escribe the phases of burn management. Phase of Burn Management & Typical Time Period Pathophysiology Clinical Manifestations Complications/Interventions Emergent Acute Rehabilitation
Describe the phases of burn management.
| Phase of Burn Management & Typical Time Period |
Pathophysiology | Clinical Manifestations | Complications/Interventions |
| Emergent | |||
| Acute | |||
| Rehabilitation |
DEFINITION-"BURN is defined as the break down in the continuity of the skin due to effect of radiation, chemical, electric current, or heat".
TYPES OF BURN:-1.Thermal Burns 2.Chemical burns 3.Electrical Burns 4. Smoke and inhalation Burns.
PHASES of Burn Management according to typical time period are as follows:-
1.Emergent phase
2.Acute phase
3.Rehabilitation phase
EMERGENT PHASE:-The Emergent or Resuscitative phase is the time period required to resolve immediately, if not do so then life threatening problems resulting from the burn injury.
-Typical time period of this phase is 72 hours, that means this phase usually lasts upto 72 hours from the time the burn occurred.
MANAGEMENT OF EMERGENT PHASE INCLUDES THE FOLLOWING:-
1.Airway Management, 2. Fluid Therapy, 3.Wound Care, 4. Pain and Anxiety Relief, 5.Physical and Occupational Therapy, 6. Nutritional Therapy, 7.Respiratory Therapy, 8.Psychosocial Care.
1.AIRWAY MANAGEMENT:- It involves early Endotracheal (preferably Orotracheal) Intubation.
Early Intubation removes the need for emergency tracheotomy after respiratory problems become apparent.
The patient with burn to the face and neck requires intubation within 1-2 hours after injury.
After intubation patient is placed on ventilatory support, with the oxygen concentration based on ABG values.
Extubation may be indicated when the edema resolves usually,3-6 days after burn injury, unless severe inhalation injury exist.
In severe respiratory distress (e.g.Hoarseness, shortness of breath) develops intubation and mechanical ventilation are started. . PEEP may be used to prevent collapse of alveoli and progressive respiratory failure.
Bronchodilators may be given to treat the severe Bronchospasm.
CO poisoning is treated by administering 100% O2 until Carboxyhemoglobin level returns to normal.
2.FLUID THERAPY:- * Assess fluid need.
*Begin IV fluid replacement with RL ( Ringer lactate) solution.
*Insert indwelling urinary catheter.
*Monitor urine output, and also prepare intake output record in I/O chart.
3.WOUND CARE:- * Start daily shower and wound care.
*debride as necessary.
*Assess extent and depth of wound.
*Administer Tetanus toxoid or Tetanus Antitoxin.
4.PAIN AND ANXIETY RELIEF:- *Assess the intensity of pain and anxiety level.
*Administer Analgesics like Morphine to relieve pain.
*Administer Sedatives and Hypnotics like Lorazepam to relieve anxiety.
5.PHYSICAL AND OCCUPATIONAL THERAPY:- *Place the patient in position that prevent formation of Contracture and reduce edema.
*Assess the need for Splints.
6.NUTRITIONAL THERAPY:- * Assess the nutritional needs and begin feeding the patient with most appropriate route as soon as possible.
7.RESPIRATORY THERAPY:- * Assess Oxygenation needs. * Provide Supplemental Oxygen as Needed.
*Intubate the patient if necessary.
* Monitor Respiratory status of patient closely.
8.PSYCHOSOCIAL CARE:- Provide support to patient and caregiver during initial crisis phase.
MANAGEMENT OF ACUTE PHASE OF BURN INVOLVES FOLLOWING:-
The major therapeutic interventions in the acute phase are 1. Wound care, 2. Excision and grafting,3. Pain management, 4. Physical and Occupational therapy, 5.Nutritional therapy.
WOUND CARE:- THE Goals of wound care is To :- 1. Prevent infection by cleaning and Debriding the area of necrotic tissue.
2. Promote wound re- epithelisation and successful skin grafting.
EXCISION AND GRAFTING:-During the procedure, devitalised tissue (eschar) is excised down to the subcutaneous tissue or fascia, depending upon the degree of injury.
To decrease the surgical blood loss topical application of Epinephrine or Thrombin, injection of saline and Epinephrine, is used.
Once the Hemostasis is achieved, a graft is then placed on the clean, viable tissue to achieve good adherence.
Whenever possible the freshly excised wound is covered with Autograft.
With early excision, function is restored and scar tissue formation is minimised.
PAIN MANAGEMENT:- *Administration of Analgesics like Morphine is needed to relieve pain.
PHYSICAL AND OCCUPATIONAL THERAPY:- * It is essential to regain muscle strength and optimal joint function.
Maintain the Occupational therapy schedule for wearing custom- fitted Splints, which are designed to keep the joints in functional position.
NUTRITIONAL THERAPY:- THE goal is to provide adequate Calories and Protein to promote healing.
Antioxidants are preferred like Selenium,, Vitamin E, Ascorbic acid, Zinc,and Multivitamins.
Record Patient daily calorie intake by using Calorie count Sheets.
MANAGEMENT OF REHABILITATIVE PHASE:- the formal Rehabilitation phase begins when the patients wound have healed and he or she is engaging in some level of self care.
Goals of this Phase is To:- 1. Work towards resuming functional role in society.
2. Rehabilitate from any functional and cosmetic postburn Reconstructive surgery.
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