Burn Wound Terminology[edit | edit source]Eschar: Eschar refers to the nonviable layers of skin or tissue indicating deep partial or full thickness injury. It is black, thick and leathery in appearance. This word is not synonymous with the word "scab". Show
Scab: Dry, crusty residue accumulated on top of a wound, resulting from coagulation of blood, purulent drainage, serum or a combination of all. Pseudo-Eschar: A thick gelatinous yellow or tan film that forms with silver sulfadiazine cream combining with wound exudate. It can often be mistaken for eschar, but it can be removed with mechanical debridement. Petechiae: Pinpoint, round spots that appear on the skin as a result of bleeding. The spots can appear red, brown or purple in colour.
All photos used with kind permission from Diane Merwarth, PT Classification by Depth[edit | edit source]For an overview on wound healing, and the anatomy and physiology of the skin, please read this article.
All photos used with kind permission from Diane Merwarth, PT Circumferential burn injury special considerations[edit | edit source]A circumferential burn wound is typically found around an extremity or the torso and puts the patient at a significant risk for compartment syndrome. This pattern of burn injury involves deep partial thickness, full thickness, and or subcutaneous burns. Circumferential burn injury signs and symptoms for potential compartment syndrome:
Used with kind permission from Diane Merwarth, PT Used with kind permission from Diane Merwarth, PT If a patient is experiencing the signs and symptoms of compartment syndrome, the medical team should be immediately alerted for further assessment and intervention. A bedside or surgical escharotomy will be needed to relieve the resulting pressures of compartment syndrome. Blanch Test[edit | edit source]The blanch test is similar to the capillary refill test. It is a bedside exam to assess blood flow to the capillaries of the skin. This can be performed over intact skin or in a wound bed itself. To perform the test:
The following optional video includes a demonstration of the blanch test. Jacksons’ Burn Wound Model[edit | edit source]Jacksons’ Burn Wound Model[1] is a model used to understand the pathophysiology of a burn would. This model divides the wound into three zones.
Zone of coagulation outlined in purple; zone of stasis in green; zone of hyperaemia in blue Zone of coagulation outlined in purple; zone of stasis in green; zone of hyperaemia in blue Burn Wound Conversion[edit | edit source]Burn Wound Conversion:[2] True burn wound conversion is a deterioration of the wound due to events unrelated to the initial burn injury. This refers to the worsening of tissue damage in a burn wound which previously was expected to spontaneously heal, but instead it increases in depth to a deeper wound which may require surgical intervention. Potential Causes:
All photos used with kind permission from Diane Merwarth, PT Total Body Surface Area[edit | edit source]Total body surface area is an important figure when applying the Parkland Burn Formula. This formula is the most widely used formula to estimate the fluid resuscitation required by a patient with a burn wound upon on hospital admission. It is usually determined within the first 24 hours of admission. When applying this formula, the first step is to calculate the percentage of body surface area (BSA) damaged. This is most commonly calculated using the "Wallace Rule of Nines".[3] When conducting a paediatric assessment, the Lund-Browder Method is commonly used, as children have a greater percentage surface area of their head and neck compared to an adult. The formula recommends 4 millilitres per kilogram of body weight in adults (3 millilitres per kilogram in children) per percentage burn of total body surface area (%TBSA) of crystalloid solution over the first 24 hours of care.[4]
The latest research indicates that while this method is still in use, the fluid levels should be constantly monitored, while assessing the urine output,[5] to prevent over-resuscitation or under-resuscitation.[6] Calculation of Percentage Burn of Total Body Surface Area[edit | edit source]
1. The Rule of Nine[edit | edit source]
2. Lund-Browder Method[edit | edit source]3. Palmar Surface Method[edit | edit source]The "Rule of Palm" or Palmar Surface Method can be used to estimate body surface area of a burn. This rule indicates that the patient's palm (with the exclusion of the fingers and wrist) is approximately 1% of the patient's body surface area. When a quick estimate is required, the percentage body surface area will be the number of the patient's own palm it would take to cover their injury. It is important to use the patient's palm and not the provider's palm. References[edit | edit source]
What is the best initial step taken immediately after a burn injury?Cool the burn.
Hold the area under cool (not cold) running water for about 10 minutes. If the burn is on the face, apply a cool, wet cloth until the pain eases. For a mouth burn from hot food or drink, put a piece of ice in the mouth for a few minutes.
What is a priority in the rehabilitation phase of the burn injury?EARLY STAGES OF REHABILITATION
Regular pain relief is essential, in particular prior to all interventions such as change of dressing and exercise; this needs to be given in adequate time to take effect before commencing the procedure.
What are the 3 steps to care for someone who has a burn?Learn first aid for someone who has a burn. Cool the burn under cold running water for at least 20 minutes. Cooling the burn will reduce pain, swelling and the risk of scarring. ... . After the burn has been cooled, cover it with cling film or a clean plastic bag. ... . Call 999 if necessary.. What is the priority of interventions for the burn patient?Respiratory and fluid status remains highest priority. Assess peripheral pulses frequently for first few days after the burn for restricted blood flow. Closely observe hourly fluid intake and urinary output, as well as blood pressure and cardiac rhythm; changes should be reported to the burn surgeon promptly.
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