Principles of Burn Assessment

00:01 Hi, I'm Doctor Lawes and I'm going to go over the principles of burn assessment and burn management.

00:07 So emergency burn care is a critical area in nursing practice.

00:10 It involves your systematic assessment and management of the burn so you can prevent complications and promote the optimal recovery for your client.

00:19 Now nurses play a pivotal role in early intervention, diagnosis and care planning to ensure positive outcomes.

00:25 They make sure they are age specific considerations with pediatric and older adult populations. So I'm going to walk you through the major principles of burn assessment and management. But we're going to use the clinical judgment measurement model.

00:37 Yep. That's the one from the NCLEX to help all these pieces of information stick together.

00:43 Now this model is going to help you remember how to actually use all this information in clinical practice. So before we dive into emergency assessment of a patient experiencing a burn, let's review some terminology.

00:54 All health care disciplines are taught a similar acronym to help them prioritize care, particularly for patients who have experienced a experienced a major burn or trauma. A–B–C–D–E acronym helps every member of the team stay focused on the patient data.

01:08 That's most important. A is for airway.

01:12 B is for breathing. C is for circulation and cardiac status.

01:16 D is for disability and E is for exposure.

01:19 So this simple model will help you collaborate with the team.

01:23 Now the other labels you need to know are how burn injuries are categorized.

01:27 Now they're labeled by depth and degree.

01:29 Now you might have heard some other type of terms like first degree or second degree.

01:35 Those are the older terms, but you may still hear them either from your patients or maybe even from some colleagues.

01:41 But we're going to stick with what is most current now.

01:44 So superficial partial thickness and full thickness burns those used to be known as first degree, second degree, and third and fourth degree burns.

01:55 So let's start with the superficial or the first degree burns.

01:58 Now this only affects the epidermal layer of the skin.

02:01 The Burnside is red. It's painful.

02:04 It's dry and it won't blister.

02:06 Like a mild sunburn. Now, long term tissue damage is rare and usually involves an increase or decrease in the skin color.

02:14 Burns that involve all of the epidermis and part of the second layer of the dermis is called a partial thickness, or what used to be called a second-degree burn.

02:22 The burn site appears red.

02:24 It is blistered and it may be swollen and painful.

02:28 Now complete destruction of the epidermis, the dermis and the nerve bed, with possible extension into underlying bones, muscles and tendons.

02:37 That is called a full thickness or third-degree burn.

02:41 Now, when bones, muscles, or tendons are also burned, it may be referred to as a fourth-degree burn.

02:48 The burn site appears white or charred, and there is no feeling in the area since the nerve endings have been destroyed.

02:55 Now let's look at the important cues that you should be able to recognize for a client who's experienced a burn. First of all, you're going to want to focus on the mechanism of injury. What caused the burn? Was it a flame or a chemical? Or maybe a scalding burn? Because the cause will change the treatment.

03:12 So, for example, you have a client who has a super acidic chemical burn.

03:16 Now, they may benefit from something like an alkaline neutralizing agent.

03:21 So first of all, focus on the mechanism of the injury.

03:25 Next think about the location, the depth and the extent of the burn.

03:30 And we'll talk about the rules of nines.

03:33 So this will change the supplies that you need and how serious the situation is.

03:38 Now the rules of nine divides the body into sections that will help you estimate the total body surface of the area that's been affected by the burn.

03:45 These sections represent either 9% or multiples of 9%, though not every area is exactly 9%.

03:53 In adults, the head and neck together account for 9%.

03:58 So you've also got each arm representing 9%, making a total of 18% for both arms.

04:04 Each leg contributes 18%, with 9% for the front and 9% for the back of each leg. Now, the anterior trunk or chest and abdomen makes up 18%, as does the posterior trunk, which includes the back and the buttocks.

04:19 Now, we said this would change the supplies that are needed in how serious the situation is.

04:24 So keep that in mind and know that finally, the perineum and the genital area make up just 1%, but can become extremely problematic for your client.

04:36 So let's summarize this all up.

04:38 You'll see that we have a picture for you up there of the rule of nines.

04:41 Head and neck is 9%. Each arm is 9%, each leg is 18%.

04:48 The front of your torso is 18%, the back of the torso is also 18% and the perineum is 1%. Now the third category you're going to want to observe for signs of airway compromise.

05:00 For example, if the client has soot around their mouth or you notice they have singed nasal hairs or their voice is hoarse, all of those are warning signs that airway swelling and constriction are likely present in the airway, or they're going to be coming soon.

05:15 Number four, when you get that first set of vital signs, are you seeing signs of shock such as hypotension or tachycardia and pain? These are cues that you want to think about.

05:25 We might need additional fluids.

05:27 We might need inotropic agents.

05:29 The reason when a client experiences a burn, they have massive fluid shifting.

05:34 So they're at an extreme risk to have a low blood pressure and hypovolemic shock.

05:39 So those were just four examples of cues from that first impression.

05:43 Assessment of a burn patient that should point you towards you might have guessed it.

05:48 Our next step in the model, which is prioritizing and analyzing cues.