BURNS Genitalia----------------- 1%

Types R/L upper arm--------- 4%

1. Chemical: results from contact with a corrosive substance.
R/L lower arm--------- 3%
2. Electrical: intense heat is generated from electrical current and causes
coagulation necrosis. R/L hand---------------- 2 ½ %
3. Thermal: results from flames, flash[explosion], scald or direct contact. R/L thigh---------------- 9 ½ %
4. Inhalation: results from inhalation of noxious chemical or heat like carbon
monoxide poisoning, smoke toxicity, upper airway trauma, restrictive R/L leg------------------- 7%
defects
R/L foot----------------- 3 ½ %
Classifications
III. According to the EXTENT of burns[ from the American Association of
1. According to the DEGREE of burns Burns]
1. Partial thickness a. Minor burns
a. Superficial[1st degree] - 2nd degree burn <15% TBSA in adults
- involves epidermis only 2nd degree burn <10% TBSA in children
- local pain & erythema - 3rd degree burn < 2% TBSA
- blister absent for about 24 hrs. b. Moderate uncomplicated burns
- mild to absent systemic response
- 2nd degree burn 15-25% TBSA in adults
- no treatment necessary
2nd degree burn 10-20% TBSA in children
- rapid healing[ normally 3-5 days] without scarring
- 3rd degree burn< 10% TBSA
b. partial-thickness[2nd degree]
c. Major burns
- involves epidermis & dermis - 2nd degree burn > 25% TBSA in adults
- skin appears red to pale-ivory and moist 2nd degree burn > 20% TBSA in children
- formation of wet, thin-walled blisters immediately after injury - all burns that involves: hands, face, eyes, ears, feet, perineum
- intact tactile & pain sensors - all inalation & electrical injuries & complicated burn injuries involving
fractures or other trauma.
- healing in 21-28 days with scarring
- all poor-risk patients with burn injury of any size.
2. Full- thickness[3rd degree]
Treatment
- involves epidermis, dermis, subcutaneous tissue
- Indications of adequate fluid resuscitation
- injury appears white, cherry red or black
1. BP at 90-100 systolic
- dry, hard, leathery appearance due to loss of epidermal elasticity.
2. Pulse decrease to 120 in children & 100 in adults
- marked edema & decreased elasticity that results to ESCHAR
formation. 3. CVP around 12 cm.H2O pressure

- painless to touch- because of destruction of all superficial nerve 4. Hourly urine range: 10-20 cc/hr in infant
endings in skin
: 20-50 cc/hr in children
- requires skin graft
: 30-70 cc/hr in adults
II. According to the DEPTH of burns[% TBSA]
5. adequate gastrointestinal functioning
a. Rule of Nines
6. clear sensorium
Head & Neck-------- 9%

Arms-------------------9% each 4 formulas in fluid replacement

Anterior trunk-------18% each 1. Baxter/Parkland formula

Posterior trunk------18% each 1st 24 hr.: Ringer’s lactate: 4ml./kg/% TBSA

Legs---------------------18% each administered: ½ of 24 hr total in 1st 8hr.

: ¼ of 24 hr total in 2nd 8 hr.

Perineum-------------- 1%
: ¼ of 24 hr total in 3rd 8 hr.
b. Lund & Browder chart
2nd 24 hr: Plasma: 0.3-0.5 ml/kg/%TBSA
Head---------------------- 7%
: Glucose in H2O[2000-6000 ml] given according to Na+ level
Neck---------------------- 2%
2. Evans formula
Anterior trunk--------- 13%
1st 24hr.: Colloids:1 ml/kg/%TBSA
Posterior trunk-------- 13%
: Physiologic saline: 1 ml/kg/%TBSA
R/L buttock------------- 2 ½ %
 : Non- electrolytes[D5W]2000 ml. - as eschar is debbrided and granular tissue begins to form, grafts are
utilized to protect the wound and to promote healing.
2nd 24hr.: ½ of amounts of colloid & electrolytes administered in 1st 24 hr.
a. Autograft
3. Brooke formula
- utilizes patient’s own skin, coverage is permanent.
1st 24 hr: Colloid[ blood dextran,plasma]:0.5 ml/kg/%TBSA
b. Homograft/Allograft
: Ringer’s lactate: 1.5 ml/kg/%TBSA
- utilizes cadaver skin; coverage is temporary
: D5W 2000 ml
c. Heterograft/Xenograft
-administered: ½ of 24hr total-1st 8hr - porcine skin[pig skin] is utilized; coverage is temporary.
: ¼ of 24hr total-2nd 8hr 8. Antibiotic[topical]
: ¼ of 24hr total-3rd 8hr -ex. 0.5 AgNO3 solution
2nd 24 hr: ½ of amounts of colloid & ringer’s lactate administered in1st 24 1% silver sulfadiazine
hr.
0.1% Gentamycin sulfate[Garamycin cream]
4. MGH formula
10% mafenide cream/acetate[Sulfamylon]
1st 24hr: 125 ml.plasma/%burn
Nursing care
: 15 ml.saline/%burn
: R5W 2000 ml. 1. Provide relief/control of pain

2nd 24hr: ½ plasma and saline of 1st 24hr a. administer Morphine sulfate IV & monitor V/S.

: D5W 2000 ml b. Administer narcotic analgesic 30 minutes before wound care.

3. NGT in patient’s with 30% or greater TBSA c. position burned area in proper alignment.
Maintain NPO- paralytic ileus is common secondary to hypovolemia and 2. Monitor alterations in F&E balance
hypokalemia.
3. Promote maximal/nutritional status
4. Administer Tetanus toxoid on admission- due to increase possibility of
wound contamination. 4. Prevent wound infections
5.Provide analgesics for pain very cautiously a. place patient in controlled sterile environment.
-Analgesics mask sensorium and decreased overall body responses that b. use hydrotherapy for no more than 30 minutes to prevent electrolyte
are utilized to determine patient’s response to therapy. loss.
6. Wound care c. observe wound for separation of eschar & cellulitis.
Methods: d. apply Mafenide[Sulfamylon]
a. Open/Exposure e.apply Silver sulfadiazine[Silvadene]
- burn is covered with a topical antibiotic cream and no dressing is f. apply AgNO3
applied.
g. apply Povidone-iodine
- Advantages:
h. administer Gentamycin
1. no painful dressing changes
2. less equipment is necessary 5. Prevent GI complications

3. early detection of infection 6. Provide patient teaching and discharge planning:

Disadvantages A. Care of healed wounds
1.not suitable for hands and feet B. prevention of injury to burn wound
2.difficulty in controlling body temperature.
C. Adherence to prescribed diet
B. Closed/Occlusive
D. Importance of reporting formation of blisters,opening of healed area,
- fine mesh is used to cover the burned surface. increased foul-smelling drainage from wound, other signs of infection.

- may be impregnated with antibiotic ointment or cream maybe applied E. method of coping and resocialization.
prior to dressing.
Advantages
1. prevents 2 body surfaces from touching- frequently utilized on the
hands and feet.
2. assists to maintain functional body alignment.
Disadvantages
1. painful dressing changes
2. detection of infection may be impaired.
c. Escharotomy
- procedure involves excision through the eschar to increase circulation
to an extremity with circumferential burns.
7. Wound grafting