lOMoARcPSD|19477839
MDC4 – Examination Blueprint – Exam 2
Burns
Causes
o Thermal
Dry Heat – Flame - explosion
Moist heat - Steam
Contact – Burst of flame/stove
o Chemical – Upper airway can also be involved – acidic compounds
Find out the chemical that caused the burn to create proper treatment
o Electrical – Cannot see extent of the injury since it enters and exits but mainly internal
It’s hard to determine the extent of damaged from this type of burn because the damage can
extend under the skin. This is known as the “iceberg effect”.
o Radiation -
o Smoke- related Brun Injury – inhalation near flames can still lead to death
Skin changes
o Massive fluid loss through evaporation
o Reduced ability to sweat
o Partial – thickness burns: exposed nerve endings
o Full-thickness burns: Nerve endings destroyed
o Reduced activation of vitamin D
o Change in physical identity
Health Promotion
o Monitor water temp (<140)
o Sunscreen
o No smoking in bed, Lighters matches out of reach of kids
o Care of fire places
o No Flame near O2
o Smoke detectors & Planned escape routes
Classification of Burn Injury
o Minor burns – Partial-thickness <10%, Full-thickness <2%
Less than 60, no electrical, and no additional injuries
o Moderate burn – Partial-thickness 15 – 25%, Full-thickness 2 – 10%
Same as Minor
o Major burn – Partial-thickness >25%; full-thickness >10%
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Older than 60, electrical, and additional injury
Class of burns (1st & 2nd degree burns can heal without interventions)
o 1st degree – Superficial thickness – Only the epidermis – Sunburn (pink to red)
o 2nd degree – Superficial/Deep Partial thickness – Dermis Layer
Superficial blisters up (Pink to red with blisters)
Deep is into the middle of the dermis without blisters Red and inflamed (Red to white with soft
and dry eschar)
o 3rd degree – Full/Deep thickness – Hypodermis – closes to the muscle – Shows muscle (Black, brown,
yellow, white, red severe edema and hard eschar with yes and no pain)
Deep Full thickness – Black with absent edema, pain, blisters, and hard eschar
Complication-eschar, burn shock, stridor, Infection
o Eschar – A dry and dark necrotic tissue - must be removed to assist tissue heal
Escharotomy – surgical incision through areas of burnt skin to release the eschar and its
constrictive effects, resorts distal circulation, and allow adequate ventilation
Fasciotomy – a surgery to relieve swelling and pressure in a compartment of the body (deeper
incision to the muscle layer)
o Burn shock is a unique combination of hypovolemic, distributive, and cardiogenic shock. Burns lead to
severe hypovolemia and massive edema (Tachycardia, shallow breathing, Hypotension)
o Stridor – due to an inhalation injury
o Infection due open wounds that can lead to infected bacteria.
Curling Ulcers: treatment & escharotomy
o Curling ulcers – stress induced ulcer of the stomach or duodenum due to extreme physical stress like a
massive burn.
Treatment – Fluids - skin grafts - Fluid overload S&S
o Fluids – LR w/ Parkland formula
o Skin graft is the skin removed from a donor area and transferred to the wound and sutured in place
Grafts are done in the acute phase to reduce the time patients are at risk for infection and sepsis
(covers a deeply burned area to cover and open wound)
Assess for bleeding, Drainage, and DO NOT encourage exercise with the grafted arm.
o Pain management with meds such as Morphine sulfate, Dilaudid, Fentanyl
NOT IM or Oral – IM due to edema and is painful for the patient/ Oral no due to reduced
adsorption and motility of GI
Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase
o Resuscitation/Emergent – Onset of the burn and lasts until completion of fluid resuscitation for the first
24 hours – Most important is ABCs during this time – and Fluid administration LR or 0.9% Na Chloride
Downloaded by Steven Steve ()
, lOMoARcPSD|19477839
It is effective if there is 30 mL/hr or more/ Systolic greater than 90 effective & HR less
than 120
Monitor for signs of inhalation injury – Facial burns, nasal or scalp hair singed, Black or blood
sputum, poor O2 stats, wheezing/stridor, hoarseness, WEIGHT! (Accurate since fluids are done
based on patient weight)
Hyperkalemia!!! – peaked T waves a
Hyponatremia
H/H will be elevated when the body is dry – More concentrated blood when the fluid is low
Surgical Interventions – Trache, chest tube, escharotomy – stops in the subQ fat, Fasciotomy –
tissue is cut to the muscle in order to relieve pressure due to leathery skin adding pressure,
Debridement – removal of nonviable tissues
o Acute – 48 – 72 hours after the burn this is capillary permeability can return and urinary output should
increase if not the renal cand cardiac functions can lead to hypovolemic shock & manifest HF
Monitor Urine output, EKG in electrical burns, Decreased peristalsis and adsorption
Monitor for pneumonia, infection, and sepsis
Diet is implemented with high calories and protein – electrolytes need to be monitored due to
all the fluids being given to the patient
Major wound care – change gloves when handling multiple wounds to stop spread form wound
to wound
Wash Hands DO NOT USE HAND SANITIZER
ROM assistance & Psychosocial assistance for self-esteem
o Rehabilitative – This is when the burn begins to close and ends when the patient has reached optimal
level of functioning.
NO MORE OPEN SOURS – wear pressure garments for scaring and water based lotion
ROM exercise
Total body surface area (TBSA) – Rule of Nines Leg front & Back are 9 – whole arm is 9 -
Downloaded by Steven Steve ()
MDC4 – Examination Blueprint – Exam 2
Burns
Causes
o Thermal
Dry Heat – Flame - explosion
Moist heat - Steam
Contact – Burst of flame/stove
o Chemical – Upper airway can also be involved – acidic compounds
Find out the chemical that caused the burn to create proper treatment
o Electrical – Cannot see extent of the injury since it enters and exits but mainly internal
It’s hard to determine the extent of damaged from this type of burn because the damage can
extend under the skin. This is known as the “iceberg effect”.
o Radiation -
o Smoke- related Brun Injury – inhalation near flames can still lead to death
Skin changes
o Massive fluid loss through evaporation
o Reduced ability to sweat
o Partial – thickness burns: exposed nerve endings
o Full-thickness burns: Nerve endings destroyed
o Reduced activation of vitamin D
o Change in physical identity
Health Promotion
o Monitor water temp (<140)
o Sunscreen
o No smoking in bed, Lighters matches out of reach of kids
o Care of fire places
o No Flame near O2
o Smoke detectors & Planned escape routes
Classification of Burn Injury
o Minor burns – Partial-thickness <10%, Full-thickness <2%
Less than 60, no electrical, and no additional injuries
o Moderate burn – Partial-thickness 15 – 25%, Full-thickness 2 – 10%
Same as Minor
o Major burn – Partial-thickness >25%; full-thickness >10%
Downloaded by Steven Steve ()
, lOMoARcPSD|19477839
Older than 60, electrical, and additional injury
Class of burns (1st & 2nd degree burns can heal without interventions)
o 1st degree – Superficial thickness – Only the epidermis – Sunburn (pink to red)
o 2nd degree – Superficial/Deep Partial thickness – Dermis Layer
Superficial blisters up (Pink to red with blisters)
Deep is into the middle of the dermis without blisters Red and inflamed (Red to white with soft
and dry eschar)
o 3rd degree – Full/Deep thickness – Hypodermis – closes to the muscle – Shows muscle (Black, brown,
yellow, white, red severe edema and hard eschar with yes and no pain)
Deep Full thickness – Black with absent edema, pain, blisters, and hard eschar
Complication-eschar, burn shock, stridor, Infection
o Eschar – A dry and dark necrotic tissue - must be removed to assist tissue heal
Escharotomy – surgical incision through areas of burnt skin to release the eschar and its
constrictive effects, resorts distal circulation, and allow adequate ventilation
Fasciotomy – a surgery to relieve swelling and pressure in a compartment of the body (deeper
incision to the muscle layer)
o Burn shock is a unique combination of hypovolemic, distributive, and cardiogenic shock. Burns lead to
severe hypovolemia and massive edema (Tachycardia, shallow breathing, Hypotension)
o Stridor – due to an inhalation injury
o Infection due open wounds that can lead to infected bacteria.
Curling Ulcers: treatment & escharotomy
o Curling ulcers – stress induced ulcer of the stomach or duodenum due to extreme physical stress like a
massive burn.
Treatment – Fluids - skin grafts - Fluid overload S&S
o Fluids – LR w/ Parkland formula
o Skin graft is the skin removed from a donor area and transferred to the wound and sutured in place
Grafts are done in the acute phase to reduce the time patients are at risk for infection and sepsis
(covers a deeply burned area to cover and open wound)
Assess for bleeding, Drainage, and DO NOT encourage exercise with the grafted arm.
o Pain management with meds such as Morphine sulfate, Dilaudid, Fentanyl
NOT IM or Oral – IM due to edema and is painful for the patient/ Oral no due to reduced
adsorption and motility of GI
Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase
o Resuscitation/Emergent – Onset of the burn and lasts until completion of fluid resuscitation for the first
24 hours – Most important is ABCs during this time – and Fluid administration LR or 0.9% Na Chloride
Downloaded by Steven Steve ()
, lOMoARcPSD|19477839
It is effective if there is 30 mL/hr or more/ Systolic greater than 90 effective & HR less
than 120
Monitor for signs of inhalation injury – Facial burns, nasal or scalp hair singed, Black or blood
sputum, poor O2 stats, wheezing/stridor, hoarseness, WEIGHT! (Accurate since fluids are done
based on patient weight)
Hyperkalemia!!! – peaked T waves a
Hyponatremia
H/H will be elevated when the body is dry – More concentrated blood when the fluid is low
Surgical Interventions – Trache, chest tube, escharotomy – stops in the subQ fat, Fasciotomy –
tissue is cut to the muscle in order to relieve pressure due to leathery skin adding pressure,
Debridement – removal of nonviable tissues
o Acute – 48 – 72 hours after the burn this is capillary permeability can return and urinary output should
increase if not the renal cand cardiac functions can lead to hypovolemic shock & manifest HF
Monitor Urine output, EKG in electrical burns, Decreased peristalsis and adsorption
Monitor for pneumonia, infection, and sepsis
Diet is implemented with high calories and protein – electrolytes need to be monitored due to
all the fluids being given to the patient
Major wound care – change gloves when handling multiple wounds to stop spread form wound
to wound
Wash Hands DO NOT USE HAND SANITIZER
ROM assistance & Psychosocial assistance for self-esteem
o Rehabilitative – This is when the burn begins to close and ends when the patient has reached optimal
level of functioning.
NO MORE OPEN SOURS – wear pressure garments for scaring and water based lotion
ROM exercise
Total body surface area (TBSA) – Rule of Nines Leg front & Back are 9 – whole arm is 9 -
Downloaded by Steven Steve ()
