Management of burns includes both the first aid management and hospital management.
First aid management
1. Put out the fire. Smoother flame with fire blanket, rug, blanket or any heavy material that is handy. Then move patient away from the fire. Patient should be told not to run if his clothing is on fire because running would fan the fire and increase its intensity. Chemical or thermal burn should be cooled by flushing with copious amount of tepid water over 15 minutes.
2. If patient is not breathing, start mouth to mouth or mouth-to-nose respiration immediately.
3. If there is bleeding, it should be controlled.
4. Remove clothing if contaminated by chemicals, .otherwise clothing should be left to avoid removing the skin which may be sticking tothe cloth.
5. Remove tight clothing, rings, wrist watch or bracelet which may constrict blood vessels should set oedema.
6. Open wounds should be covered with sterile or clean dressing
7. patient Transport to the hospital.
8. Reassure patient.
Management in hospital
a. Assess patient: Patient's general condition should be assessed. Check skin surface area and depth of injury. Vital signs are taken especially the PO2 and BP. Check patient's weight which may be used later to determine weight change. Note the skin turgor to get an idea of the fluid and electrolyte status.
b. Respiratory management: Administer humidified oxygen if there is any respiratory impairment. If there are secretions, the airway should be suctioned. If there islaryngeal swelling which causes severe obstruction, endotracheal intubation should be performed.
c. Urinary output: Check vital signs and urinary output hourly if there is hypovolaemic shock. Shock is usually as a result of severe fluid loss. Pass an in-dwelling catheter so as to measure the urine output. Urine specific gravity should be measured hourly. Urine glucose, protein and blood should also be checked. If the urine becomes very dark it must be reported to the doctor as this indicates massive haemolysis of haemoglobin and myoglobin. Urine bag must be emptied regularly and urethral meatus cleaned regularly to prevent bladder infection.
d. Rehydration: Enough fluid should be given intravenously to prevent shock or to reverse it where there is already shock.Administer plasma, whole blood, 5% Dextran, Dextrose saline or Ringer's solution. Keep good records of the type of fluid and route of administration. Urine output should be about 25-30mls per hour for an adult.
e. Control pain: Pain should be administered to relieve pain. Any analgesic capable of causing respiratory depression should be avoided if patient already shows any signs of respiratory impairment.
f. Guard against infection: Nurse patient in reverse isolation. Aseptic techniques should be adhered to while dressing the wound. Patient is usually nursed in a proof net and flies on a set of bed linens sterile at the early period of management, and visitors highly restricted to prevent infection. Any staff with an infection should not also care for the patient toavoid transfer of the infection to the patient.
g. Nutrition: Food high in calories and protein should be given to control weight loss due to loss of calories through evaporation from the open wounds. Vitamin c should be given to aid healing.
Nasogastric tube Feeding through should be considered for patients who cannot tolerate oral food. Make sure bowel sounds are checked before feeding the patient because the gastric motility may be depressed by the hypovolaemic shock. Make sure there is no aspiration of gastric content while feeding the patient.
h. Align patient properly: Burned extremities should be elevated on pillows to reduce oedema. Flexion contractures, outward rotation of thighs and foot drop must be avoided by placing limbs in proper alignment. Range ofmotion exercise of the joints should be commenced out as soon as possible to prevent stiffness. Splints can be used to aid healing and help prevent contracture.
i. Involve relations: Family members should be encouraged to visit patient regularly to prevent depression, withdrawal or anxiety. Patient should also be involved in all discussions relating to his care. Proper explanations as to expected outcome of the care should be given. Give diversionary therapy such as books, movies, radios, etc.
j. Rehabilitation: Reconstructive surgery should be performed when the burn is very strict, .otherwise, rehabilitation should commence early enough right from the acute stage. It involves prevention of infection, good body alignment, and maintenance of joint mobility. Patients withextensive scars should be given psychological support as it is usually very difficult for them to mix up socially after recovery. Occupational therapy may also be needed to retrain the patient for a new occupation if he no longer carry out his initial occupation.
k. Wound management: Wound should be cleaned with soap and warm water bland to promote healing and prevent infection. When skin begins to slough, the slough should be removed with sterile thermal Copier. Antibiotics can be given to prevent or control infection. If the patient has had immunization against tetanus in the past five years, a booster dose of tetanus toxoid should be given.
The wound can be managed in three different ways:
1. Open or exposure method: The wound is left uncovered with or without topicalapplications. This type of wound management is usually employed for minor burns or for areas that are difficult to apply dressings e. g. face, neck, head, etc. The patient is kept in strict isolation to prevent infection. He is covered with a cradle which takes up the weight of the sterile sheet and blanket and also prevents direct contact between patient's skin and the linens/sheet.
2. Closed or stops method: In this case the wound is covered with many layers of gauze coated in topical anti-microbial agent. The dressing should be changed once daily but when there is severe discharge or infection it should be done twice.
3. Skin grafting: A graft implies the placement of body tissue or other material in an area of the body where it becomes a part of the local structuresubstituting for absent or damaged tissue (Watson, j. e. and Royle j. In 1988).
Skin grafting should be applied to the skin in case of full thickness burns to prevent contracture disfiguring.
Burns-How Can They Be Managed?
