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Burns require specific emergency care and continuous treatment. Preference is given to fluid hydration, swelling and its complications, establishing and maintaining an airway, nutritional supplements, a catheter for monitoring urine output, X-rays and possible skin grafts. Burns damage the skin, which protects the body from fluid loss and infection, and can result in renal failure, life-threatening infections, shock and death. Fluid loss alters the balance of potassium, sodium, chloride, calcium and water, requiring constant replacement and monitoring.
Types of Burns
Burns result from exposure to heat from fire or liquids, electricity, chemicals and radiation. Categories of burns are first-degree, second-degree and third-degree. First-degree burns damage the epidermis or outer layer of tissue and result in redness and pain. Second-degree burns damage epidermal and dermal tissue, the second layer of skin, and result in redness, pain and blisters. Third-degree burns damage skin down to the nerves, muscles, tendons and possibly bones, leaving a charred appearance with no pain as a result of nerve damage.
With minor burns, treatment can occur at home, in the doctor's office and the emergency room based on the size of the burned areas of the body affected. The care for second-degree and third-degree burns requires emergency room care and frequently placement in a burn treatment center. When deep tissues are damaged, rapid fluid loss, including electrolytes, minerals and water, leads to severe dehydration, which requires continuous replacement with intravenous solutions.
Lactated Ringers is the intravenous fluid of choice for hydration with severe burns in adults and includes sodium chloride, sodium lactate, potassium chloride, calcium chloride dihydrate and water. Fluid hydration requires heart monitoring because of potassium increases which occur as a result of cellular and tissue damage, releasing potassium into the bloodstream. Sodium, chloride, calcium and potassium levels require replacement within the initial phases of treatment for burns to prevent shock from extreme fluid loss.
Burns require increased calorie replacement to balance the damage to tissues and to aid in wound healing. If the burns affect the ability to eat, a tube may be placed into the stomach for liquid nutrition. The diet for burn patients, regardless of the method of administration, is high in calories and high-protein with vitamin and mineral supplements. Oral diets include fruits and vegetables, lean meats, fish, beans and tofu for protein.
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