Estas Despedida

Nutritional Care of
Burn Patient
Loedda Núñez Arana LND
Dietitian
Industrial Hospital, State Insurance Fund
October 9, 2015

Objectives
Identify the types and degree of
burn
 Understand the bodies metabolic,
hormonal, and immune response to
burns
 Identify proper energy requirements
for burn victims
 Understand the significance of
carbohydrate, protein, and fat in
burn patients
 Recognizethe vitamins and
minerals important in burn healing


Fire and Burn Death and Injury
Deaths
4,000 deaths a year
from fire and burns

Injuries
25,000 hospitalized in burn centers
600,000 burn injuries treated in hospital
(Close to half of all burn injuries treated in
hospital emergency departments and one-third
of admissions to burn centers are scald injuries)
(Sources:

National FireProtection Association,
National Center for Health Statistics;
American Burn Association, National Burn Repository, 2005)

Definition of a Burn
 “Tissue

injury caused by termal, radiation,
chemical, or electrical contact resulting in
protein denaturation, burn wound edema,
and loss of intravascular fluid volumen due
to increased vascular permeability.”



Scheme of the Skin
Epidermis
DermisSubcutaneous
tissue

Burn Injury



Severity depends on:


Depth of burn



Extent of surface area
involved



Intensity of the energy



Duration of exponsure



Type of tissue injured

Classification



First degree

Classification


Second degree
superficial

Classification


Second degree



deep partialthickness

Classification
 Third

degree

 Full-

thickness
burns

FuClassification
 Fourth

degree extend beneath
fat into bone and/ or muscle

Four Types of Burns
 Electrical

Burns
•

Thermal



Can be
caused by
flame, flash,
scald,



Contact with
hot objects



Most
common type

Burns
 Termal

Burns



Chemical



2 Type



Acids –can be
neutralized



Alkaline- adheres to
tissue



causing protein
hydrolyses and
liquefaction

Burn
 Radiation

ABAClassification











Minor:
< 10% in adult
< 5% < 10 years > 50 years
< 2% full thickness

Moderates:
10- 20% in adult
5-10% < 10 years > 50 years
High voltage, suspected
inhalation, circumferential
or susceptibility to infection

ABA Classification
 Mayor:
 20%

adult
 10% < 10 years > 50 years
 5% full thickness
 Any significant burn to face,
eyes, ears. Genitalia or joints Significant associated injuries

Complication
Inhalation
Fracture
Chronic

disease

Evaluation

EXTENSION
Rule of Nines

Lund & Browder Chart

CASO I

Paciente masculino de 29 años de edad con
quemaduras eléctricas en 15.3 % TBSA (9.3% de
tercer grado y 6% de segundo grado )

CASO II
Paciente masculino de 43 años de edad con quemaduras por
flama en 55 % TBSA (52 % de tercer grado y 3% de segundo
grado)

PERÍODO DE
RESUCITACIÓN






Propósito:
 Mantener órganos vitales
funcionando.
 Mantener circulación periferal a
extremidades.
Fórmulas:
 Parkland
 Brooke
 Evans
Fórmula 2-4 ml/Kg/% TBSA
 Peso del paciente

Cuidado Crítico Resucitación
 Solución

“Ringer’s lactate”



DISTRIBUCIÓN: (Primeras 24 hrs)



Primeras 8 horas: 50 %



Segundas 8 horas: 25 %

Últimas 8 horas:

25%

Cuidado Crítico
Post Resucitación


Segundas 24 horas:



Líquidos de reemplazo



D5W, Albúmina al 25%





Luego de las 48 horas:
Líquidos de mantenimiento y reemplazo

Cuidado Crítico
-Resucitación
 Estos

líquidos deben ajustarse
de acuerdo a la respuesta
hemodinámica del paciente.

Immediate Physiologic and Metabolic
Changes after Injury or Burn

ADH,Antiduretic hormone; NH3, ammonia.

Hormonal Stress
Response


Aldosterone—corticosteroid that
causes renal sodium retention



Antidiuretic hormone (ADH)—
stimulates renal tubular water
absorption



These conserve water and salt to
support circulating blood volume

Hormonal Stress
Response


ACTH—acts on adrenal cortex to
release cortisol (mobilizes amino
acids from skeletal muscles)

...