treatment modalities for burn patients -...
TRANSCRIPT
Treatment Modalities for Burn Patients
Antoinette Lozano, BSN, RN, CCRNChrista Woodley, BSN, RN, MBA
DISCLAIMER
No disclosures
Photos in presentation of actual burn injuries
Products shown in this presentation are not products we endorse; these products are available at our institution
2Treatment Modalities for Burn Patients
PURPOSE
This presentation will provide an overview of care of the burn patient, including determining level of care required for the injury and how to begin resuscitation protocols.
3Treatment Modalities for Burn Patients
OBJECTIVES
At the end of the session, the attendee will be able to:
Discuss initial care of the burn patient
Classify depth of injury & assess total body surface area (TBSA) affected
Implement fluid resuscitation formulas
Apply American Burn Association (ABA) guidelines to determine appropriate placement of the burn patient
4Treatment Modalities for Burn Patients
SKIN
Largest organ
Functions
Anatomy
Epidermis
Dermis
5Treatment Modalities for Burn Patients
BURN PATHOPYSIOLOGY
Tissue damage
Inflammation cascade
Increased vascular permeability
Increased SVR
Decreased cardiac output
Hypermetabolic state
Catabolic
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TYPE OF BURN INJURIES
Thermal
Scald –water/greaseFlame- fire/flashContact
Electrical
Chemical
Inhalation
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SCALD BURN
Line of demarcation
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FLAME BURN
9Treatment Modalities for Burn Patients
CONTACT BURN
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ELECTRICAL INJURY
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CHEMICAL BURN
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ASSESSING WOUND DEPTH
Superficial Partial FullImage retrieved from: www.gpianatomicals.com
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SUPERFICIAL (1ST DEGREE)
Superficial: epidermis only
Pink, painful, no blisters or open areas
Do not count in TBSA
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PARTIAL THICKNESS (2ND DEGREE)
Partial: epidermis and dermis
Pink, moist, blistered/open
Superficial to deep – blanching?
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Pre -Debridement Post- Debridement
FULL THICKNESS (3RD AND 4TH DEGREE)
Full: beyond dermis
White/black/dry
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ASSESSING % TBSA
Add up affected area (not including superficial burns)
Rule of 9’s
Lund & Browder
Palmar Method
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ASSESSING % TBSA
Rule of 9’s: adult and pediatric
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ASSESSING % TBSA
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Lund & Browder
ASSESSING % TBSA
Palmar Method
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FLUID RESUSCITATION
Use lactated ringers
Greater than 15%, dehydrated, intoxicated, inhalation, electrical
Consensus formula
2-4ml x TBSA x weight in kilograms = 24 hour total fluid goal
1st half given over 8 hours (from time of injury), 2nd half over next 16 hours
Urine output guides fluid titration
Adult: 0.5ml/kg/hourPediatric: 1ml/kg/hour
21Treatment Modalities for Burn Patients
When a burn patient rolls in…
Remember*
Burns can be visually intimidating…Don’t get caught up in the burn –Think ABC’s first
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PRIMARY SURVEY
A: Airway & c-spine
Intubate? Swelling peaks in 12 hours
B: Breathing
C: Circulation
D: Disability
E: Expose
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SECONDARY SURVEY
F: Focused adjuncts
G: Give comfort
IV pain medications
H: Head to toe assessment & History
I: Inspect posterior
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DECISION TIME:
TRANSFER, KEEP, OR DISCHARGE?
AMERICAN BURN ASSOCIATION (ABA) BURN REFERRAL CRITERIA
Partial thickness > 10% TBSA
Full thickness burns
Burns of face, hands, feet, genitalia, perineum, major joints, circumferential
Electrical, chemical, inhalational injury
Patients with co-morbidities, psychosocial, rehab issues that could affect treatment
Burns/trauma where patients where burn injury is most concerning – stabilize first
Pediatric patients in a non-pediatric setting
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TRANSFER TO NEAREST BURN CENTERList of ABA verified burn centers by state is available at www.Ameriburn.Org
Contact burn center with following info:
Patient name, age, DOB
Past medical/surgical history, allergies, home medications, tetanus status
Date, time, location, cause of injury
Estimated TBSA, weight, which areas are burned
Current condition, including vital signs
Lines, access
Treatments (home, EMS, ED)
Amount & type of IVF given
REMEMBER:
CLEAN, DRY DRESSINGS (GAUZE, LINEN): do not wash, debride, or apply any medication to the wounds
IV pain meds
Start fluid resuscitation
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POTENTIAL BURN COMPLICATIONS
Neuro
Cardiac
Pulmonary
GI/GU
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BURN CENTER TREATMENT PRACTICES
Shave any hair in the wound
Debride dead tissue/blisters except for palms/soles (aspirate)
Take photos
Dressing changes twice a day
Silvadene: open areas, not for sulfa allergy or pregnant patients
Sulfamylon: full thickness, cartilage
Bacitracin/polysporin : lips
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WOUND DEBRIDEMENT
• Https://www.youtube.com/watch?v=YcW4oZyeuZg
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Pre Debridement Pre Debridement Post Debridement Post Debridement
SURGICAL INTERVENTIONS
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Biobrane
SURGICAL INTERVENTIONS
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Autograft
Mesh graft Sheet graft
SURGICAL INTERVENTIONS
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Donor site
SURGIAL INTERVENTIONS
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Allograft
SURGICAL INTERVENTIONS
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Escharotomy/Fasciotomy
QUESTIONS?