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NOBLEZA, Chelsea Mae N.

BSN 3-G2 BURNS are injuries that result from direct contact with or exposure to any
thermal, chemical, electrical or radiation source.

CAUSES
1. Thermal Burns- caused by exposure or contact with flame, hot liquids, semiliquids, semisolids or hot objects. 2. Chemical Burns- caused by contact to strong acids, alkalis or organic compounds. 3. Electrical Burns- caused by the heat generated by the electrical energy as it passes through the body. People struck by lightning also sustain electrical injury 4. Radiation Burns- least common type of burns and are caused by exposure to a radioactive source. 5. Inhalation Injury- caused by exposure to carbon monoxide and smoke commonly occurs with flame injuries.

TYPES Characteristics of Burns According to Depth Depth of Burn and Causes
Superficial-Partial Thickness or FIRST DEGREE BURN  Sunburn  Low intensity flash Deep-Partial Thickness or SECOND DEGREE BURN  Scalds  Flash Flame Full- Thickness or THIRD DEGREE

Skin Involvemen t
Epidermis; possibly a portion of dermis

Symptoms
Tingling Hyperesthesia (supersensitivit y) Pain that is soothed by cooling Pain Hyperesthesia Sensitive to cold air

Wound Appearanc e
Reddened; blanches with pressure; dry Minimal or no edema; Possible blisters Blistered, mottled red base; broken epidermis; weeping surface Edema Dry; pale white,

Recuperativ e Course
Complete recovery within a week; no scarring Peeling

Epidermis, upper dermis, portion of deeper dermis Epidermis, entire

Pain free Shock

Recovery in 2 to 4 weeks Some scarring contractures Infection may convert it to full thickness Eschar sloughs

may involve connective tissue. The system assigns percentages in multiples of nine to major body surfaces. which recognizes that the percentage of TBSA of various anatomic parts. muscle. and bone Hematuria (blood in the urine) and possibly hemolysis (blood cell destruction) Possible entrance and exit wounds (electrical burn) leathery. . and sometimes subcutaneou s tissue.BURN  Flame  Prolonged exposure to hot liquids  Electric current  Chemical dermis. contractures Loss of digits or extremity possible RULE of NINE An estimation of the TBSA involved in a burn is simplified by using the rule of nines. or charred Broken skin with fat exposed Edema Grafting necessary Scarring and loss of contour and function. The rule of nines is a quick way to calculate the extent of burns. LUND and BROWDER METHOD A more precise method of estimating the extent of a burn is the Lund and Browder method.

In addition. Usually hyponatremia (sodium depletion) is present. and changes with growth. The initial evaluation is made on the patient’s arrival at the hospital and is revised on the second and third post-burn days because the demarcation usually is not clear until then. evaporative fluid loss through the burn wound may reach 3 to 5 L or more over a 24-hour period until the burn surfaces are covered. as water shifts from the interstitial to the vascular space. PHASES OF BURNS 1. Hyponatremia is also common during the first week of the acute phase. serum sodium levels vary in response to fluid resuscitation. During burn shock.especially the head and legs. one can obtain a reliable estimate of the TBSA burned. DURING BURN SHOCK     Circulating blood volume decreases dramatically. By dividing the body into very small areas and providing an estimate of the proportion of TBSA accounted for by such body parts. .

Despite this.uwhealth. including a decrease in platelets (thrombocytopenia) and prolonged clotting and prothrombin times.com/media/professional/figures/MMPE_21PHY_315_01 _eps. also occur with burn injury. An occlusive dressing is thin gauze that is impregnated with a topical antimicrobial agent or that is applied after topical antimicrobial application.org/files/uwhealth/images/img/img_levelone_winter08_2. Careful attention must be given to burns left exposed to ensure that they do not dry out and convert to a deeper burn. the areas under the breasts.jp g&imgrefurl .gif&imgrefurl http://www.  Some red blood cells may be destroyed and others damaged. at which time they are removed for examination of the graft. Functional body alignment positions are maintained by using splints or by careful positioning of the patient. Ideally. AFTER BURN SHOCK  Hyperkalemia (excessive potassium) results from massive cell destruction. Their purpose is to protect the graft. Occlusive dressings are most often used over areas with new skin grafts. Colloid is added. resulting in anemia. A light dressing is also applied over areas for which a splint has been designed to conform to the body contour for proper positioning. Circumferential dressings should be applied distally to proximally. precautions are taken to prevent two body surfaces from touching. the fingers and toes should be wrapped individually to promote adequate healing. TYPES OF DRESSING Light dressing used over joint areas to allow for motion (unless the particular area has a graft and motion is contraindicated). any point of flexion.  Abnormalities in coagulation. ear and scalp. When these dressings are applied. the hematocrit may be elevated due to plasma loss.  Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement.2. or between the genital folds. half to be given over next 16 hours Day 2: Varies. promoting an optimal condition for its adherence to the recipient site. Burns to the face may be left open to air once they have been cleaned and the topical agent has been applied. such as fingers or toes. FLUID RESUSCITATION: PARKLAND FORMULA Lactated Ringer’s solution: 4 mL × kg body weight × % TBSA burned Day 1: Half to be given in first 8hours. these dressings remain in place for 3 to 5 days. If the hand or foot is burned. References: http://www.merckmanuals.