Phases of Burn Care
Emergent Phase
Begins with the burn injury, assessing severity, initial care and ends when the patient is stable
and begins to diurese and no longer requires fluid therapy.
Acute Phase
Return of fluid from the cells (intracellular fluid) and between the cells (interstitial fluid) to the
intravascular space and continuous care of the wounds to promote grafting, prevent infections,
and promote healing. (Weeks to months).
Rehabilitation Phase
Helping the patient return to previous or optiminal level of functioning. Many aspects of
rehabilitation begins at the time of emergent care and continue through the phases.
Emergent Phase
Stop the burn:
Flames: stop, drop and roll
Chemical: remove
contaminated clothing if not
adhering to skin, rinse with
cool water
*remove all jewelry
*use cool water not ice or
cold water
* do not apply any ointments,
etc.
ABC’s
Estimate burn size:
1. Rule of nines(quick,
use for ages 12 and
older)
2.Lund-Browder
classification(good for all
ages, more accurate)
Brief history: from
patient/family (pre-existing
conditions, allergies, tetanus
vaccination date, details of
Acute Phase
Wound healing:
2 weeks to 18 months
Complications:
Infection
Scarring
Contractures
Topical antimicrobials:
Mafenide acetate
(Sulfamylon acetate)-helps
prevent common infections
seen with burns Staph,
hemolytic strept,
pseudomonas
Silver nitrate:bacteriostatic
and infection preventing
Properties
Povidone-iodine ointment:
broad spectrum of
microbicidal action
Silver sulfadiazine 1%:
(Silvadene) bactericidal can
help inhibit Candida and
Pseudomonas organisms
Rehabilitation
Phase/Period
Can be lengthy and include
further pain, cosmetic
grafting, and reconstruction.
Long-term physical, social,
and psychologic therapy and
financial planning must be
carefully coordinated.
Discharge planning needs:
Emotional-adjustment
Dressings/wound procedures
Jobst garments
Exercise, splinting, ADL’s
Medications
Return visits and phone
numbers if problems occur
Home care or community
agency f/u
accident,
Head-to-toe assessment)
Assessment & Intervention:
Pay special attention to
possible inhalation injuries
(burns on face and around
neck, singed nasal hairs, white
oral mucous membrane
tissue, sooty looking sputum,
hoarseness, etc.)
Fluid Shift to Tissues
(EDEMA):
*damage to capillary system
occurs in the burn area as well
as damage to body cells
causing shifts in water &
electrolytes from the plasma
to the interstitial fluid causing
edema
Burn Shock:
High risk if 15% burn for
adults and 10% burn in
children
Due to fluid shifts causing
decreased circulating
oxygenated blood to body
tissues
S&S: increased pulse initially,
then falling BP, increased
respirations, scant urine
output
*Fluid resuscitation must be
imitated immediately or
damage can occur to the
kidneys and other major life
sustaining organs
Fluid resuscitation:
Many different criteria can be
used as well as many different
fluids (examples: crystalloids,
colloids, glucose)
A Foley catheter is anchored
NPO status maintained
Monitor for fluid shifts to
Surgical Management:
1. Debridement
2. Autograft-from victim
3. Homograft-(allograft)another person,
cadaver or skin growth
from a culture
4. Heterograft(xenograft)- another
animal species (pig)
5. Synthetic grafts
Pressure garments
Nursing Management
I&O
Weight
Positioning
Prevention of infections
Relief
Diet
Supportive care
Emotional care
return to normal with marked
increase in urinary output or
diuresis
~24-48 hours
Diuresis:
Signals end of the emergent
stage
IV fluids are still indicated
Monitor VS, I&O, weight, H&H
levels
GI support:
NG tube is often inserted due
to peristalsis is slowed or
stopped due to the body’s
normal response to stress
Wound Care:
Initially cleansed with
antiseptics and NS (warmed),
sterile technique, analgesics
for pain (morphine sulfate),
avoid IM’s due to poor
absorption in burned tissue,
tetanus toxoid (prophylaxis),
antibiotics
Transfer:
Most emergent care takes
place in the ER, after initial
care patients will be sent to
burn units if indicated , need
to be placed in reverse
isolation (private room)