Pathophysiology

Pathophysiology Study Guide

Signs of full-thickness burns, which affect the epidermis, dermis, and underlying tissues, include: • Black color • Absence of blisters/pain/edema Total Body Surface area (TBSA) Calculations for Burns Determine (BSA) burn area percentage of total body surface using the rule of nines as follows: • Head = 9%, right/left arms = 9% each, right/left legs = 18% each, trunk = 18%, back = 18%, genital area = 1% • The areas totaled up must equal 100% • The burn status is then determined by the percentage: o Minor burns: Full thickness burns with less than 3% BSA, partial thickness burns with less than 15% BSA, and less than 10% in children o Moderate burn: Involves 3% to 10% BSA with full thickness burns, 25% or more with partial thickness burns, or 10% to 20% in children o Major burns: Over 10% BSA with full thickness burns, over 25% BSA with partial thickness burns, and over 20% BSA in children; trauma and burns to feet, hands, face, genitals, perineum, respiratory, and electrical burns are also considered major Treatment for Burns The first priority is prevention of fluid loss and shock. Fluids must be replaced by giving Lactated Ringers solution in the following formula: • Children: 3ml/kg for each percentage of BSA burned • Adults 4ml/kg for each percentage of BSA burned; give half of the total amount of fluid over the first eight hours and the second half of the fluid over the following 16 hours. The replacement of fluids must be done carefully as not to cause fluid overload. Continually monitor electrolytes including potassium, sodium, calcium, and magnesium. A tube may be inserted into the bladder tomonitor output of fluids. This tube is called a Foley catheter. If inhalation burns are present, adequate respiratory support is necessary. A pulse oximeter and Arterial Blood Gases will reveal if oxygen is needed. Hypoxemia usually results in tachycardia, tachypnea, cyanosis, and restlessness with anxiety. Elevating the head of bed in high-fowlers position may be helpful. Thermal burns may be cleaned with sterile normal saline. Chemical burns may be cleaned with large amounts of water and an antidote if needed. Individuals with electrical burns may need CPR, cardiac monitoring, and treatment of their burns. Individuals with burns should also be monitored for internal injuries. The signs of an infection include increased WBC’s, drainage of wounds, and positive wound cultures. Treatment will include: • Giving antibiotics according to physician’s orders • Assure hygiene, clean linens, hand washing, and protective garments • Administer analgesics according to physician’s prescriptions; intravenous pain medications

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