BURNS

B – BREATHING - Keep the airway open. Facial burns singed nasal hair hoarseness;
sooty sputum, bloody sputum and labored respiration indicate
TROUBLE.

U – URINE OUTPUT – in adult the normal urine output should be 30 to 70 cc per hour,
in child 20 to 50 cc per hour and in infant 10 to 20 cc per hour.
Watch for the potassium to keep it between 3.5 – 5.0
mEq/L.Keep the CVP around 12 water pressures.

R – RESUCITATION OF FLUID – Salt and electrolyte solution are essential over the
first 24 hours. Maintain the BP at 90 to 100 systolic.
One half of the fluid for the first 24 hours should be
administered over the first 8-hour period, then the
remainder is administered over the next 16 hours.
First 24 hour calculation starts at the time of injury.

N – NUTRITION –Protein and calories are components of the diet. Supplemental gastric
tube feedings or hyperalimentation may be used in clients with large
burns area. Daily weights will assist in evaluating the nutritional
needs.

S – SHOCK – Watch for the BP, CVP and the renal function and silvadene for the
infection.

BURNS

E- 1st degree – sunburns –reddish brownish and painful

D- 2nd degree-partial part skin is a swollen and intact, and vesicles
S – 3rd degree – red, brown and white –no pain – white

TBSA
1. Rule of nines – system assign percentage in multiple of nine to major body
surface
2. Lund and Browder – more precise method by estimating the extent of burn which
recognize the percentage of TBSA of various anatomic parts
3. Palm Method – estimate the percentage of a burns in patient with scattered burns

Major burns or area of concerned

1. Face neck and chest – may inhale a smoke –inhaled heat –respiratory
complication
2. Hands and feet –distal part – poor blood supply – contractures
3. Perineum – Elimination is affected
First Aide
1. Stop the effect of the heat – irrigate the burns
 2. Stop drop and roll over
3. RACE
Complication/ Stages
1. Shock –primary neurogenic
- ANS fails to response to stress – pain – neurogenic shock
- Failure of the vasoconstrictor mechanism resulting to shock

2. Fluid Loss /Fluid Mobilization

- Oliguric –dilation of the blood volume –shifting of the body fluid
- Blister due to capillary dilatation and increase permeability lead to plasma
loss
- Hematocrit-sodium shifting –hyponatremia- decrease blood volume
- Concentration of the hematocrit –increase sodium –decrease potassium –
decrease amount of the bicarbonate.
Management
a. Replace fluid
b. Give the Pain reliever
c. Inspect the Foley catheter – monitoring of the I and O –
check 30 to 60 cc/hour
d. Fluid – Plain Lr and isotonic – observe for the cardiac
overloading
e. Cradle bed –put the top sheet over the bed cradle-avoid
touching the legs
f. Monitor for the hyperkalemia – potassium escapes out of
the cell during massive tissue injury

3. Fluid remobilization /Tissue sloughing

- Infection – after 3 days to 1 week
1. Place patient in reverse isolation
2. Sterile linens
3. Surgical hand washing
4. Sterile gown
- Most common colonizer of the wound-pseudomonas-hospital acquired
- Dressing application of topical antibacterial
- Drugs –sofamylon (meferide acetate)
- 1st stages –rehab –contractures, eschar –thickening of the tissues
- debridement –a process of removing non living tissues