Burns

Question 1

RULE OF NINES
The rule of 9’s determines the amount of body surface area that is affected by the burn. The following illustration identifies the parts of the body and the percentages allocated.

Front of head = 4.5%; back of head = 4.5%= 9%
Right arm: front of arm = 4.5%; back of arm = 4.5%= 9%
Left arm: front of arm = 4.5%; back of arm = 4.5%= 9%
Right leg: front of leg = 9%
Right leg: back of leg = 9%
Left leg: front of leg = 9%
Left leg: back of leg = 9%
Torso: top half = 9%
Torso: bottom half = 9%
Back: top half = 9%
Back: bottom half = 9%
Groin= 1%

Question 2

MANAGEMENT: FIRST, SECOND, THIRD DEGREE BURNS
While all burn injuries require attention, those affecting large body surface have a greater potential to lead to shock and/or death. In any situation when a burn occurs, it is imperative to remove the patient from the burn source. Chemical burns require irrigation of the area to remove the caustic chemical. Any burned clothing should be removed and the affected area should be covered with clean, dry cloth. In burns covering large TBSA, the patient should be covered to help maintain body temperature.

Question 3

FIRST DEGREE-Superficial
Rinse area with cool water
Apply over the counter(OTC) topical cream
OTC pain medications to help control pain
Do not apply butter, lotion, toothpaste, or ice to the burned area (Barkley, 2020)

Question 4

SECOND & THIRD DEGREE superficial partial thickness and deep partial-thickness

Treatment for second degree burns depends on if it is superficial or deep.
More superficial burns can be treated with the above measures with the addition of wrapping the affected area with a clean dry cloth, especially if blisters are present to help decrease the risk of infection. Antibiotics maybe added to the treatment plan if signs of infection are present.
Deeper second degree burns will require topical antibiotics creams and special dressings to facilitate healing.

Question 5

The severity of the burn determines the type of surgical intervention which include: skin grafting, fasciotomy, and escharotomy.

Burns that affect >10 % of the TBSA require IVF therapy.

The assessment of an individual who has sustained more severe injury should follow the steps of a primary survey (ABCDE). Fluid resuscitation should begin IMMEDIATELY.

In the initial assessment, the provider should take note of the following as intubation maybe necessary:

Singed nose hairs
Facial burns
Soot form nose or mouth
Drooling
Hoarseness
Dysphagia (Barkley, 2020)

Question 6

The following require hospital admission:

Partial thickness affecting > 5% of TBSA
Full thickness burns
Burns to the face, hands, feet, perineum
Burns in individuals < 2 years old and > 60 years old (Barkley, 2020)

COMMON LABS
The following labs are often indicated for patients hospitalized with burn injuries:

CBC
CMP
EKG
Urinalysis

Question 7

IVF
Burn patients requiring IVF should receive half of the fluids needed within the first eight hours of treatment and the remained over the next 16 hours. The Parkland formula is often used to calculate the amount of fluid needed to maintain fluid balance.

Parkland Formula: 4ml/kg x TBSA (Lactated Ringer’s fluid of choice)

Question 8

PAIN MANAGEMENT (BARKLEY, 2020)
Pain is controlled with IV pain medications ( ex: Morphine)
PO NSAIDS, Tylenol maybe used for minor burn injuries
For moderate to severe burns IV route is preferred

Question 9

ONGOING MONITORING
Ongoing monitoring of the patient’s airway is necessary because it can become blocked due to edema. The patients urinary output and labs should be monitored. Patients with a UOP < 30cc/hr. are not being properly hydrated and there should be an adjustment in the fluid therapy. Watch out for metabolic acidosis and hyperkalemia during the first 48 hours of care.

Question 10

What type of IVF should be used with burn patients? LR
What causes fluid loss in patients the large body surface area burns? heat damage increases per body of the capillaries which means plasmas able to leak out of the blood circulation. Also thru Exudate, blisters, and evaporated loss at the burn surface. Burn>15% of TBS warrants IV hydration.
What is the importance of an UA in burn patients? Looking for