This document discusses burn assessment and management. It provides details on assessing burn severity based on depth, percentage of total body surface area burned, and other factors. It also describes the mechanisms and potential complications of thermal, electrical, and inhalation burns. For the case study, the patient has partial thickness burns isolated to the lower arms, comprising less than 10% TBSA. While painful, this is not considered a critical burn based on the assessment criteria described in the document.

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Burn Assessment and
Management

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Objectives
 • Discuss the mechanisms and
 complications of a thermal burn,
 electrical burn and an inhalation burn
 • Explain the factors to consider when
 determining the severity of a burn

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Burn Assessment and
Management
Case Study
• You are called to an elementary school
for a burn injury.
• You are told that a staff member lost
their grip on a vat of hot oil and spilled
it on their arms.
• The patient is in the school nurse’s
office.

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Questions Regarding the Case
Study
• How severe is this mechanism of injury?
• Will you expect to find any compromise
to airway, breathing or circulation during your
initial assessment?
• How severe will you expect the burn to be?

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Patient Assessment
The patient is awake,
conscious and tearful
She is breathing
normally but appears to
be in significant pain
Her burns appear
isolated to her hands
and lower arms.

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Patient Assessment
Vital signs
– HR is 96
– RR is 16
– BP is 140/88
Patient History
– She is 55 years old
– History of hypertension

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More Questions
Is this a critical burn?
– Rationale, please
Treatments?
– Oxygen?
– IV size and rate?
– Pain control?
– Trauma entry?

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Mechanisms of Thermal Burns

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Phases of a Burn Injury
• Emergent Phase
• Fluid Shift Phase
• Hypermetabolic Phase
• Resolution Phase

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Complications of Thermal Burns
• Infection
• Eschar formation

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Burn Assessment

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Burn Assessment
Scene Assessment
 Safety First!
 Mechanism of Injury
 Chemicals
 Enclosed space?
 Other trauma?
 Intentional?
Initial Assessment
 Airway compromise
now?
Potential for this later?
 Breathing
associated with cough
Circulation
 Signs of shock

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Burn Assessment

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Potentially Critical Findings
Hoarseness
Adventitious airway
sounds
Soot in nose or on
tongue
Singed hair
Facial edema
Scene
Dysphagia (difficulty in
swallowing)
Dysphasia (difficulty in
producing or
comprehending spoken
word )
Adventitious breath sounds
Significant dyspnea
Altered level of
consciousness

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Focused Physical Assessment
Signs of trauma
– Musculoskeletal injuries
– Isolated injuries
– Evidence of abuse
– Signs of shock

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Focused Physical: Burn
Assessment
Appearance
Description and location
(s)
 Redness
 Blisters
 Edema
 Weeping of fluid
 Charring
 Sloughing of skin

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Focused Physical Assessment
Determining the Severity of a Burn
 Depth of the burn
 Percentage of the body burned
 Location of the burn
 Other factors

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Determining Burn Severity
Depth
 Classification
 Superficial
 Partial-thickness
 Full-thickness
What is the depth of her
burn?

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Determining Burn Severity
Body surface area
Rule of Nines
 Adult
 Pediatric
 Rule of Palms
 Small burns
 Use of the patient’s
palm

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What is the % of BSA Involved in
Our Patient?

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Determining Burn Severity
Other factors
 Burn location
 Hands, feet, genitalia
 Age
 Pre-existing medical conditions
 Medications
 Presence of multi-systems trauma
 Inhalation injury

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Back to the Patient
Is this a critical burn?
 Will you still stick to
your original treatment
plan?
 Oxygen rate
 IV
 Pain medications
 Trauma entry

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Complications From a
Significant Burn Injury

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Complications
 Fluid loss
 Weeping of wounds
 Hypothermia potential
 Electrolyte loss
 Hypovolemia
Signs of shock indicate that there is another
serious injury present
Shock resulting from a burn will typically occur hours
after the insult

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Complications
Systemic acidosis
 From tissue death
 Hypoxia
 Infection
 Organ failure
 Eschar (a scab formed especially after a
burn.)
 Circumferential burns

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General Management of Burns
Airway and ventilatory support
 Early recognition of potential airway
compromise
 ALS intercept is critical for early advanced
airway management
 Consider transport to a trauma facility if the
MOI and/or initial patient presentation
indicates a severe inhalation injury

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Emergency Care - Thermal
Burns
 Stop the burning
 Assess breathing
 Look for signs of airway injury, soot, burnt
nasal hair, facial burns
 Oxygen
 Complete initial assessment
 Treat for shock

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Emergency Care - Thermal
Burns
 Evaluate burns by depth, extent, and severity
 Remove clothing and jewelry
 Separate fingers or toes with sterile
 gauze pads
 Wrap in dry sterile dressing

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General Management of Burns
 Medications for pain management
 Entonox
 Suppresses the conscious awareness of pain
in the brain
 Reduces anxiety
 NSAID

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General Management of Burns
 Suppresses the pain response in the cell
membrane
 Works well with acute, severe pain

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Specific Burn Profiles

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Patient Assessment
 Patient is approximately 45 years old and is
unconscious/unresponsive to painful stimuli.
 He has heavy soot deposits on his face and in his
nose. He is not breathing.
 Firefighters tell you that the patient was not moving
when they found him on his bed.
 The patient has no thermal burns on his body.

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Mechanisms of Inhalation Injuries
 Superheated air
 Mechanism similar to a thermal burn
 Mucous membranes will intensify the burn
 Fluid shifts may cause progressive airway
obstruction
 Chemical burns

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Inhalation Injuries Severity
 Product of combustion
 Duration of exposure
 Confined space

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Inhalation Injuries
Edema can be progressive and may appear
mild at first
Symptoms may not appear for hours

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Progressive Edema

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Signs and Symptoms of Upper
Airway Injury
 Singed nasal hairs
 Facial burns
 Burned specks of
carbon in the sputum
 Sooty or smoky smell
on breath
 You may see burns of
the oral mucosa

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Upper Airway
 Restriction of chest wall
movement
 Restlessness
 Chest tightness
 Stridor
 Wheezing
 Difficulty in swallowing
 Hoarseness
 Coughing
 Cyanosis
 Signs of Respiratory
Distress

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Inhalation of Noxious Fumes
 Mucosa in lungs swell
and break
 Fluid leaks into alveolar
space
 Cilia is damaged
 Mucus builds up
 Airway is plugged
 Oxygen exchange is
reduced

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Inhalation Assessment Tip
Isolated burns do not alter levels of
consciousness of the patient
If the patient is unconscious assume carbon
monoxide poisoning

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Electrical Burns
 Contact Burns (when
the current is intense
at the entrance and exit
sites)
 Flash Burns
 Arcing injuries (when
current jumps from one
surface to another)

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Severity of Electrical Shock
 Voltage and amperage of the current
(amperage kills)
 Alternating or Direct current
 Amount of time the patient is exposed
 Amount of moisture on the patient

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Severity of Electrical Shock
 Amount of body surface in contact with water
 Amount of insulation worn by the patient
 Area of the body through which the current
passes

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Signs and Symptoms of
Electrocution
 Patient is dazed or confused
 There are obvious and severe burns on the
skin
 The patient is unconsciousness
 Weak, irregular, or no pulse
 Shallow, irregular, or absent breathing
 Multiple severe fractures due to intense
muscle contractions

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Electrical burns are
more
severe at the point of
exit.
This child shows exit
burns
from the face.
Point of entry could
not be
determined.

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Emergency Care - Electrical
Burns
 Assure your safety first
 Provide airway care
 Provide CPR as needed
 Care for shock
 Care for spinal injuries, head injuries, and
severe fractures

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Emergency Care - Electrical
Burns
 Evaluate electrical burns, looking for at least
two external burn sites, entrance and exit
 Cool the burn, remove clothing
 Apply sterile dressing
 Transport, be prepared for cardiac or
respiratory arrest

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Summary
 Multiple factors should be evaluated when
determining the severity of a burn
 Burn injuries will generate inflammation and
swelling
 Severe injuries will result in severe swelling
 Consider this complication when making treatment
and transport decisions
 Emotional care is also a necessary component in
the EMRs treatment plan
Don’t neglect this!