Touch sensation is impaired.
Lack of blanching with pressure is observed.
Wounds appear waxy white, dark brown, or charred
Touch sensation is impaired due to impaired nerve endings in full-thickness burns. Lack of blanching with pressure is observed, because all skin elements are destroyed. Wounds appear waxy white, dark brown, or charred in full-thickness burns, because all skin elements and local nerve endings are destroyed, and coagulation necrosis is present. Blanching with pressure is observed in partial-thickness burns, because varying degrees of both the epidermis and dermis are involved, and skin elements of regeneration are viable. Wounds appear mottled white, pink to cherry-red in a partial-thickness burn.
p. 434
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Possible airway burns
Airway burns are the leading contributor to death of burn patients in the prehospital environment. Indications of burns include burns to the face, respiratory distress accompanied by restriction of chest wall movement, restlessness, chest tightness, stridor, wheezing, difficulty in swallowing, hoarseness, coughing, and cyanosis.
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Terms in this set [28]
Classifying burns
According to depth of injury.
Superficial.
Partial thickness burns.
Full thickness.
Superficial burn
Involves only epidermis. Reddened skin. Pain at the site.
Care of superficial burn
Stop burning process with water or saline. Remove smoldering clothing or jewelry. BSI. Continually monitor airway. Prevent further contamination. Cover burned area with a dry sterile dressing. Do not use lotion or antiseptic. Transport.
Partial thickness burns
Involves epidermis and dermis: does not involve underlying tissue. Intense pain. White to red skin that is moist and mottled. Blisters.
Full thickness burns
Extends through all dermal layers; may involve subcutaneous layers, muscles, bone, or organs. Skin becomes dry and leathery: may appear white, dark brown or charred
Loss of sensation- little or no pain, pain at periphery.
classifying severity of burns
depth of burn-
Extent of burn, palm rule or rule of nines.
Location of burn- airway, face, hands , feet, genitalia.
Per existing medical conditions.
Age of patient.
Patients will experience burn shock
A form of non hemorrhagic hypovolemic shock resulting from there burn injury.
Fourth degree burns
Commonly associated with electrical burns
The tough and leathery dead soft tissue formed in the full thickness burn injury is called an eschar.
...
A fourth degree burn is a very deep burn that extends through all layers of skin and into the tendons, ligaments, muscles, bone and blood vessels.
...
Burns are classified as critical, moderate, or minor.
...
Inhalation injuries or burn involving the airway are always critical.
...
The most important factors to consider in determining burn severity
Depth of burn-
Location of burn-
Patients
age-
Preexisting medical conditions-
Percentage of body surface area involved.
Critical burns
Full thickness burns to hands, feet, face, or genitalia.
Burns associated with respiratory injury.
Partial/full thickness or chemical burns over 10% body surface area
Critical burns continued
Burns complicated by painful,
swollen, deformed extremity.
Moderate burns in children or elders. Circumferential burns.
Hydro floric acid
Moderate burns
Full thickness burns of 2-10% body surface area, excluding hands, feet, face, genitalia, & upper airway.
Partial thickness burns of 15-30% BSA.
Superficial burns greater than 50% body surface area.
Pediatric considerations
Relative size...
Greater surface are in relationship to total body size.
Results in greater fluid and heat loss.
Full thickness / partial thickness burns greater than 20% or involving hands, feet, face, airway, genitalia are considered a critical burn in a child.
Pediatric burns
Partial thickness burn of 10-20% is a moderate burn in a child.
Higher risk of shock, airway problems, and hypothermia.
Consider child abuse.
ALS upgrades are required for
Partial to full thickness or chemical burns to face or suspicion of airway involvement.
Partial to full chemical burns greater than 10% BSA.
ALS upgrades
Partial-full thickness or chemical burns if patient is 5
years or younger.
Electrical burns.
Hydro floric acid.
Chemical burns
Protect yourself!
Brush off dry powders prior to flushing.
Flush with large amounts of water. Continue flushing the area en route to hospital. Do not contaminate uninjured areas when flushing.
Electrical burns care
Administer oxygen. Monitor patient closely for respiratory and cardiac arrest. Often more severe then external indications. Treat soft tissue injuries associated with burn. Look for entrance and exit wound.
Minor burns
Full thickness burns involving less than 2% BSA.
Partial thickness burns less than 15% BSA.
Superficial burns less than 50% BSA.
The rule of nines
Is a method for estimating how much body surface area is burned in an adult or infant patient.
The rule of nines or other BSA calculations are not applied to superficial burns
...
Adult rule of nines
The head and neck together, each upper extremity, the chest, the abdomen, the upper back, the lower back, the front and back of each lower extremity each represents a BSA of 9%
Infants 1 year or less.
The head and neck are 18% the chest and abdomen 18% the entire back as 18% each upper extremity 9% and each lower extremity as 14%
Remember that critical burns are not immediately life threatening. Immediate causes of death are airway swelling and inhalation injuries
...
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