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Summary Med-Surg: Burns Assessment and Management
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- Louisiana State University At Eunice
Comprehensive Assessment and Management of Burns; Nursing
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Burns Assessment and ManagementHow much total body surface area is burned is determined by one of the following methods:
Rule of Nines: an estimation of the total body surface area burned by assigning
percentages in multiples of nine to major body surfaces.
Parkland formula:
(4ml of Ringers Lactate) x (% burn) x (kg weight) = mls required in first 24 hrs.
½ is given in the first 8 hours (calculated from the time the patient was burned)
¼ is given in the second 8 hours
¼ is given in the third 8 hours
EXAMPLE: 4 ml / 70 kg / 50% TBSA = 14,000 ml fluid resuscitation required
(7 liters given in first 8 hours)
This calculator will provide the following values.
Total fluid over first 24 hours:
Fluid over first 8 hours:
Fluid over the next 16 hours:
Fluid Summary - ml/hour
Fluid Resuscitation (in the first 24 hours post-burn)
For burn victims, fluid resuscitation is critical within the first 24 hours. The amount of fluid
resuscitation can be determined from the percentage of body surface area (%BSA)
involved. "Rule of 9's" can estimate the %BSA.
The Parkland Formula is as follows.
Fluid for first 24 hours (ml) = 4 * Patient's weight in kg * %BSA
Afterwards, the first half of this amount is delivered in the first 8 hours, and the remaining
half is delivered in the remaining 16 hours.
Characteristics of Burn
, The depth of a burn injury depends on the type of injury, causative agent, temperature of the
burn agent, duration of contact with the agent, and skin thickness. Burns are classified according
to the depth of tissue destruction:
Superficial partial thickness burns (similar to first degree), such as sunburn: The
epidermis and possibly a portion of the dermis are destroyed.
Deep partial thickness burns (similar to second-degree), such as a scald: The
epidermis and upper to deeper portions of the dermis are injured.
Full-thickness burns (third degree), such as a burn from a flame or electric current: The
epidermis, entire dermis, and sometimes the underlying tissue, muscle, and bone are
destroyed.
Second-degree burn (partial-thickness)
Usually caused by flash, scalds, or brief contact with a hot object, it involves the epidermis
and part of the dermis.
Has vesicles and bullae; moist appearance – usually red to pale pink
Tactile and pain sensibility is intact – very painful; develops significant edema
Heals in 7-21+ days with variable amounts of scarring
Third-degree burn (full-thickness)
Usually caused by flame, high-intensity flash, electricity, chemicals, or prolonged contact
with hot liquids or hot objects
Extends through the epidermis and dermis; usually appears white, brown, or black; may
have thrombosed veins.
The wound appears dry; the elasticity of the wound is destroyed, so the wound becomes
leathery and feels firm to the touch.
Marked edema and decreased elasticity may necessitate escharotomies, which are
painless to touch.
Escharotomies
Longitudinal incisions through eschar that release constriction may be necessary in full-
thickness circumferential burns of an extremity or chest.
Assess the adequacy of circulation (pulse, capillary refill, movement, numbness, tingling,
pain) and elevate
Smoke Inhalation
Carbon Monoxide poisoning (kills during and immediately following the fire)
CO from the fire combines with the circulating hemoglobin, bumping the oxygen
from its receptor sites
Signs of CO poisoning include confusion, dizziness, headache, nausea
Treatment: administration of 100% oxygen
Pulmonary injury from the chemicals inhaled
Patient develops ARDS over the first 24 hours post-injury
Pneumonia may also occur (sometimes as late as 10 days post-burn)
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