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Suminta Productions MASTER OF SCIENCE IN NURSING 1


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TO ALL OUR KLASMEYTS

WHO ARE ..........SINGLE

Love is like a butterfly.

The more you chase it, the

more it eludes you.

But if you just let it fly, It will

come to you when you least

expect it.

Love can make you happy butoften it hurts, but love is onlyspecial when you give it tosomeone who is really worth it.

So take your time and choose

the best.


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TO ALL OUR KLASMEYTS WHO ARE ..........

ENGAGED

The true measure of compatibility is not the years spent together

But how good you are for each other.


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TO ALL OUR KLASMEYTS WHO ARE...........

MARRIED

Love is not about "it's your fault", but "I'm sorry."Not "where are you", but "I'm right here for you"

Not "how could you", but "I understand"Not "I wish you were", but "I'm thankful you are"


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TO ALL OUR

KLASMEYTS WHO ARE.......... HEARTBROKEN

The challenge is not how tosurvive heartbreaks

But to learn from them.

Heartbreaks last as long asyou want

and cut as deep as you allow

them to go


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TO ALL OUR KLASMEYTS WHO ARE .......... NAIVE

How to be in love:

Be consistent but not too persistent,Share and never be unfair,

Understand and try not to demand,

And get hurt but never keep the pain.


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TO ALL OUR KLASMEYTS WHO ARE

..........P

OSSESSIVE

It breaks your heart to see the one you love

Happy with someone else

But it's more painful to know that the one you love

Is unhappy with you.


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AFRAID TO CONFESS

Love hurts when you break up with someone.

It hurts even more when someone breaks up with you.

But love hurts the most:

When the person you love has no idea how you feel about him/her


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STILLHOLDING ON

A sad thing about life is when you meet someone and fall inlove, only to find out in the end that it was never meant to be,and that you have wasted years on someone who wasn'tworth it.

If that person doesnt worth it now, its not going to be worth

it a year or 10 years from now.


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TO ALL OUR KLASMEYTS..........

Our wish is for you to study by heart and have focus on BURNMANAGEMENT, as the RIGHT man/woman whose love is: honest,

strong, mature, never-changing, protective, encouraging, rewarding andunselfish, is deemed to fall unexpectedly right in front of your door.


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Roderick C. Suminta, RN, PTRPRoderick C. Suminta, RN, PTRP

Maria Theresa G. Suminta, RNMaria Theresa G. Suminta, RN

The ReportersThe Reporters


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B U R N M A N A G E M E N TB U R N M A N A G E M E N T


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Burn ManagementBurn Management

Roderick C. Suminta, RN, PTRPRoderick C. Suminta, RN, PTRPMaria Theresa G. Suminta, RNMaria Theresa G. Suminta, RN

INSTRUCTOR(S) IINSTRUCTOR(S) I

Union Christian CollegeUnion Christian College


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occur when there is contact between tissue and an

energy source, such as heat, chemicals, electrical

current, or radiation.

Burn wounds


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The effects of the burn are influenced by:

intensity of the energy

duration of exposure

type of tissue injured


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Where do most burns occur?

0 - 4 years, from kitchen, bathroom.

5-74 years, outdoors, kitchen.

Teenagers, suicide (females). > 75 years, kitchen, outdoors.


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Major cause of fires in the home

Carelessness with cigarettes

Hot water from water heaters set at high levels

above 60 C

Cooking accidents

Space heaters

Gasoline, lighter fluids, etc. Chemicals


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Types ofBurn Injury

Thermal burns

Scald burns

Chemical burns Electrical burns

Smoke & inhalation injury

Frost bite


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Clinical Manifestations


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Zones of Injury


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Thermal Burns


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Scald Burns


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Chemical Burn

Examples: cleaning agents...

Remember.

Tissue destruction may continue for up to 72 hours.

It is important to remove the person from the burning agent or

vice versa. The latter is accomplished by lavaging the affected area with

copious amounts of water.


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Smoke and Inhalation Injury

Can damage the tissues of the

respiratory tract

Although damage to the respiratory

mucosa can occur, it seldom happens

because the vocal cords and glottis

closes as a protective mechanisms.


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Electrical Burns


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Electrical Burns

Injury from electrical burns results from

coagulation necrosis that is caused by intense heat

generated from an electric current.

The severity depends on:

amount of voltage

tissue resistance

current pathways

surface area in contact with the current

length of time the current flow.


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Electrical injury can cause:

Fractures of long bones and vertebra

Cardiac arrest or arrhythmias--can be delayed 24-

48 hours after injury

Severe metabolic acidosis can develop in

minutes

Myoglobinuria acute renal tubular necrosis.


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Treatment of electrical burns

Fluids Ringers lactate or other fluids-flushes out

kidneys--you want 75-100 cc/hr until urine sample

clear

An osmotic diuretic (Mannitol)


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Cold Thermal Injury (Frostbite)


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Classification ofBurn Injury

Severity is determined by:

depth of burn

extend of burn calculated in percent of total body

surface (TBSA)

location of burn

patient risk factors


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Depth ofBurnsMedicolegal Classification Clinical Classification

Superficial

Partial

Thickness

1st

2nd

3rd

Deep

PartialThickness

Full

Thickness


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Extent ofB

urnsExtent ofB

urns


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Lund-Browder Chart

Adult1510510Age in years

345689A-head (back or front)

444432B-1 thigh (back or front)

333222C-1 leg (back or front)


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RULE OF NINES


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Location ofBurns

Vital organs of burn:

Face, neck

Chest

Perineum

Hand

Joint regions

Other areas


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Patient risk factors

Associated trauma

Inhalation injuries

Circumferential burns Electricity

Age (young or old)

Pre-existing disease Abuse


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CARDIOVASCULARFluid loss

CO & BP

Hypovolemia

CO & BP

(further)

Burn Shock

SNS Response

Peripheral Resistance &

PR

CO

SHOCK


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BURN EDEMA

Capillary Integrity

Fluid shift

Blister Formation &

Edema

(Circumferential

Burns)

Pressure on small

BV & nerves

Compartment

Syndrome

Neurovascular

Compromise


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RESPIRATORY

Inhalation of toxic gases

Chemical irritation

Loss of ciliary action

Mucosal edema

Bronchospasm

Surfactant

CO

Hypoxia

ARDS & RF


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RENAL INJURY

RBC Destruction

Free Hgb in Urine

If muscle damage occurs

Myoglobinuria

If with CO

Occlusion of renal

tubules

Acute tubular

necrosis

Renal Failure


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3 Phases ofBurn Management

Emergent (resuscitative)

Acute Rehabilitative


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Pre-hospital Care

Remove from area! Stop the burn!

If thermal burn is large--FOCUS on the

ABCsA=airway-check for patency, soot around nares, or

signed nasal hair

B=breathing- check for adequacy of ventilation

C=circulation-check for presence and regularity of

pulses


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Other precautions...

Burn too large--dont immerse in water due to

extensive heat loss

Never pack in ice

Pt. should be wrapped in dry clean material to

decrease contamination of wound and increase

warmth


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Emergent Phase (Resuscitative Phase)

Lasts from onset to 5 or more days but usually

lasts 24-48 hours

begins with fluid loss and edema formation and

continues until fluid motorization and diuresis

begins

Greatest initial threat is hypovolemic shock to a

major burn patient!


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Management in the emergent phase is...

Airway management-early nasotracheal or

endotracheal intubation before airway is actually

compromised (usually 1-2 hours after burn)

ventilator? ABGs? Escharotomies?

6-12 hours later: Bronchoscopy to assess lower

respiratory tact

chest physiotherapy, suction


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Complications during emergent phase of

burn injury are 3 major organ systems...

Cardiovascular

Respiratory

Renal systems


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ACUTE PHASE OF BURN CARE

48 to 72 hours after the burn injury

Goals:

Infection Prevention

Wound Cleaning Topical Antibacterial Therapy

Wound Dressing

Wound Dbridement

Dressing Changes

Wound Dbridement

Pain Management


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Fluid Therapy

1 or 2 large bore IV lines

Fluid replacement based on:

size/depth of burn

age of pt.

individualized considerations.

there are formulas for replacement:

Parkland formula

Brooke formula


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Parkland formula

Lactated Ringers solution: 4 mL kg body

weight % TBSA burned

Day 1: Half to be given in first 8 hours; half to be

given over next16 hours

Day 2: Varies. Colloid is added.


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Brooke formula

1. Colloids: 0.5 mL kg body weight % TBSA burned

2. Electrolytes (lactated Ringers solution): 1.5 mL kgbody weight % TBSA burned

3. Glucose (5% in water): 2,000 mL for insensible loss4. Day 1: Half to be given in first 8 hours; remaining half

over next 16 hours

5. Day 2: Half of colloids; half of electrolytes; all of

insensible fluid replacement.6. Second- and third-degree (partial- and full-thickness)

burns exceeding 50% TBSA are calculated on the basisof 50% TBSA.


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Assessment of adequacy of

fluid replacement

Urine output is most commonly used parameter

Urine osmolarity is the most accurate parameter UOP= 30-50 ml/hrin an adult


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Wound care

Escharotomy / Fasciotomy

Escharectomy + homograft

D

ressing / hydrotherapy Debridement

Application ofautograft

Splinting Contractures management


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Wound Care continued...

Staff should wear disposable hats, gowns, gloves,

masks when wounds are exposed

appropriate use of sterile vs. nonsterile techniques

keep room warm

careful handwashing

any bathing areas disinfected before and after

bathing


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Other ConsiderationsOther Considerations


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Physiotherapy


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Drug Therapy

Analgesics and Sedatives

Tetanus immunization

Antimicrobial agents Silver sulfadiazine

Mafenide acetate

Silver nitrate Acticoat


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Nutritional Therapy

Burn patients need more calories & failure to

provide will lead to delayed wound healing and

malnutrition.


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Care ofB U R N S

BB -- breathing

UU - urine output

RR - rule of ninesresuscitation of fluid

NN -- nutrition

SS - shocksilvadene


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Referral Criteria

2nd or 3rd Degree Burns

>10% TBSA

Burns to vital organs of burn

Circumferential burns

Electrical Burns

Chemical Burns Inhalation Injury


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Referral Criteria

Concomitant trauma (If Major Trauma, The

Trauma Center , Not the Burn Center should be

the initial stabilizing unit)

When in doubt , consult with a burn center


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UPDATESUPDATES


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HyperBaric Oxygen Therapy

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