# Chapter 46 - Burn Injury

## 45 terms · Chapter 46 - Burn Injury

Superficial burn

### Burn is gray, white, or charred. Looks thickened and leathery. Pain is absent.

Full thickness burn

### Burn is salmon-pink and moist. Sever pain is present. Blisters may be present.

Partial thickness burn

Critical burn

Moderate burn

Minor burn

### What are the layers of skin?

Epidermis, dermis, subcutaneous tissue

Dermis

9%

18%

1%

18% (1-year-old)

### Using the rules of nines with a 1-year-old child, what is the percentage of the total body surface area of each lower extremity?

13.5% (1-year-old)

9% (1-year-old)

1% (1-year-old)

approx. 1%

9% + 9% = 18%

### A 6-month-old infant is rescued from a house fire. She has burns to the anterior aspect of the chest and abdomen. Aprroximately what percentage of her body is burned?

18% (anterior trunk)

### A 3-year-old patient has burns covering his back, buttocks, and the posterior aspect of both legs. Approximatelty what percentage of the child's body is burned?

In a 3-year-old child, each lower extermity is approx. 16% of the total body surface area. 18% (posterior trunk) + 7.25% (posterior half of right lower extremity) + 7.25% (posterior half of left lower extremity) = 32.5%. To use the rule of nines in children, for each year older than 1, subtract from the head and add 0.5% to each lower extremity.

### An 80-kg patient has been burned over 70% of his body surface. What IV fluid would you use to resuscitate him and use the Parkland formula to determine how much fluid should be given during the first 24 hours fater being burned.

Ringer's lactate. 80kg x 70% burned x 4mL/kg/% burn = 22,400mL (22.4L)

### A 50-kg patient has been burned over 50% of her body surface. How much fluid should be given during the first 8 hours after she was burned?

50kg x 50% burn x 4mL/kg/% burn = 10,000mL (10L) x 1/2 = 5000 mL (5L). One half of the required fluid volume shoudl be given in the first 8 hours after the patient has been burned. The other half should be infused over the next 16 hours.

### Why is Ringer's lactate preferred to normal saline for management of fluid loss produced by burns?

It is closer in its composition to normal extracellular fluid than normal saline. In particular, it contains potassium, while NS does not. Infusion of massice amounts of NS into a burn patient can produce severe hypokalemia, leading to dysrhythmias.

### If a burn patient shows rapid onset of signs of hypovolemic shock after being burned, what should you suspect?

Burns do not present with rapid hypovolemic shock. You should suspect other injuries causing a hemorrhage.

### A patient has burns on the bith hands and both forearms. Where should you obtain vascular access?

It should be obtained in the upper extremities, even if it means starting an IV through a burn. IVs should never be started in the lower extremities of a burn patient. Because burn patients remain immoble for long periods of time, IV sites in the lower extremities increase the risk of pulmonary emboli.

### Should the IV or Sub-Q route be used for medication administration to a patient with a large burn?

The IV route should be used to administer all medications to burn patients. Burn injuries produce massive peripheral vasoconstriction. Medicationa administered by the IM or Sub-Q routes will be absorbed slowly and produce effects unreliably.

### If you suspect that a patient has been injured by contact with an electrical current, what should your first action be?

Be sure the current is turned off before making patient contact (scene safety).

### A dockworker had large amounts of dry chemical spilled on him from a 55-gallon drum. He is complaining of burning pain in his armpits and groin. What should you do?

Don't contaminate yourself. Undress the dockworker and brush away as much of the chemical as possible. The remaining amount of small chemical should be washed away with large amounts of water. Water shoul dnot be used initially, as water can cause a chemical reaction that could liberate large amounts of heat.

### A patient was burned on her face, neck, and chest by a gas stove explosion. Her nasal hair is singed, the mucosa of her mouth and pharynx are red and dry, and she is hoarse. What is the most immediate danger facing this patient?

Loss of upper airway due to tissue edema caused by the burn.

### What is the difference between the paths followed through the body by low-voltage and high-voltage current?

Low-voltage current tends to follow structures such as muscles, nerves, and blood vessels, which provide low-resistance pathways. High-voltage current follows the shortest pathway to the ground.

### List three questions you should ask if you suspect that a patient may have inhaled smoke or another toxic gas.

What was burning/what was the toxic substance? Was the smoke or other gas trapped in an enclosed space, increasing its concentration? Was there loss of consciousness, leading to the inability to protect the lower airway? How long was the patient exposed?

### If a child and an adult are both burned over the same amount of their body surface areas, why does the child not tolerate the burn as well as the adult?

Children have larger body surface to volume ratios than adults. Therefore for the same percentage of burned body surface area, a child will lose fluid and heat more rapidly than an adult.

Child abuse

### What is burn shock?

The loss of plasma from the vascular tree. The loss is a result of capillary leak.

### What are the three types of radioactive particles?

Alpha, beta, and gamma

### A student had carbolic acid splashed in her eyes. You should immediately:

flush her eyes with water or saline solution

### A 70-kg patient has suffered burns over 60% of his body surface area. During the first 8 hours after being burned, he should receive:

8400mL of Ringer's lactate

54%

33%

### A patient sustained second-degree burns to her entire right leg, and has an open right femur fracture. The severity of her burn is"

critical, as there is trauma associated with the burn.

### A patient has sustained a 30-40% second-degree burn in a house fire. In the prehospital setting the most appropriate management for the burn wound would be:

cover the injury with a dry, clean sheet to reduce pain and limit contamination.

### Children and infants who are burned are more likely to suffer significant fluid loss than adults because:

their body surface area is larger in proportion to their body volume, compared to adults.

### A patient has skin burns caused by dry lime. Your first step should be to:

brush away as much of the lime as possible before washing.

### What problems may a patient who has extensive burns develop?

Infection by bacteria; extensive fluid loss, leading to hypovolemic shock; inability to regulate body temperature, leading to hypothermia.

### Commercial gels (and wet dressings) may be applied to burned areas covering:

no more than 5% of the body surface area. Otherwise, you run the risk of causing hypothermia.

Gamma