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Burn Management PDF

This document provides guidance on burn management, including assessment of burn severity using the Rule of 9s, estimating depth of burn, signs of infection, wound care involving debridement and topical antibiotics, managing nutrition to support healing, and addressing scar maturation. Serious burns requiring hospitalization include over 15% total body surface area burned in adults, over 10% in children, and any full thickness or circumferential burns. Proper fluid resuscitation, wound care to prevent infection, nutrition to support healing, and scar management are essential to treatment.

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Muhammad husein
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326 views7 pages

Burn Management PDF

This document provides guidance on burn management, including assessment of burn severity using the Rule of 9s, estimating depth of burn, signs of infection, wound care involving debridement and topical antibiotics, managing nutrition to support healing, and addressing scar maturation. Serious burns requiring hospitalization include over 15% total body surface area burned in adults, over 10% in children, and any full thickness or circumferential burns. Proper fluid resuscitation, wound care to prevent infection, nutrition to support healing, and scar management are essential to treatment.

Uploaded by

Muhammad husein
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BURN MANAGEMENT

The burn patient has the same priorities as all other trauma patients
Assess: Considerations:

AIRWAY Rapid airway compromise


BREATHING Beware of inhalational injury
CIRCULATION Fluid replacement
DISABILITY Compartment Syndrome
EXPOSURE Percentage area of burn

Essential
Burn severity is determined by Management Points
Stop the burning
 Surface area ABCDE
 Depth Rule of 9s
 Other considerations Obtain good IV access
Early fluid replacement

Morbidity and mortality rises with increasing burned surface


area and the patient’s age. Even small burns may be fatal in
elderly people.

Burns greater than 15% surface area (adult),


greater than 10% (child) or
any burn occurring in the extremes of age
are considered serious
BURN MANAGEMENT
Adults Children
The Rule of 9s is commonly The Rule of 9s is modified
used to estimate the burned for infants and children
surface area in adults. since their heads and lower
extremities represent
different proportions of
The body is divided into body surface area.
anatomical regions that
represent 9% (or multiples
of 9%) of the total body
surface area.

The outstretched palm and


fingers approximate to 1%.

If the burned area is small, assess how


many times your hand covers the area
BURN MANAGEMENT
Depth of Burn
It is important to estimate the depth of the burn to assess its severity
and to plan future wound care.

Depth of Burn Appearance Sensation


First degree Red Painful
Blanches with pressure
Dry
No blisters

Second degree Red Painful to


Partial thickness Blanches with pressure temperature and
- superficial Moist, weeping air
Blisters

Second degree Variable colour Perceptive of


Partial thickness No blanching with pressure pressure only
- deep Wet, waxy or dry
Blisters (easily unroofed)

Third degree Waxy white, leathery gray, Deep pressure only


Full thickness charred or black
No blanching with pressure
Dry, inelastic

Fourth degree As with Third degree, but Deep pressure


extends into fascia and/or
muscle

It is common to find all types of burns within the same wound


and the depth may change with time, especially if infection occurs.
BURN MANAGEMENT
Serious burns requiring hospitalization include the following:
 Adult: greater than 15% burn
 Pediatric: greater than 10% burn
 Any burn in the very young, elderly or the infirm
 Any full thickness burn
 Specific regions: face, ears, eyes, hands, feet, perineum
 Circumferential burns
 High-voltage electrical burns
 Inhalational injury
 Associated trauma or significant pre-burn illness, e.g. diabetes

Wound Care
If the patient arrives at the health care facility without first aid given
yet, do the following
First Aid
Drench the burn with cool water to prevent further damage
Remove all burned clothing, if easily removable
If burn area is limited, immerse the site in cold water for 30
minutes to reduce pain, edema and tissue damage
If burn area is large, apply clean wraps around the burned
area (or the whole patient) to prevent systemic heat loss
and hypothermia
Hypothermia is a particular risk in young children.

The first 6 hours following injury are critical; transport the patient
with severe burns to a hospital as soon as possible.
BURN MANAGEMENT
Wound Care
Initially, burns are sterile. Focus the treatment on speedy healing and
prevention of infection.
Initial Treatment
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

Fever is not a useful sign of


infection as it may persist until the
burn wound is closed.
Cellulitis in the surrounding tissue is a
better indicator of infection.
BURN MANAGEMENT
Wound Care
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.
Give systemic antibiotics in cases of hemolytic streptococcal
wound infection or septicemia.
Pseudomonas aeruginosa infection often results in septicemia
and death. Treat with 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. It depletes electrolytes
and stains the local environment.
Use silver sulfadiazine (1% miscible ointment) with a single layer
dressing. It has limited eschar penetration and may cause
neutropenia.
Mafenide acetate (11% in a miscible ointment) is used without
dressings. It penetrates eschar but causes acidosis. Alternating
these agents is an appropriate strategy.
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.
BURN MANAGEMENT
Wound Care
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.

Burn scars undergo maturation, at first being red, raised and uncomfortable.
They frequently become hypertrophic and form keloids. They flatten, soften and
fade with time, but the process is unpredictable and can take up to two years.

In children
The scars cannot expand to keep pace with the growth of the child and may lead to contractures.

Arrange for early surgical release of contractures before they interfere with growth.

Burn scars on the face lead to cosmetic deformity, ectropion and contractures
about the lips. Ectropion can lead to exposure keratitis and blindness and lip
deformity restricts eating and mouth care.

Consider specialized care for these patients as skin grafting is often not
sufficient to correct facial deformity.

Nutrition
Patient’s energy and protein requirements will be extremely high due to the
catabolism of trauma, heat loss, infection and demands of tissue regeneration. If
necessary, feed the patient through a nasogastric tube to ensure an adequate
energy intake (up to 6000 kcal a day).

Anemia and malnutrition prevent burn wound healing and result in failure of skin
grafts. Eggs and peanut oil are good, locally available supplements.

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