Burn Injuries and Management

Burn Injuries and Management

• Burns are wounds caused by exposure to excessive heat, chemicals, fire/steam, radiation, or electricity.

Types of Burns

• Thermal burns: caused by exposure to flame, hot object, or very cold object.
• Chemical burns: caused by exposure to acid, alkali, or organic substances.
• Electrical burns: result from the conversion of electrical energy into heat, extent of injury depends on the type of current, pathway of flow, local tissue resistance, and duration of contact.
• Radiation burns: result from radiant energy being transferred to the body, resulting in production of cellular toxins.

Burn Wound Assessment

• Classified according to depth of injury and extent of body surface area involved.
• Burn wounds differentiated depending on the level of dermis and subcutaneous tissue involved.

Superficial Burns (First-Degree)

• Epidermal tissue only affected.
• Erythema, blanching on pressure, mild swelling, no vesicles or blisters.
• Not serious unless large areas involved, e.g., sunburn.

Deep Burns (Second-Degree)

• Involves the epidermis and deep layer of the dermis.
• Fluid-filled vesicles, red, shiny, wet, and associated with severe pain.
• Hospitalization required if over 15-20% of body surface involved, e.g., tar burn, flame.

Full-Thickness Burns (Third/Fourth-Degree)

• Destruction of all skin layers.
• Requires immediate hospitalization.
• They are dry, waxy white, leathery or hard skin, and with no pain.
• Exposure to flames, electricity, or chemicals can cause 3rd-degree burns.

Calculation of Burned Body Surface Area

• Superficial burns are not involved in the calculation.
• Lund and Browder Chart is the most accurate because it adjusts for age.
• Rule of nines divides the body, its adequate for initial assessment for adult burns.

Vascular Changes Resulting from Burn Injuries

• Circulatory disruption occurs at the burn site immediately after a burn injury.
• Blood flow decreases or ceases due to occluded blood vessels.
• Damaged macrophages within the tissues release chemicals that cause constriction of vessels.
• Blood vessel thrombosis may occur, causing necrosis.

Fluid Shift

• Occurs after initial vasoconstriction, then dilation.
• Blood vessels dilate and leak fluid into the interstitial space, known as third spacing or capillary leak syndrome.
• Causes decreased blood volume and blood pressure.
• Occurs within the first 12 hours after the burn and can continue up to 36 hours.

Fluid and Electrolytes Imbalances

• Occur as a result of fluid shift and cell damage, leading to:
  • Hypovolemia
  • Metabolic acidosis
  • Hyperkalemia
  • Hyponatremia
  • Hemoconcentration (elevated blood osmolarity, hematocrit/hemoglobin) due to dehydration.

IV Fluid Therapy

• Infusion of IV fluids is needed to maintain sufficient blood volume for normal CO.
• Clients with burns involving 15% to 20% of the TBSA require IV fluid.
• Purpose is to prevent shock by maintaining adequate circulating blood fluid volume.

Common Fluids

• Protenate or 5% albumin in isotonic saline.
• LR (Lactate Ringer) without dextrose.
• Crystalloid (hypertonic saline) adjust to maintain urine output at 30 mL/hr.
• Crystalloid only (lactated ringers).

Dressing the Burn Wound

• After burn wounds are cleaned and debrided, topical antibiotics are reapplied to prevent infection.
• Standard wound dressings are multiple layers of gauze applied over the topical agents on the burn wound.

Diet

• Initially NPO.
• Begin oral fluids after bowel sounds return.
• High protein, high calorie diet.

Debridement

• Done with forceps and curved scissor or through hydrotherapy (application of water for treatment).
• Only loose eschar removed.

Skin Grafts

• Done during the acute phase.
• Used for full-thickness and deep partial-thickness wounds.

Post-Care of Skin Grafts

• To be determined.