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Shock, dehydration, sepsis
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If pt survives first 72 hours infection
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American Burn Association (ABA)
- Develops strategies, prevention, research |
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PRIMARY GOAL IS PREVENTION!
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Burn: alteration in skin integrity resulting in tissue loss/damage
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Thermal
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Chemical
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Electrical
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Radiation
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MOST COMMON
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Due to exposure to dry heat (flames) or moist heat (steam, hot liquids)
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Direct exposure to heat = cell destruction
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Direct skin contact w/ acidic or basic agents
- Treating acidic easier than basic (caustic) |
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May cause local tissue damage, system tox.
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Damage can continue until traces disappear
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Includes powders & gases
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Treat quick to flush pH & lessen damage
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Higher mortality than thermal burns
- Can generate a lot of damage, subdermal - high resistance off of tissues |
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Destructive process of electrical burns persists for weeks beyond the insult
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Has an "exit wound"
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Affects...
- Muscles & bones - Heart (dysrhythmias) - Rhabdo AKI, acute tubular necrosis |
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Caused by solar or radioactive agents
- UV burns, thermal radiation, ionizing radiation (x-rays) |
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Also may include friction burns r/t trauma
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Length of exposure
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Mechanism of injury
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Depth of burn
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Location on body
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TBSA %
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Age - children, older
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PMH - DM, CHF
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Protective barrier
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Assists w/ fluid & elect. balance
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Thermoregulation
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Excretion
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Sensory organ
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1st degree
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(Superficial wounds)
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2nd degree
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(Partial thickness)
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3rd degree
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(Full thickness)
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4th degree?
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(Bone?)
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All systems are affected
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Extent of dysfunction depends on the TBSA involved
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Early: hypofunction hyperfunction
- Occurs rapidly - Inc. permeability plasma leaks to interstitial spaces dec. CO r/t dec. fluid volume (dec. BP) hyperfunction (compensatory mechanisms) |
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Maximal edema occurs in 8-48 hours
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R/t systemic inflammation
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Concerns:
Shock: - Fluid & electrolyte imbalance - Temp. regulation - Pain control (IV) Infection: - Reverse isolation (no plants, fresh fruits/veggies, current immunizations) - Temp. regulation (room ~80oF) |
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Leading cause of mortality
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Leads to...
- Hypotension - Tissue hypoxia - Acute renal failure |
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It's critical to accurately estimate fluid losses in order to determine replacement!
- Replace using Parkland Formula |
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1. Stop the burning process
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2. Airway - ensure patent
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3. C-spine stabilization
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4. Breathing - give 100% O
2 or ventilate |
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5. Circulation - assess pulses or CPR
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1. Emergent/Resuscitative Phase
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2. Acute Phase
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3. Rehabilitative Phase
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24-48 hours
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Point of injury
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Fluid resuscitation
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Big risk of...
- Hypovolemic shock - Resp. problems - Compartment syndrome |
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48-72 hours/wound starts to heal
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Starts w/ diuresis - Ends w/ closure of burn wound
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Interventions:
- Reassess ABC's - Fluid resuscitation - Urine output (myoglobinuria) - Circulation (escharotomy) - Pain control - Nutritional support - Focus on wound care - Prevent infection |
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A
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Airway intubated prophylactically
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B
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Breathing & ventilation
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C
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Circulation
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D
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Deficits (neuro)
Deformities Disability |
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E
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Exposure
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May be years
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Begins w/ wound closure - Ends w/ pt at highest level of functioning
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Debridement
- Surgical, enzymatic - May be painful ALWAYS pre-medicate - Prepare for graft |
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Dressings
- - Biologic (skin, membrane) - Synthetic - Biosynthetic |
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Skin grafts
- Skin won't heal on its own (full thickness) - Concerns: circulation, mobilization/ROM, pressure on injury |
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Pressure garments
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Hydrotherapy (cleaning)
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Minor
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Solosite (gel)
Opsite (clear Tegaderm) |
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Superficial
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Allevyn
Acticoat (antimicrobial) Mepillex Silvadene/Bacitracin (part/full thickness) |
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Mid to Deep
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Acticoat
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Scar Management
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Cica Care (silicone gel sheeting)
Jobskin |
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Risk for infection
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Fluid volume deficit
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Alteration in...
- Skin integrity - Tissue perfusion - Resp. status |
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Imbalanced nutrition (weight loss r/t inc. metabolic rate)
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Impaired mobility
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Decreased self-esteem
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Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
