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BURN A. Definition: Cell destruction of the layers of the skin and the resultant depletion of fluid and electrolytes. B. Types of burns: According to mechanism 1.Thermal burns 2.Chemical burns 3.Electrical burns 4.Radiation burns C. Types of burn: Burn is typically divided into three major categories- 1.First degree or superficial burn 2.Second degree or partial thickness burn 3. Third degree of full thickness burn in which structure beneath the skin is definitely affected .4/21/2012 golam/nurse/kibria 2
D. Methods to estimate extent of burn injury : (rules of nine) a. Head and neck-9% b. Anterior trunk-18% c. Posterior trunk-18% d. Arms(9%)-18% e. Legs(18%)-36% f. Perineium-1% E. Factors determination the severity of a burn: a) Depth of burn b) Size of burn(percentage of body surface area) c) Part of body burned d) Age e) Past medical history f) Cause of burn4/21/2012 golam/nurse/kibria 3
SIGNS AND SYMPTOMS: Signs symptoms of burn develop of depth of the burn as well as extent of the area- 1st degree burn: 1. Epidermises are affected 2. Skin becomes pink or red colour 3. It may form small thin blister 4. Usually heal itself within 3 to 7 days 2nd degree burn: 1. Part of the skin damaged or destroyed 2. Epidermis and dermis both are affected 3. Thicken walled blister appear all over the burned area 4. The underlying tissue is deep red in colour and is usually wet and shiny appearance. 5. Healing is requiring form 21 to 28days4/21/2012 golam/nurse/kibria 4
3rd degree burn: 1. Epidermis and dermis both are destroyed and underlying structure, like tissue, muscle ,bones may be involved. 2. The appearance of this burn may vary .The colour may be deep red, white, black or brown. 3. Usually this type of burn appears dry. It requires grafting procedure.4/21/2012 golam/nurse/kibria 5
EMERGENCY MANAGEMENT: 1. Remove constricting jewelery and clothing. 2. Cover burns with sterile on clean cloths. 3. In case of chemical burn, clothing which has been socked by the chemical agent must be removed immediately. 4. Assess for associated trauma. 5. Evaluate the degree and extent of the burn and treat life – threatening condition. 6. Ensure a patient airway and administer 100% oxygen as prescribed, if the burn occurred in an enclosed area. 7. Monitor for respiratory distress. 8. Initiate peripheral IV access to non-burned skin proximal to any extremity burn.4/21/2012 golam/nurse/kibria 6
9. Assess for hypovolemia and prepare to administer IV fluids to maintain fluid balance. 10. Monitor vital signs closely 11. Insert a foley’s catheter as prescribed, and maintain urine output at 30 to 50 ml per hour. 12. Maintain NPO status. 13. Insert a nasogastric (NG) tube as prescribed, to prevent paralytic ileus, to prevent vomiting, and to reduce the risk of aspiration. 14. Administer tetanus prophylaxis as prescribed. 15. Administer pain medication, as prescribed, by the IV route.4/21/2012 golam/nurse/kibria 7
16. Administer prophylactic antibiotic, as prescribed. 17. Administer wound care, as prescribed, which may include cleansing, debriding loose tissue, and removing any damaging agents, followed by the application of topical antimicrobial cream and a sterile dressing. 18. The goal is to prevent shock by maintaining adequate circulating blood volume and maintaining vital organ perfusion.4/21/2012 golam/nurse/kibria 8