BURNS

BURN
Is a form of traumatic injury caused by

thermal, electrical, chemical or radioactive

agents.

Are caused by transfer of energy from a heat

source to the body

Cell destruction of the layers of the skin and

the resultant depletion of fluids and

electrolytes.

TYPES OF BURNS
A. Thermal caused by exposure to flames,
B.
C.

D.

hot liquids, steam or hot objects

Chemical caused by tissue contact with
strong acids, alkalis or organic compounds
Electrical caused by heat generated by an
electrical energy as it passes through the
body; it results in internal tissue damage
Radiation caused by exposure to
ultraviolet, x-rays or a radioactive source

Signs and Symptoms

Blisters
Charred mouth, burned lips, burns on the neck, head or

face
Wheezing
Change in voice
Difficulty in breathing/ coughing
Singed nose hairs and eyebrows
Dark carbon-stained mucus
Edema
Pain
Peeling skin or red skin
Signs of shock
White or charred skin

DIAGNOSTIC TESTS
1. URINALYSIS
- myoglubinuria, hemoglobinuria
2. ABG
- hypoxia
3. FIBER-OPTIC BRONCHOSCOPY
- inhalation injury
4. CBC
- elevated WBC
5. BUN
- elevated
6. CREATININE
- elevated

BURN DEPTH
SUPERFICIAL
THICKNESS
(1st Burn)

PARTIAL
THICKNESS
(2nd Burn)

FULL
THICKNESS
(3rd Burn)

Epidermis

Epidermis and
dermis

Subcutaneous
and fascia

Erythema

Blister

Edema

Minimal pain

Most painful

Heals 3 to 7
days

Heals 2 to 4
weeks

DEEP FULLTHICKNESS
(4th Burn)
Muscles and
bone

No edema
With Eschar
Little or no pain Painless
Heals weeks to
months
Heals weeks to
months

SUPERFICIAL
THICKNESS
(1st Burn)

PARTIAL
THICKNESS
(2nd Burn)

FULL
THICKNESS
(3rd Burn)

Skin grafts not

required

Grafts may be Grafts required

used if healing
is prolonged

Ex.
- sunburn

Ex.
- scald

DEEP FULLTHICKNESS
(4th Burn)
Grafts required

Ex. Burn from a

Ex. Burn from a flame and
flame and
electric current
electric current

METHODS TO ESTIMATE EXTENT OF

BURN INJURY
I.

RULES OF NINES

- an estimation of the total body surface area

(BSA) burned by assigning percentages in
multiples of nine to major body surfaces
Adult:
- head and neck:
9%
- anterior trunk:
18%
- posterior trunk:
18%
- anterior arm:
9%
- posterior arm:
9%
- anterior legs:
18%
- posterior legs:
18%
- perineum:
1%

II.

LUND AND BROWDER METHOD

- a more precise method of estimating

the extent of the burn; takes into account
that the percentage of the surface area
represented by various anatomic parts
(head and legs) changes with growth.

III.

PALM METHOD

- used to estimate percentage of

scattered burns, using the size of the
patients palm (about 1% of body surface
area) to assess the extent of burn injury

FLUID AND ELECTROLYTE CHANGES

EMERGENT

ACUTE

> 24 48 hours
> Fluid shift:

> 2 5 days
> Fluid shift:

Vascular to Interstitial

Interstitial to Vascular

> blood volume

> Hemoconcentration
Hct.

> blood volume

> Hemodilution
Hct.

GFR oliguria
> O2 Metabolic
Acidosis
> Na, K

GFR - diuresis
> O2 Metabolic
Acidosis
> Na, K

arrhythmia

R
E
H
A
B
I
L
I
T
A
T
I
O
N

REHABILITATION
Tissue Repair
Prone to infection

- Prevent and control infection

a. Reverse Isolation
b. Prophylaxis Tetanus Toxoid
Maintain patent airway esp. burns on the neck, face,
chest laryngeal edema
Give pain medications Narcotics-Analgesics
a. Demerol
b. Morphine Sulfate
S/E : Respiratory Depression
Restore and maintain adequate fluid volume

 Monitor urine output

- 30 to 60 ml/hour
Maintain adequate nutrition
- 1st 24 hours NPO

Prone to Paralytic Ileus

Curlings Ulcer
* To prevent, give H2 Antagonist.
a. Ranitidine
b. Cimetidine
c. Famotidine
(+) Flatus High caloric, CHON, Vitamin

 Monitor hematocrit

- decreasing
Monitor CVP
- to determine if hypervolemic/hypovolemic
Hydrotherapy (Hubbard tank)
- tubbing, tanking or showering
> is the bathing of the burn patient in a tub of
water or with a water shower to facilitate
cleansing and debridement of the burned area
Advantage:
fast healing and easy dressing
Disadvantage:
evaporative fluid loss (chills)

> Debridement

MECHANICAL

ENZYMATIC

> Use of scissors

and forceps to lift
and trim away
loose eschar

> Application of
prepared proteolytic
and fibrinolytic
topical enzymes
that digest necrotic
tissue, which
facilitates eschar
removal

SURGICAL
> Excision of eschar and
coverage of wound
A. TANGENTIAL
- Shaving of thin layers
of eschar until viable
tissue

B. FASCIAL
- Used for deep burns
and removal of burn
tissue and underlying fat
down to the fascia

> Antibiotic :
SILVER SULFADIAZENE
Description:
- a white, crystalline, highly insoluble
compound in an opaque, odorless, water-miscible
cream
- exerts antimicrobial effect at the level of cell
membrane and cell wall against gram-negative
and gram-positive bacteria and yeast

> Assist for SKIN GRAFTING

* In full thickness burn:
immobilize the area and never touch to
prevent disruption of granulation tissue
1. Autografts
grafts done with tissue transplanted from the
patients own skin.
2. Allografts
involve the transplant of tissue from one
individual of the same species; these grafts are
also called Allogenic or Homografts.
3. Xenografts or Heterografts
- involve the transfer of tissue from another
species.

> Assist in Physical

Therapy
1. Individualized program for splinting, positioning
and activities of daily living.
2. Perform range of motion exercises.
3. Ambulate the client.

TRIAGE CRITERIA FOR DETERMINING WHEN IT

IS ADVISABLE TO TRANSFER PATIENT TO A
BURN CENTER
1. Burned area second degree and third degree
(age <10 or >50) : 10%
2. Burned area second degree and third degree
(age >10 or <50) : 20%
3. Burned area third degree : 5% at any age
4. Chemical burn
5. Electrical injury
6. Burn of face, hands, feet or perineum
7. Burn accompanied by airway or inhalation injury

POTENTIAL COMPLICATIONS
1. RESPIRATORY FAILURE
S/Sx : increasing dyspnea
stridor
changes in respiratory pattern
cerebral hypoxia
2. DISTRIBUTIVE SHOCK
S/Sx : urine output
cardiac output
blood pressure
increasing pulse
progressive edema

3.

ACUTE RENAL FAILURE

S/Sx : abnormal urine output
BUN
Creatinine level
4. COMPARTMENT SYNDROME
S/Sx : extremity pain
capillary refill
absence of sensation
loss of peripheral pulses
5. PARALYTIC ILEUS
S/Sx : absence of bowel sounds
6. CURLINGS ULCER