Priorities
ABC. Airway, Breathing, & Circulation are priorities. And FLUIDS
Phases of Burn Management
1. Emergent Phase
Hypovolemic Shock
Decreased tissue perfusion: Tachycardia, hypotension, and decreased urine output.
Edema
Due to capillary permeability. Plasma and sodium shift to the interstitial space leading to edema and fluid deficit in the vascular space.
Give Fluids
Goal in the emergent phase is to give fluids: Crystalloids and Lactated Ringer’s. Monitor urine output and BUN/Creatinine.
Hemoconcentration
⇑ Hct, ⇑ Hgb due to fluid leaving the intravascular space and moving to the interstitial space.
Hyperglycemia & Decreased Protein
 ⇑ glucose due to stress & ⇓ protein due to loss through burn wounds.
Hyperkalemia & Acidosis
⇑ K+ due to cell destruction. ⇓ pH: Metabolic acidosis due to decreased tissue perfusion.
Edema
Edematous, but in hypovolemic shock due to third spacing.
2. Acute Phase
Acute Phase
Labs changes in acute phase: ⇓ Hct, ⇓ Hgb, ⇓ Na+, ⇓ K+. Decreased since interstitial fluid is moving back to the vascular space, causing hemodilution
Tetanus Vaccine
Give tetanus vaccines and antibiotics to prevent infection
GI
Decreased perfusion to GI and stress leads to paralytic ileus and Curling’s ulcer. Give H2 blockers (famotidine) and PPI (Protonix). NG tube and monitor bowel sounds
Nursing Interventions
Prevent infection, foley to monitor urine output, pain management, nutrition for healing, and wound care. Vitamin C and Protein for healing
Removing old tissue and promoting healing
Hydrotherapay
Hydrotherapy: use of water for debridement. May cause electrolyte imbalances
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Debridement
Mechanical Debridement: scissors and forceps to remove dead tissue. Painful procedure. #1 priority pain meds.
Enzymatic
Enzymatic (autolysis): This is the use of enzymes to remove dead tissue.
Hyperbaric Oxygen
Hyperbaric oxygen therapy: increase oxygen to tissue for healing.
Grafting
Eschar is removed and a graft is placed.
3. Rehabilitation Phase
- Burn is healed. The goal is to return to optimum function
- Prevent scars and contractures
- Encourage ROM to prevent contractions
- Meet emotional and psychological needs
- Encourage participation in ADLs
- Physical therapy and occupational therapy
- Cosmetic correction
- Make take weeks to years