burns forner gros, mj
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BurnsBurns
Mª José Forner GrosMª José Forner GrosMaster Degree in Nursing ScienceMaster Degree in Nursing Science
2013/142013/14
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BurnsBurns
definitiondefinition
classification - depthclassification - depth
- first degree/ superficial thickness- first degree/ superficial thickness
- second degree / partial thickness- second degree / partial thickness
. superficial. superficial
. deep. deep
- third degree / full thickness- third degree / full thickness
- fourth degree / complete burn- fourth degree / complete burn
classification – extend – TBSAclassification – extend – TBSA
treatmenttreatment
minor and severe burns (A & E)minor and severe burns (A & E)
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DefinitionDefinition
burn: injury that causes destruction of tissue, the skin, from exposition of burn: injury that causes destruction of tissue, the skin, from exposition of thermal extremes (either hot or cold) , electricity, chemicals and/or thermal extremes (either hot or cold) , electricity, chemicals and/or radiationradiation
the primary cause is exposure to temperature extremesthe primary cause is exposure to temperature extremes - - heat injuries are more frequent than cold injuries - cold injuries almost exclusively result from frostbite
electrical and chemical burns: 5-10% of burn injuries (result of electrical and chemical burns: 5-10% of burn injuries (result of occupational accidents)occupational accidents)
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1st degree
2nd degree
3rd degree
4th degree
Superficial thickness
Superficial partial thickness
Deep partial thickness
Full thickness
Complete burn
Burn Classification - Depth
Old terminology New terminology
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www.telegraph.co.ukwww.telegraph.co.uk
www.trialx.comwww.trialx.com
. superficial thickness
. epidermis - only the top layer of the skin is damaged
. caused by: sun, chemicals, hot water
. symptoms:- slight swelling- peeling of the skin- itching sensation- no blisters- skin color: pink to red- dry- discomfort- treatment: outpatient basis- healing: 5 days*
* depending on your patient's clinical history
11stst degree burn degree burn
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22ndnd degree burn degree burn
. superficial partial thickness / deep partial thickness
. both layers of the skin are damaged : epidermis & part of the dermis
symptoms SPT:
- skin color: red & shiny- pressing: turns to white- healing: 7 – 21 days*- future skin: darker or lighter
symptoms DPT:
- skin color: yellow to white- pressure discomfort- pressing NO white- healing: around 3 weeks*- future skin: scar, risk of contractures
wet ( blisters break & open) swelling edema pain (severe to extreme)
www.baprass.org.uk
second degree burns have a tendency to induce a more severe inflammatory tissue response : blisterssecond degree burns have a tendency to induce a more severe inflammatory tissue response : blisters
* depending on your * depending on your
patient's clinical historypatient's clinical history
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- remove jewellery or tight clothing (before skin begins to swell) remove jewellery or tight clothing (before skin begins to swell) - stop the burning process – flush with cool running waterstop the burning process – flush with cool running water- put burn ointment or gel / topical antibiotic (Gram – coverage)put burn ointment or gel / topical antibiotic (Gram – coverage)- no butter, petroleum jelly, home remediesno butter, petroleum jelly, home remedies- dry sterile non-stick dressing ( loosely )dry sterile non-stick dressing ( loosely )- pain relief : acetaminophen or NSAIDspain relief : acetaminophen or NSAIDs- tetanus immunization updatetetanus immunization update- elevate burnt areaelevate burnt area- 24 hrs. follow-up (re-evaluation)24 hrs. follow-up (re-evaluation)
- Goal ---- minimizing further damageGoal ---- minimizing further damage
- if Body Surface Area (BSA) burnt 10 % if Body Surface Area (BSA) burnt 10 %
Out patient BasisOut patient Basis
First Aid (minor burns)First Aid (minor burns)
www.mapfre.com
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33rdrd degree burn degree burn
www.medstudentlc.com
full thickness burn
epidermis & all dermis ---subcutaneous tissue
patient's clothes caught on fire
skin: - dry and leathery- waxy pearly white - visible blood vessels , bone- hair follicles, sweat and sebaceous glands are destroyed- eschar
no pain ????
scars – surgery – skin grafts
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44thth degree burns degree burns
full thickness extending to muscle or bone - hypodermis
severe burn :high voltage electric injury- severe thermal burns
skin: charred, insensate, eschar formation
pain is due to adjacent areas, not in the injury
severe scarring
high risk of contractures
www.medstudentlc.com
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First aid of major/severe burns (not superficial)First aid of major/severe burns (not superficial)
- no breathing secure airway ABC - RCP process- no breathing secure airway ABC - RCP process- cover the burn area- cover the burn area- prevent hypothermia- prevent hypothermia- remove any jewellery- remove any jewellery- elevate burnt areas - elevate burnt areas - call emergency services - call emergency services
remove burnt clothing that is stuckremove burnt clothing that is stuckimmerse large severe burns in cold water – risk of shockimmerse large severe burns in cold water – risk of shockapply ointmentsapply ointmentsiceicetight or adhesive dressingstight or adhesive dressingscotton for dressing - fibbers deposition increases risk of infection cotton for dressing - fibbers deposition increases risk of infection pop blister pop blister
no food no water - surgery?no food no water - surgery?
DO NOT:
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Referral criteria to A&EReferral criteria to A&E
partial thickness 10% TBSApartial thickness 10% TBSA
partial thickness burn to:partial thickness burn to:face genitaliaface genitaliafeet perineumfeet perineumhands major jointshands major joints
circumferential burns of limb or chestcircumferential burns of limb or chest
electrical or chemical burnelectrical or chemical burn
patient with co-morbiditiespatient with co-morbidities
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A & EBurn Care Goals
• secure airway ABC – respiratory care- intubation? O2?
• assess depth / extend - Total BSA burnt
• administration of fluids “Parkland Formula” - fighting shock
• sub secure risk of infection
• thermoregulation
• adequate pain control
• restore skin integrity – skin grafts
• physical / occupational therapy
• skin wound care (Nursing)
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Rule of 9´s – TBSARule of 9´s – TBSA
Extend of burns
To calculate how much fluid we will need to restore
. for adults; different rule forkids
. add anterior and posteriorsides of the body separately; plus front and back if necessary
.do not include 1st degree burns when calculating
.can be revised after edemaresolves, when edema goes down
TBSA total body surface area
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Fluids Therapy
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Innovation: calculating fluid requeriments
www.jambinnovations.com
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Medical AppMedical App
www.jambinnovations.com
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“ “Thirty to forty years ago, many burn patients Thirty to forty years ago, many burn patients didn't live. Advances in treatment have created a didn't live. Advances in treatment have created a whole new patient population that not only lives, whole new patient population that not only lives, but has an improving quality of life “but has an improving quality of life “ Charles Durfor, PhDCharles Durfor, PhD
Mª José Forner GrosMª José Forner Gros2013/142013/14