Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 28 views

    Burn Management

    Uploaded by

    Adam Macadindang
    1. This document provides guidelines for the emergency care, outpatient management, and wound care of burns. It outlines initial first aid measures, evaluation and treatment in the emergency department, and outpatient treatment for minor burns. 2. For major burns requiring hospitalization, the guidelines describe rapid assessment, airway management, IV fluid resuscitation, and monitoring of urine output. Wounds should be dressed with sterile bandages until further treatment is determined. 3. Wound care involves daily cleaning and dressing changes. Dead tissue should be debrided and burns dressed with antibiotic ointment. Hands require special care to preserve function and range of motion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Burn Management

    Uploaded by

    Adam Macadindang
    28 views19 pages
    1. This document provides guidelines for the emergency care, outpatient management, and wound care of burns. It outlines initial first aid measures, evaluation and treatment in the emergency department, and outpatient treatment for minor burns. 2. For major burns requiring hospitalization, the guidelines describe rapid assessment, airway management, IV fluid resuscitation, and monitoring of urine output. Wounds should be dressed with sterile bandages until further treatment is determined. 3. Wound care involves daily cleaning and dressing changes. Dead tissue should be debrided and burns dressed with antibiotic ointment. Hands require special care to preserve function and range of motion.

    Original Title

    BURN-MANAGEMENT

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1. This document provides guidelines for the emergency care, outpatient management, and wound care of burns. It outlines initial first aid measures, evaluation and treatment in the emergency department, and outpatient treatment for minor burns. 2. For major burns requiring hospitalization, the guidelines describe rapid assessment, airway management, IV fluid resuscitation, and monitoring of urine output. Wounds should be dressed with sterile bandages until further treatment is determined. 3. Wound care involves daily cleaning and dressing changes. Dead tissue should be debrided and burns dressed with antibiotic ointment. Hands require special care to preserve function and range of motion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views19 pages

    Burn Management

    Uploaded by

    Adam Macadindang
    1. This document provides guidelines for the emergency care, outpatient management, and wound care of burns. It outlines initial first aid measures, evaluation and treatment in the emergency department, and outpatient treatment for minor burns. 2. For major burns requiring hospitalization, the guidelines describe rapid assessment, airway management, IV fluid resuscitation, and monitoring of urine output. Wounds should be dressed with sterile bandages until further treatment is determined. 3. Wound care involves daily cleaning and dressing changes. Dead tissue should be debrided and burns dressed with antibiotic ointment. Hands require special care to preserve function and range of motion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    Management of

    BURN
    INDICATIONS FOR HOSPITALIZATION
    FIRST AID MEASURES
    Acute care should include the following measures:

    1. Extinguish flames by rolling the child on the ground; cover the child with a blanket, coat, or
    carpet.
    2. After determining that the airway is patent, remove smoldering clothing or clothing saturated
    with hot liquid. Jewelry, particularly rings and bracelets, should be removed or cut away.
    3. In cases of chemical injury, brush off any remaining chemical, if powdered or solid; then use
    copious irrigation or wash the affected area with water. Call the local poison control center for
    the neutralizing agent to treat a chemical ingestion.
    4. Cover the burned area with clean, dry sheeting and apply cold (not iced) wet compresses to
    small injuries. Significant large-burn injury (>15% of BSA) decreases body temperature
    control and contraindicates the use of cold compresses.
    5. If the burn is caused by hot tar, use mineral oil to remove the tar.
    6. Administer analgesic medications.
    FIRST AID MEASURES
    EMERGENCY CARE

    1. Rapidly review the cardiovascular and pulmonary status and


    document preexisting or physiologic lesions (asthma, congenital heart
    disease, renal or hepatic disease).

    2. Ensure and maintain an adequate airway, and provide humidified


    oxygen by mask or endotracheal intubation.

    3. Children with burns > 15% of BSA require intravenous (IV) fluid
    resuscitation to maintain adequate perfusion.
    EMERGENCY CARE
    4. Evaluate the child for associated injuries, which are common in patients
    with a history of high-tension electrical burn, especially if there has also
    been a fall from a height.

    5. Children with burns of >15% of BSA should not receive oral fluids
    (initially) because gastric distention may develop. These children require
    insertion of a nasogastric tube in the ED to prevent aspiration.

    6. A Foley catheter should be inserted into the bladder to monitor urine


    output in all children who require IV fluid resuscitation.

    7. All wounds should be wrapped with sterile dressings until it is decided


    whether to treat the patient on an outpatient basis or refer to an appropriate
    facility.
    EMERGENCY CARE

    8. A CO measurement (carboxyhemoglobin [HbCO]) should be


    obtained for fire victims and 100% oxygen administered until the result
    is known.

    9. Review child immunization. Burns <10% BSA do not require tetanus


    prevention, whereas burns >10% need tetanus immunization. Use
    diphtheria, tetanus toxoids, and acellular pertussis (DTaP) for tetanus
    prophylaxis for children <11 yr old, and use tetanus, diphtheria, and
    pertussis (TdaP) for children >11 yr old.
    OUTPATIENT
    MANAGEMENT
    FOR BURNS
    • A patient with 1st and 2nd-degree burns of <10% BSA may be treated on an
    outpatient basis unless family support is judged inadequate or there are
    issues of child neglect or abuse.
    • Outpatients do not require a tetanus booster (unless not fully immunized) or
    prophylactic penicillin therapy.
    • Blisters should be left intact and dressed with bacitracin or silver
    sulfadiazine cream (Silvadene).
    • Dressings should be changed once daily, after the wound is washed with
    lukewarm water to remove any cream left from the previous application.
    • Very small wounds, especially those on the face, may be treated with
    bacitracin ointment and left open.
    • Debridement of the devitalized skin is indicated when the blisters rupture.
    • A variety of wound dressings and wound membranes are available in soft
    felt-like material impregnated with silver ion, may be applied to 2nd- degree
    burns and wrapped with a dry sterile dressing.
    • Similar wound membranes provide pain control, prevent wound desiccation,
    and reduce wound colonization.

    • These dressings are usually kept on for 7-10 days but are checked twice a
    week.
    • Burns to the palm with large blisters usually heal beneath the
    blisters; they should receive close follow-up on an outpatient
    basis.
    • The great majority of superficial burns heal in 10-20 days.
    • Deep 2nd-degree burns take longer to heal and may benefit from
    enzymatic debridement ointment (collagenase) applied daily on
    the wound, which aids in the removal of the dead tissue.
    • The depth of scald injuries is difficult to assess early;
    conservative treatment is appropriate initially, with the depth of
    the area involved determined before grafting is attempted.
    WOUND CARE
    (WHO)
    INITIAL CARE
    • In all cases, administer tetanus prophylaxis.
    • Except in very small burns, debride bullae.
    • Excise adherent necrotic (dead) tissue initially and debride all
    necrotic tissue over the first few days. Gentle scrubbing will
    remove loose necrotic tissue.
    • After debridement, gently cleanse the burn with 0.25% (2.5
    gm/L) chlorhexidine solution, 0.1% (1 gm/L) cetrimide solution
    or another mild water-based antiseptic.
    • Do NOT use alcohol-based solutions
    • Apply a thin layer of antibiotic cream (silver sulfadiazine)
    • Dress the burn with petroleum gauze and dry gauze thick
    enough to prevent seepage to the outer layers
    DAILY TREATMENT
    • Change the dressing daily (twice daily, if possible) or as often as
    necessary to prevent seepage through the dressing. Remove any
    loose tissue with each dressing change.
    • Inspect the wounds for discoloration or hemorrhage; this could
    indicate infection.
    • Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5%
    aqueous) is the cheapest, is applied with occlusive dressings but
    does not penetrate eschar.
    • Use silver sulfadiazine (1% miscible ointment) with a single layer
    dressing. It has limited eschar penetration and may cause
    neutropenia.
    DAILY TREATMENT
    • Mafenide acetate (11% in a miscible ointment) is used without
    dressings. It penetrates eschar but causes acidosis. Alternating these
    agents is an appropriate strategy.
    DAILY TREATMENT

    • Treat burned hands with special care to preserve function.


     Cover the hands with silver sulfadiazine and place them in
    loose polythene gloves or bags secured at the wrist with a crepe
    bandage.
     Elevate the hands for the first 48 hours, and then start the
    patient on hand exercises.
     At least once a day, remove the gloves, bathe the hands,
    inspect the burn and then reapply silver sulfadiazine and the gloves.
    • If skin grafting is necessary, consider treatment by a specialist after
    healthy granulation tissue appears
    HEALING PHASE
    • The depth of the burn and the surface involved
    influence the duration of the healing phase. Without
    infection, superficial burns heal rapidly.
    • Apply split thickness skin grafts to full-thickness
    burns after wound excision or the appearance of
    healthy granulation tissue.
    • Plan to provide long term care to the patient.

    You might also like