Session 8  Second-degree (Deep Partial Thickness)

BURNS • Burns affects the epidermis and dermis

- Interferes with the skin’s ability to help keep out • Painful wound
infectious organisms, maintain fluid balance and • Swollen, red appearance
regulate body temperature • Blisters
- damage to your body's tissues caused by heat, • Blanching and refill when pressure is applied
chemicals, electricity, sunlight, or radiation. • Variable amount of scarring

Causes and kinds:  Third-degree (Full Thickness)

 Thermal injuries  Burns affects the epidermis, dermis and tissue
• Exposure to dry heat (flames or excessive below the dermis
sun)  Painless wound
• Exposure to moist heat (steam or hot liquids)  White to black (charred) color
 Fry, leathery appearance
 Mechanical injuries
 No blanching if pressure is applied
• Friction or abrasion from skin rubbing harshly
against a coarse surface
Rule of Nines
 Electrical injuries (Lund-Browder Chart)
• Contact with high voltage power lines - Tool to determine the extent of Burn.
• Immersion in water that has been electrified - used to determine the to percentage based on the
• Lightning strikes body surface area

 Chemical and radiation injuries

• Direct contact, ingestion, inhalation or
injection of acids or alkali

Types of Burns

 First-degree (Partial Thickness)

 Burn affects the superficial layer of the
epidermis.
 Dry, painful wound
 Pink or red appearance
 Slight edema
Sample Drill:
A 25 y.o. burn victim came into the emergency room ˃ All this adds up to 100% of the body.
with 2nd degree burns on the following area: Left side ˃ The part of the body burned must be considered
of his head and neck, left arm, half of his left leg as when evaluating the extent and severity of the
well as his genitals. How much % of BSA is affected? burn.
Left side of his head and neck: 4.5%
Left arm: 9% 3% burn
Half of his left leg: 9%  Anterior thigh is not serious as a 3% burn to the
Perineal area: 1% neck, face, or perineal area.
Total: 23.5%
Examples:
Video  If a patient’s entire left leg (18%) and entire right
Rule of Nines – quick assessment tool used for leg (18%) are burned, about 36% of the patient’s
determining the size of a burn until a more thorough body surface area is affected.
 If their entire right arm (9%) and the right side of
assessment can be made.
their head (4.5&) were burned, the amount of
˃ Size and depth of a burn determines the severity body surface area affected would be 13.5%.
of the burn injury.
˃ Calculations are modified for infants and children
Factors in determining the burn severity under 10 years old because of their larger head
 Size and depth and smaller body size. The head is assigned
 Age of patient 18%, and the legs are given 13.5% each.
 Body part involved
 Mechanism of injury Example:
 Injuries sustained at time of burn If a patient has a burn to the entire left side of his
 History of cardiac, pulmonary, renal, or back and the posterior side of his left arm, what is the
hepatic disease estimated body surface area burned?
Entire left side of his back: 9%
˃ The measurement of burn surface is important for Posterior side of his left arm: 4.5%
estimating the patient’s fluid requirements and Total: 13.5%
determining hospital admission criteria.
˃ To estimate body surface are (BSA) of a burn, the
rule of nines assigns BSA values to each major Diagnostic Test reveals:
body part.  ABG analysis:
• Bicarbonate below normal
Body parts that make up 9% each • pH below normal (both will result to Metabolic
 Entire left arm Acidosis)
 Entire right arm
 Head  Electrolyte levels:
 Chest • Potassium above normal
 Abdomen • Sodium below normal

18%  Blood test levels:

 Entire back • BUN and creatinine above normal
 Entire left leg • Carboxyhemoglobin above normal
 Entire right leg • HCT above normal
˃ Can be broken down into 9% sections
o Upper and lower back  ECG tracings:
o Right and left side of the back • Changes characteristics of electrolyte
o Front right leg and back right leg imbalances or myocardial damage.
o The front left leg and back left leg
ECG tracing and electrolyte imbalances such as High
1% - groin K and low Na will show in a burn patient.
Activity 1:
Compute the total percentage of burn using the rule
of 9 based on the body surface area.

A. Adult: head and neck, right back or posterior

area, right hand, right leg.
Answer: ______________

B. Child: Front face and neck, whole anterior

chest, both arms, genitals and both legs.
Answer: ______________

C. Adult: Both anterior and posterior chest, Left

arm, Left leg and genitals.
Answer: ______________

D. Child: Right anterior side from head to foot.

Answer: _____________)