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Burns

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(Close to half of all burn injuries treated in hospital emergency ... the thickening, buckling, and nodular formations seen in hypertrophic scars (Keloids) ... – PowerPoint PPT presentation

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Title: Burns


1
2.1
  • Burns

2
Fire and Burn Death and Injury
  • Deaths
  • 4,000 deaths a yearfrom fire and burns
  • Injuries
  • 25,000 hospitalized in burn centers
  • 600,000 burn injuries treated in hospital EDs
  • (Close to half of all burn injuries treated in
    hospital emergency departments and one-third of
    admissions to burn centers are scald injuries)

(Sources National Fire Protection
Association,National Center for Health
Statistics American Burn
Association, National Burn Repository, 2005)
3
  • 40 years ago 9,000 people died of burns each
    year. Those with burns of more than 20 Total
    Body Surface Area usually died.
  • Today, 4,000 die and some with 90 Total Body
    Surface Area burns survive.
  • Survival rate burn centers 94.4

4
Clinical Application
  • Dale
  • 24
  • 176 lbs.

5
Clinical Application - Burns
  • Priority of Urgent Care (On Scene)

6
Clinical Application - Burns
  • Cool Water
  • Problems with cooling water?

7
Clinical Application - Burns
  • Why remove clothing and jewelry

8
Clinical Application - Burns
  • Dale is awake, VS stable, EMTs immobilize him,
    start IV, put on O2 and transported

9
Dale Arrives in your ER
  • He has burns to face and anterior neck, singed
    hair and hoarseness
  • A-B-Cs

10
Clinical Application - BurnsCirculation
  • Burns Hypovolemia
  • Why?

11
Fluid Shifts Hypovolemic Shock
12
1st
Superficial
2nd
Deep
3rd
4th
Deep
13
Superficial (1st Degree burn)- Heal 3-5 days
14
Partial-Thickness Superficial-(2nd Degree) Heal
2-4 Weeks
15
Deep Partial Thickness Full-Thickness weeks to
months
16
Deep Full thickness (4th Degree) Burn weeks to
months on small area Need skin grafts for other
17
(No Transcript)
18
Clinical Application - BurnsRule of 9s
  • Dale
  • 1. Partial thickness to anterior right trunk
  • 2. Right upper anterior leg
  • 3. Most of right arm
  • 4. Anterior neck and face

19
Clinical Application - BurnsFluid Replacement
  • Parkland (Baxter)
  • Lactated Ringers Solution
  • 4 ML x Kg x Burn

20
Clinical Application - BurnsFluid Replacement
  • 1/2 to be given in First 8 hours
  • 1/4 in EACH of the next 8 hours
  • Start of the FIRST 24 hours is FROM TIME OF
    INJURY

21
Clinical Application - BurnsFluid Replacement
  • Dales total need for first 24 hours is
    ???? ML then How ML per hour
    for the first 8 hours?
  • How many ML per hour if you started fluid
    replacement 2 hours after injury?

22
Clinical Application - BurnsFluid Replacement
  • What do we do about fluid replacement after the
    first 24 hours?

23
Clinical Application - BurnsFluid Replacement
  • Urinary Output
  • Serum sodium
  • Cardiopulmonary Factors
  • Level of conscience

24
Burn Classification
Major Burn Injury 25 TBSA lt 40 years of
age 20 TBSA gt 40 years of age 20 TBSA lt10
years of age OR Burn involving face, eyes, ears,
hands, feet, or perineum OR High voltage OR
Concomitant inhalation or major trauma
Moderate Burn Injury 15-25 TBSA lt 40 years of
age 10-20 TBSA gt 40 years of age 10-20 TBSA lt
10 years of age Minor Burn Injury lt15 TBSA lt 40
years of age lt10 TBSA gt 40 years of age lt10
TBSA lt 10 years of age
25
Clinical Application - Burns
  • What else do we need to do to care for Dale?

26
Clinical Application - BurnsMajor Organs Affected
  • Cardiovascular
  • Respiratory

27
78 of burn deaths are related to Toxins
28
  • Renal
  • GI
  • Immune system

29
Clinical Application - BurnsWound Care
  • Goals as we clean and debride
  • Minimize further destruction of viable skin
  • Patient comfort
  • Prevent Infection

30
Clinical Application - BurnsSkin Grafts
  • Autograft (Patient own)
  • Homograft or Allograft (Cadaver skin)
  • Heterography or xenograft (Pigskin)
  • Synthetic coverings

31
Clinical Application - BurnsSkin Grafts
  • Dale has split thickness skin grafts to his
    right arm. Donor site is left leg.
  • Nursing management of donor site and graft sites.

32
Clinical Application - BurnsWound Healing
  • Jobst pressure garments
  • Contractors

33
Pressure Garments
The continuous wearing of pressure garments
prevents the thickening, buckling, and nodular
formations seen in hypertrophic scars (Keloids).
A soft pliable elastic scar develops which allows
for normal joint movement. The external pressure
applied by the garments decreases inflammatory
response and the amount of blood in the scar,
reducing itching and prevents collagen from
synthesizing. Additionally pressure garments
provide protection against injury.
34
Clinical Application - Burns
  • Nutritional care -
  • Ulcers
  • Diabetics
  • ROM exercise
  • PAIN

35
Clinical Application - BurnsPsychological Care
  • Body image
  • Role
  • Relationships
  • Lifestyle
  • Occupation

36
Burns - Phases
  • Emergency - 24-48 Hours to a week
  • Acute - Weeks to months
  • Rehabilitation - Few to several months to years

37
Burns - Phases
  • AND THIS ONLY CONSIDERS THE PHYSICAL !!

38
Chemical Burns
  • Brush or Wash off and neutralize
  • Water
  • Respiratory up to 72 hours

39
Electrical Burns
  • Voltage, Time, Pathway
  • Entrance exit wounds
  • Severe metabolic acidosis
  • Myoglobinuria (Kidneys)

40
Electrical Burns
  • High Voltage John touched TV antenna to power
    line. Entrance hands, exit foot
  • Low voltage (house current 110 volts) Carl
    touched with BOTH hands. Entrance and exit
    wounds small

41
Setting a Safe Hot Water Temperature
  • Time and temperature relationship required to
    scald a healthy adult

42
Nursing Staff in Burn Units
  • Protective equipment
  • Temp - 85 - 88o F
  • Humidity gt 50
  • Isolation
  • Physical and Psychological challenging
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