Burn Injuries Assessment by Faye Travilla 2008-42021

a Potential complications

Fluid and Electrolyte loss Hypovolemia Hypothermia, Infection, Acidosis catecholamine release, vasoconstriction Renal or hepatic failure Formation of eschar Complications of circumferential burn

a An important step in management is to determine depth and extent of damage to

determine where and how the patient should be treated Types of Burn Injuries a Thermal burn Skin injury Inhalation injury

a Chemical burn Skin injury Inhalation injury Mucous membrane injury

a Electrical burn Lightning

a Radiation burn

Burn Injuries Assessment by Faye Travilla 2008-42021

Depth Classification
As of now, burns are described based on the depth of injury to the dermis and are loosely classified as first, second and third degree burns. The system was devised by the French barber surgeon Ambroise Pare and remains in use today (Walls, Ratey, & Simon, 2009). To determine accurately the depth of a burn is often difficult. It is more pronounced in cases of second degree burns which can evolve over time. It may progress to a third degree burn over time even after initial treatment. Differentiating superficial-thickness burn and partial-thickness burn is important since the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting (Urden, Stacy, & Lough, 2010).

a Superficial 1st degree (Superficial burn) Involves the epidermis Characterized by reddening Tenderness and Pain Increased warmth Edema may occur, but no blistering Burn blanches under pressure Example - sunburn Usually heal in ~ 7 days

a Partial thickness 2nd Degree Burn (Partial Thickness Burn) Damage extends through the epidermis and involves the dermis.

Burn Injuries Assessment by Faye Travilla 2008-42021

Not enough to interfere with regeneration of the epithelium Moist, shiny appearance Salmon pink to red color Painful Does not have to blister to be 2nd degree Usually heal in ~7-21 days

a Full thickness 3rd degree

Both epidermis and dermis are destroyed with burning into subcutaneous fat

Thick, dry appearance Pearly gray or charred black color Painless - nerve endings are destroyed Pain is due to intermixing of 2nd degree May be minor bleeding Cannot heal and require grafting

a Often it is not possible to predict the exact depth of a burn in the acute phase.

Some 2nd degree burns will convert to 3rd when infection sets in. When in doubt call it 3rd degree (Urden, Stacy, & Lough, 2010). Total Body Surface Area Estimation a Rule of Nines

Burn Injuries Assessment by Faye Travilla 2008-42021

Adult

In adults, the "rule of nines" is used to determine the total percentage of area burned for each major section of the body.

Pediatric

For each yr over 1 years of age, subtract 1% from head and add equally to legs.

Palm Rule

Burn Injuries Assessment by Faye Travilla 2008-42021

In some cases, the burns may cover more than one body part, or may not fully cover such a part; in these cases, burns are measured by using the casualty's palm as a reference point for 1% of the body (Urden, Stacy, & Lough, 2010). a Lund and Browder

For children and infants, the Lund-Browder chart is used to assess the burned body surface area. Different percentages are used because the ratio of the combined surface area of the head and neck to the surface area of the limbs is typically larger in children than that of an adult (Urden, Stacy, & Lough, 2010). Burn Patient Severity a Factors to Consider Depth or Classification Body Surface area burned Age: Pediatric and Geriatric Pediatric

Burn Injuries Assessment by Faye Travilla 2008-42021

a Thin skin increases severity of burning relative to adults

a Large surface/volume ratio

rapid fluid loss increased heat loss hypothermia

a Delicate balance between dehydration and overhydration

a Immature immunological response sepsis

a Always consider possibility of child abuse Geriatric a Decreased myocardial reserve fluid resuscitation difficulty

a Peripheral vascular disease, diabetes a COPD increases complications of airway injury slow healing

a Poor immunological response - Sepsis a % mortality ~= age + % BSA burned

Preexisting medical conditions Associated Trauma blast injury

Burn Injuries Assessment by Faye Travilla 2008-42021

fall injury airway compromise child abuse

Critical Burn Criteria

Age 10-50yrs: partial thickness burns >25% of total body surface area Age <10 or >50: partial thickness burns >20% of total body surface area Full thickness burns >10% Burns involving the hands, face, feet or perineum Burns that cross major joints Circumferential burns to any extremity Any burn associated with inhalational injury Electrical burns Burns associated with fractures or other trauma Burns in infants and the elderly Burns in persons at high-risk of developing complications

These burns typically require referral to a specialized burn treatment center (American Burn Association, 2010.

Moderate Burn Criteria

Age 10-50yrs: partial thickness burns involving 15-25% of total body surface area Age <10 or >50: partial thickness burns involving 10-20% of total body surface area Full thickness burns involving 2-10% of total body surface area

Excluding hands, face, feet, or genitalia Without complicating factors

Persons suffering these burns often need to be hospitalized for burn care (American Burn Association, 2010).

Minor Burn Criteria

Burn Injuries Assessment by Faye Travilla 2008-42021

a Age 10-50yrs: partial thickness burns <15% of total body surface area a Age <10 or >50: partial thickness burns involving <10% of total body surface area a Full thickness burns <2% of total body surface area, without associated injuries These burns usually do not require hospitalization (American Burn Association, 2010).

Works Cited
American Burn Association (2010). Burn Incidence and Treatment in the United States: 2011 Fact Sheet. American Burn Association National Burn Repository. Urden, L., Stacy, K., & Lough, M. (2010). Critical Care Nursing 5th ed. Canada: Mosby. Walls, R., Ratey, J. J., & Simon, R. I. (2009). RoRosen's Emergency Medicine: Expert Consult Premium Edition. Mosby.