Running head: METHODS OF TREATING BURNS 1

Methods of Treating Burns

Adam King

Brigham Young University-Idaho

NURS 422

Rod Sanders and Linda Ward

June 10, 2018

METHODS OF TREATING BURNS 2

Methods of Treating Burns

Significance of Burn Injuries

Acute burn injuries occur all over the globe, inducing terrible trauma everywhere they

occur. Approximately 330,000 deaths each year can be associated to acute burn injuries (Dang et

al 2015). Many would agree this is a considerable number of deaths. With so many deaths

occurring, it is of high interest for treatments to be sufficient and affordable for the population to

use when needed. In addition to treatment, education and safety precautions are also important in

prevention of these types of injuries as they can be avoided. With proper treatment, education,

and prevention, the deaths caused by acute burn injuries would likely decrease.

Types of Burns

There are numerous ways to get burned, each of which requiring different methods of

treatment to acquire most desired results. Some of the most common types of burns include

thermal burns, chemical burns, and electrical burns. Each of these burns are acquired through

different methods and affect the body in diverse ways. Furthermore, each burn varies in severity

and influences the amount of treatment needed.

Thermal burns are the most prevalent types of burns and involves touching hot objects,

interacting with flames, or boiling liquid. These types of injuries vary greatly as the severity

depends greatly on the temperature of the source of heat and amount of time exposed (Bucher et

al,, 2017). This type of burn is so common and dealt with in hospitals frequently because many

of the sources are everyday household items. These items include gasoline, stovetops, cigarettes,

hot grease and oil, auto parts, and much more. Each of these items very greatly in temperature,

impacting the severity of the burns induced.

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Another primary type of burn injuries is chemical burns. These are caused by contact

with acidic and basic compounds (Bucher et al,, 2017). Chemical burns are also relatively

common because of the association with many items found within the average household. Many

cleaning supplies and disinfectants contain acids and bases that can cause harm. Some people

interact with these chemical agents more often than others, increasing their chance of harm.

These burns can often be particularly difficult to treat as the damage can extend beyond just the

injury site.

Electrical burns also have alterations in treatment options. These burns are caused by

generated heat from electrical current, causing damage to many internal structures including

vessels, nerves, and sometimes even organs (Bucher et al,, 2017). The treatment needed directly

depends on the voltage, duration of electrocution, and location and pathway of electric current.

In addition, the electric current may cause more problems in addition to the burn. For example,

the shock can cause muscle contractions that may fracture bones throughout the body, or even

effect the heart and its pattern. Many sources of electricity can cause these burns such as car

batteries, hot wires within the house, and even lightning. To decide on treatment plans, it must be

determined which parts of the body were affected by the shock.

Overall, each of the types of burn injuries vary greatly, and specified treatment is

required for each affected individual. With acute burn injuries being such a devastating type of

injury that leads to significant mortality rates, it is crucial the interventions are adequate to

promote survival and desired results (Dang et al 2015). Many methods have been tested to find

the best results for treatment.

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Treating Thermal Burns

Understanding treatment of these specific types of burns requires a foundational

understanding of the pathophysiology must be understood. Thermal burns disturb natural

homeostasis by disrupting the balance and distribution of fluids (Dang et al 2015). This

disruption of fluids is caused when the trauma initiates elevated capillary permeability, causing

fluids to leak from circulation and into interstitial space. This ultimately results in fluid loss as

the fluid evaporates. Over time, this can result in decreased cardiac output, harming many other

systems of the body if not treated.

One of the greatest concerns resulting from acute thermal burn injuries is decreased

cardiac output. This can ultimately result in death if adequate fluid amount is not resupplied to

the patient quickly (Dang et al 2015). As fluid is lost and not replenished, the cardiovascular

system loses fluids to pump through the body. This eventually results in collapse of the

cardiovascular system. If the fluid is not replaced and these effects continue to take place, death

can occur. This proves fluid resuscitation to be the most important intervention in treating

thermal burn injuries. Once fluid resuscitation has been initiated, it can help prevent the

devastating effects of fluid loss.

Ideally, treatment is initiated before any additional symptoms can take place in the

patient. The crucial time for treatments to take place is the first 48 hours after injury (Dang et al

2015). After this period has passed, additional damage may have already occurred to the body.

Treatment needs to be initiated as quickly as possible to promote the swift recovery and better

patient outcomes.

There are many formulas to determine the amount of fluid suggested to supply adequate

amount of fluid replacement. A general rule of thumb for fluid required is given by the Parkland
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formula (Boyle, Fahlstrom, & Flynn, 2013). This formula involves estimating the total surface

area of the skin that was burned and compares it to their weight, calculating the estimated fluid

needed. The equation is fairly straight forward and involves monitoring urine output, changing

the supplied fluid as needed. With each patient being different and each hospital having alternate

protocols for fluid replacement therapy, it is hard to say exactly how much each patient will

need.

General Burn Treatment

After initial fluid resuscitation has begun, other aspects of treatment can be started. One

of these crucial treatments involves debridement of the skin, clearing the necrotic tissue from the

patient (McFarland & Smith, 2014). This is a vital process in treatment as necrotic tissue must be

removed to allow room for healthy skin to grow. The process of this treatment often involves

chemical or mechanical elimination of the dead tissues. There are multiple methods of which the

tissue can be removed, each having benefits and disadvantages. For example, mechanical

debridement may remove viable tissue but can be part of routine nursing care. In comparison,

surgical debridement may be more precise but also requires hospital admission and surgery.

There are many more options, such as autolytic, larval therapy, ultrasonic, hydrosurgical, and

sharp treatment. All these options should be considered in treatment when educating patients

about their options for debridement. Some patients will benefit more from certain options, so it

increases the importance of taking each treatment into consideration.

Grafting is also often required to properly heal burn victims’ skin. It provides new skin to

grow when the original skin is too damaged to properly grow back on its own (Rowley-Conwy,

2014). It is hugely beneficial and provides a foundation for new skin to grow. In addition, it
METHODS OF TREATING BURNS 6

provides protection for the damaged layer underneath. Skin grafts don’t come without risks

however, as the tissue may be rejected or even cause infections.

There are more factors to consider when choosing a treatment plan, including pain

management. Any acute burn injury and subsequent treatment it certain to cause pain and should

be minimized whenever possible. There are many aspects that go into controlling pain, including

positioning, pharmacologic interventions, and nonpharmacologic strategies (Gallagher, Kinsella

& Rae, 2000). The positioning should always be taken into consideration to prevent further

damage of viable tissue. This damaged tissue would cause additional pain and delay the healing

process. Along with proper positioning, many drugs can offer relieve to the patient. The provider

can prescribe many medications, including creams and topical agents to help decrease pain.

Intravenous opioids are a common choice in treating pain. In addition to drug therapy in

decreasing pain, many other methods such as electrical stimulation, massage, and hypnosis have

been successfully implemented (Gallagher et al, 2000). Although the common expectation for

treatment is often thought to be just medication, there is much more that can be done than many

people may realize.

An aspect often overlooked is proper dieting and nutrition. One of the most important

things to intake and promote healing is protein (Rowley-Conwy, 2014). Protein promotes

healing, growth, and revascularization of tissue. It is required for the regrowth of tissue and

healing. A rule of thumb for adequate daily intake is about one gram per kilogram of weight.

This amount should be increased when severe burns occur to provide additional material for

healing and restructuring of skin and lower layers when needed.

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Conclusion

In conclusion, there are many types of burns, each of which can require different

treatments. Overall, the treatments follow a general rule of thumb for improved patient

outcomes. These treatments include fluid resuscitation, debridement, pain management, adequate

nutrition, and skin grafting. With each of these treatments implemented properly, patients are

more likely to recover and return to a more optimal level of functioning.

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References

Boyle, C., Fahlstrom, K., Flynn, M. (2013). Implementation of a nurse-driven burn resuscitation

protocol: A quality improvement project. Critical Care Nurse, 33. Retrieved from

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Bucher, L., Harding, M. M., Heitkemper, M. M., Kwong, J., Lewis, S., Roberts, D. (2017).

Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Available

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Dang, Y., Li, W., Li, Y., Luo, Q., Wang, K., Wu, J., Zou, X. (2015). Modeling fluid resuscitation

by formulating infusion rate and urine output in severe thermal burn adult patients: a

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Gallagher, G., Kinsella, J., Rae, CP. (2000). Treatment of pain in severe burns. Am J Clin

Dermatol, 6. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11702609

McFarland, A., Smith, F. (2014). Wound debridement: A clinical update. Nursing Standard, 28.

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Rowley-Conwy, G. (2014). Management of major burns: rehabilitation and recovery. Nursing

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