BURNS

Tunechi
DEFINITION
 A Burn is a wound caused by dry heat, which
coagulates the protein in the skin causing
coagulation necrosis.
 Scalds are caused by moist heat

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CAUSES OF BURNS

 Dry heat e.g. flame, fire, hot air

 Contact with a hot surface
 Friction
 Electricity
 Extreme heat (sunburn), extreme cold
(frostbite)
 Radium, X-rays, ultraviolet light

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CAUSES OF SCALDS
 Moist heat e.g. hot liquids – tea, porridge
etc.
 Steam
 Chemicals – corrosive acids / alkalis

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EFFECTS OF BURNS
 The skin (epidermis) and capillaries are
damaged, causing body fluids, especially
plasma, to leak through, either into blisters
in superficial burns or loss to the surface in
deep burns, within the first 48 hours.
 If the area burnt is extensive, more fluid is
lost and the casualty goes into shock.
 If fluid goes into the tissues, it causes
oedema.

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SIGNS AND SYMPTOMS OF
BURNS
 Pain
 Subnormal temperature - > feeling cold
 Bradycardia
 Low blood pressure (hypotension)
 Dyspnoea
 NB: The volume of fluid loss and the
extent of the red cell destruction is related
to the percentage of the body surface
burned and not to the depth of the burn.
10 – 15 % of burns may be fatal.

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PRIORITY OF TREATMENT
WITHIN 48 HOURS
 Treat shock in extensive burns to preserve
life – by maintaining the blood volume
through replacing the lost fluids with –
plasma expanders and blood intravenously if
extensive and oral fluids liberally as soon as
possible if burns not extensive
 Relief of pain by administration of analgesics
e.g. IV morphine 5 mg hourly or as prescribed
 To prevent infection - by use of strict
aseptic technique, prophylactic antibiotics
and tetanus toxoid 0.5mls stat
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SPECIAL OBSERVATIONS
 Urinary output hourly through an indwelling
catheter
 Respirations for anxiety and onset of
respiratory infections
 Extremities if cyanosed or cold indicating
dropping circulating volume
 Extreme thirst and restlessness – indicating
changes in patient`s mental status

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HEALING
 Depth of damage determines either
spontaneous healing or the type of surgical
technique necessary.

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GUIDELINES AND FORMULAS FOR
FLUID REPLACEMENT IN BURNS
 Consensus Formula
 Lactated Ringer`s (Hartmann`s ) solution or
other balanced saline solution
 2 – 4 ml x kg body wt x % Total Body Surface
Area (TBSA) burned
 Half to be given in first 8 hours
 Remaining half to be given over next 16
hours

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CONT…
 Evans Formula
 Colloids: 1 ml ×kg × % TBSA burned
 Electrolytes (saline): 1 ml × kg × / % TBSA burned
 Glucose 5 %: 2000 ml insensible loss
 Day One : Half to be given in first 8 hours
 Remaining half over the next 16 hours
 Day Two : Half of the previous day`s colloids and
electrolytes ; All of insensible loss fluid
replacement; Maximum of 10,000 ml over 24 hours
 2nd and 3rd (partial and full thickness) burns
exceeding 50 % TBSA are calculated on the basis of
50% TBSA
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CONT…
 Brook Army Formula
 Colloids : 0.5 ml / kg / % TBSA burned
 Electrolytes (Lactated Ringer`s solution) : 1.5
ml / kg / % TBSA burned
 Glucose 5 % : 2000 ml for insensible loss
 Day One : Half to be given in first 8 hours;
Remaining half over the next 16 hours
 Day Two : Half of colloids; half of electrolytes; all
of insensible fluid replacement
 2nd and 3rd (partial and full thickness) burns
exceeding 50 % TBSA are calculated on the basis
of 50 % TBSA
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CONT…
 Parkland / Baxter Formula
 Lactated Ringer`s (Hartmann`s) solution : 4
ml / kg / % TBSA burned
 Day One : Half to be given in first 8 hours;
Remaining half over next 16 hours
 Day Two : Varies with prescription – colloid is
added

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 Hypertonic Saline
 Concentrated solutions of sodium chloride
(NaCL) and Lactate may be given at a rate
to maintain desired urinary output
 Goal: To increase serum sodium and
osmolarity to reduce oedema and prevent
pulmonary complications
 Serum sodium levels must be monitored
closely

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CLASSIFICATION OF BURNS
 Depth of the injury
 Extent of body surface area
 A) Depth of injury
 First Degree (Superficial Partial thickness
Burn)
 This involves the epidermis with simple
erythema, blistering, oedema and pain
 Fluid loss is slight if less than 15% of body
surface involved
 Generally results in spontaneous healing

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CLASSIFICATION CONT…
 Second Degree (Deep partial thickness
burn)
 Involves destruction of the epidermis and the
upper layer of the dermis
 The wound is painful, appears red and
exudes fluid.
 Hair follicles remains intact
 Takes longer to heal and may cause
hypertrophic scars

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CLASSIFICATION CONT…
 Third Degree (Full Thickness burn)
 Total destruction of the dermis and epidermis and
in some cases destruction of the underlying tissues
 Wound color ranges from white to red, brown or
black.
 The burned areas is painless because nerve fibers
are destroyed
 Hair follicles and sweat glands are destroyed
 Absence of pain
 Fluid loss is severe especially if more than 2% of
body surface is involved
 No healing takes place
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CLASSIFICATION CONT…
 B) Extent of Body surface area
 Methods used

I. Rule of Nines
II. Lund and Browder
III. Palm method

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CLASSIFICATION CONT…
I. The rule of nine
 The system assigns percentages in
multiples of nine to major body surfaces

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CLASSIFICATION CONT…
ii. Lund and Browder Method
 The percentages of surface area of various
anatomical parts, especially the head and
legs, changes with growth.
iii. Palm Method
 Used for patients with scattered burns.
 The size of the patients palm is
approximately 1%

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CLASSIFICATION OF 2ND AND 3RD
DEGREE BURNS
 Minor burns: No involvement of hands, face
or genitalia; total burn area does not exceed
15 %; and 3rd degree burn does not exceed 2 %
of body area
 Major Burns: Involvement of 15 % to 30 % of
body surface area, but 3rd degree burns do not
exceed 10 % of body area
 Critical Burns: Involvement exceeds 30 % of
body surface; if client has pre-existing chronic
health problem, is under 18 months or over 50
years of age or has additional injuries

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MANAGEMENT
 4 Pillars of Treatment
 Intravenous therapy
 Nutrition – Naso-gastric (NGT) feeding for the
first 24 – 48 hours until bowel sounds return
 Local wound care
 Antibiotics
 Painkillers
 Closure of the open wound by skin grafting

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MANAGEMENT
 Local Care
 Aim: To prevent infection
 Methods
 Closed method
 Surgery

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MANAGEMENT CONT…
 Closed Method
 Clean / scrub the wound thoroughly with normal
saline and dry carefully
 Spread antibiotic / antiseptic cream on the
wound as prescribed e.g. silver sulphadiazine
 Apply a nonstick dressing e.g. paraffin or
petroleum jelly gauze “Tulle gras”
 Cover the burn with absorbent gauze and
bandage
 Dressings can be frequent but can also be
covered and left for several days if ordered

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SURGICAL TECHNIQUES
 Excision of the damaged tissue in full
thickness burns
 Application of skin graft (auto-graft) to assist
healing
 It may then be closed dressing or exposure
method.

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NURSING CARE
 Isolation
 Reverse barrier nursing to prevent infection
 Protect burn from bed clothes with a bed cradle
 Dressings using strict aseptic technique
 Analgesics e.g. IV morphine 5 mg hourly or as prescribed
 Prophylactic antibiotic cream e.g. silver sulphadiazine,
sulphamylon
 Observations – vital signs and special observations
 Hygiene especially of the genital area to keep free of
urine and faeces to prevent infection
 Prevention of deformity and contractures and preservation
of joint movement by :> ensuring no two surfaces come
together, -> active and passive exercises, -> physiotherapy

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NURSING CARE CONT…
 Diet
 IV fluids during shock
 NGT feeding for the first 24 – 48 hours until bowel
sounds return if face not involved
 Plenty of fluids orally if possible
 Input and output chart to monitor kidney function
 Then light, nutritious (high protein) diet
 Later – full diet high protein with supplements –
eggs, milk, concentrated high protein fluids; high
calorie with vitamin supplements, especially
Vitamin C

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CONT…
 Patient Morale
 Occupational therapy to prevent boredom
 Support, reassure and encourage patient in a
long tiring process in isolation and
disfigurement to restore confidence
 Refer for further management as necessary
e.g. for reconstructive plastic surgery.

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