Emergency Nursing - Burns (Lecture 8)

Study Notes

Burns can be classified into three degrees: first, second, and third
First-degree burns: limited to superficial epidermis, heal within 7 days without long-term sequelae
Second-degree burns: partial-thickness injuries, subdivided into:
Superficial partial thickness: hair follicles and sweat and sebaceous glands intact, heal within 2-3 weeks with minimal scarring
Deep partial thickness: destruction of deeper dermal structures, often require skin grafting
Third-degree burns: full-thickness injuries, extend deep into subcutaneous tissues, leaving behind avascular and insensate skin, require skin grafting

History: details of the injury, mechanism of injury, and identification of victims of closed space fires
Physical Examination:
Primary survey to address emergent life threats
Assessment of vital signs, inhalation injury, and circumferential burns
Complete undressing and comprehensive secondary survey to detect concomitant traumatic injuries
Skin exam to identify burn degree

Perform an appropriate primary survey and address emergent life threats
Secure the airway early in patients with significant supraglottic inhalation injury
Rule out carbon monoxide and cyanide poisoning in seriously ill patients with smoke exposure
Calculate the total body surface area (TBSA) involved and initiate aggressive volume resuscitation in patients with burns > 20% TBSA

Administer oxygen via nonrebreather mask to all patients
Administer pain medications as needed
Treat carbon monoxide poisoning with 100% oxygen and cyanide toxicity with sodium thiosulfate or hydroxocobalamin
Initiate aggressive volume resuscitation using the Parkland formula
Use lactated Ringer's or isotonic saline, with colloid fluids not shown to improve survival

Irrigate thermal and chemical burns with cool running water to minimize tissue injury
Remove affected clothing to limit ongoing chemical exposure
Brush off adherent solid chemicals before irrigation
Apply nonadherent sterile dressings to superficial injuries
Deeper burns require debridement of necrotic tissue and protection with topical antiseptic such as silver sulfadiazine