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Initial Care of Burns

Initial Care of Burns. Connie Handel RN University of Wisconsin Hospital and Clinics. Objectives. Discover who’s getting burned? Discuss Burn pathophysiology. Understand why some treatments are better than others. Review treatment options. Skin Structures.

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Initial Care of Burns

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  1. Initial Care of Burns Connie Handel RN University of Wisconsin Hospital and Clinics

  2. Objectives • Discover who’s getting burned? • Discuss Burn pathophysiology. • Understand why some treatments are better than others. • Review treatment options.

  3. Skin Structures • Epidermis – outermost layer of keratinized cells • Dermis – contains skin appendages, vascular supply and nerve endings • Subcutaneous Tissue

  4. Barrier to infection Protection from external injury Temperature control Control of body fluids Sensory organ Determines identity Functions of the Skin

  5. What is a burn? • Cutaneous injury caused by heat, electricity, chemicals, friction, or radiation.

  6. Burn Depth

  7. First Degree Burns • Epidermis affected only • Red or pink, dry, painful, blanches to touch • Epidermis is intact • Spontaneous healing within 7 days. Outer injured epithelial cells peel • Seldom clinically significant

  8. Superficial Partial Thickness • Entire epidermis & portion of dermis (Papillary dermis) • Homogenous pink • Painful • Blisters • Blanches • Hair usually intact • Does not scar, may pigment differently

  9. Sup 2nd degree

  10. Deep partial thickness • Reticular dermis • Mottled red and white • Not painful to pinprick or pressure • Does not blanch • Heals > 3 weeks • Usually scars • Need to excise and graft

  11. Deep Partial Thickness x

  12. Deep dermal

  13. Full Thickness: 3rd degree • May go into fat or deeper • Red, white, brown, black • Inelastic and leathery • painless or numb • Heals only from the periphery • Always excise and graft

  14. Full-thickness

  15. Etiology

  16. Types of burns

  17. Circumstances of injury

  18. Where do burns occur

  19. Admissions by age

  20. % of admissions vs. burn size

  21. Inhalation Injury Exposure to heat and toxic products of combustion • 50% of fire deaths are related to inhalation injuries • Asphyxia/Carbon Monoxide displacement of oxygen

  22. Inhalation injury diagnosis • Closed-space fire • Face burns

  23. Terminology • Inhalation injury “nonspecific” • Thermal injury • Upper airway • Heat and toxic fumes • Local chemical irritation • Throughout airway • Primarily toxic fumes • Systemic toxicity • CO

  24. Lacrimation Cough Hoarseness Dyspnea Disorientation Anxiety Wheezing Conjunctivitis Carbonaceous sputum Singed hairs Stridor Bronchorrhea Signs and symptoms

  25. Pathophysiology • The main factor responsible for mortality in thermally injured patients • Carbon monoxide the most common toxin • 200 times greater affinity • Competitive inhibition with cytochrome P-450

  26. Poison management = CO • 500 unintentional deaths each year • Persistent Neurologic Sequelae • May improve over time • Delayed Neurologic Sequelae • Relapse later

  27. Carbon Monoxide Poisoning • 10% COHb – asymptomatic, seen most often in smokers, truck drivers, traffic police • 20% COHb - headache, nausea, vomiting, loss of dexterity • 30% COHb - confusion & lethargy, possible ECG changes • 40-60% COHb - coma • 60% + - usually fatal

  28. Poison management = CO • Treatment • CO level means nothing to predict outcome • Length of hypoxia is the determining factor • Oxygen • HBO • No studies show benefit in treatment

  29. Reduction of CO

  30. Determine Burn Severity • % BSA involved • Depth of injury • Age • Associated/pre-existing disease or illness • Burns to face, hands, genitalia xx

  31. Difficulties with accurate initial assessment of burn size & depth • Soot, blisters, adherent clothing or debris obscure wound • Burns are dynamic…Progression is always a risk

  32. Burn Extent Total Body Surface Area (TBSA)? • Rule of nines • Lund and Browder chart • Patients palm = about 1% TBSA

  33. Extent of Burn :“Rule of Nines” • Adult anatomical areas = 9% BSA (or multiple) • Not accurate for infants or children due to larger BSA of head & smaller BSA legs. • Burn diagrams illustrate adult – child differences

  34. Lund & Browder Chart

  35. Extent of Burns Patient’s palmar surface (hand + fingers) = 1% TBSA

  36. Burn Depth Factors • Temperature • Duration of contact • Dermal thickness • Blood supply • Special Consideration: Very young and very old have thinner skin

  37. Burns begin at 44 degrees C • 6 hours for burns to occur at 111 degrees F (44 C) • 1 second of burns to occur at 140 degrees F (60 C)

  38. Time For Full Thickness Burns To Occur In Scalds • 5 seconds in water @ 140 F (60 C) • 30 seconds in water @ 130 F (55 C) • 5 minutes in water @ 120 F (49 C)

  39. Pain control

  40. Ice Pack-----DO NOT USE EVER • DOES NOT • Reverse temperature • Inhibit destruction • Prevent edema • DOES • Delay edema • Reduce pain

  41. Non-medication methods • Cover burns with plastic wrap • Wet dressings will stick and cause more pain • Other burn dressings are expensive and not necessary • Quik Clot is expensive and will not provide any patient benefit

  42. Medication • Medications • Opioids • Narcotics • Pain medications • IV Analgesia

  43. Resuscitation

  44. IV access • < 15% TBSA – oral resuscitation • 15 – 40% TBSA – one large bore IV • > 40% -- two large bore IV’s • IV’s should be in the upper extremities • Suture IV’s started through burns

  45. Field resuscitation • Start IV with LR, through burn OK • < 6 years = 125mL/hr • 6-13 years = 250mL/hr • >13 years = 500mL/hr

  46. Contact

  47. Contact Burn

  48. Scald Burn

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