Adult Burns Flashcards
Degree of burns
- Superficial: damage to epidermis – pain, redness, swelling
- Patrial: damage to epidermis and dermis – pain, redness, swelling, blisters
- Full Thickness: damage to all skin layers – tissue destruction, painless
Jacksons Rule of Burns
- Zone of hyperemia
o Top layer: ↑blood flow due to inflammatory response - Zone of stasis
o Middle layer: potentially viable tissue and can be reversed with fluid replacement. If left untreated causes ↓ perfusion, clotting and vasoconstriction - Zone of coagulopathy
o Non-viable tissue: clotting occurs to prevent further injury, irreversible damage, necrosis occurs
S+S of airway burns
Evidence of burns to upper torso, neck and face
Facial and upper airway oedema
Sooty sputum
Burns that occurred in an enclosed space
Singed facial hair (nasal hair, eyebrows, eyelashes, beards)
Respiratory distress (dyspnoea +/- wheeze and associated tachycardia, stridor)
Hypoxia (restlessness, irritability, cyanosis, decreased GCS)
Burn Cooling
Burn cooling should ideally be undertaken for 20 minutes. Stop cooling if the patient begins shivering
or has a temperature ≤ 35°C. Cooling provided prior to AV arrival should be included in the
timeframe.
How do we want to cool patients
Cool with gentle running water between 5 – 15°C where available. Ice and iced water is not desirable.
Dirty (e.g. dam) water should be avoided due to contamination and risk of infection.
If running water is not available, cooling may be achieved by immersing the injury in still water, using
a spray bottle or applying moist towels.
Cooling chemical burns
Whilst being mindful of temperature management, chemical burns should be irrigated for as long as
pain persists. Avoid washing chemicals onto unaffected areas, especially eyes.
Jewellery and Clothing in burns
Remove burnt clothing or clothing containing chemicals or hot liquid when safe to do so. Do not
remove any matter that is adhered to underlying tissue. Remove jewellery prior to swelling occurring.
Why do we want to elevate affected burn areas if possible
If clinically appropriate, elevation of the affected area during transport will minimise swelling and
oedema, especially in circumferential burns.
What direction do we want to apply cling wrap in burns pts
It should be applied
longitudinally to allow for swelling.
Explain the Wallace Rule of 9’s and their percentages
Wallace rule of nines assists in estimating the % of total body surface area for burns patients. The
breakdown is:
Head 9 %
Torso 18 % front (abdomen and chest) and 18 % back
Arm 9 % in total circumference (each)
Leg 18 % in total circumference (each)
Groin 1 %
Calculation for Pts >15yrs with TBSA >15%
NS - % TBSA x Pt wgt (kg) = mL (volume)
Administer over first 2 hours post time from burn
Calculation for pt 12-15yrs with TBSA >10%
NS - 3 x TBSA% x Pt wgt (kg) = mL (volume)
Give over 24hrs from time of burn
Give first half of volume in first 8/24
Burns Patho
Cellular destruction > 45 degrees
↓
Inflammatory response
↓
Localised: oedema, pain, loss of fluid and head, dehydration and hypothermia
Systemic: peripheral dilation and ↑HR, ↑capillary permeability and relative fluid loss, hypotension (cardiogenic, distributive, there shock), tissue hypo-perfusion, MODS
Why is fluid important in the burns pt
- Once skin damaged, fluid loss through evaporation occurs rapidly
- Fluid is required to minimize the extent of necrotic tissue
NOTE: amount of fluid is for the burn only. If pt has other injuries (such as open fracture) then you need to use the calculation PLUS 20mL/kg
Mgx for SD4
R+R
POC
MICA C1
O2 NRB 15L/min
Cool burn under cool water for 20/60 (watch for hypothermia ≤35º)
Warm patient
IV Access
Pain relief
Fluids
Dress burns (gladwrap)
MICA up/downgrade/SR
Extricate
VSS 5/60
Load Sig 1 Hospital w/ notification
