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Module 14: Further Evaluation of the Burn Patient

Terms in this set (13)

Essentials of Diagnosis
Evaluate for severity of injury
Provide wound care
Transfer to the appropriate facility
Once initial resuscitation efforts have begun, additional information is often required to determine the disposition of the burn patient.
Find out whether the patient was burned in an open or enclosed space; the latter increases the risk of inhalation injury and should prompt consideration of early intubation. Also ask about underlying medical problems, tetanus immunization status, and medication allergies.
In general, patients with minor burns may be managed as outpatients, patients with moderate uncomplicated burns should be hospitalized, and patients with major burns should be transferred to a burn center.
The following criteria should be used to determine severity of a burn:
Burn size, depth, site, Presence of circumferential burns, inhalation injury, electrical injury, age of patient, associated injuries and major underlying medical problems
Burn size is expressed as percentage of BSA (body surface area)
The size of scattered small burns can be estimated by comparing them with the size of the patient's hand, which constitutes about 1.25% of body surface area.
Can also use Rule of nines or by using age adjusted surface area chart. http://accessmedicine.mhmedical.com.ezproxy3.lhl.uab.edu/data/books/ston7/s_ston7_c045f002.png
Burn depth is typically described as first, second, third or fourth degree.
A more useful description, based on the wound's ability to heal, is partial thickness (heals spontaneously) and full thickness (requires skin grafting).
Because it is difficult to distinguish deep partial-thickness burns from full-thickness burns, these burns should be assumed to be full-thickness injuries and should be treated accordingly. Burn wounds change over 48-72 hours, and what may appear to be superficial injury on initial examination may progress to a deeper-level injury, especially if the patient has poor perfusion or the wound becomes desiccated or infected.
Burns in the following areas are considered major injuries
Hands and feet
Face: They are also often associated with inhalation injury and compromised airway.

Eyes: Burns of the eyes may cause corneal scarring and eyelid dysfunction that may ultimately lead to blindness. Note: Patients with possible eye burns should be examined as quickly as possible, preferably in the emergency department, because massive periorbital edema often develops and hinders later examination.

Ears: Deep burns of the ears predispose to development of pressure deformity and infection. Examine the tympanic membrane in patients with external ear injuries caused by hot liquids or chemicals. Burns associated with electrical injury, including lightning strikes, also require examination of the tympanic membrane. A high incidence of rupture occurs with this mechanism of injury.

Perineum: more susceptible to infection than are other types of burns.
Any deep circumferential burn is a potential major injury.
Circumferential deep burns of the neck may cause lymphatic and venous obstruction that leads to laryngeal edema and airway obstruction. Circumferential burns of the extremities may restrict blood flow, causing an increase in tissue pressure and ischemia. Circumferential chest wall injuries may impede chest wall movement and lead to respiratory failure.
Burns sustained in a confined space, singed nasal nares, soot around the nares, carbonaceous sputum, hoarseness, stridor, respiratory distress, and a carboxyhemoglobin level >10% are suggestive of what kind of injury?
Inhalation Injury
Electrical injuries can cause Cardiac arrhythmias and renal failure from myoglobinuria.
Electrical currents as little as 100 milliamps can cause ventricular fibrillation. All electrical injuries should be considered major injuries.
What age group is most likely to sustain a burn and in what age group are burns most detrimental?
Burns in a child younger than 5 years or in an adult older than 55 years are more likely to be serious than are burns in other age groups. These are also the age groups in which burns most commonly occur.
Any pre-existing condition that prevents normal healing puts a patient with even minor burns at risk for complication.
Patients with a history of myocardial infarction, angina, significant pulmonary disease, diabetes mellitus, or renal failure are considered poor-risk patients even if their burns are not serious. Burned patients with a history of alcohol or other drug abuse are also at higher risk for complications following burn injury.
Provide Appropriate Wound Care
Irrigation with sterile saline (at room temperature) may be helpful. Do not scrub wounds or use harsh detergents or chemical disinfectants. A simple nonadherent dressing such as petrolatum-impregnated gauze or sterile saline-soaked dressings should be applied. Administer tetanus prophylaxis if indicated. Direct communication with the accepting physician at the burn center can provide specific and individualized instructions for wound care prior to transfer.
Transfer the Patient to a Burn Center-All major burns and many moderate burn injuries are best treated in a burn center.
Fluid resuscitation and all other supportive measures should be continued during transport, and the patient should be kept warm.
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