Burn:- Injuries that result direct contact or exposure to any thermal, chemical, electrical or radiation source are termed as burns.
Causes of Brun:-
1. Thermal Burn:- Caused by exposure to or contact with flame, hot liquids, semiliquids, stem or hot objects ( dry and moist burn).
2. Chemical Burn:-
- By strong acid
- Strong base
- Detergent
3. Electrical Burn:- caused by electric current or short circuit.
4. Radiation Burn:-
- By U. V (ultraviolet) rays
- X-ray
Classification of Burn:-
1. First degree of Burn:- superficial and painful Burn. Affect only the epidermis or outer layer of skin. The burn side is red of painful dry and with no blister.
Causes:- Sunburn, low intensity flash.
Skin Involvement:- epidermis, possibly a portion of dermis.
Symptoms:- Tingling, hyperesthesia, pain that is soothed by cooling.
Appearance:- Reddened, blanches with pressure.
Course:- discomfort lasts about 48 hours. Desquamation peeling in 3-7 days.
Second degree of Burn:- (partial thickness) second degree of burn. affects both the epidermis and the second layer of skin (dermis). It may cause of swelling and red or white splotchy skin. Blisters may develop and pain can be severe.
Causes:- Scalds, flash, flame.
Skin involvement:- epidermis, upper dermis, portion of deeper dermis.
Symptoms:- pain hyperesthesia sensitive to cold.
Appearance:- Blisters mottled red, base broken epidermis edema, wet, shiny, weeping surface.
Course:- Recovery in 2 to 4 weeks, some scarring and Depigmentation contractures. infection may convert it to full thickness.
Third degree of Burn:- (Full thickness) third degree of burn,of painless of burn. into the innermost layer of skin, the subcutaneous tissue. The burn site may look white and blackened and charred.
Causes:- Flame Prolonged exposure to hot liquids, electric current, chemical.
Skin involvement:- epidermis entire dermis, subcutaneous tissue may involve connective tissue muscles and bone.
Symptoms:- Pain free, shock, hematuria, hemolysis.
Appearance:- Dry, pale white or Charred broken skin with fat exposed, edema. tissues distrupted.
Course:- Full thickness dead skin suppurates and liquefies after 2- 3 weeks, spontaneous healing impossible requires removal of eschar and subsequent split or full thickness, skin grafting.
Burn determination method:-
Rule of nine:- the rule of nine is a quick way to calculate the extent of burns. The system assigns percentage in multiples of nine to measure body surface. Basis of this rules is that the body is divided into Anatomical sections. each of which represents 9% or a multiple of 9% of the TBSA (total body surface area).
- Head and face- ———9 = 9%
- Upper extremities — 9×2 = 18%
- Lower extremities –18×2 = 36%
- Back and chest –18×2 = 36%
- Genital –1 = 1%
- Total(9%+18%+36%+36%+1%)=100%
Management:-
- Emergency phase ( Resuscitation)
- Acute phase (in hospital)
- Rehabilitation phase
Emergency phase resuscitation:-
- Firstly we should remove to victim from burn source.
- Assess ABC (airway, breathing, circulation of patient.
- If there is need of CPR (cardiopulmonary) resuscitation then we would give properly.
- Pain management should be done.
- T.T (tetanus Toxid) prophylaxis is necessary.
- Initial wound care.
- Teaching .
Acute phase (in hospital) :-
- Reassess airway breathing and circulation.
- Elevated headend that helps in expansion of lungs.
- Administer O2 as prescribed.
- Start fluid replacement therapy.
By Parkland formula:-
- In first 24 hours.
4 ml. R.L. (ringer lactate) × weight in kg × % of total burn surface area.
In 1, 8 hours given half part of fluid and half to given over next 16 hours
- Day 2 ( 24 hours)
0.5 ml colloid × weight of patient in kg × % TBSA (total burn surface area) +2000 ml. 5% dextrose.
Example:-
- Weight of patient = 70 kg
- 80% surface burn then it’s first 8 hours — 11200 ml. Or 1400 ml/ hours
- In next 16 hours — 11200 ml. Or 700 ml/ hrs.
- In second 24 hours (next day)
- 0.5 ml × 70 × 80 = 2800 ml.
- Percentage of indewelling catheter.
- Monitoring of vital signs.
- Pain management by analgesic.
- Data collection.
- Wound care.
- Provide psychological support.
- Control the infection by use of aseptic technique and administer antibiotics
Provide physical therapy:-
– Splinting (joint position)
– positioning
– exercise
– Ambulation and pressure therapy
– Provide proper nutritional diet to patient
– Topical antimicrobials should be used e.g.
– silver sulfadiazine 1%
– Silver Nitrate 0.5%
Rehabilitation phase:-
- In this phase we should encourage to patient for restart has socially, physically, and mentally healthy life.
- Also provided psychological support and physically exercise training.
- To provide education.
- To immunize deformities.
- To achieve maximal functional recovery
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