface area
• Full thickness burns involving 2-10% of total body
surface area
17. Minor burns are:
• Age 10-50yrs: partial thickness burns <15% of total
body surface area
• Age <10 or >50: partial thickness burns involving
<10% of total body surface area
• Full thickness burns <2% of total body surface area,
without associated injuries
18. Pathophysiology
Burn Injury
↓
Release of vasoactive substances
↓
Increase in capillary permeability
↓
Plasma seeps to the surrounding tissues
↓
Generalized edema
↓
Decrease in circulating intravascular blood volume
19. ↓
Decrease in organ perfusion
↓
Increased heart rate, decrease CO, decreased BP
↓
Hyponatremia , Hyperkalemia
↓
Initial Increase in hematocrit level then falls to below
normal
↓
Red blood cell damage and loss
↓
21. Effects of Major burns
1. Cardiovascular response
Severe burn injury
↓
Breakdown of capillaries
↓
Plasma Fluid and protein leak into the interstitial space
↓
Increased tissue pressure, exacerbation of tissue
hypoxia and worsening damage
↓
Release of prostaglandins, leukotrienes and histamine
22. ↓
Further increase in capillary permeablitiy to water and
protein
(loss of capillary seal)→increased blood
viscosity→sluggish blood flow
↓
edema spreads beyond burned tissue and renal hypoxia
↓ ↓
Accumulation of fluid in the decrease urine output
interstitial space Activation of RAAS
↓ ↓
↓ stroke volume and BP
24. 2. Cellular Response
a. Diffusion of cells
Burn injury
↓
Cells outside the burned area are permeable to
electrolytes
↓
K into the extracellular fluid compartment
↓
Intracelllar accumulation (Na and calcium)
↓
Leaking out of of magnesium and Phosphate
25. 2. Cellular Response
↓
Water diffusion to the cells
↓
Swelling of cells
↓
bursting of injured cells
↓
Release of potassium to the extracellular fluid
26. b. Inhibited immune function- loss of barrier function
of the skin
Decreased immune function appears to result of the
release of cortisol
c. Hypermetabolism-
Activation of the SNS and stress response
↓
Release of cytokines and widespread inflammatory
function of the skin is lost
↓
Tissue breakdown and CHON and fat wasting
↓
Severe muscle wasting
27. Signs and symptoms
• A. Smoke inhalation injury
• Facial burns
• Erythema
• Swelling of the oropharynx and nasopharynx
• Singed nasal hairs
• Flaring nostrils
• Stridor, wheezing and dyspnea
• Hoarse voice
• Sooty (carbonaceous) sputum and cough
29. Signs and symptoms
B. Thermal Heat injury
• Erythema and edema of the upper airways
• Mucosal blisters and ulcerations
30. Management:
A. Emergent Phase
Begins at the time of injury and ends with
the restoration of the capilllary permeability
(Fluid resuscitation) usually at 48 to 72 hours
following the injury.
1. Prehospital care
• Remove victim from the source of the burn
• Remove the source of heat
• Assess ABC
31. • Assess for associated trauma.
• Conserve body heat.
• Cover burns with sterile of clean cloths.
• Remove constricting jewelry or clothing.
• Assess the need for intravenous fluids
• Transport.
32. Emergency Wound Care of Major Burns
• Evaluate the degree and extent of the burn
and treat life-threatening conditions.
• Ensure patent airway and administer 100%
oxygen as prescribed if the burn occured in an
enclosed area.
• Monitor for respiratory distress and assess the
need for intubation
• Assess oropharynx for blisters and erythema
• Initiate peripheral IV access to non-burned
skin proximal to any extremity burn.
33. • Prepare for a central venous line if prescribed.
• Assess for hypovolemia and prepare to
administer fluids intravenously .
• Monitor VS closely.
• Insert foley catheter as prescribed and
maintain a normal urine output per hour.
• Insert a nasogastric tube as prescribed
• Administer tetanus prophylaxis as prescribed.
• Administer pain medication as prescribed by
IV route.
• Prepare the patient for escharotomy or
fasciotomy as prescribed.
34. B. Resuscitative Phase
- begins with the initiation of fluids and ends
when capillary integrity returns to near-
normal levels and the large fluid shifts have
decreased.
1. Fluid resuscitation
The amount of fluid administered depends
on how much IV fluid per hour is required to
maintain a urinary output of 30 to 50 ml per
hour.
-This is given at 15-20% TBSA
35. Interventions:
• Monitor for tracheal and laryngeal edema and
administer respiratory treatments as
prescribed.
• Monitor pulse oximetry and prepare for
arterial blood gases and carboxyhemoglobin
levels if inhalation injury is suspected.
• Elevate head of bed to 30 degrees or more for
burns of the face and head.
• Initiate protective isolation techniques.
• Shave or cut body hair around wound
margins.
36. • Monitor daily weights.
• Monitor for the presence of stress ulcer.
Administer antacids as prescribed.
• Auscultate bowel sounds and monitor abdominal
distention and GI dysfunction.
• Monitor IV fluids and hourly intake and output.
• Elevate circumferential burns of the extremities
on pillows above the level of the heart if no
obvious fractures are present.
• Monitor pulses and capillary refill of the affected
extremities
37. Pain management:
Administer Morphine SO4 or meperidine (Demerol)
as prescribed by IV route
Nutrition:
Maintain NPO status until the bowel sounds are
heard and then advance to clear liquids as
prescribed.
Nutrition may be provided via enteral tube feeding,
peripheral parenteral nutrition or total parenteral
nutrition
Provide a diet high in protein, carbohydrates, fats
and vitamins.
38. Surgery:
1. Escharotomy - Incision into a burn eschar in
order to lessen its pull on the surrounding
tissue
39. 2. Fasciotomy- fascia is cut to relieve tension or
pressure commonly to treat the resulting loss
of circulation to an area of tissue or muscle
40. C. Acute Phase
• Begins when the client is hemodynamically
stable, capillary permeability is restored and
diuresis has begun.
• Emphasis is placed on restorative therapy and
the phase continues until wound closure is
achieved.
41. Interventions:
• Continue with protective isolation techniques.
• Provide wound care as prescribed and prepare
for wound closure.
• Provide pain management.
• Provide adequate nutrition as prescribed.
• Prepare client for rehabilitation.
42. Wound care
• Hydrotherapy
-Wounds are cleansed by immersion,
showering or spraying
- Occurs for 30 minutes or less
- Client should be premedicated before the
procedure.
- It is generally not used for clients who are
hemodynamically unstable or for those who
have new skin drafts.
43. • Debridment
- removal of eschar to prevent bacterial
proliferation under the eschar and to promote
wound healing.
- may be mechanical, enzymatic or surgical.
44. Wound closure
A. Temporary wound coverings:
1. Amnion
2. Allograft homograft
3. xenograft heterograft
4. Biosynthetic and synthetic
48. B. Autografting
- surgical removal of a thin layer of the client’s
own unburned skin, which then is applied to
the excised burn.
• Autografts are immobilized following surgery
for 3-7 days.
• Position patient for immobilization and
elevation of the graft site to prevent
movement and shearing of the graft.
49.
50. Physical Therapy
• Individualized program of splinting,
positioning, exercising, ambulation and
activities of daily living is implemented early
during the acute phase of recovery to
maximize functional and cosmetic outcomes
51. D. Rehabilitative Phase
Rehabilitation is the final phase of burn care
Goals of this phase are designed so that the
client can gain independence and achieve
maximum function.
Goals:
1. Promote wound healing.
2. Minimize deformities.
3. Increase strength and function.
4. Provide emotional support.
52. NCM 106: Acute Biologic Crisis Lecture
Series
BURN Injury
