Burns 101 Assessment Video Lecture | Introduction to Burn Care: Medical Treatment - Health & Fitness

burns are typically assessed by both the
total percent body surface area covered
and by the depth and type of burn the
most common way of estimating the total
percent body surface area involved is
with the famous rule of nines smaller
burns are better assessed by the palm
rule a patient's palm including the
fingers is roughly equivalent to 1% of
the total body surface area burns can
generally be classified as penetrating
through the epidermis dermis or sub
dermal tissues a burn that involves only
the epidermis is known as a superficial
burn these burns are dry red and painful
they do not form blisters within 3 to 4
days dead epidermis is left off and
replaced by regenerating keratinocytes
these burns typically leave no mark when
healed and importantly should not be
included in calculations of total body
surface area burned most sunburns fall
into the category of superficial burns a
superficial dermal burn extends into the
papillary dermis these burns may
initially appear to be superficial burns
as they initially are similarly red and
painful however disruption of the dermal
epidermal Junction eventually causes
formation of blisters on the skin
debridement of the blister reveals a wet
hyperemic blanching and hypersensitive
base superficial dermal burns may take
several weeks to heal but they rarely
require grafting unless infection
supervenes deep dermal burns may also
blister as tissue planes are disrupted
but the skin beneath the blister will
appear pale pink or white immediately
after the burn won't blanch as easily
and will not be nearly as painful as the
more superficial burns full thickness
burns extend through both the epidermis
and dermis into the subcutaneous tissues
these burns are often easy to identify
with a thick leathery eschar & charring
however full thickness burns can
sometimes be deceiving they may appear
red or modeled like superficial or deep
dermal burns some immersion and
convection or bake injuries may even
appear the same red color of a
superficial epidermal burn one telltale
marker of a full thickness burn is the
doesn't Blanche another is the
circumstances in which the burn occurred
the strength of the heat source duration
of exposure and thickness of the injured
skin will help predict the extent of the
burn equally important to the depth of
burn is the type of burn different sorts
of thermal injury are associated with
completely different treatments flash
and flame burns account for about half
of burn center admissions flash burns
are caused by short exposure to high
temperatures clothing unless it -
catches on fire generally provides a
barrier against these short lived fires
and so the distribution of the burn is
often limited to exposed skin only if
the patient wasn't wearing face
protection be sure to check for burns to
the upper airway flame burns involve a
longer exposure to the heat source and
are almost Oh as deep dermal or full
thickness if these burns occur within an
enclosed space it is essential to
inspect the patient's airway and
evaluate them for carbon monoxide
poisoning by measuring the level of
carboxy hemoglobin in the blood scald
burns are also very common as was flash
and flame burns the depth of the burn
depends on the temperature of the liquid
involved and on the duration of contact
thick soups or syrups will remain in
contact with skin longer and cause a
deeper burn scald burns tend to be
shallower on exposed skin and thicker
where the liquid is held in contact with
the skin by clothing a classic example
is the toddler who pulls a bowl of soup
down from a table or stove the face will
have a superficial burn the chest and
indeterminant burn and the area beneath
the diaper a deep dermal burn from
prolonged exposure in injuries with this
pattern be sure to remove the diaper and
closely inspect the groin and perineum
non accidental scalds are a common form
of abuse and are inflicted on those who
cannot defend themselves children the
elderly and people with disabilities
warning signs includes circumferential
extremity burns with clean demarcation
lines and symmetrical burns to both
buttocks other scald burns include
grease and oil burns which often cause
deep dermal or full thickness burns and
tar and asphalt burns which are
similarly severe tar must be completely
removed before the depth of the
can be assessed petroleum-based
ointments or commercially available tar
removal sprays are useful for this
purpose chemical burns from acids or
alkali are common in industrial
accidents and with household chemicals
alkali burns caused deeper injuries
because the alkali combined with lipids
in the skin in a saponification reaction
that breaks down cell layers and allows
the alkali to penetrate deeper layers
the first task of rescue personnel and
emergency room staff must be to
decontaminate the patient without
placing themselves at risk any residual
dry chemical on the side of the burn
should be wiped away before irrigation
has begun and then the skin should be
copiously irrigated for at least 15 to
20 minutes longer for alkali burns water
is the best irrigant neutralizing
chemicals should almost never be used
the neutralization reaction releases
heat and can worsen a thermal burn now
the exception is hydrofluoric acid burns
which sequester calcium can actually act
as a metabolic poison to the tissues
hydrofluoric acid burns of just 10% of
the total body surface area may be fatal
but these burns can be reversed acutely
by the infusion of intra-arterial
calcium immediate referral to a burn
center is essential the last type of
burn will discuss is electrical burns
low-voltage burns below about 440 volts
rarely caused damage beyond the site of
contact with the current however
high-voltage burns defined as greater
than a thousand volts often cause severe
internal destruction as the current
passes from the source through the body
of the patient and into the ground while
the surface burn may still be small deep
tissues may be severely damaged high
resistant tissues such as bone buildup
the most heat when current passes
through the body often causing tissue
around the bone to necrosis
similarly thin areas like fingers and
toes carry more current per unit area
and they're often severely burned
patients with electrical burns are at
risk for rhabdomyolysis in myoglobin
area compartment syndromes are likewise
common and thorough ceará evaluations of
the extremity compartments should be
performed especially in unconscious or
intubated patients immediate fasciotomy
is indicated for progressive neurologic
symptoms
in the setting of increased compartment
pressures