Burns

A fourth degree burn is a very deep burn that extends through all layers of skin and into the tendons, ligaments, muscles, bone and blood vessels.

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Burns are classified as critical, moderate, or minor.

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Inhalation injuries or burn involving the airway are always critical.

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Remember that critical burns are not immediately life threatening. Immediate causes of death are airway swelling and inhalation injuries

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The rule of nines or other BSA calculations are not applied to superficial burns

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The tough and leathery dead soft tissue formed in the full thickness burn injury is called an eschar.

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Patients will experience burn shock

A form of non hemorrhagic hypovolemic shock resulting from there burn injury.

Classifying burns

According to depth of injury. Superficial. Partial thickness burns. Full thickness.

Electrical burns care

Administer oxygen. Monitor patient closely for respiratory and cardiac arrest. Often more severe then external indications. Treat soft tissue injuries associated with burn. Look for entrance and exit wound.

Critical burns continued

Burns complicated by painful, swollen, deformed extremity. Moderate burns in children or elders. Circumferential burns. Hydro floric acid

Fourth degree burns

Commonly associated with electrical burns

The most important factors to consider in determining burn severity

Depth of burn- Location of burn- Patients age- Preexisting medical conditions- Percentage of body surface area involved.

Full thickness burns

Extends through all dermal layers; may involve subcutaneous layers, muscles, bone, or organs. Skin becomes dry and leathery: may appear white, dark brown or charred Loss of sensation- little or no pain, pain at periphery.

Minor burns

Full thickness burns involving less than 2% BSA. Partial thickness burns less than 15% BSA. Superficial burns less than 50% BSA.

Moderate burns

Full thickness burns of 2-10% body surface area, excluding hands, feet, face, genitalia, & upper airway. Partial thickness burns of 15-30% BSA. Superficial burns greater than 50% body surface area.

Critical burns

Full thickness burns to hands, feet, face, or genitalia. Burns associated with respiratory injury. Partial/full thickness or chemical burns over 10% body surface area

Partial thickness burns

Involves epidermis and dermis: does not involve underlying tissue. Intense pain. White to red skin that is moist and mottled. Blisters.

Superficial burn

Involves only epidermis. Reddened skin. Pain at the site.

The rule of nines

Is a method for estimating how much body surface area is burned in an adult or infant patient.

Pediatric burns

Partial thickness burn of 10-20% is a moderate burn in a child. Higher risk of shock, airway problems, and hypothermia. Consider child abuse.

ALS upgrades are required for

Partial to full thickness or chemical burns to face or suspicion of airway involvement. Partial to full chemical burns greater than 10% BSA.

ALS upgrades

Partial-full thickness or chemical burns if patient is 5 years or younger. Electrical burns. Hydro floric acid.

Chemical burns

Protect yourself! Brush off dry powders prior to flushing. Flush with large amounts of water. Continue flushing the area en route to hospital. Do not contaminate uninjured areas when flushing.

Pediatric considerations

Relative size... Greater surface are in relationship to total body size. Results in greater fluid and heat loss. Full thickness / partial thickness burns greater than 20% or involving hands, feet, face, airway, genitalia are considered a critical burn in a child.

Care of superficial burn

Stop burning process with water or saline. Remove smoldering clothing or jewelry. BSI. Continually monitor airway. Prevent further contamination. Cover burned area with a dry sterile dressing. Do not use lotion or antiseptic. Transport.

Infants 1 year or less.

The head and neck are 18% the chest and abdomen 18% the entire back as 18% each upper extremity 9% and each lower extremity as 14%

Adult rule of nines

The head and neck together, each upper extremity, the chest, the abdomen, the upper back, the lower back, the front and back of each lower extremity each represents a BSA of 9%

classifying severity of burns

depth of burn- Extent of burn, palm rule or rule of nines. Location of burn- airway, face, hands , feet, genitalia. Per existing medical conditions. Age of patient.