TOMAS DEL ROSARIOCOLLEGENCM 106 BURN Submitted to:Prof. Teresa Dela TorreSubmitted by:Reynaldo M. Van!on "r.BSN IVI.DescriptionA burn is a type of injury to the skin caused by heat, electricity, chemicals, light, radiation or friction. Most burns only affect the skin (epidermal tissue and dermis). Rarely deeper tissues, such as muscle, bone, and blood vessels can also be injured. Managing burns is important because they are common, painful and can result in disfiguring and disabling scarring. Burns can be complicated by shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress. arge burns can be fatal, but modern treatments, developed in the last !" years, have significantly improved the prognosis of such burns,especially in children and young adults #he anatomy of the skin is comple$, and there are many structures %ithin the layers of the skin. #here are three layers&'. (pidermis, the outer layer of the skin ). *ermis, made up of collagen and elastic fibers and %here nerves, blood vessels, s%eat glands, and hair follicles reside.+. ,ypodermis or subcutaneous tissue, %here larger blood vessels and nerves are located. #his is the layer of tissue that is most important in temperature regulation.#he amount of damage that a burn can cause depends upon its location, its depth, and ho% much body surface area that it involves.II.PathophysiologyBurns are caused by a transfer of energy from a heat source to the body. ,eat may be transferred through conduction or electromagnetic radiation. Burns are categori-ed as thermal (%hich includes electrical burns),radiation, or chemical. #issue destruction results from coagulation, protein denaturation, or ioni-ation ofcellular contents. #he skin and the mucosa of the upper air%ays are the sites of tissue destruction. *eep tissues, including the viscera, can be damaged by electrical burns or through prolonged contact %ith a heat source. *isruption of the skin can lead to increased fluid loss, infection, hypothermia, scarring, compromised immunity, and changes in function, appearance, and body image. #he depth of the injury depends on the temperature of the burning agent and the duration of contact %ith the agent. .or e$ample, inthe case of scald burns in adults, ' second of contact %ith hot tap %ater at !/.01 may result in a burn that destroys both the epidermisand the dermis , causing a full thickness (third2degree) injury. .ifteen seconds of e$posure to hot %ater at 3!.'45 1 results in a similar full2thickness injury. #emperatures less than '''. are tolerated for long periods %ithout injury.Classification of Burns:By degree First-degree burns are usually limited to redness (erythema), a %hite pla6ue and minor pain at the site of injury. #hese burns involve only the epidermis. Most sunburns can be included as first2degree burns. Second-degree burns manifest as erythema %ith superficial blistering of the skin, and can involvemore or less pain depending on the level of nerve involvement. 7econd2degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer. *eep dermal burns usually take more than three %eeks to heal and should be seen by a surgeon familiar %ith burn care, because in some people very bad hypertrophic scarring can result. Burns that re6uire more than three %eeks to heal are often e$cised and skin grafted for best result. Third-degree burns occur %hen the epidermis is lost %ith damage to the subcutaneous tissue. Burn victims %ill e$hibit charring and e$treme damage of the epidermis, and sometimes hard eschar %ill be present. #hird2degree burns result in scarring and victims %ill also e$hibit the loss of hair shafts and keratin. #hese burns may re6uire grafting. #hese burns are not painful, as all the nerves have been damaged by the burn and are not sending pain signals8 ho%ever, all third2degree burns are surrounded by first and second2degree burns. Other classifications A ne%er classification of 97uperficial #hickness9, 9:artial #hickness9 (%hich is divided into superficial and deep categories) and 9.ull #hickness9 relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.ST!"S OF B#$%S: &ypo'ole(ic state - begins at the onset of burn and lasts for the first ;/ hours 2 :rotein loss 2 hypoproteninemia ,emoconcentration 2 ,ct increases o% blood volume, oliguria ,yponatremia 2 loss of sodium %ith fluid ,yperkalemia 2 damaged cells release ?, oliguria Metabolic acidosis Diuretic Stage - begins ;/ 2 + loss in urine, increase in fat metabolismIII.Signs ) Sy(pto(s#he symptoms of burns could be summed up in t%o parts. Minor and severe burns. Minor burns are painfuland cause reddening and blistering of the skin %hile severe burns are painless causes %hite or charred area.First-degree burns are mild and injure only the outer layer of skin. #he skin becomes red, but %ill turn %hite %hen touched. #he area may also be painful to the touch.Second-degree burns are deeper, more severe, and very painful. Blisters may form on the burned area. #his type of burn takes about ) %eeks to heal.Third-degree burns are the deepest and most serious kind. #he skin becomes %hite and leathery, but it does not feel very tender %hen touched.Burns %ith a 9sock9 or 9glove2like9 appearance on hands or feet and 9doughnut9 shaped burns on the buttocks. #hese types of burns are usually caused by either dipping or forcing the child to sit in scalding li6uid.Burns %hich leave a pattern outlining the object %hich %as used to make the burn such as an iron, electric burner, heater or fireplace tool8 Burns caused by rope friction, usually found on legs, arms, neck or torso as the result of having been tied up.Significance of the a(ount of body area burned=n 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. #he *$ule of %ines* is often used, though this measurement is adjusted for infants and children. #his calculation is based upon the fact that the surface area of the follo%ing parts of an adult body each correspond to appro$imately 0@ of total (and the total body area of '""@ is achieved)& ,ead A 0@ 1hest (front) A 0@ Abdomen (front) A 0@ BpperCmidClo% back and buttocks A '/@ (ach arm A 0@ (ach palm A '@ Droin A '@ (ach leg A '/@ total (front A 0@, back A 0@) As an e$ample, if both legs ('/@ $ ) A +!@), the groin ('@) and the front chest and abdomen %ere burned,this %ould involve 33@ of the body. I+.%ursing ,anage(entAir%ay , Breathing and 1irculationAlthough the local effects of a burn are the most evident, the systemic effects pose a greater threat to life. #herefore, it is important to remember the AB1s of all trauma care during the early postburn period&EAir%ayEBreathingE1irculation8 cervical spine immobili-ation for patients %ith high2voltage electrical injuries and if indicated for other injuries8 cardiac monitoring for patients %ith all electrical injuries for at least ); hours after cessation of dysrhythmia#he circulatory system must also be assessed 6uickly. Apical pulse and blood pressure are monitored fre6uently. #achycardia and slight hypotension are e$pected soon after the burn. #he neurologic status is assessed 6uickly in the patient %ith e$tensive burns. >ften the burn patient is a%ake and alert initially, and vital information can be obtained at that time. A secondary head2to2toe survey of the patient is carried outto identify other potentially life2threatening injuries.+.,edical ,anage(ent,anage(ent of fluid loss and shoc-Fe$t to handling respiratory difficulties, the most urgent need is preventing irreversible shock by replacing lost fluids and electrolytes. As mentioned previously, survival of burn victims depends on ade6uate fluid resuscitation. #able 3utput totals of +" to 3" mChour have been used as goals. >ther indicators of ade6uate fluid replacement are a systolic blood pressure e$ceeding '"" mm ,g andCor a pulse rate less than ''"Cminute.+I.Surgical ,anage(ent