Phases of Burn Management
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Phases of Burn Management
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Emergent Phase
- Labs: ⇑ Hct, ⇑ Hgb due to fluid moving to interstitial fluid: hemoconcentration. ⇑ K+ due to cell destruction, ⇑ BUN due to fluid loss, ⇑ glucose due to stress, ⇓ protein due to loss through the wound, ⇓ pH due to metabolic acidosis.
- Edematous, but in hypovolemic shock due to third spacing.
- Signs and symptoms of shock: tachycardia, hypotension, ⇓ cardiac output, and decreased tissue perfusion
- Debridement may be necessary
- Hydrotherapy: use of water for debridement. May cause electrolyte imbalances
- Mechanical Debridement: scissors and forceps to remove dead tissue
- Enzymatic (autolysis): use of enzymes to remove dead tissue.
- Hyperbaric oxygen therapy: increase oxygen to tissue for healing.
- Grafting: eschar is removed and a graft is placed.
- Labs changes in acute phase: ⇓ Hct, ⇓ Hgb, ⇓ Na+, ⇓ K+. Decreased since interstitial fluid is moving back to the vascular space, causing hemodilution
- Burn is healed. The goal is to return to optimum function
- Prevent scars and contractures
- Encourage ROM to prevent contractions
- Meet psychosocial and psychological needs
- Encourage participation in ADLs
- Physical therapy and occupational therapy
- Cosmetic correction