Burns

Question 1

What are the different types of burn injuries?

Answer 1

1) Thermal (exposure to flame or hot object)
2) Chemical (exposure to acid, alkali or organic substances)
3) Electrical (conversion of electrical energy into heat) (damage underneath affected area likely to be +++ more significant that it appears on surface level!)
4) Radiation (radiant energy being transferred to the body resulting in production of cellular toxins)

Question 2

What does the extent of injury from electrical burns result from?

Answer 2

Type of current, pathway of flow, local tissue resistance, and duration of contact

Question 3

Describe assessment of burn injuries:

Answer 3

• Depth of wound
• Size of wound
• Age of patient
• Past medical history
• Location of burn injury
• Associated trauma

Question 4

How are burn wounds classified?

Answer 4

• To depth of injury
• Extent of body surface involved
• Severity

Question 5

What are the different types of burn depths?

Answer 5

• Superficial
• Superficial-partial thickness
• Deep partial thickness
• Full thickness
• 4th degree

Question 6

Describe superficial (first degree) burns:

Answer 6

• Epidermal tissue only affected
• Erythema, blanching on pressure, mild swelling
• no vesicles or blister initially
• Not serious unless large areas involved
• i.e. sunburn

Question 7

Describe deep partial thickness (second degree) burns:

Answer 7

• Involves the epidermis and deep layer of the dermis
• Fluid-filled vesicles –red, shiny, wet, severe pain
• Hospitalization required if over 25% of body surface involved
• Significant scaring d/t extended healing time; needs to be treated like full thickness burns
• i.e. tar burn, flame

Question 8

Describe full thickness (third/fourth degree) burns:

Answer 8

• Destruction of all skin layers
• Requires immediate hospitalization
• Dry, waxy white, leathery, or hard skin, no pain
• Exposure to flames, electricity or chemicals can cause full thickness burns

Question 9

How is extent of burn injury determined?

Answer 9

• Expressed by % of total body surface area (TBSA) burned
• Calculated and documented on specific body charts, such as “rule of nines” (initial assessment), “palmer surface” or Lund-Browder chart (most accurate, adjusts for age)
• Superficial burns are not involved in calculation

Question 10

How is severity of burn determines?

Answer 10

• Depth and total body surface area burned

- Classified as minor moderate or major

Question 11

What are minor burns?

Answer 11

• <15% if the total BSA
• Full thickness burns <2%
• No involvement of eyes, face, hands, feet or perineum
• No pre-existing medical conditions
• Adult < 50 years old
• No other injury associated with burn

Question 12

What are moderate burns?

Answer 12

• < 25% of BSA
• full thickness burns < 10%
• no involvement of eyes, face, hands, feet or perineum
• no pre-existing medical conditions
• adult < 50 years old
• no other injury associated with burn

Question 13

What are major burns?

Answer 13

• > 25% of BSA
• full thickness > 10 %
• involvement of eyes, face, hands, feet or perineum
• caused by electricity
• > 50 years old
• accompanied by other injuries or inhalation burns
• has pre-existing medical conditions

Question 14

What are the three stages of burn care?

Answer 14

1) Emergent
2) Acute
3) Rehabilitation

Question 15

What is emergent stage care?

Answer 15

• From onset of injury to completion of fluid resuscitation
• ABCs of trauma care
• Critical management of the burn wound is essential at the time of the injury
• Immediate problem is fluid loss, edema, reduced blood flow (fluid and electrolyte shifts)

Question 16

What are the goals of the emergent phase of care?

Answer 16

1) secure airway
2) support circulation by fluid replacement
3) keep client comfortable with analgesics
4) prevent infection through wound care
5) maintain body temperature
6) provide emotional support

Question 17

Describe the pathophysiology of burns:

Answer 17

• Local skin response (infection, inflammation)
• Systemic response (hypovolemic shock)
• Cellular response (leaky capillaries, electrolyte alterations [K+ increase])
• Cardiac function (output decreased 30% within 30 minutes)
• Renal function (AKI)
• GI function (not enough to keep GI going, ileus)
• Stress response (increased metabolic rate, need for more glucose, loss of water, protein loss)
• Immune response (macrophages and neutrophil activity, sepsis risk)
• Generalized edema (plasma leaks)
• Reduction of blood volume (2nd to plasma loss, decreased cardiac output)
• < urinary output (2nd to fluid loss,

Question 18

When do we suspect inhalation injury along with burn injury?

Answer 18

• Facial injury
• Singed nasal hair
• Closed space injury
• Carbonaceous sputum
• Wheezing
• Pharyngeal edema
• Hoarseness

Question 19

What are additional interventions we do in the emergent phase?

Answer 19

• Knowledge of circumstances surrounding burn injury
• Obtain client’s pre-burn weight to calculate fluid rates
• Calculations based on weight obtained after fluid replacement is started are not accurate d/t water-induced weight gain
• Know client’s health history because physiologic stress c burn can make a latent disease process develop symptoms

Question 20

Describe the consensus formula/Parkland formula:

Answer 20

• Warmed RL is fluid of choice for crystalloid replacement
• Consensus formula = 2 mlRL x %TBSA x pt wt (kg)
• Parkland formula = 4 mls RL x %TBSA x pt wt (kg)
• 1/2 of total in first 8 hours
• 1/4 in second 8 hours
• 1/4 in third 8 hours

Question 21

Describe the acute stage of burn care:

Answer 21

• From start of diuresis to near completion of wound closure
• Efforts directed at managing the wound through pain relief (+ pain relief of tx modalities, such as long, uncomfortable positions during surgery)
• Adequate nutrition (enteral preferred since peripheral used ++ for fluids)
• Maintaining fluid, electrolyte and acid-base balance (remember, burns cause problems to multi-systems)
• Ongoing monitoring of complications
• Providing emotional support
• Planning for rehab and discharge

Question 22

What are the four goals of wound management?

Answer 22

1) Contain bacterial growth
2) Provide comfort
3) Facilitate the healing process
4) Promote restoration and function

Question 23

Describe the rehabilitation stage of burn care:

Answer 23

• Often a long process not only encompassing physical injuries but also the psycho-social care of the individual and family
• Reconstructive surgery may be necessary to address functional and cosmetic problems