Burns%20-%20initial%20management Diagnosis
Diagnosis
Degree of Burns
First-Degree Burns or Superficial Burns
- Appearance: Similar to sunburn – painful, dry, swollen, erythematous without blisters & involves only the epidermis
- Not included in estimates for fluid resuscitation
- Hospitalization not required; pain resolves in 48-72 hours, peels off without residual scarring in 2-5 days
Second-Degree Burns or Partial-Thickness Burns
- Appearance: Moist blebs, formation of vesicle & blister; underlying tissue is mottled pink & white with good capillary refill; this involves the entire epidermis & a variable portion of the dermal layer
- Considered significant burns & are counted in burn size estimates
- Subclassification
- Superficial:
- Extreme pain attributed to a large number of remaining viable nerve endings exposed
- Re-epithelialize in 7-14 days in the absence of infection
- Deep
- Pain is less because fewer nerve endings remain viable; fluid losses & metabolic effects are similar to those of third-degree burn
- Heals in 21-35 days if without infection; converts to full thickness burns if with wound infection, some may require grafting
- Superficial:
Third-Degree Burns or Full-Thickness Burns
- Appearance: Dry, leathery eschar, mixed white waxy, khaki, mahogany, soot-stained
- Involves the entire epidermis & dermis, leaving no residual epidermis cells, may include fat, subcutaneous tissue, fascia, muscle & bone
- No pain sensation & capillary filling
- Wound cannot epithelialize, heals only by wound contracture or skin grafting
- The difference in the growth rate of the head & extremities throughout childhood makes it necessary to use surface area charts
- The “rule of nines” used in adults is applicable only to children >14 year or as a very rough estimate to initiate therapy before transfer to a burn unit
- In small burns <10%, the “rule of palm” (area from the wrist crease to finger crease in the child) may be used
- This equals 1% of the child’s body surface area (BSA)
- Calculation of the fluid for resuscitation depends on the total BSA involved in the burn injury
Classification
Lund & Browder Classification
Relative percentage of body surface area affected by growth
0 years | 1 year | 5 years | 10 years | >15 years | |
A = one-half of head | 9.5% | 8.5% | 6.5% | 5.5% | 4.5% |
B = one-half of one thigh | 2.75% | 3.25% | 4% | 4.5% | 4.5% |
C = one-half of one lower leg | 2.5% | 2.5% | 2.75% | 3% | 3.25% |
Evaluation
- A brief, accurate history must be obtained from guardian upon presentation of the patient
- Determine the time of injury, causative agent & type of burn, any first aid measures done, patient’s associated medical problems, & vaccination status
- Stop the burning process by applying cold water on burned area & removing smoldering clothing or clothing saturated with hot liquid or chemicals
- Assess degree, site & extent of burn
Laboratory Tests
- All trauma patients will have their own specific radiologic & laboratory examinations depending on the involved organ during the injury
- General
- Complete blood count (CBC)
- Serum electrolytes
- Blood glucose
- Blood urea nitrogen (BUN)
- Creatinine (Cr)
- Clotting factor tests
- Blood typing & cross-matching
- Urinalysis
- Arterial blood gas (ABG)
- Inhalational injuries
- Chest X-ray
- Carboxyhemoglobin levels
- Inhalational injuries
- 12-lead electrocardiography (ECG)
- Cardiac enzymes