Management of Acute Veteran Burns - Essay Example

Role of a Nurse in Management of Acute Veteran Burns affiliation Burns management Introduction Burn injuries are a real threat in the military environment. They form a medical problem that has been present since the beginning of war history. From the time veterans used fire as a weapon, and before, burns have been a cause of veteran casualty that has a real threat to the mission and to the health and life of the victim and their partners. Statistics show that in the US Army military operations, more than 180 serious noncombatant burns were recorded between 2003 and 2008. These included fuel mishaps, unintentional detonations of ammunition and chemical exposures. The prevalence of noncombatant burns among the US military is estimated to be 20 burns/ 100,000 persons (Kauvar, Wade, & Baer, 2009). It has, therefore, become a necessity that burns management is done at the battlefield to reduce the acuity and prevent pathologies associated with the burns. Nurses’ practitioners are important in this management and are thus actively involved in military training to help solve the burns and other health problems. The nurses’ roles in management of acute veteran burns depends on the type of burns that are. Types of burns in battlefield. There are many types of burns in the battlefield depending on the causes. Ideally, burns result from exposure to extreme temperatures, biological and chemical reactions or energy transfer through the body cells. Some burns in the battlefield occur ad a direct effect of the causative factor such as fires from fuels and ammunition or as a secondary effect from causes such as explosives and mines. The common types of burns in the battlefield are thermal, electrical, chemical, and radiation burns (Alvarado, Chung, Cancio, & Wolf, 2009). Thermal burns are the most common types of burns in all environments including the battlefields. Thermal burns in the battlefield result from exposure to open fires from incendiary weapons, munition, fuels fires and flames from weapons. These weapons are designed to burn at very high temperatures and incorporate highly heat sensitive elements such as magnesium, phosphorus and thermite. These burns affect all parts of the body, and the management depends on the effect. Acutely, when these burns happen in enclosed space, airway burns are common. These results to sudden life-threatening inflammation of the airway that requires immediate attention (Alvarado et al., 2009). The role of the nurse in this case is to monitor the casualty for signs of airway compromise which include stridor, oropharyngeal swellings, hoarseness of voice and inability or painful swallowing. Emergency cases involving these airway effects require intubation and airway patency maintenance (Thompson & Mastel-Smith, 2012). Chemical burns results from sudden or prolonged exposure to corrosive or burning chemical agents. The most common chemical burns in the battlefield include acid and alkali burns. These are I cleaners and other chemicals used in the daily duties in the battle and not directly related to the wars and weapons. However, acid burns can also be used by enemies as weapons. The immediate acute attention to chemical burns is the removal of the offending agent. These burns commonly affect the skin and the eyes. Removal involves washing the burn area with a lot of water to dilute the chemical from the surface (Kauvar et al., 2006). When the chemicals affect the eyes clean water is used to wash away the chemical, and more critical ophthalmic attention should follow. The goal of this intervention is to reduce the exposure to the chemical as much as possible by reducing the concentration. Further, this reduces extensive damage to tissues. Electrical burns are common in the battlefield on two occasions. First, they occur as a result of household electrical accidents in the camps and second as a result of high-voltage exposure in line of duty from enemy traps or electric fences. Electrical current causes tissue damage along its path from the entry to the exit point. A large muscle group is and strict monitoring even with a minor surface injury is necessary. Common problems to monitor are cardiac arrhythmias, tympanic membrane rupture, intestinal tetany and signs of intracranial bleeding. Acute management of electrical burns include airway monitoring and cardiac resuscitation. The goal of management is to save and support life as the patient seeks further medical attention (Kauvar et al., 2009). The other common type of burns in the battlefield are the radiation burns. These are common burns where nuclear weapons are present. Nuclear blasts release into the atmosphere radioactive substances that are a threat to life. The priority action in radiation exposure is to remove the casualty from the source of contamination. Care should be taken to prevent self-exposure. Contaminated clothing should be removed and appropriately disposed. The casualty should then be thoroughly irrigated with water. The goal of the intervention is to reduce the exposure and prevent the development of secondary and systemic effects (Thomas, Kramer, & Herndon, 2003). Expected outcomes in burns management Acute management of burns takes into account the continued safety of the casualty and the rest of the veterans and ensuring that the effects of the burns do not continue. To ensure this, priority basic life support should be by first ensuring that airway patency, blood circulation and breathing are maintained. In addition, the nurse should ensure that the source of hazard is, and the casualty taken away from the source. The nurse is also expected to participate in the multidisciplinary management of the burns in the rehabilitation of the burn victims. Interventions in this case include observing and monitoring for signs of sepsis and dehydration through frequent vital signs monitoring. Local wound care to prevent sepsis and allows quick healing of the wounds is also the responsibility of the nurse. Besides wound care, antibiotic prophylaxis is necessary to prevent infection. The expected outcome in the management is that the victim will not develop sepsis that threatens systemic spread and even death (Thompson & Mastel-Smith, 2012). Most types of burns especially those that result to skin breaking and wounds cause fluid loss from the body. With extensive wounds, the fluid loss is massive and require replacement. The replacement fluids commonly used are Ringers lactate and Normal saline. The nurse has the role to monitor for signs of dehydration in the victims which include hypotension, dizziness and loss of skin turgor (Thomas et al., 2003). The fluid replacement should run for 24 hours, and the nurse has the responsibility to ensure that the patient recovers from the dehydration. Input and output should be strictly monitored as they indicate the body’s response to the replacement and the renal functional capacity. Pathologies Associated With Burns Burns are associated with pathologies such as gangrene with extensive burns or unmanaged wounds. The burns and the associated loss of fluid can also result to fatal hypovolemia and shock may result. In addition, unmanaged wounds easily become infected causing systemic septicemia which is disabling and life-threatening. With electrical burns, there is a danger that the extent of tissue damage may go unnoticed by initial assessment. Monitoring is, therefore, necessary to ensure that cardiac function and nervous system integrity are maintained (Thompson & Mastel-Smith, 2012). Acute management of battlefield burns by the nurse are at saving life and ensuring that the victim is alive to access further management. Resuscitation measures are effective to ensure that life is not compromised by the burns, the rehabilitative measures such as fluid replacement therapy and local wound care prevent disability and development of the pathologies. References Alvarado, R., Chung, K. K., Cancio, L. C., & Wolf, S. E. (2009). Burn resuscitation. Burns. doi:10.1016/j.burns.2008.03.008 Kauvar, D. S., Wade, C. E., & Baer, D. G. (2009). Burn Hazards of the Deployed Environment in Wartime: Epidemiology of Noncombat Burns from Ongoing United States Military Operations. Journal of the American College of Surgeons, 209, 453–460. doi:10.1016/j.jamcollsurg.2009.06.367 Kauvar, D. S., Wolf, S. E., Wade, C. E., Cancio, L. C., Renz, E. M., & Holcomb, J. B. (2006). Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns). Burns, 32, 853–857. doi:10.1016/j.burns.2006.03.008 Thomas, S. J., Kramer, G. C., & Herndon, D. N. (2003). Burns: military options and tactical solutions. The Journal of Trauma, 54, S207–S218. doi:10.1097/01.TA.0000065013.27877.F3 Thompson, S., & Mastel-Smith, B. (2012). Caring as a Standard of Nursing When Deployed Military Nurses Provide Services to Enemy Insurgents. International Journal for Human Caring, 16, 22–26. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011906159&site=ehost-live  Read More