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Burn Staging Cheatsheet (Cheat Sheet)
Fourth Degree Burn (Image)
Second Degree Burn (Image)
First Degree Burn (Image)
Third Degree Burn (Image)
Stages of Burns (Image)
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Outline
Mr. Travis is a 32 year old male who presents to the ED after sustaining severe 2nd and 3rd degree burns in a house fire. The below diagram estimates his wounds. He weighs 85 kg and is 5’11”.
Critical Thinking Check
Bloom's Taxonomy: Application
Using the Rule of Nines, estimate the Total Body Surface Area Burned (TBSA %).
View Answer
- Half of the head/neck – 4.5%
- Top half of front torso – 9%
- Top half of back – 9%
- Full top half of right arm – 4.5%
- Full top half of left leg – 9%
- Half of front abdomen – 4.5%
- Half of lower back – 4.5%
- TOTAL – 45%
Critical Thinking Check
Bloom's Taxonomy: Application
Calculate the total fluid volume required for resuscitation in the first 24 hours using the Parkland Burn Formula.
View Answer
- 4 x 45% x 85 kg = 15,300 mL in 24 hours
- Give ½ in the first 8 hours = Start fluids at 956 mL/hr
Critical Thinking Check
Bloom's Taxonomy: Analysis
What is the TOP nursing priority for Mr. Travis?
View Answer
- Fluid resuscitation to prevent hypovolemic shock
- Mr. Travis’s vitals are: BP 90/48, HR 108, Temp 97.2, Pain 10/10.
You note circumferential burns around the Right Upper Arm and soot around the mouth with singed nose hairs, plus some facial swelling.
Critical Thinking Check
Bloom's Taxonomy: Analysis
What are your main concerns for complication(s)?
View Answer
- Airway due to possible/likely inhalation burns and airway swelling
- Compartment syndrome due to circumferential burns around right arm
Critical Thinking Check
Bloom's Taxonomy: Analysis
Physiologically, explain the alterations in Mr. Travis’s vital signs.
View Answer
- He is likely hypovolemic due to the loss of fluids from the burns, hence the low BP and high HR
- He is hypothermic because of his inability to regulate temperature due to skin loss
Critical Thinking Check
Bloom's Taxonomy: Analysis
How will you know if fluid resuscitation is effective?
View Answer
- Fluid resuscitation should be titrated to urine output of at least 0.5 mL/kg/hr or 30-50 mL/hr
- If excess urine output, slow fluids
- If not enough, speed up fluids
- Mr. Travis is intubated for airway protection and taken to the OR for surgical debridement of his burns. He is then transferred to the Burn ICU
Critical Thinking Check
Bloom's Taxonomy: Analysis
What are priorities for daily care of Mr. Travis?
View Answer
- Infection prevention and meticulous wound care – sterile dressing changes
- Pain control – PCA if able
- Manage ventilator and respiratory needs until able to be extubated
- Maintain temperature and hemodynamics
Critical Thinking Check
Bloom's Taxonomy: Comprehension
Mr. Travis will need skin grafts. How will you explain autologous skin grafts to Mr. Travis and his family?
View Answer
- Autologous skin grafts are performed by taking a slice of healthy tissue from somewhere else on the patient’s body, for example, his right thigh that isn’t burned, and then running it through a meshing device.
- This allows it to be stretched over the wound and secured in place, then the skin will grow in around the graft.
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