BurnsBurns

Mª José Forner GrosMª José Forner GrosMaster Degree in Nursing ScienceMaster Degree in Nursing Science

2013/142013/14

BurnsBurns

definitiondefinition

classification - depthclassification - depth

- first degree/ superficial thickness- first degree/ superficial thickness

- second degree / partial thickness- second degree / partial thickness

. superficial. superficial

. deep. deep

- third degree / full thickness- third degree / full thickness

- fourth degree / complete burn- fourth degree / complete burn

classification – extend – TBSAclassification – extend – TBSA

treatmenttreatment

minor and severe burns (A & E)minor and severe burns (A & E)

DefinitionDefinition

burn: injury that causes destruction of tissue, the skin, from exposition of burn: injury that causes destruction of tissue, the skin, from exposition of thermal extremes (either hot or cold) , electricity, chemicals and/or thermal extremes (either hot or cold) , electricity, chemicals and/or radiationradiation

the primary cause is exposure to temperature extremesthe primary cause is exposure to temperature extremes - - heat injuries are more frequent than cold injuries - cold injuries almost exclusively result from frostbite

electrical and chemical burns: 5-10% of burn injuries (result of electrical and chemical burns: 5-10% of burn injuries (result of occupational accidents)occupational accidents)

1st degree

2nd degree

3rd degree

4th degree

Superficial thickness

Superficial partial thickness

Deep partial thickness

Full thickness

Complete burn

Burn Classification - Depth

Old terminology New terminology

www.telegraph.co.ukwww.telegraph.co.uk

www.trialx.comwww.trialx.com

. superficial thickness

. epidermis - only the top layer of the skin is damaged

. caused by: sun, chemicals, hot water

. symptoms:- slight swelling- peeling of the skin- itching sensation- no blisters- skin color: pink to red- dry- discomfort- treatment: outpatient basis- healing: 5 days*

* depending on your patient's clinical history

11stst degree burn degree burn

22ndnd degree burn degree burn

. superficial partial thickness / deep partial thickness

. both layers of the skin are damaged : epidermis & part of the dermis

symptoms SPT:

- skin color: red & shiny- pressing: turns to white- healing: 7 – 21 days*- future skin: darker or lighter

symptoms DPT:

- skin color: yellow to white- pressure discomfort- pressing NO white- healing: around 3 weeks*- future skin: scar, risk of contractures

wet ( blisters break & open) swelling edema pain (severe to extreme)

www.baprass.org.uk

second degree burns have a tendency to induce a more severe inflammatory tissue response : blisterssecond degree burns have a tendency to induce a more severe inflammatory tissue response : blisters

* depending on your * depending on your

patient's clinical historypatient's clinical history

- remove jewellery or tight clothing (before skin begins to swell) remove jewellery or tight clothing (before skin begins to swell) - stop the burning process – flush with cool running waterstop the burning process – flush with cool running water- put burn ointment or gel / topical antibiotic (Gram – coverage)put burn ointment or gel / topical antibiotic (Gram – coverage)- no butter, petroleum jelly, home remediesno butter, petroleum jelly, home remedies- dry sterile non-stick dressing ( loosely )dry sterile non-stick dressing ( loosely )- pain relief : acetaminophen or NSAIDspain relief : acetaminophen or NSAIDs- tetanus immunization updatetetanus immunization update- elevate burnt areaelevate burnt area- 24 hrs. follow-up (re-evaluation)24 hrs. follow-up (re-evaluation)

- Goal ---- minimizing further damageGoal ---- minimizing further damage

- if Body Surface Area (BSA) burnt 10 % if Body Surface Area (BSA) burnt 10 %

Out patient BasisOut patient Basis

First Aid (minor burns)First Aid (minor burns)

www.mapfre.com

33rdrd degree burn degree burn

www.medstudentlc.com

full thickness burn

epidermis & all dermis ---subcutaneous tissue

patient's clothes caught on fire

skin: - dry and leathery- waxy pearly white - visible blood vessels , bone- hair follicles, sweat and sebaceous glands are destroyed- eschar

no pain ????

scars – surgery – skin grafts

44thth degree burns degree burns

full thickness extending to muscle or bone - hypodermis

severe burn :high voltage electric injury- severe thermal burns

skin: charred, insensate, eschar formation

pain is due to adjacent areas, not in the injury

severe scarring

high risk of contractures

www.medstudentlc.com

First aid of major/severe burns (not superficial)First aid of major/severe burns (not superficial)

- no breathing secure airway ABC - RCP process- no breathing secure airway ABC - RCP process- cover the burn area- cover the burn area- prevent hypothermia- prevent hypothermia- remove any jewellery- remove any jewellery- elevate burnt areas - elevate burnt areas - call emergency services - call emergency services

remove burnt clothing that is stuckremove burnt clothing that is stuckimmerse large severe burns in cold water – risk of shockimmerse large severe burns in cold water – risk of shockapply ointmentsapply ointmentsiceicetight or adhesive dressingstight or adhesive dressingscotton for dressing - fibbers deposition increases risk of infection cotton for dressing - fibbers deposition increases risk of infection pop blister pop blister

no food no water - surgery?no food no water - surgery?

DO NOT:

Referral criteria to A&EReferral criteria to A&E

partial thickness 10% TBSApartial thickness 10% TBSA

partial thickness burn to:partial thickness burn to:face genitaliaface genitaliafeet perineumfeet perineumhands major jointshands major joints

circumferential burns of limb or chestcircumferential burns of limb or chest

electrical or chemical burnelectrical or chemical burn

patient with co-morbiditiespatient with co-morbidities

A & EBurn Care Goals

• secure airway ABC – respiratory care- intubation? O2?

• assess depth / extend - Total BSA burnt

• administration of fluids “Parkland Formula” - fighting shock

• sub secure risk of infection

• thermoregulation

• adequate pain control

• restore skin integrity – skin grafts

• physical / occupational therapy

• skin wound care (Nursing)

Rule of 9´s – TBSARule of 9´s – TBSA

Extend of burns

To calculate how much fluid we will need to restore

. for adults; different rule forkids

. add anterior and posteriorsides of the body separately; plus front and back if necessary

.do not include 1st degree burns when calculating

.can be revised after edemaresolves, when edema goes down

TBSA total body surface area

Fluids Therapy

Innovation: calculating fluid requeriments

www.jambinnovations.com

Medical AppMedical App

www.jambinnovations.com

“ “Thirty to forty years ago, many burn patients Thirty to forty years ago, many burn patients didn't live. Advances in treatment have created a didn't live. Advances in treatment have created a whole new patient population that not only lives, whole new patient population that not only lives, but has an improving quality of life “but has an improving quality of life “ Charles Durfor, PhDCharles Durfor, PhD

Mª José Forner GrosMª José Forner Gros2013/142013/14