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Flashcards in burns Deck (52)
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what is a burn?

traumatic injury to the skin or other organic tissue primarily caused by heat or exposure to electrical discharge, friction, chemicals, and radiation


hot liquids



hot solids

contact burns


how many burns a year require medical attnetion?

1 mil


Burn Classification by depth

Superficial/Epidermal Burn (first-degree)*

Partial-thickness Burn (second-degree)*

Full-thickness Burn(third-degree)*

Deep Burn involves fascia and/or muscle (fourth-degree burns)*


Most common of burns

Full recovery is expected 3-6 days, full recovery and excellent prognoses

Tissue damage usually minimal, no scarring

Superficial/Epidermal Burn (1st Degree)


Example Sunburns
Causes minimal skin damage

Superficial/Epidermal Burn (1st Degree)


Pain, erythema (redness), slight swelling, no blisters

Superficial/Epidermal Burn (1st Degree)


Soak in cool water for 5 minutes, do not use ice
OTC analgesics for pain relief
Antibiotic ointment as needed

Superficial/Epidermal Burn (1st Degree) Intervention


Burns that go through the epidermis and reach the dermis, varying depth.

Partial-thickness Burn (2nd Degree)


Full recovery is expected, skin heals may take up to 3 weeks, skin may change color, especially with sun exposure.
Rarely need OT intervention.

Partial-thickness Burn (2nd Degree)


Skin infection may develop
Red, white or splotchy skin, swelling

Partial-thickness Burn (2nd Degree)


Blister, swelling and are generally more painful.

Partial-thickness Burn (2nd Degree)


Requires medical treatment, especially if deep or over large area, on face, neck or, over joint.
Cool injured area for 15 minutes, no ice
Use OCT analgesics
Antibiotic ointment to blistered areas
Keep wound clean and bandaged to prevent infections.
Skin will heal on its own- Skin epithelial cells are intact.

Partial-thickness Burn Treatment.


Epidermis and dermis are completely burnt.
Extensive fluid loss and metabolic effects

Full-thickness Burn (3rd Degree)


No pain in immediate area, possibly adjacent areas if burnt at 2nd degree.
Affected area may appear white (like burned charcoal)

Full-thickness Burn (3rd Degree)


Waxy, white color, may be charred or dark brown
Raised leathery texture

Full-thickness Burn (3rd Degree)


Requires medical intervention, hospitalization
In some case “specialized burn units”
Skin grafts are required.
Other surgeries may be required in Rehab stage.
LT Physical and psychological implications.
Long term rehab is needed.
OT can intervene at all 4 stages of Burn Rehab.

the skin graft covers the wound and attaches itself to the cells beneath and begins to grow in its new location.

Full thickness Treatment Cont.


Goes through all layers of skin and damages muscle, bones, nerves, and fat lying underneath
There is no pain due to nerve damage
Recovery depends on extent of damage.

Deep Burn (4th degree burn)


Causes of Burn

Boiling liquids: water, steam & other liquids,
Dry burns: flame, house fires, car fires etc
Chemical burns, Cleaning supplies, household chemicals
Electrical burns
Friction burns
Explosions, Fireworks


Thermal Burns

Heat sources raise the temperature of the skin and tissues and cause tissue cell death or charring
Dry burn (flames, hot metals or other hot material)
Moist heat burn (steam, hot liquids)
Gas burn (inhaling hot gases)


#1 cause of burn injuries in children

scalds! (1st and 2nd degree)


chemical burns

strong acids, alkalines, detergents, solvents coming into direct contact with the skin or eyes
often common household chemicals (drain cleaners, oven cleaners, toilet bowl cleaners, batteries, ammonia, bleach, dishwasher liquids, etc.)
includes the liquid or dry chemical and its fumes
Immediate treatment
Remove the chemical agent and contaminated clothing
Immediately and thoroughly flush the burn area with a steady stream of water for 10 or more minutes. A thorough shower may be effective.
If eyes are contaminated, immediately flush the eyes with running water, continue for 15 minutes. Go to the ER.


from electrical current, lightening
Adult electrical injuries usually occur in occupational settings, downed powerlines d/t storms
Full extent of tissue damage, may not be know for 10 days after the injury
Burns marks may initially be at the entry and exit of the elec. current
Usually involves internal tissue damage, initially unseen .

electrical burns


Prolonged exposure to ultraviolet rays of the sun (solar), or to other sources of radiation such as X-ray
UVA: Ultraviolet A: weakest, Can cause skin aging, damage, wrinkles.
UVB: Ultraviolet: more energy, damage cells’ DNA, main cause of sunburns. Thought to cause most skin cancers.
UVC: Ultraviolet C: most energy, react with ozone in atmosphere, don’t reach the ground, thus cause no skin cancer.

radiological burns


Estimating Extent of body surface are BSA of Burn

Rule of Nines ( Wallace Rule of Nines) accurate with Adults.
Rule of One (Palmar surface) &
Lund—Browder method: used mostly with children.


What is Rule of Nines?

Quick estimate of how much body surface area BSA is burned.
Assess Surface area (Breadth) not the depth (Burn Degree )
Quick, reasonable accuracy, subjective and tends to overestimate, poor interrater reliability.
Used to help guide treatment decisions, fluid resuscitation
Helps determine whether a person requires transfer to a burn unit *Approximate Criteria/ may vary  >= 20% TBSA,  high-voltage electrical injuries, multiple trauma including burn, burns w/ inhalation injury


Adult Percentages for Rules of Nines

Arms: (shoulder to hand).9% each
- Torso:(18% Back, 18% front) 36%
- Lower Extremity: (Groin to foot) 18% each- Head (entire surface area) 9%
Genital area 1%


Lund Browder Rule for kids

takes into account age

Trunk is 13%X2, UEs 5%X2. - Feet 1.75%X2. - Decreasing percentage BSA for the head (a) and - increasing percentage BSA for the legs(b and d) as the child ages.- making it more useful in pediatric burns.


Four Phases of Burns

Emergent Phase (onset to 24/48 hrs): goal is fluid resuscitation & adequate airways): OT does elevation, positioning to counteract edema, anti- deformity position.

Acute Phase:(0- Epithelialization, 12 to 14 days) splint “oppose deforming force”, Don FT, except for ROM, wound care. Gentle AROM-especially with dorsal hand burns.

Skin Graft Phase: Don splint for 5+days in OR, anti-deformity position, gentle exercises

Rehab Phase: nighttime splinting, “oppose deforming force”, may use dynamic splint.