Transcript Advanced Burn Life Support Course Pathphysiology of Burns

Advanced Burn Life Support Course
General Course Objectives and
Describtion
Dr. Aidad Abu Elsoud Alkaisi
BA law, RN, BSc, MSc, PhD
Specialist in Intensive Care Nursing,
Anaesthetic Nursing & Nursing Education
GENERAL COURSE OBJECTIVES:
The quality of care during the first
hours after a burn injury has a major
impact on long-term outcome.
Yet most initial burn care is provided
outside of the burn center environment.
The Advanced Burn Life Support (ABLS)
Pre-Hospital Course is a course designed to
provide paramedics, transport teams and
emergency care personnel with the skills
and information that will enable them to
assess and stabilize the burn patient at the
scene of an emergency in preparation for
transport to the nearest appropriate
emergency facility.
The course addresses:
Scene Management (medical control,
scene safety, and multiple casualties;
the Psychophysiology of Burns;
Initial Assessment and Management (general
patient care and stabilization and
transportation);
Burn Injury Types (inhale- don, chemical,
and electrical);
Pediatric Burn Patients; and
Special Burn Situations:
pregnancy,
hypothermia, and
radiation injury.
The objectives of the course are to provide
the student with the knowledge and
information required to:
Identify potential danger to the prehospital provider, patient or
bystanders at the emergency scene.
Identify the role of medical control
in managing the burn patient in the
pre-hospital setting.
The objectives of the course are to provide
the student with the knowledge and
information required to:
Determine the magnitude and severity of a
burn injury.
• Identify and establish priorities of emergency
care in the pre-hospital setting.
Identify criteria to be used in establishing
priorities of care and evacuation in multiple
casualty or disaster situations.
Provide initial pre-hospital treatment and
stabilization for a burn victim.
COURSE DESCRIPTION
Burn injuries occur in the home, in industry and in
recreational environments.
The physiologic response to burn injury is complex.
Smoke injuries present a challenge requiring early
identification.
Threatened airway and pulmonary function demand
appropriate resuscitative measures.
Chemical and electric injuries present unique
challenges to the entire medical team.
Summary
The management of a seriously burned patient in
the first few hours post-injury can of significantly
affect the long-term outcome.
Therefore, it is important that the patient be
managed properly in the early hours after injury.
All aspects of the Pre-Hospital ABI.S Course have
been designed to provide pre-hospital personnel and
transport team with sufficient knowledge to meet
the challenges of immediate care of patients with
burn injuries.
Local medical protocols should be followed and
medical control consulted by all pre-hospital
providers, in any burn injury.
Advanced Burn Life Support Course
Pathphysiology of Burns
Dr. Aidad Abu Elsoud Alkaisi
BA law, RN, BSc, MSc, PhD
Specialist in Intensive Care Nursing,
Anaesthetic Nursing & Nursing
Education
Objectives:
Upon completion of this topic, the
participants did be able to:
Discuss the pathphysiology of burn injures.
describe the hemodynamic changes that occur
in the patient with burn injuries.
Describe signs and symptoms of the
compromised circulatory system.
Determine severity of burn injuries
Introductions
The treatment of other life- and limb threatening injuries always takes precedence
(status established in order of importance or
urgency) over the treatment of the burn wound
per se.
Attention is directed to the burn wound only
after -saving support of other organ systems
has begun.
the burn patient's outcome depends on the
effective treatment and ultimate healing of
the burn wound.
Furthermore , the severity of the
patient's multiple-system response to
injury the likelihood of complication
and the ultimate outcome are all
intimately linked to the extent of the
burn wound and to its successful
management.
II. ANATOMY AND physiology
oF THE SKIN:
A. Skin structure
Skin the largest organ of the body, is
composed of two layers:
Epidermis
Dermis:
1. Epidermis
The outermost layer; serves as the body's first
line of defense against injury and infection.
The outer layer of the epidermis is a non-viable,
hardened cell layer, which is continuously
shedding.
The deeper layers of the epidermis are living
cells which are constantly undergoing change
leading to desquamation or shedding.‫تقشر أو ذرف‬
2. Dermis:
The dermal (deep) layer of the skin is a
highly elastic structure made of connective
tissue which supports nerve and is blood
vessels, sweat glands, hair follicles and
sebaceous glands.
The nerve endings in the dermis provide a
sense of touch temperature, pressure and
pain.
2. Dermis:
The blood vessels transport oxygen and
nutrients to the skin and remove carbon
dioxide and metabolic waste products.
The sweat glands produce a secretion which
contains water and electrolytes and
participates in temperature regulation.
The dermis is supported by underling
subcutaneous tissue, which is a layer of fatty
tissue sparsely supplied by blood vessels
ANATOMY & PHYSIOLOGY
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B. skin Function
The skin functions to protect the underlying
tissue from injures caused by temperature
fluctuation, Physical impact, chemical or thermal
Injuries, and infection.
l. Enhances heat loss when core body
temperature rises
2. Reduces heat loss when core body
temperature falls
3. Prevents excessive water loss that may lead
to dehydration
4. Serves as a sensory organ guarding against
damage from heat or cold
II. Physiologic Impact or
BURN INJURIES:
The physiologic response to burn injuries is
largely determined by the depth and extent of
the burn. Age is also an important factor in the
severity of the burn.
factors, including associated injuries preexisting
medical illness, and burns involving special areas
of the body, such as the face, hands, feet, major
joints or genitalia, influence treatment needs and
may have an adverse influence on patient outcome.
The severity of the injury is
determined by the extent of the
body surface involved and the depth
of the burn.
The depth of the injury is a function
of the temperature and the length of
exposure
A. Depth of Tissue Injury
1. A “first-degree” burn (Surface burn) :
A first degree- burn is any injury that is
limited to the epidermis.
It is frequently a result of exposure to
sunlight.
These burns are typically red and
hypersensitive.
2. Second dgree burn ( partial thickness
burn):
A “second-degree” burn involves the
epidermis and a varying depth of the
dermis as result of exposure to heat
from scald (means to heat a liquid) ,
flame or chemical it is manifested by
blister formation redness and pain.
3 Third-degree Burn (full
thickness burn)
A “third degree” burn is an injury that
destroys both layers of the skin epidermis
and dermis.
The injury may extend into the underlying
subcutaneous tissues muscle, bone and
adjacent structures. The skin may appear
charred (having been burned so as to affect
color or taste ) and leathery, or may be dry
and pale.
Pains typically absent since nerve endings
are destroyed .
Classification of Burn Depth
First degree burn
(epidermal burn)
Second degree burn
(superficial dermal burn)
Third degree burn
(sub-dermal burn)
Fourth degree burn
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B. Extent of the Burn
The Rule of Nines is a convenient means of
estimating the extent or body surface injury
the adult.
Specific nontoxic areas represent 9% or two
times 9% of the total body surface (e.g.),
the head and neck = 9%,
each arm = 9%,
each, Leg = 18%.
The front and back of the trunk =18% each).
In the infant and child, these calculations vary from
the adult (e.g. the infant's head represents twice the
fraction of the body surface area represented by
the head of the adult).
Rule of Nine
Scattered (occurring or distributed over widely
spaced) burns are conveniently equated by
reference to the palmer surface of the patient's
hand, which represents 1% of the patient's body
surface.
Calculation of the body surface area (BSA) is
most difficult in the pre-hospital setting
therefore, the most expedient and accurate
method of reporting the patien´s condition is to
inform Medical Control of the anatomical area of
the burn (e.g. right hand, left leg from knee to
ankle).
III. PATHOPHYSIOLOGY
OF BURN EDEMA
FORMATION:
In edition to cellular damage, the classic
inflammatory reaction is generated by :
thermal injury, with early and rapid accumulation of
fluid (edema formation) in the burn wound.
Following the burn, capillaries in the burn wound
become highly permeable.
Tlis results in leakage of fluid electrolytes and
proteins into the area of the wound.
In patients with large burns, edema
formation accrues in unburned tissues as
well.
This plasma loss into both burned and
unburned issues causes hypovolemia, and is
the primary cause of shock in burn
patients.
At the same time edema formation can
cause deceased blood flow to the
extremities and/or impaired chest
movement during breathing.
Fluid migration occurs early following
a burn injury and continues
throughout the first 24 hours
postburn.
The greatest fluid shift occurs in the
first eight hours following the injury
As edema formation occurs in the issues,
the total blood volume is decreased and
cardiac output is significantly reduced.
The magnitude and duration of the
systemic responses are proportional to the
extent of the body surface area (BSA)
burned.
Third-degree burns result in the
destruction of the entire thickness of the
dermis with resulting formation of a thick,
non-elastic escher.
Edema beneath circumferential eschar (is a
piece of dead tissue that is cast off from the
surface of the skin, particularly after a burn
injury) can compromise both venous and
arterial blood flow and produce
neurological symptoms.
Clinical MANIFESTATIONS
of Shock IN Burn injuries.
Signs and symptoms of deceased tissue
perfusion, or shock are viable in the burn
patient.
A. Level of Consciousness
Anxiety, restlessness, and nausea are early
signs of hypovolemia and/or hypoxemia.
B. Blood Pressure
Early release of substances
(catecholamines) that constrict blood
vessels following burn injury helps to
maintain an adequate systemic blood
pressure in the presence of hypovlemia.
A non-invasive blood pressure is an
unreliable means of identifying shock or
monitoring adequate fluid replacement in
the burn patient.
C. Heart Rate
Tachycardia is not a reliable indicator
of fluid volume deficit in the burn
patient.
It is common for an adequately
resuscitated patient to have a pulse
rate of 100-120 beats per minute
D. Decreased Peripheral
Perfusion
Decreased arterial blood flow can
result in poor tissue perfusion in an
extremity as manifested by:
1. Cyanosis
2. Deep tissue pain
3. Altered sensation
4. Progressive decrease or absence of
pulses
V. SUMMARY
Initial assessment and stabilization of the burn
patient requires an awareness of the
pathophysiologic responses that occur with burn
injuries.
The physiologic response of the patient is
principally related to the extent of the burn
injury, which is readily estimated by the rule of
nines
the pre-hospital provider must be aware of the
edema and fluid migration that occurs early
following a burn injury and the subsequent need
for appropriate monitoring of the burn victim.
NCP
Care of the Patient During the
Emergent/Resuscitative Phase
of Burn Injury
Dr. Aidah Abu ElsoudAlkaissi
An-Najah National University
Nursing College
Nursing Diagnosis: Impaired gas
exchange related to carbon
monoxide poisoning, smoke
inhalation, and upper airway
obstruction
Goal: Maintenance of adequate
tissue oxygenation
Nursing Diagnosis: Ineffective
airway clearance related to edema
and effects of smoke inhalation
Goal: Maintain patent airway and
adequate airway clearance
Nursing Diagnosis: Fluid volume
deficit related to increased
capillary permeability and
evaporative losses from the burn
wound
Goal: Restoration of optimal fluid
and electrolyte balance and
perfusion of vital organs
Nursing Diagnosis: Hypothermia
related to loss of skin
microcirculation and open wounds
Goal: Maintenance of adequate body
temperature
Nursing Diagnosis: Pain related to
tissue and nerve injury and
emotional impact of injury
Goal: Control of pain
Nursing Diagnosis: Anxiety related
to fear and the emotional impact of
burn injury
Goal: Minimization of patient’s and
family’s anxiety
Collaborative Problems: Acute
respiratory failure, distributive
shock, acute renal failure,
compartment syndrome, paralytic
ileus, Curling’s ulcer
Goal: Absence of complications
Nursing Diagnosis: Fluid volume
excess related to resumption of
capillary integrity and fluid shift
from interstitial to intravascular
compartment
Goal: Maintenance of optimal fluid
balance
Nursing Diagnosis: Risk for
infection related to loss of skin
barrier and impaired immune
response
Goal: Absence of localized or
systemic infection
Nursing Diagnosis: Altered
nutrition, less than body
requirements, related to
hypermetabolism and wound healing
Goal: Attainment of anabolic
nutritional status
Nursing Diagnosis: Impaired skin
integrity related to open burn
wounds
Goal: Demonstration of improved
skin integrity
Nursing Diagnosis: Pain related to
exposed nerves, wound healing, and
treatments
Goal: Reduction or control of pain
Nursing Diagnosis: Impaired
physical mobility related to burn
wound edema, pain, and joint
contractures
Goal: Achievement of optimal
physical mobility
Nursing Diagnosis: Ineffective
individual coping related to fear and
anxiety, grieving, and forced
dependence on health care
providers
Goal: Use of appropriate coping
strategies to deal with postburn
problems
Nursing Diagnosis: Altered family
processes related to burn injury
Goal: Achievement of appropriate
patient/family processes
Nursing Diagnosis: Knowledge deficit
about the course of burn treatment
Goal: Verbalization of understanding
of the course of burn treatment by
patient and family
Collaborative Problems: Congestive
heart failure, pulmonary edema,
sepsis, acute respiratory failure,
ARDS, visceral damage (electrical
burns)
Goal: Absence of complications