burns

1. BURNS
by:- MR. firozqureshi
Dept. psychiatricnursing

2. Definition
 Burns is defined as the injuries that results
from direct contact wit or exposure to any
chemical, thermal or radiation source.
(JOYCE M BLACK)
 Burns is defined as injury to the tissues of the
body caused by heat, chemicals, electric
current or radiation.
(LEWIS)

3. INCIDENCE
 Burns can occur at all age groups and socio
economic groups.
 An estimated 1 million Americans and
100,000 Canadians seek medical care each
year for burns.
 Approximately,100,000 are hospitalised and
70,000 people required extensive care
services and an estimated 12,000 of these
people die anually as a direct result of burns.

4. Etiology
 Chemical burns
 Thermal burns
 Electrical burns
 Radiation burns
 Smoke and inhalation burns

5. Chemical burns
 Chemical burns are caused by contact with
strong acids, alkalis or organic compound.
 It can be result from contact with certain
household cleansing agents and various
chemical used in industry and agriculture.

7. Thermal burns
 Thermal burns are caused by exposure to or
contact with flame, hot liquids, semi liquids
(e.g steam),semisolids (e.g tar) or hot objects.
 E.g residential fires, explosive automobile
accidents, cooking accident.

8. Electrical burns
 It is caused by heat, that is generated by the
electrical energy as it passess through the
body.
 Direct damage to nerve and vessels causing
tissue anoxia and death can also occur.
 It can result from contact with exposed or
faulty wiring or high voltage power lines.

9. Electrical burns

11. Radiation burns
 This are least common types of burn injury
and are caused by exposure to a radiation
source.
 This types of injuries have been associated
with nuclear radiation accidents, the use of
ionising radiation in industry and therapeutic
irradiation.
 Sun burn from prolonged exposure to UV rays
is also considered to be a radiation burns.

12. Smoke and inhalation burns
 It results from the inhalation of hot air or
noxious chemical and caused damage to the
tissues of the respiratory tract.
 A) carbon monoxide poisoning : CO poisoning
and asphyxiation account for the majority of
death at a fire scene.
 It is produced by the incomplete combustion
of burning material

13.  It is subsequently inhaled and displaced
oxygen on the hemoglobin molecule, causing
hypoxia, carboxyhemoglobinemia and
ultimately death.

14. Classification of burns
injury
 Burns injuries are classified according to the
depth of the injuries and the extend of the
body surfaced areas injured.

15. Depth of the injury
 Burns are classified according to the depth of
the tissue destruction as:
 Superficial partial thickness
 Deep partial thickness
 Full thickness

17. Superficial burns
 A typical first degree burn is a sun burn or
superficial scald. This type of injury does not
included in calculation ofTBSA.

18. Superficial partial thickness
 In superficial partial thickness, the epidermis is
destroyed or injured and a portion of the
dermis may be injured.
 The damaged skin may be painful and appear
red and dry as in sun burn or it may blister

20. A deep partial thickness
 A deep partial thickness involves destruction
of the epidermis and upper layers of the
dermis and injury to the deeper portions of
the dermis.

22. Full thickness burns
 It involves total destruction of the epidermis
and dermis.
 The burned areas is painless.
 Prolonged exposure or high voltage electrical
injury
 Deep tissue ,muscle and bone

25. Extent of TBSA injured
 Rule of nine
 Palm method
 The Lund and Browder method

26. Rule of nine
 It is the quick way to estimate the extent of
burns.
 The system assigns percentages in multiples
of nine to major body surfaces.

28. Palm method
 In patient with scattered burns, the palm
method may be used to estimate the extent
of the burns.
 The size of the patient palm is approximately
1% of theTBSA

29. Lund and Browder method
 The more precise method of estimating the
extent of a burn in the Lund and Browder
method, which recognise that the percentage
of the surface area of various anatomical
parts especially the head and legs, changes
with growth

30. Lund and Browder method

31. Pathophysiology
 Heat from the external source is conducted
into the skin
 Direct injury to the skin
 Destroys tissue
 At sustained temperature of 54 to 60 degree
Celsius various cellular enzyme system and
cellular system fails

32.  The sodium potassium fails and cellular
edema will occur
 Cell necrosis occurs
Cell damage
Following a burns injury, vasoactive substance
(Catecholamine, histamine, serotonin,
leukotrines, kinins and prostaglandins) are
released from the injured tissue

33. Normal Vasodilation

34.  Increased capillary permeability which
permits Na ion to enter the cell and
potassium to exit
 Increased in intercellular and interstitial fluid
that further deplete intravascular fluid
volumes
 Hemodynamic balance, metabolism and
immune status are altered

35.  Decreased cardiac output and tissue
perfusion
 Decreased renal flow, tissue damage, cellular
dysfunction and decreased GI function

36. Clinical manifestations
 Cardiovascular system alteration
 Decreased cardiac output
 Decreased blood pressure
 Decreased in platelet
 Prolonged clotting and prothrombin time
 Weak pulse

37. Pulmonary alteration
 Increased respiratory rate
 Decreased oxygen saturation
 Hypoxia
 Dyspnea
 Increased work of breathing and eventually
cyanosis

38. Fluid & electrolyte alteration
 Hypovolemia
 Hyponatremia
 Hypernatremia
 Hyperkalemia
 Less urine output
 Dry mucus membrane poor skin turgor

39. Renal alteration
 Destruction of RBC result in free hemoglobin
in urine
 Decreased in urine output
 Acute tubular necrosis
 Increased in urea level
 Renal failure

40. Immunologic alteration
 Sepsis
 Impaired neutrophil function
 Reduction in lymphocyte
 Resulting in immunosuppression

41. Thermoregulatory alteration
 Low body temperature
 Hyperthermia in the post burn period

42. Gastrointestinal alteration
 Decreased or absence of bowel sound stool or
flatus
 Nausea, vomiting and abdominal distention
 Paralytic ileus and curling ulcers

43. Psychological response
 Psychological and emotional response
 Body image and ineffective coping abilities
 Isolation
 Disbelief
 Anxiety
 Grief
 Depression

44. Pain response
 Pain
 Clinical response to pain may include an
increased in BP, heart rate, respiratory rate
with dilated pupils and rigid muscle tone

45. Diagnostic evaluations
 History collection
 Physical examination
 ABG analysis
 Na, K, Cl
 CBC
 Prothrombin time
 Bleeding time and clotting time
 RBS, urea and creatinine , ECG,chest Xray etc

46. Management
 Burns care then proceeds through three
phases:
 Emergent/resuscitative phase
 Acute/intermediate phase
 Rehabilitation phase

47. Emergent/resuscitative phase
Emergent / resuscitative phase start from the
onset of injury to completion of fluid
resuscitation
This phase include
 Cooling of wound
 Establish the airway
 Supply oxygen
 Insert a least one large bore IV line

48. Other management
 First aids
 Prevention of shock
 Prevention of respiratory distress
 Therefore it is important to remember the
ABG of all trauma care during the early post
burns period

49.  The circulatory system must be assessed
quickly. Apical pulse and BP are monitored
quickly.
 Neurological status is assessed quickly in the
patient with extensive burns.

50. Airway management
 Airway management frequently involves
endotracheal intubation
 Early intubation eliminates the necessity for
emergency tracheostomy after respiratory
problems have become apparent
 After intubation, the patient may be placed
on ventilatory assistance and the delivered
oxygen is determined by assessing ABG
values

51.  When intubation is not performed,
supplemental oxygen is given/provided.
 Fowlers position should be provided unless
contraindicated by a possible spinal injury.

52. Fluid loss management
 Fluid replacement therapy
 The total volume and rate of IV fluid
replacement are gauged by the patient
response and guided by the resuscitation
formula.
 The adequacy of fluid resuscitation is
determine by monitoring urine output total.
 Urine output totals of 30 to 50 ml/hr have
been used as the resuscitation goal.

53.  Other indicators of the adequate fluid
replacement are a systolic blood pressure
exceeding 100 mmHg and pulse rate less than
110 beats/min

54. Fluid requirement
 The projected fluid requirement for the first
24 hours are calculated based on the extent
of the burn injury.
 Some combination of fluid categories may be
used including colloids and crystalloid
 Adequate fluid resuscitation results in slightly
decreased blood volume level during the first
24 hour post burn and restoration of plasma
level to normal by the end of 48 hours.

55. Various formula
 Consensus formula:
 Lactate ringer solution ( other balanced
saline) 2-4 ml X kg body weight X % TBSA
burned.
 Half to be given in first 8 hrs
 Half to be given over next 16 hrs.

56. Evans formula
 Colloids =1 ml X kg body weight X % TBSA
burned
 Electrolyte = 1ml X body weight X % TBSA
burned
 Glucose (5% in WATER) = 2000 ml for
insensible loss

57.  Day1: half to be given in first 8 hours
remaining half to be given over next 16
hours.
 Day 2: half of previous days colloids and
electrolyte cells of insensible fluid
replacement

58. BRROKE ARMY FORMULA
 colloid 0.5 mlX kg body weight X % TBSA
burned
 Electrolyte (lactate RL)
 1.5mlX kg body weight X %TBSA Burned
 Glucose : 2000ml

59. PARKLAND FORMULA
 Lactate RL: 4ml X kg body weight X % TBSA
burned
 Day 1: half to be given in first 8 hours
 Half to be given over next 16 hours
 Day2: various colloid is added.

60. Thank you