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.
Thermal burn are caused by exposure to or contact
with flame, hot liquids, semi liquids or steam.
a). Flame: e.g. clothing ignite (catch fire)
with fire
b).Flash(Spark): Explosion of combustible fuels
c).Scald(injury/blister): e.g. Hot bath water
Hot grease or liquids from cooking ,Steam burns,
microwave food
Specific examples of thermal burn
are those sustained in residential
fires, explosives, scald injuries,
clothing ignition and ignition of
poorly stored flame able liquid
petrol
 Chemical burn are result of tissue
injury and destruction from
necrotizing substance
 Chemical burns are caused by tissue
contact with strong acids, alkalies or
organic compounds
 Chemical injuries to eyes and
inhalation of chemical fumes are
particularly serious
 Cont..
• Chemical burns are mostly caused by
acids , however alkali burns also occur
• Alkali are more dangerous than acids
because alkali substance are
neutralized by tissue fluids Alkali
adhere (stick) to tissues, causing
protein hydrolic and liquefaction thus
damage continues until alkali
neutralized
 Cont..
• Chemicals can produce respiratory and
systemic symptoms as well as skin or
eyes injuries
• For example when chlorine is inhaled
toxic gas produce respiratory distress.
• By products of burning substances e.g.
carbon are toxic to the sensitive
respiratory mucosa. Tissue destruction
may continue for up to 72 hours after
chemical injury
• Electrical injuries result from coagulation necrosis
that is caused by intense heat generated by the
electrical energy as it passes through the body.
• These injuries can result from contact with
exposure or faulty electrical wiring or high voltage
power lines.
• It can also result from direct damage to nerves and
vessels causing tissues anoxia (absence of oxygen)
and death
• Electrical contact with voltage greater than 40 is
potentially dangerous
• Radiation burn are caused by exposure to
the radioactive service
• These types of injuries have been associated
with nuclear accidents, the use of ionizing
radiation in industry.
• A sun burn solar radiation from prolonged
exposure to ultraviolet rays is also
considered to be a type of radiation burn.
The treatment of burn is related to the
severity of burn injury.
The severity of burn injury is determined
by:
Burn depth
Burn size
Burn location
Age of burn victim
General health of burn victim
Mechanism of injury
Burn injuries are classified as a
partial or full thickness
A). Partial Thickness
Partial thickness burn injuries are
classified as first and second
degree burns or superficial and
deep burn.
 Cont..
Causes of Superficial (1st deg) Burn
i.Sunburn
ii.Quick heat flash
In superficial burn pain sensation is
intact
Sign and Symptoms
a). Mild swelling
b). Erythaemia
c). Blenching on pressure
Causes of Deep Burn (2 deg) Burn
nd

The causes of deep burns / 2nd degree are

a). Flame
b). Flash
c). Scald
d). Contact burns
In deep burn the epidermis and dermis
involved
 Sign and Symptoms of deep burn
1. Fluid filled vesicles that are red shinny. if,
vesicles are ruptured
2. Severe pain caused by nerve injury
3. Mild to moderate edema
Superficial burns heal in less than 21 days and
deep burns require more than 21 days
Healing rates vary with burn depth and
presence of infection
 B). Full Thickness

Full thickness burn injuries are

classified as THIRD and Fourth
Degree burn
Causes of burn
Flame
Scald
Chemical
Electric current
 Cont…
Here all skin elements and nerve endings
are destroyed
Clinical appearance will be:
Dry
Waxy
White
Leathery (Rubbery)
Hard skin
 Cont…
1. Visible thromboses vessel
2. Insensitivity to pain and pressure
because of nerve destruction
3. There will be possible involvement of
muscles, tendons and bones
4. 3rd degree require auto grafting and
4th degree require auto grafting and
amputation of extremity
 Burn Size Extent
The size of a burn (percentage of injured skin,
excluding first degree burn) is determined by
following techniques
The Rule of Nine (9)
The rule of nine was introduced in the late 1940 as
a quick assessment tool for estimating burn size.
The basis of this rule is that the body divided into
anatomic sections, each of which represents 9%
or a multiple of 9% of the TBSA.
Head and Neck 9%
Arms 9%
Anterior trunk 18%
Posterior trunk 18%
Legs 18%
Perineum 1%
100%
• The location of burn wound has a direct
relationship to the severity of the burn injury.
Burn of the head, face, neck and
circumferential burns of the chest are
frequently associated with pulmonary
complications it may inhibit respiratory
functions by virtue of mechanical obstruction
secondary to edema.
• These injuries may also indicate the possibility
of inhalation injury or respiratory mucosal
damage
Burned face
 Cont…
• Burns of hands, feet, joints and eyes are of concern
because they make them self –care impossible.
• Hands and feet are difficult to manage medically
because of superficial vascular and nerve supply
system
• Burn involving the perinea area are prone to
infection due to auto contamination by urine
• The burn of the buttock and genital are susceptible
to infection and may be source of emotional conflict
because of the pain involved possible disfigurement.
The client’s age affects the severity and outcome of
the burn. Mortality rate are higher for children
younger than 4 years and for client older than 65
years
Because of an immature immune system and
generally poor host defense mechanism an infant
is less able to cope with burn injuries
The older adult heals more slowly and has more
difficulty with rehabilitation than a child or
younger adult.
Any patient with pre-existing cardiovascular,
pulmonary or renal disease has poorer prognosis for
recovery because of the tremendous demands placed
on the body by a burn injury
The patient with diabetes mellitus or peripheral
vascular disease is at high risk for gangrene and
poor healing , especially with foot and leg burns.
Patients who concurrently sustained fractures, head
injuries or other trauma has poorer prognosis for
recovery from the burn injury
Mechanism of burn injury is an important factor
used to determine severity.
As stated earlier, in electrical injuries heat is
generated as the electricity travels through the
body resulting internal tissue damage. Here, the
voltage, type of current, AC or DC, contact site and
the duration of contact are important consideration
because they affect morbidity.
AC is worst than DC because it is associated with
cardiopulmonary arrest, ventricular fibrillation
and vertebral compression fractures
Nursing care of minor wounds include:

1.Wound assessment and initial care of

wound
2.Tetanus immunization
3.Pain management
4.Health education
Burn management can be classified in three
phases
1.Emergent phase (Resuscitation)
2.The acute phase
3.The rehabilitative phase
The emergent phase begins at the time of
injury, with the pre hospital care and
concludes when capillary integrity is
restored, typically at 48 to 72 hours
following injury.
The primary goals during the emergent
phase of recovery are directed towards
sustaining life through prevention of
hypovolemia burn.
The intermittent /acute phase begins 48-72 hours after the burn
injury
In this phase continues attention is directed towards continues
assessment and maintenance of respiratory and circulatory status,
fluid and electrolyte balance and GI function, infection
prevention, burn wound care, pain management , nutritional
support are priorities in this stage of burn.
Cautious administration of fluid and electrolyte continues during
this phase of burn care b/c of shift in the fluid from interstitial to
intravascular compartment, loss of fluid from large burn wound
Blood component are administered as needed
Central venous, peripheral arterial, or pulmonary artery thermo
dilution catheter may be required for monitoring venous and
arterial pressure, pulmonary artery pressure and cardiac output.
However, invasive lines are avoided unless essential because they
provide an additional port for infection in an already greatly
compromised patient.
Infection progressing to septic shock is the major cause of death
in patient who has survived the first few days after the a major
burn
The infection that begins within the burn site may spread to the
blood stream
1. The rehabilitation phase begins immediately after the
burn has occurred-often extend years after injury
2. Patient increasingly focus on alternations in self image
& life style that may occur
3. Wound healing, psychological support and restoring
maximum functional activity remain priorities
4. Reconstructive surgery to improve body appearance
and functions may be needed
5. Family members also need support and guidance in
assisting the patient to return to optimal health
Impaired gas exchange related to carbon mono oxide poisoning,
smoke inhalation and upper airway obstruction secondary to
Burn
Ineffective airway clearance related to edema and effect of
smoke inhalation
Fluid volume deficit related to increase capillary permeability &
evaporative losses from the burn wound
Hypothermia related to loss of skin microcirculation & open
wound
Pain related to tissue and nerve injury
Anxiety related to fear and emotional impact of burn injury