thermal

chemical

electrical (includes lightening strikes)

radiation

inhalation injuries - can't tell they are burnt from outside

misc burns(cold weather injuries) ie frost bite

first-degree / superficial

Second degree - superficial partial vs deep partial thickness

third degree / full thickness

fourth degree

not only destroyed the skin but also damaged underlying structures

(muscle, fat, bone, ect)

minimal injury

skin is red and can be painful

skin gels

aloe vera gels

get out of the sun

symptomatic

blistering present and very painful 

skin red and moist

____ heals in 14-21 days with minimal scarring

returns to full function

skin blistered 

dermis pale white to yellow

does not blanch/pain is absent

full thickness burn in which tissue is destroyed below the hair follicle and sweat glands 

(entire skin thickness)

all dermal elements are destroed

significal scarring 

rule of nines (adult body)

hands estimation (small and irregular burns)

divides body into segments that are approximately 9% of the BSA

(can have multiples)

examine for signs of inhalation injury

100% oxygen

rapipd endotracheal intubation for any evidence of airway compromise

cover wounds with DRY sterile dressing

prompt fluid resuscitation

monitor urinary output (foley)

assess adequacy of circulation

erythematous vocal cords

carbon deposits

edema to oropharynx

to keep infection away from the wound

No goo on major burns - in case they have to get skin graft

cardiac monitor

vital signs/mental status

4 ml x weight (kg) x % TBSA burn 

give 50% total volume over the first 8 hrs after the burn

remaining 50% volume over the next 16 hrs (1/4 over each 8 hours)

decreasing signs of shock - skin perfusion & VS

mental status (clear w/n 8-10 hrs)

elimination of metabolic acidosis

urinary output 

generally progresses during the first 24-48 hrs after the injury

results in constricting eschar 

may compress trachea

may obstruct airway

early intubation is indicated

edema

neck burns

chest wall burns

emergent escharotomy

temperature maintenance

prevents further ischemic injury

chest wall burns

circumferential 2nd-3rd degree burns of any extremity

nerve/ciculatory supply is compromised

If it swells too much we compromise neurovascular supply to the foot so this helps allow the foot to swell – this way circulation can still take place and they don’t lose their foot

Required this cutting so we can ventilate that patient – skin will become scarred and leathery and wont stretch to expand

guard against hypothermia

increased ischemia

tissue damage/necrosis

Come in big packages to wrap big areas  - even if the skin hasn’t been cleaned – these help decrease the microorganisms that go into the wound

consult the burn team

minor burns may be treated locally

check criteria for tranfor to a burn center

1. second & third degree burns > 20% TBSA any age 

2. third degree > 5% TBSA any age group

3. second & third degree that involve the face, hands, feet, genitalia, perineum, and/or major joints

4. electrical burns, including lightening injury

5. inhalation injuries