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Assessing Types of Burns and their Severity

Written by Lippincott Williams & Wilkins · Friday 26th April 2013

This is an excerpt from "Wound Care Made Incredibly Easy! 1st UK Edition" by Julie Vuolo For more information, or to purchase your copy, visit: http://tiny.cc/woundcare. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at http://lww.co.uk when you use the code MEDUCATION when you check out!

Introduction

A burn is an acute wound caused by exposure to thermal extremes, electricity, caustic chemicals or radiation. The degree of tissue damage caused by a burn depends on the strength of the source and the duration of contact or exposure. Around 250,000 people per year sustain burn injuries in the UK (NBCRC 2001). Because of the specialist care burns require, they are considered here separately from other traumatic wounds.

Types of burns

Burns can be classified by cause or type. Knowing the type of burn will help you to plan the right care for your patient.

Thermal burns

The most common type of burn, thermal burns can result from virtually any misuse or mishandling of fire, combustible products, hot fluids and fat or coming into contact with a hot object. Playing with matches, pouring petrol onto a BBQ, spilling hot coffee, touching hot hair straighteners and setting off fireworks are some common examples of ways in which burns occur. Thermal burns can also result from kitchen accidents, house or office fires, car accidents or physical abuse. Although it’s less common, exposure to extreme cold can also cause thermal burns.

Electrical burns

Electrical burns result from contact with flowing electrical current. Household current, high-voltage transmission lines and lightning are sources of electrical burns. Internal injury is often considerably greater than is apparent externally.

Chemical burns

Chemical burns most commonly result from contact (skin contact or inhalation) with a caustic agent, such as an acid, an alkali or a vesicant.

Radiation burns

The most common radiation burn is sunburn, which follows excessive exposure to the sun. Almost all other burns due to radiation exposure occur as a result of radiation treatment or in specific industries that use or process radioactive materials.

Assessment

Conduct your initial assessment as soon as possible after the burn occurs. First, assess the patient’s ABCs. Then determine the patient’s level of consciousness and mobility. Next, assess the burn, including its size, depth and complexity.

Determining size

Determine burn size as part of your initial assessment. Typically, burn size is expressed as a percentage of total body surface area (TBSA). The Rule of Nines and the Lund–Browder Classification provide standardised and quick estimates of the percentage of TBSA affected.

Memory Jogger

To remember the proper sequence for the initial assessment of a burns patient, remember your ABCs and add D and E.

  • Airway – Assess the patient’s airway, remove any obstruction and treat any obstructive condition.
  • Breathing – Observe the motion of the patient’s chest. Auscultate the depth, rate and characteristics of the patient’s breathing.
  • Circulation – Palpate the patient’s pulse at the carotid artery and then at the distal pulse points in the wrist, posterior tibial area and foot. Loss of distal pulse may indicate shock or constriction of an extremity.
  • Disability – Assess the patient’s level of consciousness and ability to function before attempting to move or transfer them.
  • Expose – Remove burned clothing from burned areas of the patient’s body and thoroughly examine the skin beneath.