burns student pack

8/3/2019 Burns Student Pack

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STUDENTGUIDETOBURNS

DawnWestlake

3rdYearStudentNurseUWE

October2011


2/26

WelcometotheBurnUnit

ThisstudentpackhasbeenputtogetherasanintroducContobeingastudentonaburns

unit,itisbynomeansexhausCveofthe

knowledgethatyoucangainfromthis

placement,butmeantasastarCngpointto

guideyouinquesConstoaskandlearning

opportuniCesavailabletoyou.Enjoy!


3/26

TheAnatomyoftheskin


4/26

Func1onsofskin

Maintenanceofbody

temperature

Synthesisof

vitaminD

Fluidandelectrolytebalance

PercepConofsCmuli

ProtecCon


5/26

FlameScalds

hemical Electrical

InhalaCon

Typesof

Burns

ontact RadiaCon


6/26

Injuryfromhotfluidssuchastea,coffee,bathwater,saucepans.

Normallysuperficialskinloss. Boilingwaterfromkelewillcausefullthicknessskinlossinseconds. Boilingfatisatahighertemperatureandwill

resultinadeeperburn.

FirstAid:Removeclothesiftheyareinvolvedastheywillholdheatandmaketheburndeeper.Immerseincoldwaterforapprox20minutes.

Scalds


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IgniConofclothingfromunguardedgas,electricaloropenfires.

hildrenplayingwithmatches. Elderlydroppingcigareesintoarmchairorbedclothes. Explosionofparaffinandpetrolignitedbonfiresand

barbecues.Flashburnsoccurwhenskinismomentarilyexposedtohightemperatures.

IgniConoffatfromchippans. Deliberateselfharm.FirstAid:

Stop,Drop,RollexCnguishflames.ProtectairwayfromsmokeImmerseaffectedpartincoldwaterforapprox20minutes

Flame


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ausCcsodaunblockingdrains. Limemakingcement Bleaches,domesCccleaners Industrialacidsandalkalis

Theseverityoftheburnwilldependontypeofchemical,

itsconcentraConandcontactCme.

Firstaid:Washoffwithcopiousamountsofcoldwater.Ifle\onskin

willconCnuetoburn,resulCnginadeeperburn.

hemical


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ontactwithhotmetals,domesCcappliancessuchasironsorovens.

Radiatorshildrenusingthemtopullthemselvesuportheelderlyfallingagainstthem.

ontactwithextremeresulCnginfrostbite. FricConburnsresulCngfromroadtrafficaccidents

resulCnginshearingoftheskinagainstanothersurface.

FricConburnsfromfallingontoarunningmachine.FirstAid:Immerseaffectedareaincoldwaterforapprox20minutes

ontact


10/26

Electrical

ontactwithhigh-tensionoverheadorundergroundpowercables.Mayresultinviolentpropulsionofthe

paCentintheexplosion,causingfracturesorinter-

peritonealbleeding.WillhaveanentryandexitpointcausingextensiveburnswithmassiveCssuedestrucCon.

DomesCcapplianceswronglyordangerouslywired,touchingwithwethands.

FirstAid:Turnoffelectricalsupplyatmains,donottouchperson

unClthisisdone.

heckforcardiac/respiratoryarrest,commencePRif

necessary

allformedicalassistanceimmediately.


11/26

Sunlightorsunbeds Usuallysuperficial Leakofnuclearfuel Duringradiotherapy.

Thesewoundsareslowtohealandthe

resulCngscarCssueispronetofurtherulceraCon.

RadiaCon


12/26

InhalaConofhotgasesorsmokeusuallywhenincidentisinaconfinedspace.

InhalaConinjurygreatlyincreasestheriskofmortality.

Assessairwaylookforburnstomouth,nose,singednasalhairandsootinsputum.Listenforchangeinvoice,hoarsebrassycough,

stridor.

InhalaCon


13/26

ToSumup

HeatIncreased

permeabilityofvesselwalls

PlasmaleaksintosurroundingCssues

LocalcirculaConbecomessluggish

ResultellDies

BurnInjury

i.e:Flashburn=hightempbutforverybriefduraCon=notdeepburn.

i.e:LongduraCon(unconsciouspt)onradiatormaybedeepdespitelowertemp.

Amountof

damage

Amountofheatapplied

Forhowlong


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NURSINGASSESSMENT:

-AIRWAY

-SIZEOFBURN-DEPTHOFBURN

-ASSOCIATEDINJURY

-MEDICALHISTORY-TIMEOFINCIDENT/STORY

-WEIGHT


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lassificaConofBurnDepth


16/26

Assessmentoftotalburnpercentage

TheLundandBrowderchart(LundandBrowder1944).

anbeusedforchildrenandadults.

Donotincludeerythema.

Isthetoolofpreferenceasitisofferssuperioraccuracy.


17/26

Assessmentoftotalburnpercentage

Wallacesruleofnines(KyleandWallace,1951).

Aquickandeasymethodofburnassessment.Thebody

surfaceisdividedintoareas

of9%ormulCplesof9%,

leaving1%forthegenitalia/

perineum.

OralternaCvelyusethePalmarMethod.Wherebythe

sizeofthepaCentspalm

equatestoapprox1%oftheir

bodysurface.


18/26

ManagementofBurnsTreatment

Adults(>16years)withBurns>15%-commencefluidresuscitaConusingParklandFormula(forfirst24hours)

3-4mlHartmannSoluConxweightinKgx%ofBurn

Ifappropriateinsertcatheterandmonitoroutput. ommencepainmanagementchart UsingNutriConalrisktoolassessburnsnutriConalriskscore.If>11

refertodieCcian.Ifburn>15%passNasogastricTube.

TakebloodsFB,U&Es,RP,ardiacenzymeelectricalburn. EGandheartmonitorifelectricalburn. Medicalphotography DrtoseepaCentandprescribeanalgesia,fluidsandO2ifneeded. DressWounds


19/26

omplicaConsofBurns

Hypovolemicshock-decreasedbloodvolumecausedbylossofbloodplasma.

RenalFailure->20%burnincreasedriskduetotubularandglomerulardamage=proteinuria

RespiratoryomplicaConsinhalaConburns ElectrolyteDisturbancesvolumeoffluidtransfused InfecCondangerofsepsis ToxicShockstaphylococcusaureuscolonisingonburnmainlyaffectschildrenasadultshavebuiltup

immunity


20/26

HypovolemicshockAlifethreateningmedicalemergencyinwhichtheheartisunabletopumpoxygenrichbloodtothevitalorgansofthebodyandcancausemanyorganstostopworking.

auses:

Hypovolemicshockhappensduetodecreasedbloodvolume,losingabout1/5ormoreofthenormalamountofbloodinthebodycauseshypovolemicshock.Inburnsitiscausedbylossofbloodplasmaduetosevereburns,thishappensduetolossofskinanddamagetothebloodvessels.

Signsandsymptoms:

Anxiety,agitaConorconfusion. old,paleskin. Generalweakness. Lowbloodpressureandrapidpulsecompensatorymechanism VomiCnggastricdilataConassociatedwithreducConinsplanchnicbloodflow Decreasedornourineoutput-duetoreducedrenaloutputresulCngfromreducedbloodflowtothekidneys. Airhunger Ifsevereitcanleadtounconsciousness.

Treatment:

Ensurethattheairwaysareopenandthepersonisbreathing. Placethepersononhisbackandelevatethelegs6-12inchesunlessthereisasuspectedbackorneckinjury

wherethepersonshouldbeimmobilized.

Keepthepersonwarm. Hypovolemicshockistreatedbyreplacingthefluidand/orblood,usuallydonethroughanIVline,inaddiConto

treaCngthecause.Bloodtransfusiongivenforfullthicknessbursof10%andover.

Ifburn>15%ptcatheterised,measureoutputhourly.Adult0.8-1mlperkgofbodyweightperhour.Approx30100mlperhour.

Themoreseveretheburnis,thehigherthepossibilitythathypovolemicshockwilloccur.Severityofshockisnotrelatedtothedepthoftheburnbuttothesurfaceareaofskindamaged.


21/26

MetabolicEffectsofBurns

Aburninjuryplacesuniquemetabolicdemandsuponthebody.Approx36-48hours

postburninjuryaseverecatabolicstate

develops.Thisisassociatedwithsignificantweightloss,whichcanprovefatal.

NutriConalsupportisvitaltorestrictweight

lossandpreserveleanbodymass,therebyensuringdonorsiteandgra\healing.


22/26

TreatmentforBurnsInjuries

Conserva1vely Dressings reams

Surgically SkinGra\s Escharotomy-Surgicalincisioninan

eschar(necroCcdermis)tolessen

constricCon,especiallya\era

circumferenCalburn,usuallyperformed

totreatorminimizepressureinjurytounderlyingstructures.


23/26

SkinGra\s Skingra\ingisasurgicalprocedureinwhichskinoraskinsubsCtuteisplacedoveraburnornon-healingwound.

Skingra\sareusedintreaCngparCalthicknessandfullthicknessburns.Earlysurgicalremoval(excisionordebridement)ofburnedskinfollowedbyskingra\ingreducesthenumberofdaysinthehospitalandusuallyimprovesthefuncConandappearanceoftheburnedarea.

Thebestskingra\scomefromthepaCentsownunburnedskin(donorsites).Thegra\s(calledautogra\s)willideallycomefromlocaConsthatarenotordinarilyvisible,suchasthebuocksorupperthighs,becausethedonorsiteswillnotbenormalinappearancea\ertheyheal.However,thesizeofgra\sthatareneededandthelocaConofburnswillalsodeterminewherethegra\saretakenfrom.

AninstrumentcalledapowerdermatomeissettoaparCculardepthandshavesoffauniformlayerofhealthyskintogra\ontoaburnedsite.Thethicknessoftheskingra\

dependsontheareaneedingthegra\.Mostgra\saresplit(parCal)thickness.Thedonorsiteforasplitthicknessgra\doesnotneedtobesurgicallyclosedandwillordinarilyformanewtoplayerofskinin10to14days.InmanycasesdonorsitescanbeusedagainforaddiConalgra\s.Becauseskinaroundasplitthicknessgra\usuallycontractsandgrowsCghter,fullthicknessskingra\smaybeneededinareassuchasaroundtheeyes,whereCghtskincouldpreventtheeyelidsfromfullyclosing.Afullthicknessdonorsiteneedstobesurgicallyclosed.Forlargeareasrequiringskingra\s,ameshismadeoutofmulCpleskingra\s.Theareatobegra\edhasthedeadskinremoved(debrided),o\enwitha

powerdermatome,inpreparaConforthegra\.


24/26

BurnsDressings

Themoistness,size,depth,andareaoftheburnneedstobetakenintoconsideraConfordressingselecCon.Theaimoftheburndressingistokeepthewoundcleananddry,andpreventinfecCon.

Dressingwillbecheckeda\er24hourstomakesuretherearenosignsofinfecCon.Itwillbechangeda\er48hours,andtheneverythreetofivedaysunClitiscompletelyhealed.

Lotsofusefulinfo:

hp://www.knowledgenet.ashfordstpeters.nhs.uk/nknet/content/resources/Burns%20wound%20care.pdf

hp://www.cobis.scot.nhs.uk/pdf/Paediatric/Burn%20Dressing%20Guidelines.pdf


25/26

Whathappensa\erleavinghospital?

BurnsDressinglinicoutpaCentclinicfordressingchangesandmonitoringhealing.

TissueSupportlinicScarmanagement. BUGSBurnsUnitSupportGroup,charityforpeoplewhohavebeenburntandtheir

families/carers.


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References:

Williams(2009)Successfulassessmentandmanagementofburninjuries.NursingStandard.23,32,53-62.Dateofacceptance:December292008.

BosworthBousfield,.(2003)(ed)BurnTraumaManagement&NursingCare,2ndediCon,WhurrPublishers,London

hp://www.bmj.com/content/329/7457/101.full.pdf hp://www.wounds-uk.com/pdf/content_9498.pdf hp://www.burn-injury-resource-center.com/2010/03/hypovolemic-

shock.html

Leverage.A(1991)TherapyfortheBurnsPa;ent,hapman&Hall,London.

hp://www.cks.nhs.uk/burns_and_scalds/management/detailed_answers/managing_superficial_dermal_burns/dressing_the_burn#-289343

hp://www.knowledgenet.ashfordstpeters.nhs.uk/nknet/content/resources/Burns%20wound%20care.pdf

hp://www.cobis.scot.nhs.uk/pdf/Paediatric/Burn%20Dressing%20Guidelines.pdf

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