Burns

Question 1

How to classify burns

Answer 1

Classification
Severity
Depth
Extent
Special Considerations

Question 2

Superficial

Answer 2

1st degree

Question 3

Partial Thickness

Answer 3

2nd degree

Superficial partial thickness
Deep partial thickness

Question 4

Full thickness

Answer 4

3rd degree

Question 5

First degree burn

Answer 5

Ex: Sunburn

Involves epidermis only
Local pain and erythema
No blisters
Heals spontaneously without scarring
Systemic response is minimal.

Question 6

Superficial Partial Thickness

Answer 6

Erythema + blisters

Question 7

Deep Partial Thickness Burn

Answer 7

Involves epidermis and dermis
Moist appearance
Blister formation
Tacticle and pain sensors in tact

Question 8

Third Degree Burn : Full thickness burn

Answer 8

Involves all layers of the skin
Variable color: White, waxy, red, brown

Destroys elasticity, dry

Does not heal

PAINLESS

Question 9

Rule of 9s

Answer 9

Head and Neck: 9
Arms: 9 each
Ant trunk: 18
Post trunk:18
Legs: 18 each
Perineum: 1

Question 10

Burns of the face

Answer 10

May indicate inhalation injury
Facial edema may lead to compromised airway
Closely monitor respiratory status
Head of bed elevated to reduce edema
Shave hair to reduce risk of infection
If neck burns avoid the use of pillows

Question 11

Referral Criteria for Transfer to a Burn Center

Answer 11

1. Partial-thickness burns > 10% TBSA
2. Full thickness burns in any age group
3. Burns involving the face, hands, feet, genitalia, perineum, or major joints
4. Chemical burns
5. Electrical burns
6. Presence of inhalation injury
7. Preexisting medical conditions that could complicate management, prolong recovery, or affect mortality
8. Associated trauma
9. Hospitals without qualified personnel or equipment to care for burn-injured children
10. Burn injuries in patients who will require social, emotional, or long term rehabilitative intervention

Question 12

Primary Survey

Answer 12

Stop the burning
Airway
Breathing (O2, 15L, nonrebreather, intubation)
Circulation
Assessment of neurological deficits
Remove clothing
Cover

Question 13

Secondary Survey

Answer 13

History, mechanism of injury
Head to toe exam
Assessment of etiology
Assessment of burn depth and extent
Fluid resuscitation
Vital signs
NG tube
Foley catheter
Tetanus shot (0.5 mL SQ)

Question 14

Airway Management

Answer 14

Early nasotracheal or endotracheal intubation!
Extubate after 3 – 6 days unless major inhalation injury (this is)
High Fowlers with
100% O2
Bronchodilators

Question 15

Wound Care

Answer 15

Not addressed until ABC’s and fluid replacement established
Debridement – to remove loose necrotic skin in;
OR
Tub < 20 – 30 minutes
Shower water T < 104 ° ° or 40° C