Monday, December 11, 2006


The relationship is between duration + temp.
Superficial Partial Thickness Burn= First degree burn=Epidermis and maybe some dermis. soothed by cooling. reddened, blanches with pressure. no scar. peeling. recovery in 1 week. ie: sun burn, or low intensity flash.
Deep Partial Thickness=Second Degree burn=epidermis and upper dermis, portion of deeper dermis. Pain! Blistered, mottled red base, weeping surface, edema. Infection may convert this to full thickness. ie: scalds, flash flame.
Full-Thickness= Third Degree burn= epidermis, all of dermis and some SQ and may involve muscle or bone. Symptoms= NO PAIN! shock, hematuria. Wound may look dry, pale white, leathery or charred. Fat may be exposed. Edema. Need grafting.
Rescuer should stay safe.
Airway-C-spine immobilization.
Breathing- 100% O2
Neuro-may be very alert w/ deficits later. So gather information now.
Deal with the wounds last.
Then find out how they were burned and Med history
MED History includes
P=past illness
L=last meal
E=events that preceded injury
Stop the burning process= flush chemical burns, remove contacts, cool water to stop the burning.
Airway management= humidified O2 @100%. Smoke inhalation is the leading cause of death in burn pt. The hemoglobin loves CO better than O2. it creates carboxyhemoglobin which competes with the O2.
Next to the respiratory system fluid and lytes are next in line.
The body is going to try and conserve fluids and can lead to kidney failure. A decreased BP+decreased cardiac output leads to shock.
LR is infused via a large bore IV.
Most common formula is the Parkland/Baxter formula=4ml pf LR x body weight in kg x % of BSA burned= the fluid replacement. 1/2 of that is given the first 8 hours. Then 1/4 for the next 8 hours. And then again 1/4 of that for the next 8 hours. Of course this depends also on the clinical picture. Assess--heart rate, BP, urine output HOURLY.
This is what is happening during the emergent phase... concerning fluids
General dehydration as plasma leaks through the damaged capillaries. Blood volume is reduced secondary to plasma loss, decrease in BP, and decreased cardiac output. Decreased urinary output secondary to fluid loss, decreased renal blood flow, Na+ and water retention. To much K+ because of massive cellular trauma releases K+ into the extracellular fluid. Na+ deficit because it is trapped in edema fluid and because of the K+ shift. Metabolic Acidosis because of a loss of bicarbonate ions that goes with sodium loss. Hemoconcentration-elevated hematocrit because liquid blood component is lost into the extracellular space.

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