Definition of Burn
An injury caused by exposure to heat or flame
Classifications of Burn
According to Extent of Burn
• Various methods are used to estimate Total Body Surface Area (TBSA)
affected by burns such as Rule of Nine, Lund and Browder Method
and Palmer Method.
Note
Total body surface area (TBSA)
- is an assessment measure of burns of the skin
Body Surface Area Estimation
RULE OF NINES
• An estimation of the TBSA
involved in a burn is simplified
by using the rule of nine
• The rule of nines is a quick way
to calculate the extent of burns.
The system assigns percentages
in multiples of nine to major
body surfaces.
LUND AND BROWDER METHOD
A more precise method of estimating the
extent of a burn is the Lund and Browder
method, which recognizes that the
percentage of TBSA of various anatomic
parts, especially the head and
legs, and changes with growth.
By dividing the body into very
small areas and providing an estimate of
the proportion of TBSA accounted for by
such body parts, one can obtain a reliable
estimate of the TBSA burned.
PALMAR METHOD
In patients with scattered burns, a
method to estimate the percentage
of burn is the palmer method.
Management of Burn Injury
Three Phases of Care:
1.Emergent/resuscitative phase
2.Acute/intermediate phase
3.Rehabilitation phase.
1.Emergent/resuscitative phase
First Aid
a) Stop, drop, cover wound and roll if on fire
b) Establish an airway
c)
Supply O2
d) IV line
Fluid Resuscitation Formula
• The following example illustrates use of ParkLand/Baxter Formula
4 ml x Kg body weight x % TSBA
Day 1: Half to be given in first 8 hours
Half to be given over next 16 hours
Day 2: Varies, Colloid(volume expander) is added
Example:
in 70 kg patient with 50% TBSA burn:
 4 ml /kg/%TBSA
 4ml x 70 kg x 50% =14,000 ml/ 24 hours
 Plan to administer: first 8 hours= 7000 ml, and next 16 hours= 7000 ml
NURSING ALERT
•
Formulas are only a guide. The patient’s response, evidenced by heart rate, blood pressure, and urine output, is the primary
determinant of actual fluid therapy and must be assessed at least hourly. Patient outcomes are improved by optimal fluid
resuscitation.
Nursing Management
•
Aseptic management of the burn wounds
•
Invasive lines continues
•
Monitors vital signs frequently.
•
Respiratory status is monitored closely, and apical, carotid, and femoral pulses
•
Cardiac monitoring(cardiac disease, electrical injury,or respiratory conditions.
Burn Wound Care
• Wound Cleaning
• Topical antibacterial therapy
• Wound dressing
• Wound debridement