8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 1/9

BURN

A burn is a type of injury that may be caused by heat, electricity, chemicals, light,

radiation, or friction. Burns can be highly variable in terms of the tissue affected, the

severity, and resultant complications. Muscle, bone, blood vessel, dermal and epidermaltissue can all be damaged with subsequent pain due to injury to nerves. Depending on the

location affected and the degree of severity, a burn victim may experience a wide number

of potentially fatal complications including shock, infection, electrolyte imbalance and

respiratory distress. Beyond physical complications, burns can also result in severe

psychological and emotional distress due to scarring and deformity.

The anatomy of the skin is complex, and there are many structures within the layers of

the skin. There are three layers:

1. Epidermis, the outer layer of the skin

2. Dermis , made up of collagen and elastic fibers and where nerves, blood vessels,

sweat glands, and hair follicles reside.

3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are

located. This is the layer of tissue that is most important in temperature

regulation.

ANATOMY OF THE SKIN

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 2/9

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 3/9

• dermis

• fat layer

epidermis

The epidermis is the thin outer layer of the skin. The epidermis itself is made

up of three sub-layers:

• stratum corneum (horny layer)

This layer contains continually shedding, dead keratinocytes (theprimary cell type of the epidermis). The keratin, a protein formed from

the dead cells, protects the skin from harmful substances.

• keratinocytes (squamous cells)

This layer contains living keratinocytes (squamous cells), which help

provide the skin with what it needs to protect the rest of the body.

• basal layer

The basal layer is the inner layer of the epidermis, containing basalcells. Basal cells continually divide, forming new keratinocytes and

replacing the old ones that are shed from the skin's surface.

The epidermis also contains melanocytes, which are cells that produce melanin

(skin pigment).

dermis

The dermis is the middle layer of the skin. The dermis is made up of the

following:

• blood vessels

• lymph vessels• hair follicles

• sweat glands

The dermis is held together by a protein called collagen, made by fibroblasts

(skin cells that give the skin its strength and resilience). This layer also

contains pain and touch receptors.

subcutis

The subcutis is the deepest layer of skin and is also known as the subcutaneous

layer. The subcutis, consisting of a network of collagen and fat cells, helps

conserve the body's heat while protecting other organs from injury by actingas a "shock absorber."

How are burns classified?

Burns are classified based upon their depth.

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 4/9

A first degree burn is superficial and causes local inflammation of the skin. Sunburns

often are categorized as first degree burns. The inflammation is characterized by pain,

redness, and a mild amount of swelling. The skin may be very tender to touch.

Second degree burns are deeper and in addition to the pain, redness and inflammation,

there is also blistering of the skin.Third degree burns are deeper still, involving all layers of the skin, in effect killing that

area of skin. Because the nerves and blood vessels are damaged, third degree burns appearwhite and leathery and tend to be relatively painless.

What is the significance of the amount of body area burned?

In addition to the depth of the burn, the total area of the burn is significant. Burns are

measured as a percentage of total body area affected. The "rule of nines" is often used,

though this measurement is adjusted for infants and children. This calculation is based

upon the fact that the surface area of the following parts of an adult body eachcorrespond to approximately 9% of total (and the total body area of 100% is achieved):

• Head = 9%

• Chest (front) = 9%

• Abdomen (front) = 9%

• Upper/mid/low back and buttocks = 18%

• Each arm = 9%

• Each palm = 1%

• Groin = 1%

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 5/9

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 6/9

As the percentage of burn surface area increases, the risk of death increases as well.

Patients with burns involving less than 20% of their body should do well, but those with

burns involving greater than 50% have a significant mortality risk, depending upon avariety of factors, including underlying medical conditions and age.

MEDICATIONS

Thermal Burn Medications

Analgesics  

For thermal burns doctors will prescribe analgesics for pain control to ensure that the

patient is as comfortable as possible. Morphine sulfate, Demerol and Vicodin may be

prescribed. These analgesics are prescribed for severe pain.

Nonsteroidal Anti-inflammatory Agents 

These are used for the relief of mild to moderate pain. Ibuprofen (Advil, Motrin) is usuallyused for initial therapy, but other options such as Naproxen, Ansaid, and Anaprox may be

prescribed.

Topical Antibiotics 

Topical antibiotics are used to prevent infections and bacteria growth. Neosporin is used

to treat minor infections and is applied to the skin 1 to 3 times a day to the affected

areas.

Silvadene is a topical cream that is used for more severe burns. Silvadene is a sulfa

medicine used to prevent and treat bacterial or fungus infections. Silvadene should be

applied using a sterile technique to affected areas and the areas should be washed beforeapplying. Avoid applying Silvaden to the face and it should not be use in newborns, infants

 younger than 2 years or in late pregnancy.

Chemical Burn Medications 

Though medications play a limited role in the treatment of most chemical burns topical

antibiotics, calcium and magnesium salts may be used. After decontamination is performed

a standard IV fluid and narcotic therapy is administered.

Antibiotics 

Silvadene is used for dermal burns and is useful in the prevention of infections in second

or third degree burns. It should be applied to skin once or twice daily and all previousmedication must be removed before applying each new dose. Erythromycin ointment

(Bacitracin) is used to prevent infections following ocular burns.

Analgesics 

Morphine, and Acetaminophen are prescribed for pain management and may be used forsedation which beneficial for patients who have sustained injuries to their eyes.

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 7/9

Nonsteroidal Anti-inflammatory Agents 

Advil, Motrin Ansaid, Naprosyn and Anaprox are anti-inflammatory agents used to control

mild to moderate pain.

Electrical Injuries 

When treating electrical injuries hydration is the key to reducing morbidity. If muscledamage is severe an osmotic diuretic will be administered.

Fluids  

Lactated ringers are used for fluid resuscitation. It is an isotonic and has volume

restorative properties. They are administered using an IV and should be stopped if

pulmonary edema develops.

Osmotic Diuretics  

Mannitol is an osmotic diuretic which is not significantly metabolized which passes to

through the glomerulus without being reabsorbed by the kidneys. It is used to restore andmaintain urinary output.

Scar Treatment Medications 

Mederma is a topical gel used to reduce the visibility of scars. The gel should be rubbed

into the scar 3 to 4 times a day for 3 to 6 months for burn scars.

Cica-Care gel sheets are made of a silicone gel and they are designed to flatten and soften

scars. These sheets are self adhesive and one sheet can be for up to 28 days.

Management Of Burn Patient

First Aid -

(1) Stop the burning process, flames from burning clothing or from burning inflammable

substances on the skin surface should be extinguished by wrapping the patient in a fire

blanket. In electrical burn any live current is to be switched off.

(2) Cooling the burn surface - Immediate cooling of the part should continue for 20

minutes. Irrigation with cold water is useful in chemical burn. Hypothermia should be

avoided , do not use ice or ice water. Ideal temperature of cooling water is 15 o C. The

burn is wrapped in a clean linen and transported to hospital.

Emergency Treatment 

1. A - Airway.2. B - Breathing and ventilation.

3. C - Circulation.4. D - Disability - neurological status.

5. E - Environmental control - keep warm.

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 8/9

6. F - Fluid resuscitation.

In severe facial and neck burn early endotracheal intubation or tracheostomy should be

considered. Early escharotomy is needed in circumferential chest and limb burns whererespiratory or circulatory disturbance is observed. Altered consciousness may due to

carbon monoxide poising. 

For major burns (second and third degree burns)

1. Remove the victim from the burning area, remembering not to put the rescuer indanger.

2. Remove any burning material from the patient.

3. Call 911 or activate the emergency response system in your area if needed.

4. Once the victim is in a safe place, keep them warm and still. Try to wrap the injured

areas in a clean sheet if available. DO NOT use cold water on the victim; this may

drop the body temperature and cause hypothermia.

Burns of the face, hands, and feet should always be considered a significant injury

(although this may exclude sunburn.

For minor burns (first degree burns or second degree burns involving a small area of

the body)

• Gently clean the wound with lukewarm water.

• Though butter has been used as a home remedy, it should NOT be used on any burn.

• Rings, bracelets, and other potentially constricting articles should be removed(edema, or swelling from inflammation may occur and the item may cut into the

skin).

• The burn may be dressed with a topical antibiotic ointment like Bacitracin orNeosporin.

• If there is concern that the burn is deeper and may be second or third degree in

nature, medical care should be accessed.

• Tetanus immunization should be updated if needed.

NURSING MANAGEMENT 

• Soak the burned area in cold water for 10 minutes.

• Gently wash the burn with warm, soapy water. Pat it dry with a clean towel, and

cover it with a clean, dry bandage.

8/14/2019 A Burn is a Type of Injury

http://slidepdf.com/reader/full/a-burn-is-a-type-of-injury 9/9

• You will need to clean the burn and put on new bandages several times a day. Be

sure that everything that touches the burn is clean. Only use the burn medicine

prescribed by your doctor. When changing bandages:

○ Wash your hands well with soap and water. Dry them with a clean towel.

○ Remove the outer bandage by cutting it off with a pair of scissors. Do notpull off the bandage if it is sticking to the burn. Instead, soak it in warm

water for a few minutes and then remove it slowly.

○ Gently wash the burn with warm, soapy water. Use a clean, soft washcloth to

help remove any old cream, blood, and loose skin. Do not break blisters. This

may increase the pain.

○ Rinse the burn with clear warm water. Pat dry with a clean towel.

○ With a clean tongue depressor, apply the antibiotic ointment prescribed by

 your doctor to a gauze pad in a thin layer. Throw the tongue depressor away

when you're done. Do NOT put it back in the container of ointment.○ Cover the burn with the gauze. Be careful not to touch the gauze that comes

in contact with the burn. Carefully rewrap the burn with a clean bandage as

directed by your doctor.

• Keep the bandage clean and dry. Change it if it gets wet.

• If the burn is on your arm or leg, keep it raised or propped up for the first 24hours to help reduce swelling.

• You may use aspirin, acetaminophen, or ibuprofen for pain.

•

Do not bump or overuse the burned area.• Drink plenty of water or juice to prevent dehydration.

Call Your Doctor If...

• You have increasing pain and redness in the burned area or bad-smelling drainagefrom the burn. These are signs of infection.

• You develop a high temperature.

Seek Care Immediately If...

• You develop swelling, numbness, or tingling below a burn on your arm or leg.