Basic Burn Assessment
A. Assess for associated injuries
B. History - time and mechanism of the injury;
enclosed fire, or if toxic chemicals involved
C. Assess burn
1. First degree: (Sunburns):
characterized by erythema, pain, and the absence of blisters – NOT COUNTED IN
TBSA
2. Second degree:
(Superficial Partial Thickness or Deep partial thickness): characterized by a
red or mottled appearance with swelling and blister formation. The surface may
have a weeping, wet appearance and is painfully hypersensitive
3. Third degree: (full
thickness): skin appears dark and leathery; may also appear translucent,
mottled, or waxy white; the surface is painless and generally dry, but may also
be moist
D. Circumferential extremity burns:
1. Remove rings and bracelets and Assess distal
circulation
2. Check pulses with a Doppler (absent pulse may
indicate inadequate fluid resuscitation)
d. Observe for cyanosis, impaired capillary refill,
or progressive neurological signs (i.e., paresthesia and deep tissue pain)
E. Limb Escharotomy
Relieve compromised distal circulation in a
circumferentially burned limb by escharotomy, which can be done without
anesthesia, due to the insensitive full - thickness burn
1. The incision must extend across the entire
length of the eschar in the lateral and/or medial line of the limb including
the fingers and joints
2.
The incision should be deep enough to allow the cut edges of the eschar to
separate
F. Thoracic Escharotomy:
Circumferential burns of the thorax occasionally
impair respiratory excursion. Bilateral, mid-axillary escharotomy incisions
should be considered
Special Burn Requirements
A. Chemical burns
1. Flush burns for at least 20 to 30 minutes;
alkali burns require longer irrigation
2. Brush dry powder off before irrigation
3. Alkali burns to the eye require continuous
irrigation during the first eight hours
B. Electrical burns - frequently more serious than
they appear on the surface
1. Initial care as above
2. Full spinal immobilization
3. EKG monitoring
4. Urinary catheter
a. Observe for myoglobinurea (due to
rhabdomyolysis)
b. Increase IV rate fluid to ensure UO of at least
100 ml/hour
c. Consult Medical Control for Mannitol 25 GM IVP
and IV infusion with 12.5 GMs of mannitol/1000 cc NS to maintain the diuresis
C. Explosive Injuries – Any patient involved in an
explosion should be considered as having a mechanism for traumatic injuries.
Even if the patient states they were NOT thrown a distance. The force of a
flash flame explosion is enough energy to cause concussive type of injuries.
