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Burns
OVERVIEW: Burns are tissue injuries caused by heat, chemicals, electricity, or irradiation. The extent of injury (depth of burn) reflects the intensity of heat and the duration of exposure.
SIGNS AND SYMPTOMS: • First-degree burn (superficial layers of the skin)
• Reddening of affected tissue
• Skin blanches with pressure.
• Skin may be tender.
• Second-degree burn (varying degrees of skin, with blister formation)
• Skin is red and blistered.
• Skin is very tender.
• Third-degree burn (destruction of the full thickness of skin and underlying tissues)
• Burned skin is tough and leathery.
• Skin is not tender.
CAUSES: • Open flame and hot liquid (most common )
• Caustic chemicals or acids
• Electricity
• Excess sun exposure
SCOPE: • Between 2 and 5 million Americans receive burns requiring assistance annually. One million people require hospitalization for burn injuries each year, and 12,000 people die.
• Burns are the leading cause of accidental death in children
MOST OFTEN AFFECTED: Burns affect all age groups and both genders in equal proportions.
RISK FACTORS: • Hot water heaters set too high
• Work place exposure to chemicals, electricity, or radiation
• Young children and elderly adults with thin skin are more susceptible to injury.
• Carelessness with burning cigarettes
• Inadequate or faulty electrical wiring
DIAGNOSIS PHYSICAL EXAMINATION: • The Physician will perform a physical examination, measuring the depth of burn and percentage of body surface area affected.
• The Physician will diagnose and treat other associated conditions, such as smoke inhalation.
TESTS AND PROCEDURES: • A number of blood tests may be done to assist in diagnosis and treatment.
• Chest X-ray
• Arterial blood may be obtained to measure blood gasses.
• An electrocardiogram (EKG) may be done to evaluate the heart's activity.
• Urinalysis
• Bronchoscopy may be necessary to evaluate the respiratory tract.
TREATMENT GENERAL MEASURES: • Initiate first aid.
• Remove all rings, watches, etc., from injured extremities to avoid tourniquet effect.
• Remove clothing and cover all burned areas with dry sheet.
• Cool burned skin with water.
• Do not apply ice to burn site.
• Flush area of chemical burn (for approximately 2 hours).
• Serious burns require hospitalization.
• Surgery may be required.
ACTIVITY: Early mobilization is the goal of treatment.
DIET: High-protein, high-calorie diet when bowel function resumes; nasogastric tube feedings may be required in early postburn period.
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Morphine
• Silver sulfadiazine (Silvadene) topically to burn site
• Cimetidine, ranitidine, famotidine, or nizatidine for stress ulcer prevention in severely burned patients
CONTRAINDICATIONS: Specific drug allergies
PRECAUTIONS: N/A
DRUG INTERACTIONS: Read drug product information.
Other Drugs: • Third-degree burn: mafenide (Sulfamylon)
• Silver nitrate 0.5%
• Povidone-iodine (Betadine)
FOLLOW UP PATIENT MONITORING: The Physician should be seen as often as necessary according to the extent of burn and treatment.
PREVENTION/AVOIDANCE: • Use sunscreen when out of doors.
• Keep electrical cords and outlets in the home safe.
• Isolate household chemicals.
• Use low-temperature setting for hot water heater.
• Household smoke detectors with special emphasis on maintenance
• Prepare household evacuation plan.
• Store and use flammable substances properly.
• Skin grafts and healing skin are highly sensitive to sun exposure and heat.
COMPLICATIONS: • Morphine
• Silver sulfadiazine (Silvadene) topically to burn site
• Cimetidine, ranitidine, famotidine, or nizatidine for stress ulcer prevention in severely burned patients
WHAT TO EXPECT: • First-degree burn: complete resolution
• Second-degree burn: healing in 10 to 14 days (deep second-degree burns will probably require skin graft)
• Third-degree burn: skin graft required
• Length of hospital stay and need for intensive care depends on extent of burn, smoke inhalation, and age.
• 50% survival rates: with 62% of body burned in ages 0-14 years, with 63% burn in ages 15-40, with 38% burn in ages 40-65, and with 25% burn in patients over age 65.
• 90% of survivors can be expected to return to work.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: Child abuse should be considered with hot water burns in children.
GERIATRIC: The outcome is poorer for elderly persons with severe burns.
OTHERS: N/A
PREGNANCY: N/A
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