Burn Objectives
Describe the purposes of skin and the effect of a burn on the skin itself.
The skin’s purpose is to act as a barrier. It keeps the “inside” in (fluids, electrolytes, protein, heat); and it keeps
the “outsides” out (bacteria, yeast, fungi). The skin is the first line of defense, so it plays a very important role in
immune function.
State the effects of a major burn injury on the cardiovascular system, and explain why the advent of IV
resuscitation heralded increased survival for burn patients.
Prior to IVs, patients who were not able to keep down fluids were not able to be fluid resuscitated adequately.
Hopovolemia is a HUGE problem for burn patients b/c so much of the fluid leaves the vascular space d/t
permeability of capillaries (and damage to vessels).
State the major determinant of mortality in the burn patient.
The major determinant of mortality is the presence of smoke inhalation.
Explain why securing the endotracheal tube is paramount for survival in the resuscitative phase of a
major burn patient.
If that tube comes out, it is likely that you won’t be able to get it back in again. Edema sets in and the airway
could close off.
State the three classic phases of burn injury and explain why they are no longer distinct periods in burn
hospitalization.
The three phases are resuscitative, acute and rehabilitation:
• Resuscitative
• Description
• Time between initial injury to 36-48 hours after injury. This phase ends when fluid resuscitation is
complete.
• Major concerns: life-threatening airway and breathing problems
• Characterized by development of hypovolemia (leaky capillaries → edema)
• Burn itself is of less immediate concern (except for cases where escharotomy is performed to restore
perfusion)
• Manage circulatory and pulmonary abnormalities in this stage
• Medical Management
• Assess burn severity (depth, size, location, age, general health, mechanism of injury)
• Treat minor burns in outpatient or ambulatory setting; < 15% TBSA in pts under 40 or < 10% in pts
older than 40; no cosmetic or functional disabilities
• Major burns
• Monitor airway and breathing
• Prevent hypovolemic shock (burn shock): 2 large bore IVs; goal is to maintain vital organ
perfusion while avoiding complications of fluid administration
• Prevent aspiration: NG tube and no oral fluids!
• Minimize pain and anxiety: IV opioids (morphine sulfate or fentanyl). Small doses are given and
repeated q 5-10 min. Explain everything to patient
• Wound care:
• Stop the burning process (remove clothes, irrigate chemical burns). Cover with a dry sheet.
• Immediate care is to cover wound with sterile towels and place clean dry sheets/blankets
over the pt. Definitive wound care takes place at the hospital and consists of cleansing with
mild soap and water, debridement, removal of damaging agents such as chemicals and tar,
and application of dressing and topical agent. Trim away loose tissue, shave hair within 1-
inch margin.
• Prevent tetanus: Booster if haven’t had tetanus within 5 years. Immunoglobulin (passive
immunity) and immunizations (active acquired immunity) for anyone who has never had a
tetanus shot.
Describe the purposes of skin and the effect of a burn on the skin itself.
The skin’s purpose is to act as a barrier. It keeps the “inside” in (fluids, electrolytes, protein, heat); and it keeps
the “outsides” out (bacteria, yeast, fungi). The skin is the first line of defense, so it plays a very important role in
immune function.
State the effects of a major burn injury on the cardiovascular system, and explain why the advent of IV
resuscitation heralded increased survival for burn patients.
Prior to IVs, patients who were not able to keep down fluids were not able to be fluid resuscitated adequately.
Hopovolemia is a HUGE problem for burn patients b/c so much of the fluid leaves the vascular space d/t
permeability of capillaries (and damage to vessels).
State the major determinant of mortality in the burn patient.
The major determinant of mortality is the presence of smoke inhalation.
Explain why securing the endotracheal tube is paramount for survival in the resuscitative phase of a
major burn patient.
If that tube comes out, it is likely that you won’t be able to get it back in again. Edema sets in and the airway
could close off.
State the three classic phases of burn injury and explain why they are no longer distinct periods in burn
hospitalization.
The three phases are resuscitative, acute and rehabilitation:
• Resuscitative
• Description
• Time between initial injury to 36-48 hours after injury. This phase ends when fluid resuscitation is
complete.
• Major concerns: life-threatening airway and breathing problems
• Characterized by development of hypovolemia (leaky capillaries → edema)
• Burn itself is of less immediate concern (except for cases where escharotomy is performed to restore
perfusion)
• Manage circulatory and pulmonary abnormalities in this stage
• Medical Management
• Assess burn severity (depth, size, location, age, general health, mechanism of injury)
• Treat minor burns in outpatient or ambulatory setting; < 15% TBSA in pts under 40 or < 10% in pts
older than 40; no cosmetic or functional disabilities
• Major burns
• Monitor airway and breathing
• Prevent hypovolemic shock (burn shock): 2 large bore IVs; goal is to maintain vital organ
perfusion while avoiding complications of fluid administration
• Prevent aspiration: NG tube and no oral fluids!
• Minimize pain and anxiety: IV opioids (morphine sulfate or fentanyl). Small doses are given and
repeated q 5-10 min. Explain everything to patient
• Wound care:
• Stop the burning process (remove clothes, irrigate chemical burns). Cover with a dry sheet.
• Immediate care is to cover wound with sterile towels and place clean dry sheets/blankets
over the pt. Definitive wound care takes place at the hospital and consists of cleansing with
mild soap and water, debridement, removal of damaging agents such as chemicals and tar,
and application of dressing and topical agent. Trim away loose tissue, shave hair within 1-
inch margin.
• Prevent tetanus: Booster if haven’t had tetanus within 5 years. Immunoglobulin (passive
immunity) and immunizations (active acquired immunity) for anyone who has never had a
tetanus shot.
