Burn Injury M3
Burn Injury M3
Burn Injury M3
INJURY
NCMB312 LEC
DR. POTENCIANA A. MAROMA
LEARNING OBJECTIVES:
BP SHOCK
PATHOPHYSIOLOGY
Superficial-thickness wounds
• epidermis is the only part injured;
• desquamation occurs for 2-3 days after
the burn & heals in 3-5 days without a
scar or complications
• e.g., sunburn, short (flash) exposure
to a high intensity heat
Superficial burns on the trunk and right arm of a young child.
Typically, these are red burns that blanch with pressure.
DEPTH OF BURN
INJURY
Partial-thickness wound
• entire epidermis & varying depths of the
dermis
• 2 types:
•Superficial partial thickness
•Deep partial thickness
DEPTH OF BURN INJURY
Superficial partial-thickness wound
• There is involvement of the upper 3rd of the dermis leaving a good blood
supply; wounds are red, moist & blanch (whiten) when pressure is applied
• Blister formation (leakage of large amount of plasma from the injured
small vessels lifting off the destroyed epidermis)
• Intense pain due to exposed nerve endings especially when stimulated by
touch & temperature changes
• with standard care, heals in 10-21 days with no scar, but some minor
pigment changes may occur
Superficial partial-thickness burn on a man's right knee.
Blistering wounds that blanch with pressure are
characteristic of superficial partial-thickness burns. These
wounds are also typically moist and weeping.
DEPTH OF BURN INJURY
Full-thickness wound
• destruction of the entire epidermis & dermis, leaving no residual
epidermal cells to repopulate; wound may be waxy, white, deep red, yellow,
brown or black, hard, dry, leathery eschar (burn crust) [eschar is a dead
tissue; it must slough off or be removed from the burn wound before
healing can occur]
• avascular, no sensation, healing can take from weeks to months
depending on the establishment of a good blood supply to the injured areas
Full-thickness burn on a woman's left flank. Burn areas of this type
are characteristically insensate and waxy white or leathery gray in
color.
DEPTH OF BURN INJURY
Deep full-thickness wound
Quickinitial
method
Disadvantage:
overestimation
EXTENT OF BURN INJURY
• inhalation injury
• hypovolemic shock
• infection
MEDICAL
MANAGEMENT
Acute Care
Quick assessment (extent of burn injury,
additional trauma – fractures, head injuries,
lacerations)
Maintain adequate ventilation
• Bronchoscopy (assess internal airway)
• Warmed humidified O2
• ET should be available for insertion
• Eschar (a hard leathery crust of dehydrated skin) in the neck
area = tracheostomy
MEDICAL
MANAGEMENT
MEDICAL
MANAGEMENT
Acute Care
• Mechanical ventilation
• Hyperbaric O2 treatment (100% O2 3x greater
than atmospheric pressure in a specifically
designed chamber)
Initiating fluid resuscitation
• Goal:
• Restore IVF, Prevention of tissue & cellular ischemia,
maintenance of vital organ function
• UO: 0.3-0.5 ml/kg/hr = SUCCESFUL!!!
• Fluid-replacement regimen is calculated from the time
the burn injury occurred
MEDICAL
MANAGEMENT
Lactated Ringers: alkalinizing sol’n; Na+,
Cl-, K+, Ca++ plus Lactate w/c is converted
to HCO-3 in the Liver (met. acidosis)
MANAGEMENT
MEDICAL
MANAGEMENT
Pain
•Morphine is generally the DOC
•Severe: 50 mg/hr
•If respiratory depression occurs:
naloxone (Narcan)
Tetanus immunization is also
administered
WOUND MANAGEMENT
• Open method
• Wound is left uncovered
• Closed method
• Wound is covered
WOUND MANAGEMENT: OPEN
METHOD (EXPOSURE METHOD)
Advantages Disadvantages
Reduces labor- Contributes to wound
intensive care desiccation (dryness)
Promotes loss of water
Causes less pain and body heat
during wound care
Exposes wound to
Facilitates pathogens
inspection Contributes to pain
Decreases expense during repositioning
Compromises modesty
WOUND MANAGEMENT: CLOSED
METHOD (EXPOSURE METHOD)
Advantages Disadvantages
Maintains moist wound Requires more time
Promotes maintenance of Adds to expense
body temperature Enhances growth of
Decreases cross pathogens beneath
contamination of wound dressings
Provides wound Interferes with wound
debridement during assessment
dressing removal Causes more blood loss
Keeps skin fold separated with removal
Reduces pain during Can interfere with
circulation if tightly applied
position changes
WOUND MANAGEMENT
Open method (exposure method)
• Abandoned already (except in face & perineum)
WOUND MANAGEMENT
Closed method – current preferred method
• Covered first with non adherent & absorbent dressings (gauze
impregnated w/ petroleum jelly or ointment-based antimicrobials)
• Occlusive or semi occlusive dressing made of polyvinyl, polyethylene,
polyurethane & hydrocolloid materials as final dressing
ANTIMICROBIAL THERAPY
Skin grafting
• Necessary for deep partial-thickness & full-thickness burns
• Purpose:
Types of Autografts
Split-thickness graft
• Epidermis & a thin layer of dermis are harvested
• Cosmetic appearance is less than desirable, less
elastic, hair does not grow from their surface
Full-thickness graft
• Epidermis, dermis & some subcutaneous tissue
• Comparable appearance to normal skin
• Tolerate more stress once they become permanently
attached to the burn wound
Slit/ lace/ expansile graft
SURGICAL MANAGEMENT
Skin substitute
SURGICAL MANAGEMENT
Skin substitute
• Biobrane (nylon silicone membrane coated with a protein derived
from pig tissue)
TransCyte is stored
and sealed in a
cassette with two
pieces per cassette.
Product is thawed just
prior to use.
SURGICAL MANAGEMENT
SURGICAL MANAGEMENT
Cultured Skin
• Growing the client’s own skin cells in a laboratory culture medium
• Postage stamp-sized skin entire body (3weeks)
• Disadvantage: pigmentation does not perfectly match the original skin
NURSING
MANAGEMENT
Focus: assessing the wound & how the burn injury has
affected the client’s status
Calculates fluid-replacement requirements & infuses
the prescribed volume according to agency’s protocol
Quickly recognized & efficiently treats signs of shock
Administer prescribed analgesics
Wound care
Helps the client & family to cope with the change in
body image
Health teaching (pressure garments, skin care, etc…)
THANK YOU!
PLEASE PREPARE FOR THE QUIZ!
GOOD LUCK!