Thermal Injuries/Burns
The British Burns Association has identified the following as requiring referral to a burn unit:
• Burns > 10% of total body surface area (TBSA) in adults (a crude calculation may be made, assuming that the palm of the patient’s hand is equivalent to 1% of total body surface)
• Burns > 5% TBSA in children
• Burns of special areas, eg face, hands, feet, genitalia and major joints
• Full thickness burns > 5% TBSA
• Electrical and chemical burns
• Burns associated with inhalation injury
• Circumferential burns of the limbs or chest
• Burns in young children or the elderly
• Burn injuries in patients with pre-existing medical disorders which complicate management, prolong recovery or effect mortality
• Suspected ‘non-accidental injury’ (NAI).
• Burns > 10% of total body surface area (TBSA) in adults (a crude calculation may be made, assuming that the palm of the patient’s hand is equivalent to 1% of total body surface)
• Burns > 5% TBSA in children
• Burns of special areas, eg face, hands, feet, genitalia and major joints
• Full thickness burns > 5% TBSA
• Electrical and chemical burns
• Burns associated with inhalation injury
• Circumferential burns of the limbs or chest
• Burns in young children or the elderly
• Burn injuries in patients with pre-existing medical disorders which complicate management, prolong recovery or effect mortality
• Suspected ‘non-accidental injury’ (NAI).
Superficial Burns
a) Description
Quick capillary return. Red, slightly swollen appearance. No blister formation. Any damaged epithelium may peel off after 5 to 7 days without scarring.
a) Description
Quick capillary return. Red, slightly swollen appearance. No blister formation. Any damaged epithelium may peel off after 5 to 7 days without scarring.
b) Treatment Aim
• To relieve pain
• To protect from infection.
• To relieve pain
• To protect from infection.
c) Treatment
• Immediately place the affected part under cold running water (approx 15°C) for at least 20 minutes (Yuan et al 2007).
• Immediately place the affected part under cold running water (approx 15°C) for at least 20 minutes (Yuan et al 2007).
This relieves pain and reduces the temperature of the burning process
• Remove any clothing carefully
• Apply dressings as for blisters.
• Remove any clothing carefully
• Apply dressings as for blisters.
Superficial, Partial Thickness Skin Loss Burns
a) Description
Slow capillary return. Epidermis and superficial layers of dermis are destroyed. Hair follicles, sebaceous and sweat glands are intact. This is likely to be a painful burn as the nerve endings have not been damaged. Usually heals in 10 to 14 days, without scarring.
a) Description
Slow capillary return. Epidermis and superficial layers of dermis are destroyed. Hair follicles, sebaceous and sweat glands are intact. This is likely to be a painful burn as the nerve endings have not been damaged. Usually heals in 10 to 14 days, without scarring.
Deep, Partial Thickness Skin Loss Burns a) Description Slow capillary return. Greater part of the dermis is lost. Sensation is altered. Patient may have no pinprick sensation.
b) Treatment Aims of Both Superficial and Deep Partial Thickness Skin Loss Burns
• To relieve pain
• To protect from infection
• To manage exudate. Reproduced by permission of NHS Lothian c) Treatment
• Immediately place the affected part under cold running water (approx 15°C) for at least 10 to 15 minutes
• Remove any clothing carefully avoiding any further injury.
• Apply non-adherent interface dressing such as Atrauman®. An absorbent secondary dressing such as polyurethane foam film may be used.
• To relieve pain
• To protect from infection
• To manage exudate. Reproduced by permission of NHS Lothian c) Treatment
• Immediately place the affected part under cold running water (approx 15°C) for at least 10 to 15 minutes
• Remove any clothing carefully avoiding any further injury.
• Apply non-adherent interface dressing such as Atrauman®. An absorbent secondary dressing such as polyurethane foam film may be used.
The primary dressing may be left in place and the secondary dressing changed as often as necessary, depending on choice of product and exudate levels. Note: Silver sulfadiazine cream should not be used routinely until after specialist assessment as this will mask the wound bed and make for difficult assessment.
Full Thickness Skin Loss Burns
a) Description
No capillary return.
No epithelium so burn can only heal by contraction, granulation and migration of epithelium from wound edges. The wound may look pale, charred and coagulated veins may be visible.
No sensation is present on testing. This will cause scarring.
a) Description
No capillary return.
No epithelium so burn can only heal by contraction, granulation and migration of epithelium from wound edges. The wound may look pale, charred and coagulated veins may be visible.
No sensation is present on testing. This will cause scarring.
b) Treatment Aim
• To protect from infection
• To manage exudate.
• To protect from infection
• To manage exudate.
c) Initial Treatment and Assessment
• Immediately place the affected part under cold running water (approx 15°C) for at least 10 to 15 minutes. If greater than 3 hours from time of injury, cold water will have no beneficial effect.
• Remove any clothing carefully avoiding any further injury.
• Immediately place the affected part under cold running water (approx 15°C) for at least 10 to 15 minutes. If greater than 3 hours from time of injury, cold water will have no beneficial effect.
• Remove any clothing carefully avoiding any further injury.
d) If Patient is to be Transferred to Accident & Emergency or Burns Unit
• Cover all burned areas primarily with cling film (which prevents infection and allows for ease of assessment) and wrap patient in clean covers to prevent heat loss
• If transfer journey is greater than 2 to 3 hours, a secondary surgical absorbent dressing of gauze and cotton tissue will be necessary to retain exudates, which may be extensive. Note: Silver sulfadiazine cream should not be used until after specialist assessment as this will mask the wound bed and make for difficult assessment.
• Cover all burned areas primarily with cling film (which prevents infection and allows for ease of assessment) and wrap patient in clean covers to prevent heat loss
• If transfer journey is greater than 2 to 3 hours, a secondary surgical absorbent dressing of gauze and cotton tissue will be necessary to retain exudates, which may be extensive. Note: Silver sulfadiazine cream should not be used until after specialist assessment as this will mask the wound bed and make for difficult assessment.
f) If Patient is not to be transferred
• Apply primary non-adherent interface dressing such as Atrauman®.
• Secondary dressings should be highly absorbent whilst maintaining a moist wound bed as thick eschar usually forms. This may be debrided surgically or by autolysis.
• Treat as for wound type as it progresses through wound healing stages.
• Initially, dressings may need to be carried out daily but this is dependent on the amount of exudate.
• Argyll and Bute CHP patient pathway is to NHS Greater Glasgow & Clyde. There may, therefore, be slight differences in dressings selection. More information is available from the following website: http://www.cobis.scot.nhs.uk/
• Apply primary non-adherent interface dressing such as Atrauman®.
• Secondary dressings should be highly absorbent whilst maintaining a moist wound bed as thick eschar usually forms. This may be debrided surgically or by autolysis.
• Treat as for wound type as it progresses through wound healing stages.
• Initially, dressings may need to be carried out daily but this is dependent on the amount of exudate.
• Argyll and Bute CHP patient pathway is to NHS Greater Glasgow & Clyde. There may, therefore, be slight differences in dressings selection. More information is available from the following website: http://www.cobis.scot.nhs.uk/
REFERENCE
Yuan J, Wu C, Holland AJA, Harvey JG, Martin HCO, La Hei ER, Arbuckle S, Godfrey C (2007) Assessment of cooling on an acute scald burn injury in a porcine model. J Burn Care Res 28: 514–20.
Yuan J, Wu C, Holland AJA, Harvey JG, Martin HCO, La Hei ER, Arbuckle S, Godfrey C (2007) Assessment of cooling on an acute scald burn injury in a porcine model. J Burn Care Res 28: 514–20.
Tidak ada komentar:
Posting Komentar