MANAGEMENT OF BURN

 BURN
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity,
chemicals, friction, or radiation.

 TYPES:
• Electrical burns- it is caused from shocks, short circuits
• Thermal burns- it is caused from Stove, Direct flames, Domestic accidents
• Chemical burns- it is caused form acids or alkalis
• Contact burns- it is caused from heated metals or liquids at extreme temperatures,
prolonged immersion in hot water etc.

 ASSESSMENT OF BURN WOUND:

1. Percentage of body surface: the size of a burn is usually expressed as a percentage
of total body surface area, which is most accurately estimated by using age related
charts.
2. Depth of injury: a thermal injury is a three dimensional wound, and is assessed in
relation to depth of injury.
 First degree burn: it is frequently a latent period followed by erythema. Tissue
damage is minimal, protective functions remain intact and systemic effects are
rare.
 Second degree burn: or partial thickness. Burns are deeper and involve not
only the epithelium but also a part of corium. Superficial partial thickness
burns are painful whereas deep, dermal burns are often anesthetic for first 1-2
days after injury.
 Third degree or full thickness: all layers of skin are destroyed, may involve
underlying tissues as well and are usually combined with extensive partial
thickness damage. Systemic effects can be life threatening and involve every
organ system in the body.
3. Other factors: burns involving the head, face, hands, feet, genitalia etc are
considered serious. Children less than 2 years of age have a significantly higher
mortality rate than older children with burns of similar magnitude.

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 MANAGEMENT:
Immediate treatment: the aims of immediate treatment of thermal injury are stopping the
burning process, covering the burn, transporting the child to medical aid, and providing
reassurance.
1. First aid:
-Cover the patient with a blanket, coat, or carpet
- Remove patient from smoke
- Ensure that patient’s airway is patent.
- Remove jewelry if any
- If it happen by chemicals brush it off reaming
- Cover burn area with a clean dry sheeting
- do not apply cold for large injury
- Administer analgesics
2. Fluid management:
Parkland formula:
Parkland formula is a method of calculating the 24 hours fluid to be administered
Parkland formula is an appropriate starting guideline for fluid resuscitation-4 mL lactated
Ringer/kg/% BSA burned-. Half of the fluid is given over the 1st 8 hr, calculated from the
time of onset of injury. The remaining ½ is given at an even rate over the next 16 hr.
If burn injury is below 10% of BSA, the dressing of the wound is done by using the
following :
 0.5% silver nitrate solution
 Silver sulfadiazine
 Silvadene cream
If burnt surface area is above 30%, Following measures are to be taken:
Cover the wound
Grafting
Sodium supplement
Protein and electrolyte supplement

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 NURSING MANAGEMENT OF PATIENT WITH BURN INJURY:
Immediate Care:
 Obtain baseline information-vital signs, weight, extent of injury, laboratory
studies(hematocrit, sodium, chloride, carbon dioxide)
 Prevent shock- help establish intravenous line, administer fluids as ordered, monitor
CVP and intravenous infusion closely.
 Prevent complications like respiratory distress, fluid overload, abdominal
distension(insert nasogastric tube and keep NPO), impaired circulation in extremities,
cardiac and renal failure.

Control Of Infections:
The infections can be controlled by the following measures:
 Covering of wound should be made by sterile material
 Isolate the child to prevent cross infections
 Use penicillin as prophylactic.
 Periodic replacement of central venous catheter.
 Strict aseptic dressings
 Topical anti microbial

Establishment Of Adequate Airway:

 Administer oxygen and blood gases including carbon monoxide is determined.
 An endotracheal tube is inserted if the child shows air hunger or appears critical
 Place the child under an oxygen hood with a high flow of oxygen and maximum
humidity to reduce reflex bronchospasm due to trauma to the bronchial mucosa.

Fluid Replacement Therapy:

 CRYSTALLOID IS USED rather than colloid solutions in resuscitation of burn
shock.
 It consists of isotonic saline solution, a near isotonic solution (such as RL) or even
hypertonic saline solution.
 After diuresis, in 48-72 hours, colloid solutions such as albumin or plasma are useful
in maintaining plasma volume.

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Wound Care:
 The cleansing, debriding and applying topical medication and dressings to the burn
wound is important.
 Administer light analgesia 30 minutes before a painful procedure.
 Explain new procedures to the child to make the child comfortable.
 All the areas must be clean before application of medications.
 Child must be reassured when the medications are applied.

Pain Management
 Adequate analgesics
 Psychological support
 Allow the primary care giver to be with the child
 Decrease the stress of child and primary care giver
 Oral morphine sulphate 0.3-0.6mg/kg every 4-6th hourly
 Benzodiazepines SOS

Nutrition For burn patient

Mortality related burn injury is related mainly due to malnutrition not the skin that burnt
 Protein supplement
 Albumin supplement
 High caloric diet-it will be as much as 2-3 times their usual requirements for size and
age.
 High doses of vitamins B, C and iron.
 Nourishing snacks should be provided in between the meals.
 Meals should not be planned immediately after a dressing change.

Rehabilitation
 Ensure maximum cosmetic effect of treatment
 Physical and occupational rehabilitation
 Assist in ADL
 Special garments

Complications
 Pain
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  Wound infections
 Generalized sepsis
 Bacterial pneumonia
 Dry skins
 Itching
 Amputations
 Osteoporosis
 Sleep disorders
 Depressions
 Phobia
 Renal failure
 C.V disorders

Prevention Of Burn Injuries

 Install and use smoke detectors
 Control hot water to be reached to children
 Keep cloths away from heat
 Avoid smoking in child’s presence
 Protest child abuse
 Do not leave child alone
 Do not neglect child
 Keep chemicals out of reach to child
 Use safe electrical devices

THANK YOU