Introduction to burns

The skin has an important role to play in the fluid and temperature regulation of the body. If
enough skin area is injured, the ability to maintain that control can be lost. The skin also acts as a
protective barrier against the bacteria and viruses that inhabit the world outside the body.
The anatomy of the skin is complex, and there are many structures within the layers of the skin.
There are three layers:

1. Epidermis, the outer layer of the skin

2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands,
and hair follicles reside.

3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are located. This is
the layer of tissue that is most important in temperature regulation.

The amount of damage that a burn can cause depends upon its location, its depth, and how
much body surface area that it involves.

Burns are one of the most devastating conditions encountered in medicine. The injury represents
an assault on all aspects of the patient, from the physical to the psychological. It affects all ages,
from babies to elderly people, and is a problem in both the developed and developing world. All of
us have experienced the severe pain that even a small burn can bring. However the pain and
distress caused by a large burn are not limited to the immediate event. The visible physical and the
invisible psychological scars are long lasting and often lead to chronic disability. Burn injuries
represent a diverse and varied challenge to medical and paramedical staff. Correct management
requires a skilled multidisciplinary approach that addresses all the problems facing a burn patient.
How are burns classified?
Burns are classified based upon their depth.
 First degree burn is superficial and causes local inflammation of the skin. Sunburns often
are categorized as first degree burns. The inflammation is characterized by pain, redness,
and a mild amount of swelling. The skin may be very tender to touch.
 Second degree burns are deeper and in addition to the pain, redness and inflammation,
there is also blistering of the skin.
 Third degree burns are deeper still, involving all layers of the skin, in effect killing that
area of skin. Because the nerves and blood vessels are damaged, third degree burns appear
white and leathery and tend to be relatively painless.
Burns are not static and may mature. Over a few hours a first degree burn may involve deeper
structures and become second degree. Think of a sunburn that blisters the next day. Similarly,
second degree burns may evolve into third degree burns.
Regardless of the type of burn, inflammation and fluid accumulation in and around the wound
occur. Moreover, it should be noted that the skin is the body's first defense against infection by
microorganisms. A burn is also a break in the skin, and the risk of infection exists both at the site of
the injury and potentially throughout the body.
Only the epidermis has the ability to regenerate itself. Burns that extend deeper may cause
permanent injury and scarring and not allow the skin in that area to return to normal function.

Name of Drug Classification Adverse Effect Indication Contraindication Nsg. Consideration

Cefuroxime IV ANTIINFECTIVE; Body as a Whole: It is effective for the Hypersensitivity  Determine

50mg q6 Thrombopheletis treatment of to cephalosporins history
ANTIBIOTIC (IV site); pain, penicillinase and related of hypersensiti
SECOND- burning, producing neisseria antibiotics; vity reactions
GENERATION cellulitis(IM site); gonorrhea(PPNG) Pregnancy to
CEPHALOSPORIN super infections, (Category B), Cephalosporins
positive Coombs Effectively treats bone Lactation , penicillins,
'test. and joint infections, and history of
GI: bronchitis, meningitis allergies,
,gonorrhea, otitis particularly to
Diarrhea Media drugs, before
nausea, antibiotic- pharyngitis/tonsillitis, therapy is
associated colitis. sinusitis, lower initiated
Skin: respiratory tract  Inspect IM and
Rash ,pruritus, infections, skin and IV injection
Urticaria soft tissue infections, sites frequently
Urogenitall: urinary tract for signs
infections, and is used
 Increased serum for surgical of phlebitis
Creatine and prophylaxis, reducing
BUN, decreased or eliminating
creatinine infection
Clearance

Name of Drug Classification Adverse Effect Indication Contraindication Nsg. Consideration

Ascorbic acid Vitamins GI: Nausea, Prophylaxis and Use of sodium Assessment & drug
vomiting, treatment of scurvy ascorbate in patient effects
0.5 BID Heartburn, and as a dietary on sodium
Diarrhea, supplement. restriction; use of
calcium ascorbate
Hematologic: Increased in patient receiving
protection digitalis, safety
Acute Hemolytic mechanism of the during pregnancy
anemia(Patience is immune system, (category C) or
deficiency of thus supporting lactation is not
G6PD); sickle cell wound healing. establish
crisis. CNS; Necessary for
headache(high wound healing and
doses) resistance to
infection
Other; Mild
soreness at
injection site;
dizziness and
temporary
faintness with rapid
IV Administration.