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Describe the methodology for demonstration thatwill allow observation skills 25
S clear statement
Measurable Attainable
R identified the details
It is congruent
List the equipment/supplies necessary tostimulate the learning activity w25
Effective presentation skill 25
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Objective
At the end of the discussion the learners will beable to:
1. Define what is BURN INJURY?
2. Identify the causes of BURN
3. Classify the severity, depth and extent of BURNas to 1st, 2nd,3rddegree.
4. Demonstrate competence in handling orrendering initial assessment and management
of burn injury.
Given a situation or real scenario the students willdemonstrate competence in managing or handling
a burn patient.
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BURN INJURYMANAGEMENT
ROSECHELLE SIUPAN-ELARCO,RMT, RN,MAN
BURN INJURY
MANAGEMENT
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BURN
Is an injury caused by an exogenous agent
that produces a characteristic reaction to local
tissues which may vary from mild erythema to
full thickness destruction of the skin anddeeper tissues.
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CAUSES
THERMAL
DRY HEAT- CONTACT BURN
FLAME BURNS
MOIST HEAT
FLASH BURNS
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ELECTRICITY
LOW VOLTAGE
HIGH VOLTAGE
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CHEMICALS
ACIDS
ALKALI
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RADIATION
IONIZING
NON IONIZING
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Management of Burns
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Degrees of Burn Injury
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NamesLayers
involvedAppearance Texture Sensation
Time of
healingComplications Example
First degree EpidermisRedness
(erythema)Dry Painful 1wk or less
Increased risk
to developskin
cancerlater in
life
Second degree
(superficial
partial
thickness)
Extends into
superficial
(papillary)
dermis
Red with
clearblister.
Blanches with
pressure
Moist Painful 2-3wks
Local
infection/
cellulitis
Second degree
(deep partial
thickness)
Extends into
deep (reticular)
dermis
Red-and-white
with bloody
blisters. Less
blanching.
Moist Painful
Weeks - may
progress to
third degree
Scarring,contractures
(may require
excision
andskin
grafting)
http://en.wikipedia.org/wiki/Erythemahttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Blisterhttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Skin_graftinghttp://en.wikipedia.org/wiki/Cellulitishttp://en.wikipedia.org/wiki/Blisterhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Skin_cancerhttp://en.wikipedia.org/wiki/Erythema8/12/2019 Burn Injury Management
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Names Layers involved Appearance Texture SensationTime of
healingComplications Example
Third
degree(full
thickness)
Extends throughentire dermis
Stiff andwhite/brown
Dry,leathery
Painless Requiresexcision
Scarring,contractures,
amputation
Fourth
degree
Extendsthrough skin,
subcutaneous
tissueand into
underlying
muscle and bone
Black;charred
with eschar
Dry PainlessRequires
excision
Amputation,
significantfunctional
impairment,
possible
gangrene, and
in some cases
death.
http://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Escharhttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Escharhttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Subcutaneous_tissue8/12/2019 Burn Injury Management
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Management : FIRST-DEGREE
BURN
A first-degree burn is confined exclusively to
the outer surface and is not considered a
significant burn. No barrier functions are
altered. The most common form is a Sunburn which
heals by itself in less than a week without scar.
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A second-degree burn that does not cover more than 10percent of the skin's surface can usually be treated in anoutpatient setting. Treatment depends on the severity of theburn and may include the following:
antibiotic ointments dressing changes one or two times a day depending on the
severity of the burn
daily cleaning of the wound to remove dead skin or ointment
possibly systemic antibiotics
Wound cleaning and dressing changes may be painful. Inthese cases, an analgesic (pain reliever) may need to begiven. In addition, any blisters that have formed should not beburst.
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MANAGEMENT
Management of the acute burn injury includeshemodynamic stabilization, metabolic support,wound debridement, use of topical antibacterialtherapy, biologic dressings, and wound closure.
Prevention and treatment of complications,including infection and pulmonary damage, and
rehabilitation are also of major importance.
The patient will also require physical andoccupational therapy and psychiatric andnutritional support.
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Management: Second Degree
Burn Second-degree burns are defined as those burns in which the
entire epidermis and variable portions of the dermis layer areheat destroyed. A superficial second-degree (partialthickness) burn is characterized by heat injury to the upperthird of the dermis leaving a good blood supply
Characteristics:
Confined to upper third of dermis
usually caused by hot liquids
Blisters, wet pink, painful
low risk of infection
Heals in 10-12 days without scarring
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Superficial 2 burn caused by hot water: a scald burn Superficial burn with plasma leaking into wound (note
blisters)
Treatment:
Clean, remove small blisters; apply grease gauze and soft gauze dressing (occlusion,
absorbent dressing, changed daily)
On face, perineum, apply bacitracin or neomycin ointment, applying several times a day.
Excellent alternative is the use of a synthetic skin substitute which seals the wound and
decreases pain.
Use a water-soluble topical antibiotic if the wound is grossly contaminated or if one isunsure if the wound is superficial or deep.
Prophylactic systemic antibiotics are not needed.
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Superficial Partial ThicknessBurns Covered with Synthetic
Skin Substitute
Closed Dressing ApproachThe soft gauze over the primary dressing willprotect the wound and help soak up fluidleaking from the surface
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Essential Management Points
- Stop the burning
- ABCDE
- Determine the percentage area of burn (Rule
of 9s)
- Good IV access and early fluid replacement.
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The severity of the burn is determined by:
- Burned surface area
- Depth of burn
- Other considerations.
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Serious burn requiring hospitalization
- Greater than 15% burns in an adult
- Greater than 10% burns in a child
- Any burn in the very young, the elderly or theinfirm
- Any full thickness burn
- Burns of special regions: face, hands, feet,perineum
- Circumferential burns - Inhalation injury
- Associated trauma or significant pre-burn illness:e.g. diabetes
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Burn Management (continued)
Wound care
First aid
If the patient arrives at the health facility without first aidhaving been given, drench the burn thoroughly with coolwater to prevent further damage and remove all burnedclothing.
If the burn area is limited, immerse the site in cold water for30 minutes to reduce pain and oedema and to minimizetissue damage.
If the area of the burn is large, after it has been doused withcool water, apply clean wraps about the burned area (or thewhole patient) to prevent systemic heat loss andhypothermia.
Hypothermia is a particular risk in young children.
First 6 hours following injury are critical; transport the patientwith severe burns to a hospital as soon as possible
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Initial treatment
Initially, burns are sterile. Focus the treatment on speedy healingand prevention of infection.
In all cases, administer tetanus prophylaxis.
Except in very small burns, debride all bullae. Excise adherent
necrotic (dead) tissue initially and debride all necrotic tissue overthe first several days.
After debridement, gently cleanse the burn with 0.25% (2.5 g/litre)chlorhexidine solution, 0.1% (1 g/litre) cetrimide solution, or anothermild water-based antiseptic.
Do not use alcohol-based solutions.
Gentle scrubbing will remove the loose necrotic tissue. Apply athin layer of antibiotic cream (silver sulfadiazine).
Dress the burn with petroleum gauze and dry gauze thick enoughto prevent seepage to the outer layers.
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Daily treatment
Change the dressing daily (twice daily if possible) or as often as necessary toprevent seepage through the dressing. On each dressing change, remove any loosetissue.
Inspect the wounds for discoloration or haemorrhage, which indicate developinginfection.
Fever is not a useful sign as it may persist until the burn wound is closed. Cellulitis in the surrounding tissue is a better indicator of infection.
Give systemic antibiotics in cases of haemolytic streptococcal wound infection orsepticaemia.
Pseudomonas aeruginosa infection often results in septicaemia and death. Treatwith systemic aminoglycosides.
Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is
the cheapest, is applied with occlusive dressings but does not penetrate eschar. Itdepletes electrolytes and stains the local environment.
Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It haslimited eschar penetration and may cause neutropenia.
Mafenide acetate (11% in a miscible ointment) is used without dressings. Itpenetrates eschar but causes acidosis. Alternating these agents is an appropriatestrategy.
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Treat burned hands with special care to preservefunction.
Cover the hands with silver sulfadiazine andplace 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 hand exercises;
At least once a day, remove the gloves, bathe
the hands, inspect the burn and then reapplysilver sulfadiazine and the gloves;
If skin grafting is necessary, consider treatmentby a specialist after healthy granulation tissueappears.