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What is important about the stratum Germinativum?
This is where most cells regenerate. Whether or not a burn is deeper than the SG often determines if it will heal on its own.
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What is a partial thickness burn?
- destroys epidermis
- appears red, swollen and blistered
- usually heals in 2 weeks
- can extend into the dermis (deep partial thickness burn)
- Will heal well functionally and cosmetically.
- Will blanch to touch.
- Deep partial:
- Very painful
- may appear mottled with pink or red to waxy white areas with blisters and edema
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Full thickness burn?
- Dry, leathery, penetrates all layers of skin.
- Usually painless except around the margins.
- Sensory input also gone.
- Will not blanch to touch.
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What do you need to remember about assessing emergent skin burns?
- ABCs FIRST!!!
- Then...
- Disability
- Exposure
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What to do with a burn pt.
- Intubate at 100% O2, but...
- ...get info first if possible.
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What/when are you thinking with inhalation injury?
- enclosed space?
- fumes?
- smoke?
- stridor
- carbonaceous sputum?
- singeing around face/mouth/nose?
- change in voice from baseline?-->think damage at larynx or below.
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How can a full thickness burn around the trunk affect breathing?
- Can impair ventilation
- Respiration should be closely monitored.
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T/F a little bleeding is normal with burns.
- False
- If you find bleeding, find the source and stop it.
- If need fluid, us LR.
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How is prehospital fluid management calculated?
- <6yrs---125ml/hr
- 6-13yrs---250ml/hr
- >13yrs---500ml/hr
After hospital admission, they get a foley and fluids are very tightly controlled.
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T/F Your burn pt should be alert.
- True
- If not, find out why, ie
- --CO poisoning
- --substance abuse
- --hypoxia
- --pre-existing conditions like seizure
- AVPU: Alert Verbal Pain Unresponsive
- Identify any gross deformity/serious associated injury.
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Exposure/Environmental control phase
- remove clothing, jewelry, metal, diapers, shoes, etc.
- Log roll pt to remove clothing. Assume spinal cord injury
- Keep warm by covering with dry sheets.
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What happens during the secondary survey?
- Hx? Especially tetanus?
- wt?
- head to toe exam
- %TBSA?
- Admin lines/tubes
- Fine tune fluids/cath.
- extremity perfusion
- ventilation?
- pain?
- Psych assessment
- Reassess ABCs
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How do you calculate TBSA?
- Rule of 9s
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Bullet points about burn traumas
- spinal until r/o
- dont get distracted by the burn. Remember ABCs first.
- Burns alone don't cause unconciousness or hypotension.
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What is an escharotomy/fasciotomy?
- Escharotomy: cutting through burned tissue to relieve pressure. Does not usually require OR.
- Fasciotomy: removal of dead tissue to prepare for graft. Muscle layer is exposed.
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Initial wound care?
- Cover
- Transport
- Report using SAMPLE method.
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Fluid calcs for adults after hospital admit
- Adult >14yrs.
- 2ml LR x TBSA x kg
- Give half over 1st 8hrs, other half over next 16.
- Adjust to UO to 30-50ml/hr.
- If urine out of target for 2 consecutive hours increase or decrease fluid by 1/3.
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Fluid calcs for peds after hospital admit
- 3ml x kg x TBSA
- same admin regimen as adults.
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Med calcs for electrical injuries
- 4ml Lr x kg x TBSA
- UO--> 75-100ml/hr
- May need to increase uo to 1-1.5ml per kg to maintian clear urine.
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Chemical burns?
- protect yourself
- brush off if possible, remove clothing, irrigate for at least 20 min.
- identify agent if at all possible.
- chemical burn alone-->burn unit
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Electrical burns?
- Bone has high resistance so flows along bone surface and damages adjacent muscles
- small surface burns can indicate deeper, more extensive damage.
- Can have "entrance" and "exit" points where current travels.
- Requires debridement internally.
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