Burns and its Managements

Definition

 A burn is a wound characterized by coagulative necrosis of the tissues caused by either thermal, electrical, chemical or radioactive agents.

  

Causes of burns

1. Thermal

Dry heat: Flash, flame, fire, clothes catching fire.

Moist heat: Hot liquids, steam (results in scalds)

Cold heat: Freezing (frost bite), non-freezing

 2. Electrical: Contact with high voltage electrical current. Usually results in cardiac or respiratory arrest

3. Chemical

          ·          Strong acids or base

4. Radiation:

          ·          X-rays, electrons, y rays and sun rays.

Determining Severity of Burns: The morbidity and mortality of the patient is related to

          ·          Surface area

          ·          Depth of burns

          ·          Age

          ·          Location of burnt wound

          ·          Severity of associated injury

Wallace’s Rule of Nine:

          ·          The surface area of burn injury is estimated by rule of nine.

          ·          It was developed by Polaski and Tennision

          ·          It divides the body into 11 areas each constituting of 9% and perineum 1%

          ·          It is divided as follows

Location	Adult	Children	Infants
Head and neck	9%	18%	20%
Front of chest and abdominal wall	9×2= 18%	18%	10×2= 20%
Back of chest and abdominal wall	9×2= 18%	18%	10×2= 20%
Lower limb	18×2= 36%	13.5×2= 27%	10×2= 20%
Upper limb	9×2= 18%	18%	10×2= 20%
Perineum	01%	01%	10×2= 20%
	100%	100%	100%

Fig: Rule of nine (Wallace’s rule of “9”)

Management

Proper assessment and diagnostic procedures must be carried out including bronchoscopy.

i. O2 therapy and analgesics:

          ·          O2 is given in fascial masks (mild cases) and ventilators or tracheostomy in severe cases

          ·          Analgesics is administered for pain relief

ii. Humidification

          ·          Moistening of the gases or air is essential as the function of upper respiratory tract is damaged

          ·          Thus, humidification helps in maintaining adequate air entry

          ·          During inhalation

iii. Intermittent Positive Pressure Breathing (IPPB):

          ·          It helps to maintain a positive pressure in the airways throughout inspiration and then returning back to normal atmospheric pressure during expiration.

          ·          Usually bird or Bennett device is used

iv. Suctioning

          ·          It is very essential to maintain the lung field free of any secretions

          ·          One therapist squeezes and releases AMBU bag and the other therapist performs shaking and vibration to the chest

          ·          Suctioning is done after 6-8 inflation

v. Nebulization

          ·          Bronchodilators are administered by a nebulizer to maintain the airway

          ·          It has to be given 2-3 times a day in early stages

vi. Breathing exercise

          ·          It is of utmost importance in these patient and must be started within few hours of admission

vii. In severe cases tracheostomy is preferred over Endotracheal Tube Intubation (ETI)

viii. Movements of jaw

          ·          Jaw movements must be initiated with the range of pain to prevent stiffness and loss of function

          ·          Jaw opening, losing, protrusion, retraction are taught to the patient

ix. Proper positioning

          ·          Positioning of head and neck must be done to prevent stiffness and contracture

          ·          Rolled towel under the neck-pillow under the shoulder to maintain extension is incorporated.

x. Re-education

          ·          Coughing techniques is taught to remove respiratory secretion

          ·          Spirometry training

          ·          Breathing exercises

          ·          Postural drainage

          ·          Airways clearance techniques