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Burn, Pthophysiology, Phases of management. - Coggle Diagram
Burn
Definition
Burn is the damage to the tissue caused by the heat, chemicals, radiation and electric current
factors affecting the intensity of burn
duration of the contact
area of body tissue exposed
Thigh
Hair
Temperature of the burning agent
incidence of burn
4 lakhs people suffer from burn, 40,000 gets admitted, 4000 dies in US each year.
Risk factor, children below 4 years and above 65 years elder.n and in winter burn caused by the scald are common, it the burn caused by the wet heat
Etiology of burn
House hazard like, 1 steam, 2 microwave food, 3 hot water above 60 degrees and 4 hot greasely oil.
Occupational hazard 1. electricity, 2 steam pipes 3 chemicals and 4 hot metals
Classification of burn
Based on the causative factor
chemical burn....it is caused by the acid, alkali and the organic compounds. the one caused by the alkali is difficult to manage because the body tissue takes time to get neutralize with the alkali. and it adheres to the tissue causing protein hydrolysis: industrial cleanser, fertilizer and drain cleaner. the most common being the phenol chemical disinfectant and the petroleum the teh gasoline. And the acid that involve the house hazard.... hydrochloric, hydro fluoric adn teh oxalic acid.
electric burn: it teh burn caused byt eh electric currnt. the body provides resistance that ranges. they are the bone and the muscle that has the high resistance and the nerves and blood vessle that has the low resistance, if the current enters through teh vital iorgans then life threntening manifestation can occur, the risk factor associated here are: shock, dysarrthymia, cardiac arrest and severe acidic metabolisis. it requires a close observation for 72 hours as the cardiac disarrthymia can occur without teh warning
Cold thermal burn... example the frost bite which can lead to lack of circulation leading to necrosis
Smoking and inhalation: it is caused by smoking or the inhalation of the hot air and the noxious chemicals. it mainly affects the URT because as it reaches the LRT it tends to drop its temp to normal and further more, the defense mechanism is provided byt eh glottis and the vocal cords. TEH RISK FACTOR ARE cARBONmonoxide poisioning due to teh incomplete combustion of the burnig material, teh oxygen gets replaced with the CO due to leads to carbooxyhaemoglobinimia adn hypoxia, occurs with 20 percent accumulation in the body.in severe cases the chrerry red skin is shown. the above glottis ,ailly the OROPAYRNX AND LARYNX. the redness and edema is seen which can obstruct the airway therefore emergency case adn critical care. the below teh glotis mainly sue to teh chemicals, thsi causes thePulmonary edema, that leads to no sign and symtoms but direct to ARDS.
thermal burn....Thermal burn is the most common type of burn. it is the burn that are caused by any burning agent. it can be a dry or a wet burn. example: flame or the hot water above 60 degree Celsius
Degree of burn
Partial thickness burn. it occurs in the superficial surface in the epidermis and the dermis. and epithelization occurs due to which the grafting process is not needed.
1 degree: Red, mild swelling, no second spacing, pain
2 degree, presence of 2 spacing, red, wet wound adn pain
Full thickness burn
occurs to the subcutaneous layer. where the healing takes time and grafting is required.
Based inteh extend of burn.... it is through the calculation of teh TBSA using the Lund browder and the rule of nine. Lund browder more prominent because it considers teh age, size and the body area, the rule of nine to be used only during the initail assessment
Lund browder: 7,7,2,13,13,4,3,2.5,4,3,2.5,9.5,9.5,7,7,3.5,3.5.1, 2.5,2.5
rULE OF NINE: 4.5, 4.5, 18, 18, 4,5,4.5, 9,9,1
Assessmetn of the burn
Types of burn
Degree of burn
location of burn. 1. chest and neck area: Respiratory status access. 2. circumferential area: Risk of infection, lack of circulation and nerve innervation 3. Exterity; carry teh self care activity to prevemt self care deficit. 4. int he ears and nose: withe the presence of teh collagen the circulation do not occur so change the treatment and also healing will take time.
majorly it will cause the compartment syndrome
Extend of burn
Risk factor......age, comorbidities, diabetic and peripheral vascular disease because it delay teh healing process causes infection and also obstruct teh circulation
Clinical manifestation.
partial thickness burn: 1 degree, pain, no second spacing, mild swelling and redmess
the 2 degree: secong spacing, fliud filled blister, redness and wet womud adn pain due to complete nerve damage.
the full thickness burn: involves 6 points.
dry and flaky, 2 eshar, no blister, hypothermia and shivering due to the insensible evaporation 5. no pain as teh nerve are completely destroyed adn 6 is the tendons and teh bones can be visibel.
Vital: BP decrease, heart rate increase and feeble pulse and VF, and dysarthymia
GI : Illeus where no bowel sound and movements. aute stage: hypovolemia and shock in the later aft 72 hours there would be sepsis
Renal: ARF , ATN
hyponatrimia: WATER INTOXICATIO LEADING WITH TRACHYCARDIA, DIZZINESS AND HEADACHE and fever
Hyperkalemia. : cause teh disarrthymai therefore have ECG
check teh respiratory status., IV and the RCS and the oxygen CONC
Complication
CVS: Hyperkalemia, VF, CD, abd hypovloemic shock leading to cardio genic shocha nd reduced in teh microcirculatuion with increase int eh hemocrit level
Resp"
Above the glottis: early intubation required withion 1-2 hrs after the post burn period to prevent tracheostomy. and extubation with in 3-6 days or once the edema is decreased. after intubation place patient in the ventilation with the PEEP:alveolian dprogressive and maintain the fowler position. below the glottis teh fibrotic bronchoscopy is done to examine teh damage to LTS.
GI: Illeus
Renal: ARF, ATN
Pthophysiology
fluid and electrolyte shift: leads to the teh hypovolemic shock. how. within the first 20 min of th post burn there will be massive dilatation of teh vessles adn the capillaries increasing its permeability, causing teh protein molecule to excreate in to the intestial space noe the protein molecule maintian the osmolarity int eh vessle so when it moves iout teh fliud wioll also move out which further leads to decrese osmolarity that would cause the massiver fluid to dshift to teh inteeeeeeeeestial. thsi lead sto the second spaving: accumuklation of fluid int he intestial soace. and 3 spacinh: it occurs as teh fliud accumulated int eh intestial fluid goes to teh no or minim,al flukd area.
Insensible fluid loss due to evaporation: 30-50 ml of fluid is loss causing decrease bp increase hr, feeble pulse and hypovolemic shock
Impaired circulatory status: Hemolysis IS THE BREAK DOWN OF RBC THEREFORE IT WILL NO LONGER CARRY THE OXYGEN BECOMMJNG A FREE RADICLE THEREFORE BECOMMing a further insult to teh burn poccurs.as it forms thrombud adn thrombossis takes palce.thn the plasma from teh rbs moves to the intestitial space adn the circulatory rbc is further decreas. this causes teh increase hematocit, decrease micro circulation adn leads to teh increase viscosity.....blood trasfusion and fluid resuscitation.
Major sodium and potassium shift. sodium is the extra ans k intra.....teh sodium will move from the cell into teh intestial fliud which will cause the fluid from the cell to move out as well. this is going to cause the kidney to not recive fluid fromteh cell adn blood vessles causeing the ATN and ARF
Immune response is present but it is compromised.; DUE TO the damage adn destrution to the skin barrier and Decrease wbc and decrese immuloglobulin adn due to the bone marrow depletion
Phases of management.
Pre hospital care phase and the emergent phase..... and the emergent pahse. .....resuscitatio and the wound healing the rehabilation phase.
PRE 1. remove the patient from the scene adn stop teh burning process. prevent the resurer from getiing injured. fro the electricla burn use the non conducting material. small thermalt burn where the TBSA is less than 10 percent. to prevent eh further buring of the tissue.
large.... ABC
Hypovolemic ;