B R IEF B U R N R EV IEW

Debra Mulkey Mott, RN, BSN, CCRN

September 24, 2015
UTMB SON
MSN Education Graduate Student

Burn Alphabet Soup

*A-Airway
*B-Breathing
*C-Circulation
*D-Disability
*E-Expose/Environment/Events
*F-Fluid/Foley/Food

AIRW AY
Airway maintenance and C-Spine Precautions
Do they need an ETT?
Soot in the back of the throat?
Stridor/hoarseness?
Singed nasal hairs?
Burns to the face/neck?
Large TBSA requiring lots of IVF?

***SECURE THE AIRWAY!!!

SECURE THE ETT!!! MUST
PROTECT YOUR HOLES***

BREATH IN G
Breathing
Assess: rate, depth, quality?
100% O2 by non-rebreather
If you are going to intubate, get

HISTORY/EVENTS/ALLERGIES 1st!!!

CIRCU LATIO N
Circulation
Cardiac Status, Cardiac Monitor if needed

-2 Large bore IVs

*if an Adult, use LR
*if a Child, use D5LR b/c kids need
glucose!
(use their stores faster)
*Obtain a weight in kg

D ISABILITY
Disability Any neurological deficits?

- Any deformity?
- Assess LOC Are they Alert? Alert to
Voice, to Pain, or Unresponsive?
- Any associated injuries?

EXPO SE/EVEN TS/EN VIRO N M EN T

Expose/Environment/Events

- Remove all clothing/jewelry

- Log roll to check pts back
- KEEP PATIENT WARM warm
blankets, dry sheets
- What events led to the burn? Were
there drugs and alcohol involved?

FLU ID /FO LEY/FO O D

Fluid/Foley/Food
- Fluid Formula (ADULTS):
(2cc LR) x (TBSA) x (wt in kg) = Total Volume

LR
Give Total Volume over 1st 8 hours, then the
next Total Volume over next 16 hours
Example:
(2cc)(50%TBSA)(60kg) = 6000cc
6000/2 = 3000, so give 3000 over 1st 8 hours
(375cc/hr). And 3000 over next 16 hours
(187.5cc/hr)

FLU ID /FO LEY/FO O D

Rule of 9s : ADULTS Calculate TBSA

FLU ID /FO LEY/FO O D

Adult vs Child: note child HEAD SIZE
%age

FLU ID /FO LEY/FO O D

Fluid cont.:
- Once you have IVF going, if a big

burn, PLACE FOLEY MUST know

Hourly UOP
UOP 30 50cc/hr Minimum
(MAGIC number is 30)
UOP is how we know if we are giving
enough fluid and that organs (esp
the kidneys!) are being perfused
adequately

FLU ID /FO LEY/FO O D

Fluid/Foley:
Electrical Burns:
The body is a GREAT conductor of

electricity
BAD for us and our organs!
Electrical burns need a minimum of
75cc/hr UOP to FLUSH THE KIDNEYS

FLU ID /FO LEY/FO O D

Food!! YAY!
Place a DHT if possible must use

the gut and give the body calories!!!

Avoid Bacterial Translocation!
If no calories -> no good wound
healing!!
Place an NGT to decompress the
stomach

Skin
Bodys largest organ protects,

prevents loss of fluid, regulates

temperature, gives sensory contact
3 layers: epidermis, dermis, sub-q

Burn G radings
1st degree sun burn, heals within 3-5

days, epidermis only (NOT included in

TBSA)
2nd degree (partial thickness) entire
epidermis, variable portion of dermis
skin is red, wet, weepy, blistered, PAINFUL
3rd degree (full thickness) skin is dry,
white, leathery, NO PAIN
4th degree (bone, muscle, fascia) usually
seen with bad electrical burns

Burn G radings
2nd degree: wet, red, weepy painful,
may have blisters

Burn G radings
2nd degree burns: HURT you have

damaged nerve endings, they are a

little ticked off at you
3rd degree burns: DONT HURT you
have killed the nerved endings (they
cant be mad at you)

Burn G radings
3rd Degree: white, leathery, dry,
charred

W hat H appens in Burns?

Fluid Accumulation
- Early and rapid fluid accumulation
- Hypovolemic shock if untreated
- Due to inflammatory reaction: -

your capillaries are damaged, fluid

leaks out into the 3rd space, so we
have to give the heart something to
pump to the body! Tank her up!

Circum ferentialBurns
VERY dangerous can lose limbs, can

make it impossible to ventilate

-May need escharotomies/fasciotomies
S/S vascular compromise:
Skin color pale, mottled
Deep pain, pins/needles feeling
loss of motor sensation/function
decreased cap refill
decrease/loss of pulse

Circum ferentialBurns
Escharotomy incision down to the

sub-q tissue, allows blood flow to

resume
Fasciotomy incision down to the
muscle compartments to release
pressure
If there is a circumferential burn to
the Torso, imagine an over-packed
suitcase that you unzip the top
zipper of then your clothes can

Com partm ent Syndrom e

A condition resulting from increased

pressure in a confined body space

Simulates a tourniquet effect
May require escharotomies or
fasciotomies to release the pressure
and get blood flow going again

G rafting/Treatm ent
Autograft: your own skin is taken and

used to cover the burn (donor site ->

graft site)
Xenograft: pigskin is used to cover
the burn and prepare the wound bed
for an autograft
Meshing: donor skin is
stretched/meshed to cover more
burned area
Sheet graft: donor skin is not

Tricky Burns
Chemical Burns Acids/Alkalis: THE

SOLUTION TO POLUTION IS DILUTION:

FLUSH IT!!
Hydrofluoric Acid Burns treat with
Calcium Gluconate, can be VERY
Dangerous if Ca levels drop (heart attack)
Electrical Burns NEED MORE LR! MUST
FLUSH THE KIDNEYS!! Place on Cardiac
Monitor must monitor the heart, EKG,
serial Cardiac Enzymes

Tricky Burned Areas

Face, Eyes, Hands, Feet, Ears, Axilla,

Joints, Genitalia -> send to a Verified

Burn Center
If Genitalia are burned, must protect
the holes! FOLEY!! (Things will swell
to larger than you can possibly
imagine! Fluid follows gravity!)
Keep body parts moving to prevent
loss of function!

N O TES:
Burn Patients will swell up as large as the

Stay- Puff-Marshmellow Man YOU MUST

SECURE THE AIRWAY (ETT)
Dressings should not cause such
compression that you impede blood flow
Fluid follows gravity ELEVATE, ELEVATE,
ELEVATE!!
Wound management comes 2nd to Airway
management and Life threatening
injuries
BURNS HURT: Give IV pain medication!!

References
American Burn Association. (2015). Advanced burn life

support provider course. Accessed on September 23, 2015

from http://www.ameriburn.org/ablsnow.php.
Hall, K.L., Shahroki, S., & Jeschke, M.G. (2012) Enteral
Nutrition Support in Burn Care: A review of current
recommendations as instituted in the Ross Tilley Burn
Centre. Nutrients. 4(11), 1554-1665.
Pham, T.N., Cancio, L.C., Gibran, N.S. (2008). American Burn
Association practice guidelines burn shock resuscitation.
Journal of Burn Care and Research. 29(1), 257-266.
Savitsky, E. (2012). Combat casualty care: Lessons learned
from OEF and OIF. United States Department of Defense.
Accessed on September 23, 2015 from
http://www.cs.amedd.army.mil/borden/book/ccc/UCLAchp12.
pdf