BURNS Incidence and Causes 8,000-10,00 burns per year in the U.S.A. 75-80% occur in homes Major causes: flames, scalds, heat, chemicals and electricity Under age 6, major cause is scalding 75% of burns could be avoided

Emergent Care Burning process stopped with removal of clothing, jewellery and covering affected area with cool water Increase blood volume with IV inserted in intact skin area Urinary catheter to monitor fluid output, indicates dehydration Intubation to secure an airway Vitals; BP, HR, BPM, Temp Determining extent of damage; Rule of Nines or Lund -Browder

Body surface affected (BSA) The Rule of Nines Entire head = 9% Each arm = 9% (18%) Chest = 9% Abdomen = 9% Upper back = 9% Lower back = 9% Front of each leg = 9% (18%) Back of each leg = 9% (18%) Groin = 1% Total 100% This along with the cause of the burn helps determine the severity of the burn

Lund-Browder Accurate assessment of TBSA

Complications of Major Burns Pulmonary injury; Stridor (whistling) with breathing Hypovolaemia; loss of plasma and decreased BP Hypothermia; with skin gone there is no thermoregulation Cardiac Arrhythmia; irregular heart beat. Kidney Failure Death

When burns are critical Any burn greater than 25% BSA Full or deep-partial-thickness burns greater than 10% BSA Burns complicated by a respiratory or airway injury Most burns involving the face, hands, feet or genitals Burns complicated by a fracture or major soft-tissue injury Electrical or deep-chemical burns Burns occurring in patients with serious pre-existing medical conditions

Classification of Burns First degree or superficial burns involve only the epidermis; burned area is red; no blisters. Second degree or partial thickness burns involve all of epidermis & varying depths of the dermis. Appearance -blisters, pink, moist, Extremely painful. Third degree or full thickness burns involve epidermis & entire dermis, possible deeper tissue such as muscle and bone. Appearance- white and dry. May be free of pain. Requires skin grafting.

Burn types Thermal - most common (Other than sunburn) direct flame, scalds and direct contact. Chemical - contact strong acids or alkalis. burning process continues as long as the chemical, or agent, is on the body. need to know the specific chemical because the treatment must be specific Electrical - type I, II and III. Type I - contact burn - most common - true electricity injury. burn is most severe at the entry and exit points. Type II - flash burn - victim becomes part of an electrical arc. Type III - flame burn - electricity ignites the victim's clothing. Sunburn. Radiation burns are by far the most common burns because of being exposed to an enormous nuclear reactor, the sun. sunburns are almost always superficial. Don't underestimate the potential severity of sunburn. Using the Rule of Nines, it is not uncommon for sunburn to reach the critical stage (burns greater than 25 percent BSA), Some patients require skin grafting after prolonged sun exposure.

Burn treatment 1.stop the burning 2. evaluate the injury 3. relieve pain 4. prevent shock 5. infection. Even though the fire is out, the burning can continue. Remove all burned clothing flush the skin with cool water. Flushing is crucial to a chemical burn, particularly alkalis which must be flushed for 1 to 2 hours Burned skin loses heat more rapidly than intact skin and cool water can cause hypothermia if a large BSA has been burned. Pay particular attention to the airway. An airway problem may not be immediately apparent. If the patient has airway involvement or any respiratory difficulty, advanced rapid treatment is required. Superficial burns are easily managed with cool compresses and acetaminophen for the pain. An extensive superficial burn will demand a slightly stronger analgesic and should be accompanied by an increase in fluid intake by the patient. basic systemic pain control along with fluid intake is the best approach. treatment of partial-thickness burns follows the same approach of cooling the area and covering the burn with a sterile dressing. Do not break the blisters; they are actually the best burn dressing available. If the blisters rupture later, apply Silvadene as an antibiotic ointment and cover with dry, sterile dressing. Fluid loss can be an early complication and is most common with partial-thickness and deeper burns. Depending on the extent of BSA involved, a fluid loss can rapidly lead to shock. If the BSA is greater than 15 percent, fluid replacement is required. This is best managed with I-V fluids

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