Burn Injury Management

Overview of Burn Injury Management

  • Burn Injury Phases:

    • Emergent/Resuscitative Phase (first 48 hours)

    • Acute Intermediate Phase (48-72 hours)

    • Rehabilitation Phase (not covered in depth here)

Emergent/Resuscitative Phase

  • Initial Assessment:

    • Prioritize airway, breathing, circulation, disability, exposure, and examination.

    • Stop the burning process immediately (remove clothing, jewelry).

    • Maintain spinal precautions in case of falls or electrical injuries.

  • IV Access:

    • Insert large bore IVs in unburned tissue.

    • Consider central lines for severe burns.

  • Monitoring and Assessment:

    • Insert Foley catheter to monitor urine output; check for temperature using a temperature monitoring catheter.

    • Continuous monitoring of airway is crucial, especially in cases of smoke inhalation.

    • Utilize a non-rebreather for oxygen delivery if necessary.

  • Fluid Resuscitation:

    • Use Parkland formula for fluid calculations:

      • Total fluid = (%TBSA) x (Weight in kg) x 4

      • Administer half over the first 8 hours and the remaining half over the next 16 hours.

    • Monitor urine output: 0.5 to 1 mL/kg/hr for thermal and chemical burns; 75-100 mL/hr for electrical burns.

  • Pain Management:

    • Address pain with IV medications; avoid oral forms due to altered tissue perfusion.

    • Pre-medicate before dressing changes to enhance comfort.

  • Preventing Complications:

    • Administer tetanus shots as needed.

    • Maintain NPO status and monitor vital signs frequently.

Acute Intermediate Phase

  • Wound Care and Infection Prevention:

    • Assess wounds for signs of infection such as drainage, redness, warmth, and tenderness.

    • Apply topical agents prescribed after the initial wound cleaning and drying process.

    • Ensure proper hand hygiene and use of gloves during dressing changes.

  • Nutritional Support:

    • High-calorie (up to 5000 calories/day) and high-protein diet essential due to hypermetabolic state.

    • Monitor food intake or provide enteral nutrition if needed.

  • Mobility and Psychosocial Support:

    • Implement both active and passive range of motion exercises to prevent contractures and pressure ulcers.

    • Engage with patients on psychosocial aspects such as self-esteem and coping strategies; consult social workers if necessary.

  • Monitoring for Sepsis:

    • Be vigilant for signs of sepsis due to increased risk post-burn; monitor temperature, heart rate, blood pressure, and wound characteristics.

    • Blood tests to assess white blood cell count and signs of infection.

  • Pain Management During Dressing Changes:

    • Administer pain medications at least 30 minutes before procedures.

    • Assess for pain response and adjust approaches as needed based on patient feedback.

Key Clinical Strategies

  • Hand Hygiene: Consistently practice proper hand hygiene before and after patient contact to prevent infections.

  • Warm Environment: Maintain a warm room (80-85 degrees) and use warm water for washing patients.

  • Patient Engagement: Facilitate patient involvement in their care and dressing changes to empower them and assist in their recovery.

  • Use of Appropriate Dressings: Avoid tight dressings and ensure proper coverage without constraining blood flow or causing additional pain.

Conclusion

  • Focus on maintaining airway, monitoring fluid status, addressing pain, preventing infection, and supporting psychosocial well-being throughout the various phases of burn injury management.