BURNS

Injuries that result from direct contact or exposure to any thermal, chemical, electrical or radiation source are termed as BURNS

Burn injuries occur when energy from a heat source is transferred to the tissues of the body.

Definition

_Superficial

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_{Superficial partial-thickness}

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_{Deep partial-thickness}

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_{Full-thickness}

TYPES (CAUSES) OF BURN INJURY

• Thermal
• Open flame, steam, hot liquids
• Chemical
• Acids, strong alkalis, organic compounds
• Electrical
• Direct or alternating current, lightning
• Radiation
• Radioactive agents

SUPERFICIAL BURN/1^ST DEGREE BURN

• _{Very painful, dry, red burns which blanch with pressure.}
• _{They usually take 3 to 7 days to heal without scarring.}
• _{Also known as first-degree burns.}
• _{The most common type of first-degree burn is sunburn.}
• _{First-degree burns are limited to the epidermis, or upper level of skin.}

SUPERFICIAL PARTIAL THICKNESS/2^ND DEGREE BURN

• _{Second-degree burns}
• _{Very painful More}
• _{Blister and are moist, red, weeping burns}
• _{which blanch with pressure.}
• _{heal in 7 to 21 days.}
• _{Scarring is usually confined to changes in skin pigment.}

DEEP PARTIAL THICKNESS/3^RD DEGREE BURN

• Similar to 2^nd degree
• Skin red to white
• Blisters
• Weeping surface
• Edema
• All epidermis and much of dermis damaged
• Painful
• Heals without grafting

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FULL THICKNESS/4^TH DEGREE BURN

• Similar to 3^rd degree
• Charred appearance (black, brown, leathery)
• Waxy, white
• Edema
• All layers of skin destroyed
• Nerves, muscle tissue, and bone may be destroyed
• Grafting preferred

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1. Treatment should begin immediately to cool the area of the burn. This will help alleviate pain.
2. For deep partial-thickness burns or full- thickness burns, begin immediate plans to transport the victim to competent medical care. For any burn involving the face, hands, feet, or completely around an extremity, or deep burns; immediate medical care should be sought. Not all burns require immediate physician care but should be evaluated within 3-5 days.
3. Remove any hot or burned clothing.

4. Use cool (54 degree F.) saline solution to cool the area for 15-30 minutes. Avoid ice or freezing the injured tissue. Be certain to maintain the victim’s body temperature while treating the burn.

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5. Wash the area thoroughly with plain soap and water. Dry the area with a clean towel. Ruptured blisters should be removed, but the management of clean, intact blisters is controversial. You should not attempt to manage blisters but should seek competent medical help.

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6. If immediate medical care is unavailable or unnecessary, antibiotic ointment may be applied after thorough cleaning and before the clean gauze dressing is applied.

SPECIAL CONSIDERATION

• Scalding-typically result from hot water, grease, oil or tar. Immersion scalds tend to be worse than spills, because the contact with the hot solution is longer. They tend to be deep and severe and should be evaluated by a physician. Cooking oil or tar (especially from the “mother pot”) tends to be full- thickness requiring prolonged medical care.
• Remove the person from the heat source.
• Remove any wet clothing which is retaining heat.
• With tar burns, after cooling, the tar should be removed by repeated applications of petroleum ointment and dressing every 2 hours

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Looks and tastes great, right? You should see what a hot liquid will do to a child’s skin when the two come into contact.

Be sure to keep hot liquids out of reach of small children.

Flame

a. Remove the person from the source of the heat.

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b. If clothes are burning, make the person lie down to keep smoke away from their face.

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c. Use water, blanket or roll the person on the ground to smother the flames.

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d. Once the burning has stopped, remove the clothing.

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e. Manage the persons airway, as anyone with a flame burn should be considered to have an inhalation injury.

Electrical burns: are thermal injuries resulting from high intensity heat. The skin injury area may appear small, but the underlying tissue damage may be extensive. Additionally, there may be brain or heart damage or musculoskeletal injuries associated with the electrical injuries.

a. Safely remove the person from the source of the electricity. Do not become a victim.

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b. Check their Airway, Breathing and Circulation and if necessary begin CPR using an AED (Automatic External Defibrillator) if available and EMS is not present. If the victim is breathing, place them on their side to prevent airway obstruction.

c. Due to the possibility of vertebrae injury secondary to intense muscle contraction, you should use spinal injury precautions during resuscitation.

d. Elevate legs to 45 degrees if possible.

Chemical burns- Most often caused by strong acids or alkalis. Unlike thermal burns, they can cause progressive injury until the agent is inactivated.

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a. Flush the injured area with a copious amount of water while at the scene of the incident. Don’t delay or waste time looking for or using a neutralizing agent. These may in fact worsen the injury by producing heat or causing direct injury themselves.

EMERGENCY MANAGEMENT OF ELECTRICAL BURN

A care giver should:

1. Remove patient from environment
2. Establish and maintain airway
3. Administer fluid
4. Monitor vital signs including level of consciousness and oxygen saturation
5. Remove clothing and jewelry
6. Determine depth, extent and severity of burn
7. Cover large burns with dry and sterile dressing

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NURSING OF BURN PATIENT IN HOSPITAL

1. Reassessment of airway, breathing and circulation and associated trauma
2. Initiation of fluid resuscitation/replacement
3. Placement of indwelling urinary catheter
4. Placement of nasogastric tube
5. Monitor vital signs and baseline lab studies
6. Pain management
7. Tetanus immunization
8. Data collection

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NURSING OF BURN PATIENT IN HOSPITAL

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9. Wound care

10. Psychological support

11. Infection control

12. Nutritional support

13. Physical therapy

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COMPLICATIONS.

• Complications that threaten the life of the patient directly:
• Loss of fluids
• It has already been said that a severe problem facing the patient is the loss of fluids from the burned area. The more extensive the burn, the larger the quantity of fluids lost.

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CONT…

Possible infection

• Since the continuity of the skin in the burned area has been destroyed, the burned area is more liable to contamination from airborne bacteria. This infection can easily turn into septicaemia.

CONT..

• Shock
• The immediate danger after a burn injury is shock as a result of the loss of body fluids or of septicaemia (septic shock). The acute pain due to the burn is one of the causes of shock.
• Complications that do not threaten the life of the patient directly
• Changes in the patients appearance
• The wrinkles and scars that form as the burn heals generate various aesthetic problems.
• Permanent disabilities

CONT…

• When the wrinkles and scars affect mobility and/or limit the patients movements, the burn is responsible for functional problems or disabilities.

REFERENCES

• www.healthseek.com
• http://pediatrics.about.com/gi/o.htm?zi=1/XJ/Ya&zTi=1&sdn=pediatrics&cdn=health&tm=285&f=20&tt=14&bt=1&bts=1&zu=http%3A//www.keepkidshealthy.com/welcome/firstaid/burns.html

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