Firefighters and paramedics arrived quickly on the scene. Emergency responders placed Anna on 100% oxygen, put her in a neck brace as a precautionary measure, carefully moved her on a gurney, and loaded her into the ambulance. During transport, paramedics started an IV and began administering Lactated Ringer's solution to replace lost fluid volume. They also cut away her burnt clothing and placed a light blanket over her to preserve her body temperature.
- 7. What is a Lactated Ringer's solution?
- 8. How does the administration of Lactated Ringer's help with a burn patient?
Because Anna lived within 30 minutes of a major burn center, she was transported directly there. Upon arrival, the physician, and nursing personnel quickly assessed the extent of the burn and determined if any other injuries were present. The patient presented with tachypnea and tachycardia but remained conscious.
Vital signs were taken and recorded:
|Temperature: 38.5 C (101.3 F)||Normal 37 degrees C (98.6 F)|
|Blood Pressure: 95/60 mmHg||Normal: 120/80 mmHg|
|Pulse: 130 bpm||Normal: 60-100 bpm|
|Respirations: 24 breaths/minute||Normal: 16-20 breaths/minute|
Anna's core temperature is high because of the burn. The body's thermostat in the hypothalamus is literally turned up. The hypothalamus responds to temperature changes in the body and sends out signals to try and regulate temperature. Blood pressure is low because of the loss of fluids. After fluids have been restored, blood pressure may go up because of the trauma and the pain. The heart is trying to compensate by beating faster, trying to get blood and oxygen out to the tissues.
The extent of the burns was assessed using the "Rule of Nines."
(See "Rule of Nines" hyperlink and review in the Case Study Workbook)
Anna had burns on the anterior head and neck, anterior trunk, and both anterior thighs. Using the rule of nines, this was approximately 40.5% of her body.
- 4.5% anterior head and neck
- 18% anterior and posterior of both arms (9% + 9%)
- 18% anterior trunk
The depth of the burns were also assessed. Full-thickness or third-degree burns were present on the right shoulder, upper anterior right arm, and part of the anterior trunk. Second-degree burns with blistering were present on the remaining burn areas.
See Assessing the Severity of the Burn in this link and the accompanying workbook. The following video also discusses the assessment of burns.
WARNING: This video shows graphic burns and may be disturbing. Watch at your own risk! About 4 minutes into the video there are pictures of children with burns that have been abused. You may want to stop the video before this point as these pictures are difficult to view. The video has good instructional material but it is not mandatory to watch.
- 9. Once the severity of a burn has been assessed, can the degree of the burn change?
- 10. What percentage of the body is burned when there is a significant mortality risk?
- 11. Burns on what part of the body may cause swelling and obstruction of the airway?
- 12. What is the danger of a large burn around the chest wall?
- 13. List two other types of burns beside thermal burns.
- 14. What is the best treatment for minor burns?