PADEATRIC EMERGENCIES

FALLS
Falls are common among infant, children and adolescents however it is most common
among toddler children. Falls may be from bed, chairs, stair, and window and in ground among
small children .after children engaged in play in playground and outside environment, fall may
occur in those areas also.

Risk factor
 Small children are more prone to fall accident due to
o Excessive activities , unstable gait ,undefined depth perception
o Presence of small objects on floor ,slippery floor
o Lack of supervision of children
o Activities related to curiosity of the children
o In older children fall may be related to sport and play activities
 In older children fall may be related to sport and play activities
 Among adolescents it may be due to sports , adventure ,and work related activities
 Falls are also common among children having seizure disorder and other mobility
disorders like cerebral palsy

First aid management

 Rescue the infant or child from accident immediately.
 Call for help if necessary.
 Examine the A, B C (airway, breathing, and circulation), general condition, level of
consciousness of the infant/children.
o If breathing and circulation are normal, check for any other injuries on the body and
manage accordingly such as
o If there is bleeding, control it. Apply direct pressure to stop bleeding by covering
the wound with clean cloth/gauze. Elevate the injured limb.
o Ensure there is no foreign body seen in the injured part or wound and keep the
wound clean.
o If pain and deformity is seen in the injured part, it may be fracture .If so immobilize
it, apply padded splint above and below the fracture site. Apply ice pack (wrapping
on the towel) to limit swelling and to relieve pain.
o Refer the child as required.

Prevention
 Never leave the young child alone in the high bed even while they are sleeping
especially infants and children.
  Keep the supervision of children play activities. Never leave the children in walker high
chair.
 Use grills in window, balcony and side rails in the stairs.
 Ensure the appropriate size of clothes and shoes in children.
 Keep the floor clean and dry.
Manage the adequate and safe area for play environment of children and provide safe play
materials

DROWNING
Introduction
Drowning is the condition when the child ingests water in the respiratory or alimentary tract.
Submersion of children in water is potential fatal accident. Small children (infants and children)
like to play in water. They may be drown in bathtub water, bucket, bowl with full water or in
ponds. Older children may draw in river, Pond Lake, during swimming and other water
activities. Adolescence are drawn during swimming in deep water river pods as they have risk
taking behavior and adventurous.
Drowning is defined as death by asphyxia due to submersion in a liquid medium. Near-
drowning is defined as immediate survival after asphyxia due to submersion. Drowning means
dying from not being able to breathe in air and breathing in water or another liquid.
Near drowning is the survival of drowning where the person passes out or breathes in water,
and can cause serious problems, including death, after the event.

Causes
 Negligence of parents
 Water resources near home like rivers, ponds, farming ponds.
 Undefined curiosity of children
 Suicidal tendency
 Unsafe swimming pool
 Diseases condition of children such s seizure disorders, drug abuse etc.
Signs and symptoms
 Breathing rate and depth increases.
 Snoring and gurgling breathing
 Labored or no breathing
 Bluish or pale of face and lips
 Fingernails may be cyanosed
 Frothoing at mouth and nostrils
  Confusion
 Decrease consciousness or loss of consciousness
 Bloated abdomen ,vomiting or chocking

Types
 Wet drowning: lungs are not adopted to extract oxygen from water/fluids. Therefore
when water enter into the airway it cause mechanical obstruction of airways leading
to absent oxygen transfer to blood, causing hypoxia and death.
 Dry drowning: when water suddenly hit larynx it can go into spasm totally obstruction
the airway leading to hypoxia without any water entering lung. In some sensitive
individuals sudden gush of water (cold) onto larynx can lead to extreme vagal nerve
discharge causing heart to stop suddenly

First aid management

Survival and outcomes depends on early and appropriate management. Immediate

management of the victims with drowning includes removing the victims from water and
rescue.
1. Remove the child from water and keep in safe place.
2. Assess the child airway, breathing, and circulation.
3. Clear airway remove any foreign material from airway.
4. Remove the inhaled or ingested water by keeping the head upside down and applying
pressure on abdomen carefully.
5. Perform cardiopulmonary resuscitation if the child has no pulse or respiration.
6. Assess the general condition temperature and other trauma.
7. Remove wet clothes and cover child with warm blanket.
8. Refer the victim to hospital to hospital continuing first aid management on the way.

Prevention
 Supervise closely with near sources of water.
 Have fence around ponds well and other source of water.
  Keep bathroom door always closed.
 Bucket and bowl filled with water must be covered and keep the children away from it.
 Never leave the young child alone in bath tub or water bucket.
 Teach about risk of water among preschool and school aged children.

Instruct child rub tube or safety.

INSECT BITE
When the insect pierces it sting into tissue and release venom is called insect bite. In
general bites are usually not a serious problem but in some cases it may be serious. Most stings
can cause pain and localized swelling, sometime severe anaphylactic reaction are possible
which requires emergency management. Bites are bees and wasps,scorpions,hornet
,spider,leech bite ,ticks and mites etc.

Signs and symptoms

The symptoms of insect bites or stings can vary a lot depending on how sensitive your child is to
that insect. Your child's allergic reaction to a bite can worsen over two to three days. If your
child has been bitten or stung by an insect, they may have:

 a minor skin reaction with a painful, itchy lesion at the site of the bite or sting
 a more significant reaction, with a larger area of swelling and redness, and sometimes
blisters.

If the child is having a severe allergic reaction, they may show the following signs of
anaphylaxis:

 a widespread rash (hives) or severe itching

 coughing, wheezing or choking
 difficulty breathing and swallowing
 difficulty talking and/or hoarse voice
 swelling of the lips or tongue
 fainting 
 becoming pale and floppy (young children).

Management
Although insect bites can be irritating, they usually begin to disappear by the next day and do
not require a medical treatment.

 To relieve the itchiness apply a cool compress or calamine lotion freely on child body
expect the area around the eyes and genitals.
 If the child is stung by a wasp or bee, soak a cloth in cold water press it over the area of
the sting to reduce pain and swelling.
 If the bite is of tick and mites ,it should not be pulled forcefully otherwise some part of
their body will be left wound and if it gets crushes then germs will enter the body.it
should be taken out either by forceps pr fall themselves by applying burns of cigar rete
on dorsal surface.
 If itchiness is severe, creams or lotions contains antihistamines or oral antihistamines
can be used.
 Remove a bee stringer quickly and completely from skin to prevent venom from being
pumped in the skin.
 Keep child fingernail short and clean to minimize the risk of infection from scratching.
 Keep the place cool by alcohol, spirit or ice.
 The bitten area should be clean and bandaged.
 If infection does occur, it may need to be treated with antibiotics.
 Refer the child to hospital immediately if the child has any of those symptoms after
being bitten or stung.
o Sudden difficulty in breathing.
o Weakness collapse or unconsciousness
o Hives or itchiness all over the body.
o Extreme swelling near the eyes, lips, or penis that makes it difficult for the child
to see eat or urinate.

Prevention
 Avoid areas where insects nest such as garbage waste, stagnant pools of water.
 If the child will be exposed to insect, dress her in long trouser and long sleeves shirt.
 Avoid dressing the child will bright color of flowery prints.
 Don’t use scented soaps, perfumes or hair sprays on child attract insects.
 Apply insect repellent cream while there is the chance to be exposed to insects.
 SNAKE BITE
Snakebite is a bite by snake to an individual. During bite there is a release of its venom. The
venom is hemotoxin/neurotoxin that destroy RBCs or tissues. Through bite of all snake is
not poisonous but the victim may require medical aid.
Types of venom
1. Hemotoxic venom: affects the blood and circulation (VIPER).The preys dies from
cardiovascular failure and bleeding. It often results in great pain, swelling and bruising, drops of
blood pressure, followed by bleeding from the gums, nose, eyes, and in the brain. Death can
result from untreated bites. It cause severe tissue and organ damage.

2 Myotoxic: effects muscle tissue (rattle snakes, sea snakes and sea kraita). In prey the venom
rapidly disables muscle contractions. It results in pain in legs, hips and shoulders, with paralysis
and damage to the kidneys. About 25% of victim’s severe muscle and kidney damage. Venom
can cause muscle necrosis.

3. Cytotoxic: Destroys cell. In humans, bites from its species can produce severe, local
and systematic symptoms, bleeding, swelling, and pain. They are responsible for more fatalities
than other African snakes.

4. Neurotoxic: Affects the nervous system (cobra). There is a progressive paralysis of the
skeletal and peripheral muscles, followed by death from respiratory failure. It results in
drooping of eyelids and a dazed sleeplike paralysis, sometimes followed by spasms, excess
salivation and vomiting. .
There are mainly two types of poisonous snakes in Nepal
 Elapids (cobra)-release neurotoxins
 Viperidae (viper): release hemotoxic

Common sign and symptoms

 Two puncture wounds
 Bleeding
 Burning of skin
 Swelling
 Diarrhea
 Pain dizziness due to blood pressure dropping
 Skin may become pale, cool
  Extreme weakness, sweating and fainting
 Rapid and weak pulse
 Numbness and tingling
 Fever
 Blurring of vision
 Nausea and vomiting
 loss of muscle coordination
 unconscious
Prevention
 Avoid areas where snake may be hiding, such as under rocks and logs
 Even though most snakes are not venomous, avoid picking up or playing with any
snake unless you have been properly trained
 Don’t provoke a snake. That is when many serious snake bites occurs
 When hiking in an area known to have snakes, wear long pants and boots if
possible.
Treatment
 Reassure the child who may be anxious
 Immobilization of the affected limb in splint as this will retard absorption of the
venom into the bloodstream and lymphatic’s.
 If the area of bite begins to swell and change color, the snake was probably
poisonous.
 Pressure immobilization for elapid bites.
 Cover the bite lightly and then leave it alone. If sterile bandage available ,place it
over the bite
 Get medical help right away.
 No tourniquets, incision of fang marks, snake stones for absorption of venom, oral
suction of the venom or ice packs.
 Bring the dead snake only if this can be done safely. Do not waste time hunting for
the snake and do not risk another bite if it is not easy to kill the snake. Be careful of
the head when transporting it- a snake can actually bite for several hours after its
dead.
DO NOT
 Do not allow the child to overexert
 Do not apply a tourniquet.
 Do not apply cold compresses to a snake bite.
 Do not cut with knife or razor.
 Do not try to suck out the venom.
 Do not give anything to eat by mouth.
 Do not raise the site of the bite above the level of the person heart.
General management
 Even non-venomous snake bite may lead to infections
 Stop the bleeding, bites from nonpoisonous snake are unlikely to be life
threatening, but they still require first aid treatment to prevent infection
 Don’t treat the bites as a non-venomous bite unless you are absolutely sure that the
snake was not venomous and clean with soap and water. For several minutes and
apply thin coating of antibiotic.
 Clean the wound carefully with clean water and administration of anti-snake venom
and fresh frozen plasma.
BURNS
DEFINITION
A burn is a type of injury to tissue caused by heat, electricity, chemicals, light, and radiation
of friction. Most burn only affect the skin (epidermal tissue and dermis). Rarely deeper tissues
such as muscle, bone, and blood vessels can also be injured.

TYPES/ETIOLOGY OF BURN
 Thermal burn: thermal burns are generally the common type of burn .they result from
exposure to or contact with steam, flames and hot surface or hot liquids with the
temperature above 115 degree F.(e.g. boiling water at 212 C or 100 c ) .the extent of
damage depends on the temperature of the substances and how long the skin is exposed.
This type of burn commonly occur in the home while ironing, cooking, or touching water.
 Chemical burn: chemical burn occurs when the skin is in contact with strong alkali .the
extent of damage depends on how long the skin is exposed to the chemicals. The chemicals
will continue to damage the skin and deeper layers until it is removed away. Household
chemicals that cause burns include bleach, boric acid, paint thinner. While many chemicals
burns occur in the home, they are also common in the work [place in the certain industries.
 Electrical burn: burn suffered in electrical accident three types which are electrical burn,
thermal contact burn and electrical burn have deeper surface penetration. The person with
an electrical burn in his or her arm may have another wound in the leg (entry point and exit
point).because the electricity runs through the body it effects the muscles, veins, arteries
and nerves between entry and exit point.
 Radiation burn: a radiation burn is the damage to the skin or other biological tissue caused
by exposure to ionizing radiation. The most common type of radiation burn is sunburn
caused by UV radiation
 Inhalation burn injury: smoke inhalation injury commonly results from the breathing in of
harmful gases,vapours and hot smokes. There is large total body surface area in inhalation
burn.

DEGREE OF BURN
1. Superficial burn (1st degree burn): the epidermis destroyed or injured and the portion of
the dermis may be injured. The damage skin may be painful,hyperesthetic and appears red
 and dry. Erythema blanches is minimal so the protective function of the skin remain
intact .pain is the predominant symptoms and heals in 5 to 10 days.
2. Partial thickness (2nd degree burn): partial thickness involves the destruction of the
epidermis and upper layers of the dermis and injury to deeper portion of the dermis.
In superficial partial thickness burn injury, dermal elements are intact, sweat glands and hair
follicles remain intact that appears thick walled blisters, wet shiny, weeping surface which is
painful. Injury heals within 2 to 3 weeks if no infection.
Deep dermal burn injuries appears molted with pink, red or waxy white are exhibiting blisters
and edema formation. The wound is painful, moist, and red and blistered with exudate fluids
.the wound is extremely sensitive to temperature. Deep partial thickness burn take longer time
to heal and more likely to result in hypertrophic wound.
3. Full thickness burn( 3RD Degree): these burns are serious injuries involve the entire
epidermis and dermis and extend into subcutaneous and other underlying tissue, nerve
tissue ,sweat glands and hair follicle .wound color ranges widely from waxy white to red
,brown and is distinguish by white leathery appearance. Full thickness wound are not able
to re epithelized and require surgical excision and grafting to close the wound.
4. Fourth degree burn: this is the full thickness injuries that involve underlying structure such
as muscles, fascia and bone. The wound appears dull and dry and ligaments fascia and
bone. The wound appears dry and ligaments tendon and bone may be exposed. The chance
of immediate and long term complication like function loss, deformity is more.as the
deepest structure are injured it needs special and long time to heal.

EXTENT OF BURN ( TBSA%)

The extent of a burn is expressed as a percentage of the total body surface area (TBSA)
affected by burn. Among them they are the Lund and Browder method, palm method and
rule of nine.
1. Lund and browder method: this method modifies the percentage of the body
segment according to age, changes with growth and provides more accurate
estimate of burn size .so,it is commonly used in children. Initial evaluation on the
patient arrival at the hospital and is revised on the 2nd and 3rd post born days.
2. Palm method: in patient with scattered burns a method to estimate the percentage
of burn is the palm method. The size of the patient palm is approximately 1% of TBSA>
3. Rule of 9 method: it is the quickly way to calculate the extent of burn. The basis of
this rule is that rule is the body is divided into anatomical sections, each representing 9%
or multiple or 9% of the TBSA .it is useful only for older children or adults. Head & Neck
= 9%
• Each upper extremity (Arms) = 9%
• Each lower extremity (Legs) = 18%
• Anterior trunk= 18%
• Posterior trunk = 18%
• Genitalia (perineum) = 1%
 Body part Percent

Arm (including the hand) 9 percent each

Anterior trunk (front of the body) 18 percent

Head and neck 18 percent

Legs (including the feet) 14 percent each

Posterior trunk (back of the

18 percent
body)
•

Pathophysiology
A. LOCAL RERSPONSE
The three zones of a burn
• Zone of Coagulation:
· the point of maximum damage
· Irreversible tissue loss due to coagulation of constituent proteins.
• Zone of Stasis:
• · Characterised by decreased tissue perfusion
• · Potential to rescue the tissue in this zone
• · Problems such as prolonged hypotension, infection or oedema can convert this
area into one of complete tissue loss
• Zone of Hyperaemia:
· The tissue here will invariably recover unless there is severe sepsis or prolonged hypo
perfusion.
B.SYSTEMIC RESPONSE
DIRECT INJURY TO THE SKIN
Heat (40- 44) from external source

Conducted to the skin

Denatures/ devitalized the protein in cells

Failure of various cellular enzyme systems

 Na- K pump fail

Cellular edema
RENAL SYSTEM
Burn injury

Blood flow to the brain and heart.

Renal perfusion

Oliguria

Hypovolemia

Shock

GASTROINTESTIONAL SYSTEM
Burns

blood flow to the gastric mucosa

Ischemic change to the upper GI tract

Slows production of protective mucus lining.

Superficial erosion of the stomach and duodenum.

Curling ulcer

GI bleeding
 PULMONARY SYSTEM

the inhalation of hot gases causes thermal burn to the upper airway.

Release of histamine, serotonin and thromboxane leads to bronchoconstriction.

Causes stridor, hoarseness, cough and respiratory obstruction.

Hypoxia, Acute Respiratory Distress Syndrome (ARDS) and respiratory obstruction.

CARDIOVASCULAR SYSTEM
Burn

Fluid volume loss

Hypovolemia

Cardiac output continue to fall and BP drops

Burn shock

In response sympathetic nervous system releases catecholamine.

Results in increase in peripheral vascular resistance and increase in pulse.

Suppressed myocardial contractility

METABOLIC SYSTEM
BURN

severe injury

Secretions of catecholamine’s, cortisol, and glycogen to support tissue repair.

 Hyper metabolism

Hyperthermia

Protein wasting

Weight loss
INTEGUMENTARY SYSTEM
Burns

Skin breakdown

Loss of skin integrity

Inability to regulate body

temperature.

hypothermia
Immunosuppressant
Following factors results in immunosuppression:
– Depression of lymphocyte activity.
– Decrease in immunoglobulin production.
– Supression of complement activity.
– Alteration in neutrophil and macrophages functioning.
– Alteration in skin integrity

CLINICAL MANIFESTATIONS
• Hypothermia
• FLUID AND ELECTROLYTE IMBALANCE
– Increase fluid volume
– Hyperkalaemia
– Hypernatremia
– Hypernatremia
 – Edema
– Elevated haematocrit level
– urine output
– bowel sound
– Abdominal distension
• ALTERATION IN RESPIRATION:
• Trachynea
• increase oxygen saturation
• CARDIOVASCULAR SYSTEM:
• Increase cardiac output
• Low BP
• Weak peripheral pulse

MANAGEMENT OF CHILD WITH BURN

Management of child with burn can be divided into 4 phases
i. Resuscitative phase ( first aid management)
ii. Emergency medical management
iii. Intermediate phase
iv. Rehabilitative phase

Resuscitative phase
 Remove the child from burn area
 Extinguish the flames.
 Maintain A, B, C (airway, breathing, circulation).
 Cool the burn area.
 Do not apply ice, and any other in burn and do not disturb blisters.
 Remove the restrictive clothes, objects.
 Cover the wound with clean clothes for dress.
 Irrigate out the running water if chemical burn.
 Place the victim in comfortable positions
 Reassure the victim
 Refer the patient to health facilities with burn care activities.
Assessment of burn (classification of burn extent)
The child with the burn injury should be assesses
 Emergency medical management
1. AIRWAY , BREAATHING
 Assess breathing maintain patent airway.
 Administer 100 % humidified oxygen.
 Endotracheal intubation and manual ventilation may be needed.
 NPO to prevent aspiration.
2. CIRCULATION
Assess circulatory status quickly, monitor pulse bp frequently.
 Careful watch feature of shock and prevent it.
 Assessment of total body surface are affected and degree of burn.

3. FLUID RESUSTICATION
The goal of fluid resuscitation is to restore and maintain perfusion and tissue oxygen
delivery at optimal level. Without overloading circulation. Urine output should be maintained
up to 0.7 to 1.3 kg /hr. Isotonic solutions like normal saline or ringer lactate should be
administer initially at the rate of 20 ml/kg/hr. until calculation of appropriate replacement can
be made. Potassium is not administer during the first 12 to 24 hr. until normal kidney function
is demonstrated.
Keep the IV cannula of large bore. Administer fluid and electrolyte according to depth of
burn and TBSA affected.
 Assess vital signs (pulse <110 /m, BP > 110 mm hg) tissue perfusion.
 Central venous catheter may be needed for fluid administration and fluid monitoring.
 Monitor urine output (30 to 40 ml per hour) urine. Output is good and recovering health If
burn < 20 % orals fluid replacement can be done.
 Keep the child warm.
 Assess the body temperature frequently.
 Less exposure of wound, keep warm.
 Management of the pain usually pharmacological; management in the situation.
 Dressing of the wound.
 Administer tetanus prophylaxis.
 Insert Foley catheter facilitate urination and for accurate measurement of the urine
output.
 Accurate of monitoring of the urine output electrolyte vital signs and the general
condition.
 N G feeding in continuous drainage if abdominal area affected of abdominal distension.
Guidelines and formulas for fluid replacement in burn patient
 Brooke army formula
Colloid: 0.5 ml X kg body weight X TBSA%
RL/NS 1.5 ml X kg body weight X TBSA %
5 % dextrose: 2000 ml for insensible loss
Day 1st: half amount in 1st 8 hours, remaining ½ in next 16 hours
Day 2nd: half of colloid and ½ of electrolyte
 Parkland and Baxter formula
RL: 4ml X kg body weight X TBSA%
Day 1st: half amount in 1st 8 hours, remaining ½ in next 16 hours
Day 2nd: Varies, colloids are added.

INTERMEDIATE MANAGEMENT OF BURN

 Continuous management of the condition and acute complication of the burn injury such
as hypotonic shock, sign of CHF, renal failure.
 Estimate burn size:
The primary determinant of survival in patients with burn injury is patient below 4
yr. and the size and depth of the burn wound. the Barlow body surface area chart and
rules of 9 used to estimate surface area char and rules of 9 ,used to estimate surface area
of burn injuries in adults are not applicable to children .the Lund and Browder
modification ,which divides the body into small portion and takes into account childhood
difference in body proportion is preferred.
 Hospitalization
Minor burns can be treated at home with topical ointment .indication of
patient having like i. 5% total body surface area (TBSA), third degree burn, ii.10%TBSA
second and third degree burn of iii. Burn in the genital, face of hands. People with
inhalation injury are managed by endotracheal intubation and ventilation,
hyperventilation with 100% oxygen shortens the half-life of carbon monoxide elimination
from 4 hr to 40 minutes.
 Analgesia
Adequate control of pain and anxiety is essential is essential to minimize the stress
response of burn injury. Narcotics are the commonest form of analgesia in major burns.
Requirement for analgesia in major burn.
 Maintain thermoregulation
 Infection prevention
o Use of aseptic technique in all invasive procedure.
 o Meticulous hand washing.
o Follow isolation technique
o Visitor control
o Administer antibiotic according to culture and sensitivity.
 Wound care
o Wound cleaning (tub bath ,cleaning with warm NS)
o Topical antibacterial application (more effective than systematic)
o Most commonly used topical agents are 0.5% silver sulphadiazine, 0.5 %silver nitrate
and mefenide acetate. These agents limit bacterial proliferation but do not sterilize the
wound. Most effective in small children is silver sulphadiazine is painless and soothing
effect and restrict fluid and heat loss from burn area.
o Wound dressing, exposure or occlusive method and frequency usually daily.
Wound debridement (natural, mechanical, surgical)
o Grafting the burn wound. When the dead tissue are absent and no any infection
present ,burn wound and deep burn ,skin graft are done to promote wound feeling and
prevent scar tissue formation tissue. Skin graft may be auto graft (own body skin)
allograft (skin of others) or other synthetic graft material. Care of the grafted wound.
o Care of the donor site by keeping it clean dry and free from pressure with dry dressing
and light pressure.
 Nutrition :
Attention essential nutrition is the essential component management. High
calorie and nitrogen intake is crucial to survival. Calorie requirement is best suited by
following formula
Infants: 2100cal/m2 +100cal/m2 burn area surface
Children: 1800cal/m2 +1300csal/m2
Adolescents: 1500 kcal/m2 surface area and burn surface area.
Adequate protein (2 to 3 g/kg weight) supplementation of trace vitamins and minerals is
necessary. In the children with more extensive burn, inhalation burn and injury of
prolonged paralytic ileus, parental nutrition is considered.
 Others
Assessment of physical abilities and enabling full range of joint movement by physical
and occupational and play therapies encouraged. Family therapy and evaluation of the
child environment should not be overlooked.

Rehabilitative care
 Promoting activity tolerance and prevent hypertrophic scar.
o Appropriate wound care.
o Use of elastic bandage.
o Lubricating and other wound care.
o Reduce pain ,preventing chilling ,promote skin integrity
 o Physiotherapy.
o Recreational /diversional therapy.
o Gradual increase activity.

Improving body image and self-concept.

o Reconstructive treatment of the cosmetic and functional part of the body.
o Help them to recognize their strength and enhance them
o Consultation with psychologist, social workers, vocational counselor.
o Monitoring and managing potential complication.

Monitoring and maintaining potential complication.

o Promoting home and community based care.
o Involving the patient and family in care activities.
o Home care training.
o Instructing about the community resources for help.

Nursing management
Nursing assessment:
History taking: types and cause of burn
Physical examination: total body surface area (TBSA) affected, types of area of injured and
depth of burn any complication
Necessary laboratory investigation
Nursing diagnosis
 Impaired skin integrity related to loss of superficial or deep loss of skin layer
 Acute pain related to burn injury
 Risk of infection related to moss of skin layer
 Imbalance nutrition less than body requirement related to inadequate intake of fluid
and nutrients as evidence by patient verbalization.