Burns
Classification
The traditional classification (first, second, or third degree) is being replaced by a system based on depth (see Table 2.11.1).
Acute management
After establishing classification based on depth, determine extent of burn.
“Rule of Nines”—divides the surface area (SA) of the body into multiples of 9%.
One percent SA—perineum (1% total)
Grading for burn severity and disposition (see Table 2.11.2).
Hospital admission may require treatment in the intensive care unit (ICU) due to compromised airway, hemodynamic instability, and other trauma that may accompany the burn injury.
Ambulatory treatment for minor burns (6 C’s)
Clothing—remove promptly except for adherent clothing (which is removed in cleaning phase).
Cleaning—critical phase, but can cause excruciating pain (so establish local/regional anesthesia).
Disinfectants are widely used, but generally discouraged as they can inhibit healing.
Wash burns with mild soap and tap water, then thoroughly rinse.
Chemoprophylaxis
Tetanus prophylaxis—given even for small partial-thickness burns (see Chapter 2.59)
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