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BURNS

Types of burns

Thermal
Chemical
Smoke/inhalation injury
Electrical
Cold thermal

Thermal burns

Most common
Occurs often in children, older adults
STOP, DROP, and ROLL Shuts off oxygen supply to fire
Flush with cold water
No ice on deep burns, only superficial
Cover patient with clean cover
Do not pull off clothing (skin will stick) Cut off
Keep NPO for possible surgery and to prevent stress ulcer, Curlings ulcer

Chemical burns

Smoke/inhalation injury
Electric burns

Severity of burn

Depth of burns

Superficial partial-thickness

Deep partial-thickness

Full thickness burn

Remove client from burning agent


Quickly remove chemical from skin
Irrigated with running water
Hot air/noxious chemicals Damange to respiratory tract
Observe for signs of respiratory distress
Has exit wound
Damage cannot be judge from size/depth of wound (effects internal)
**Patient at risk for arrhythmias due to potassium loss, metabolic acidosis due to
rhabdomylosis (destruction of skeletal muscle), and acute tubular necrosis due to
acute renal failure.
**Turn off source of electricity
Remove current with piece of wood (good insulator)
Initiate CPR, transport
Age Lower age increases severity
Nature of burning agent
Depth of burn
Extent by TBSA
Location
Presence of inhalation
Superficial Partial Thickness (epidermis)
Deep Paritial Thickness (dermis)
Full Thickness (subcutaneous)
(muscle and bone)
First degree
Least severe
First 2/3 of epidermis
Redness, mild swelling
Pain d/t nocireceptors
Sunburn most common
Pink to red
Slight edema
Second degree
Entire epidermis + upper dermis
Blisters, edema
Severe pain (most painful)
Red, blisters
Third/fourth degree
Hard, leathery, eschar

Full thickness burn cont.

Rule of nines

Lund-Browder chart
Pathophysiologic changes

Phases of burn management

Emergent phase

Parkland Baxter formula


Open method

Closed method
5 Ps of compartment syndrome

Edema
Pain-free
Possible muscle/bone involvement
Head and neck 9
Right arm 9
Left arm 9
Trunk 36
Left leg 18
Right leg 18
Perineum 1
Adequate for initial assement of adult
More accurate
Patients age in proportion to body-area size
Zone of coagulation Coagulation affect
Zone of statis Decreased perfusion, edema formation 24-48 hrs
Zone of hyperemia Increased blood flow from inflammatory process
Emergent (resuscitative)
Acute (wound healing)
Rehabilitative (restorative)
Onset of burns Fluid remobilization
**24-48 hours
Purpose: Replace fluid loss
Greatest threat Hypovolemic shock
Foley catheter inserted to determine renal status
Burns exceeding 25% NGT for gastic decompression
Electrical burns ECG
IV meds only for immediate relief
Carbon monoxide poisoning most immediate cause of daeth from fire Suffocation
Aseptic management
Elevate burned extremities
Large bore IV catheters
Burgundy colored urine
Use crystalloids (LR, PNSS, D5NS)
Colloids to expand plasma (Albumin, dextran, FFP)
Do not pop blisters for first 24 hrs Increase infection risk
Tetanus toxoid IM
Hydrotherapy <30 minutes
LR 4 ml x KG body weight x TBSA%
amount first 8 hours; amoung given second 16 hours
Topical chemotherapy
No painful dressing changes
Visible for assessing
Not suitable for hands and feet (might adhere together)
Difficult to control body temperature
Difficulty transferring
Silvadene**, silver nitrate, sulfamylon
Topical chemo wrapped with gauze
Check circulation and constriction
Pain
Pallor
Pulselessness
Paresthesia
Paralysis