Burn Tutorial Notes

Burn To manage burn Percentage of total burned area and depth Function: Protect against infection; produce Vitamin D; act as excretory organ; regulate temperature Prevent loss of body fluid; help in individual identity Layers: Epidermis, dermis, subcutaneous, muscle Definition of Burn Tissue damage results from overexposure to sun, radiation, chemicals, thermal Types of Burn Thermal: Contact with flame, hot liquid, or steam Chemical: Strong acid or alkaline – damage depends on concentration and volume Electrical: Electrical energy – depends on duration and voltage Radiation: Exposure to radioactive source – high energy Classification of Burn Based on depth, extent of body surface area Depth of Burn Superficial (First degree): Skin Layer: Epidermis only Symptoms: Redness, swelling Cause: Sunburn Healing: 3-6 days, no scarring Partial thickness (Second degree): Skin Layer: Epidermis and part of dermis Symptoms: Blisters, severe pain Cause: Hot liquid, flash burn Healing: 2-3 weeks, may have scarring Full thickness (Third degree): Skin Layer: Epidermis, dermis, and underlying tissues Symptoms: Dry, leathery skin, no pain (nerves destroyed) Cause: Prolonged contact with flame, hot objects Healing: Requires skin grafts, severe scarring Extent of Burn To estimate percentage of total burned area Superficial burns not included in calculation Lund and Browder Chart To estimate burn surface area; most accurate; hand represents 1% Head and neck: 9% Anterior trunk: 18% Posterior trunk: 18% Arm: 9% each Leg: 18% each Perineum: 1% Minor Burn Injury Criteria: Partial thickness <15% BSA (body surface area) in adults <10% in children and elderly Full thickness <2% BSA Major Burn Injury Criteria: Partial thickness >25% BSA in adults 20% in children and elderly Full thickness >10% BSA Burns to face, eyes, ears, hands, feet, or perineum Inhalation injury Electrical burn Burn injury with fracture or trauma All burns in special areas Burns in children <5 years or elderly >60 years Pathophysiology of Burn Local response: Burn doesn't exceed 25% total BSA – local response Systemic: >25% BSA – systemic response Burn leads to loss of protective barrier Burn lacks temperature, destruction causes blood vessel and tissue damage Inflammation, swelling After Severe Burn, Stages Occur Hypovolemic Stage Fluid Shifting: From intravascular to interstitial space Immediately after burn until 72 hours Release vasoactive substances (Catecholamines, histamine, serotonin) Loss of plasma fluid Direct heat injury to red blood cells Direct injury to cell membrane Sodium enters and potassium exits Hyperkalemia, hyponatremia Hypovolemia, metabolic acidosis Hemodynamic Instability: Loss of intravascular fluid Loss of cardiac output Decreased heart rate Decreased blood pressure Hemoconcentration Increased leukocyte count Decreased plasma protein level Hypoproteinemia Diuretic Stage Fluid shift back from interstitial to intravascular Begins about 48-72 hours after burn Vasodilation → Renal blood flow increases Cardiac output returns to normal Dehydration may occur Increased urine output Hemodilution, electrolyte imbalance, metabolic acidosis Hypokalemia, metabolic acidosis Hemodynamic Stability: Loss of sodium bicarbonate in the urine Fluid retention Edema to minimalized Negative nitrogen balance Protein loss Pulmonary injury Indicators of Pulmonary Damage History: Indicate burn of face or neck Singed nasal hair or hoarseness, charred face, dry cough, sooty sputum Bloody sputum and erythema To Diagnose: ABG, F&E, PaO2, pulmonary function test Management of Patients with Burn Injury Emergent or Immediate Resuscitation: Start at the beginning of fluid resuscitation Acute Phase: From diuresis to near completion of wound closure Rehabilitation: From wound healing to the return to individual optimal level Phases of Management Patient 1 Amount of Fluid to be given during first 24 hours Kind of Fluids: Ringer’s lactate or normal saline solution Renal Output: 0.5-1 ml/kg/hr Total Burns Area