Question

Describe the characteristics of first-, second-, and third-degree burns and the rule of nines assessment tool to estimate burn percentages. Discuss the recommended strategies for initial and maintenance fluid replacement after a major burn injury.

Answer 1

Burns is defined as injury to the tissues of the body caused by heat, chemicals, electric current or radiation.

CHARACTERISTICS OF FIRST DEGREE BURNS:

In a first degree burn, only the epidermis is affected.these injuries are characterized by redness and pain;there are no blisters, and edema in the wounded tissue is minimal. Long term tissue damage is rare and usually consists of an increase or decrease in the skin color

example is moderate sun burn

CHARACTERISTICS OF SECOND DEGREE BURNS:

In a second degree burn damage occurs in the blood capillaries and cause inflammation making it more difficult for blood to return to the surface.This gives the skin a white appearance until blood returns to the area.Peeling occurs when a burn damages living cells in the dermis.characteristics includes

1 Blisters

2 Deep redness

3 Burned area may appear wet and shiny

4 Skin that is painful to the touch

5 Burn may be white or discolored in an irregular pattern

CHARACTERISTICS OF THIRD DEGREE BURN:

Third degree burn or full thickness burns destroy the entire thickness of the skin.The surface of the wound is leathery and may be brown,tan,black,white or red.There is no pain because the pain receptors have been obliterated along with the rest of the dermis.

RULE OF NINE ASSESSMENT TOOL:

The rule of nines assessment tool assess 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

To approximate the percentage of burned surface area,the body has been divided into 11 sections

• Head
• Right rm
• Left arm
• Chest
• Abdomen
• Upper back
• Lower back
• Right thigh
• Left thigh
• Right leg below knee
• Left leg below knee
• Genitals

Head = 9%

Anterior trunk = 18%

Posterior trunk = 18%

Right arm = 9%

Left arm = 9%

Right leg = 18%

Left leg = 18%

Genitals = 1%

FLUID LOSS MANAGEMENT:

• Fluid replacement therapy
• the total volume and rate of intravenous fluid replacement are gauged by the patient response and guided by the resuscitation formula
• The adequacy of fluid resuscitation is determine by monitoring total urine output
• urine output totals of 30 to 50 ml/hr have been used as a resuscitation goal.
• Other indicators of the adequate fluid replacement are a systolic blood pressure exceeding 100 mm of Mercury  and pulse rate less than 110 beats/min
• The projected fluid requirement for the first 24 hours are calculated based on the extent of the burn injury.
• Some combination of fluid categories may be used including colloids and crystalloid
• adequate fluid resuscitation results in slightly decreased blood volume level during the first 24 hours post burn and restoration of plasma level to normal by the end of 48 hours.

most preferred solutions are Ringer Lactate

Na+ conc

Most physiological

Free of glucose

Converted to HCO3