Basics in Burns for Nurses Prema Dhanraj
INDEX
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Chapter Notes

Save Clear


49ACUTE CARE50

INTRODUCTIONChapter 9

 
 
Management at the Scene
  • Stop the burning process.
  • Put out the fire.
  • Remove the victim from the source of injury.
  • Remove the clothing and cover with a clean sheet.
  • Assess the burn percentage by following “Rule of Nines.”
 
Care of the Burn Wound
  • Irrigate with copious amounts of tap water till the pain subsides (about 10–20 minutes).
  • Transport the patient in clean dry sheets.
  • Do not use ice.
  • Do not let the core temperature drop to lower levels.
  • Cover the patient with clean and dry sheet.
  • Keep the patient warm.
  • Inform the receiving hospital.
 
Referral Criteria
  • Burns in very young children and elderly.
  • Chemical and electrical injuries.
  • Inhalational injuries.
  • Burns involving more than 15% of TBSA in adults and 10% in children.
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  • Burns of the vital areas [face, hand, foot, genitalia].
  • Burns requiring fluid resuscitation.
  • Associated other trauma, medical conditions.
 
Assessment of Burn Depth
 
First Degree
  • Erythema or redness
  • Dry
  • Painful
  • Minimal or no edema
  • No blisters
 
Second Degree
  • Superficial
    • Red
    • Blistered
    • Very painful
  • Deep
    • White
    • Soft and resilient
    • Hair follicles and sweat glands are intact.
 
Third Degree
  • Painless
  • Dry and brown
  • Leathery eschar
  • Thrombosed blood vessals
  • Cutaneous hair can be pulled out easily.
 
Fourth Degree
Clinical features are similar to third degree together with exposed bone, muscle or tendon.
 
Fluid Resuscitation
 
Indications
In children with superficial burns of more than 10% or deeper burns of less than 10%.53
  • In adults with superficial burns of more than 15% or deeper burns of less than 15%.
 
Resuscitation Formula
  • Evan's formula
  • Brooke's formula
  • Modified brooke's formula
  • Parkland formula.