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Coming to the Burn Center
Inital evaluation
When a patient arrives at the Burn Center, the medical team's initial focus involves controlling any immediate physical dangers, starting intravenous (IV) lines to replenish fluids that may have been lost as a result of the burns, and beginning wound care.
Upon arrival, a patient is taken into one of the tub rooms, where the burn wounds are evaluated. Treatment of the burn injury begins with gentle washing of the skin and application of medicine and dressings over burn wounds. The following paragraphs describe some of the medical procedures that may be performed after initial evaluation. After wounds have been evaluated, cleaned and dressed, the patient is moved to a hospital room.
All of the areas listed below are addressed when a person is first admitted to a burn unit.
Burn size
 Burns are judged by the size of the burn in relation to the whole body and by the depth of the burn injury. Different methods exist to calculate the extent or size of a burn injury. The most common method, which provides a quick estimate of burn size, uses the "Rule of Nines," where the body is divided into areas equaling multiples of nine percent of the total body surface area. The palm of your hand, for example, is equal to about one percent of your body's surface area. The head and arms are each equal to nine percent of the body surface. The chest and back are each 18 percent (two X nine percent). Each leg is 18 percent (two X nine percent). This totals 11 nines, or 99 percent. The heads of infants and small children are in relatively larger proportion to the total body surface area, and the limbs are in smaller proportion than adults limbs. The total body surface area of a burn is referred to as TBSA. A patient might have the diagnoses of a 45 percent TBSA thermal burn, for example. The TBSA and burn depth analysis are recorded on a hospital chart known as a "burn diagram." Determining the percent of body surface area burned is important for correct fluid replacement.
Beginning intravenous fluids
Skin keeps water out of the body and bodily fluids in. When burned, skin loses the ability to keep body fluids in, so the fluids that have been lost after a burn must be replaced. The process of replacing fluids is called fluid resuscitation. The doctors are able to figure out the amount of fluid the body has lost by judging how much of a patient's body has been burned (TBSA). In larger burns the fluids are put into the body through an IV, or intravenous infusion. The IV is placed into a vein. A machine regulates the amount of fluid pumped into the body through the IV line. The amount of fluid necessary is figured out by using a formula called the Baxter formula. If a burn is small, (for instance, less than 15 percent TBSA), fluids can generally be replaced by drinking pedialyte, juice, water, etc.
Controlling Swelling
Cells and blood vessels contain fluids. When a burn occurs, fluid leaks (capillary permeability) out of the cells and blood vessels, and this fluid leak causes swelling. The swelling can be local - only around the area burned or systemic - throughout the entire body. The larger the burn, the more swelling usually occurs. Generally the symptoms of swelling are limited to the area of the burn itself, as long as the total burn is less than 25 percent TBSA or the patient is less than sixty years old. When the burn is larger or the patient is older, local reactions become systemic ones. If a patient suffered face burns, the eyes may swell shut, making it impossible for him to open his eyes. This can be scary for the patient as well as the family members because the burned person no longer looks the same. Fortunately, the leak usually begins to seal about twelve hours after the injury and becomes completely sealed after twenty-four hours. What this means is that the swelling will start to decrease in two to three days.
About two-thirds of the human body is water. The remaining third is a complex mixture of chemicals. The water-and-chemical mix is arranged into structures called cells. These are tiny, but you can see them using a microscope.
There are four main body fluids; blood, lymph, tissue fluid and the fluid inside cells. An adult contains 32 to 42 quarts of water, but only four to five quarts of this is in the blood. Most of the fluid in our body is found inside the cells and as tissue fluid surrounding the cells.
Monitor breathing
Respiration is the process by which oxygen is used in cells to release energy from food. At the same time, carbon dioxide and water are released as waste products. If burns are on the face or neck, or the patient has a smoke inhalation injury, breathing may be a problem. To help make breathing easier, oxygen may be given through a mask. Intubation may also be necessary. When a person is intubated a small tube is placed through the mouth or nose directly into the windpipe. Through this tube, the patient can breathe. An intubated person cannot talk because the tube is below the vocal cords. If it becomes necessary to further assist a patient with breathing, the tube can be attached to a ventilator (breathing machine). Oxygen, intubation and a ventilator are used only when necessary and removed as the patient's breathing improves.
Providing pain control
Medications are used to relieve pain and lower anxiety for burn patients. Pain medication can be given by IV (into the blood vessel), through IM (in a muscle) injections or swallowed in pill or liquid form. The amount and number of pain medications (usually narcotics) given is gradually decreased as burn wounds heal and pain medication is less necessary.
Inserting a Foley catheter
Many patients with burns have difficulty going to the bathroom (urinating). A Foley catheter helps with this problem. The Foley catheter is a small rubber tube that is put into the bladder. Once the catheter is in place, a small balloon on the end of the catheter, positioned in the bladder, is filled with a small amount of sterile water. This balloon prevents the tube from falling out of the bladder. The catheter drains the urine produced by the body from the bladder, keeping it empty. The amount of urine that drains into a bag outside the body can be measured. Keeping track of the amount of urine is very important because it tells the physician if the patient needs more or less fluids through the IV.
Administering x-rays
X-rays are invisible waves of energy that pass through soft tissues like skin and muscle, but are stopped by heavier tissue, such as bone. Passing X-rays through the body and onto a light-sensitive plate produces images on film. X-rays are routinely ordered by doctors for patients on the Burn Center to check, for instance, for correct positioning of tubes or IVs placed in the body. Daily X-rays are taken of the lungs when patients have a breathing tube in place to watch for signs of infection, such as pneumonia.
Inserting a feeding tube
A burn patient needs to eat more than usual to help his or her skin heal. The patient may not be able to eat at this time, or may not feel like eating very much. A feeding tube is a small tube placed through a nostril that descends into the stomach or duodenum (small intestine). Liquid food is put into the stomach and the burn patient doesn't even have to swallow. Feeding tubes are usually put in place within 24 hours of admission. A patient may require two times their normal calorie intake to help heal their burn wounds.
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