Question

1. Differentiate between first degree, second degree, third degree, and fourth degree burns.

2. A 55 year old man sustains third degree burns on 65% of his body from a house fire. When the patient arrives to the ED, the patient’s temperature is 35.2 C (95.3F), his weight is 67kg.

a. How should the treatment team prioritize this patient care?

b. What resuscitation fluid is recommended?

c. How much (in mL’s) resuscitation fluid would you administer to this patient?

Answer 1

1. First-degree (superficial) burns:

First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color.

Second-degree (partial thickness) burns:

Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.

Third-degree (full thickness) burns:

Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.

2.a) To treat burns patients , follow these steps:

1. Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases. ...
2. Remove rings or other tight items. ...
3. Don't break blisters. ...
4. Apply lotion. ...
5. Bandage the burn. ...
6. Take a pain reliever. ...
7. Consider a tetanus shot.
8. The 9s assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9.

b) A variety of crystalloids, artificial colloids and human albumin solutions have been used for fluid resuscitation and there has been considerable debate for more than 30 years about the best type of fluid to use and the optimal volume and rates of delivery. Solutions such as glucose 5% and glucose saline are not suitable for fluid resuscitation because they lead to rapid dilution of plasma sodium and only modest increases in circulatory volume because of their tendency to distribute rapidly across all fluid compartments.

C) Adults are given 1 L of crystalloid (20mL/kg in children) or, in hemorrhagic shock, 5 to 10 mL/kg of colloid or packed red blood cells, and the patient is reassessed.