Burns 🔥

foreign Ninja nerds in this video we're going to be talking about Burns and the rule of nines if you like this video make sure to give it a thumbs up comment down below don't forget to subscribe and let's get started with Burns we're going to be focusing on typically the damage to the skin the tissues or the organs that are caused by either extreme heat the flame or even chemicals so what we're concerned about typically with Burns is that when we affect the skin and on the underlying tissues we're going to have problems with a loss of our temperature regulation a decrease in our sweat gland function and sebaceous gland function and even our sensory function is going to be impeded and what we're going to be focusing on today is just what are these different types of burns what is the severity and how can we figure out the rule of nines so I drew this diagram up here I'm pretty proud of it I think it looks pretty good and we are going to go through each type of different burn there is one more at the end here but we'll talk about that as we go through so first let's Orient ourselves here with the skin and let's just go through our layers really quickly so the layer at the top of the skin the surface that gets contact with the world what do we call that that's our epidermis and then we have our dermis which is below that the layer below that which is where all of our fat is is called our hypo dermis or subcutaneous and then we have a muscle layer here and a bone layer okay so as you look through it here you can see our epidermis is this purple our dermis is more of the white for this diagram hypodermis is more of this speckly orange and yellow then we have our myocytes for our muscle our muscles and then our bone layers just I left it white and I broke it up here into a couple different Burns so that we understand what's going on with the burns and what is going to be affected so the first one we have here is our superficial and if you look at the diagram here we have our superficial and the burn is this little area right here so it's pink right and it mostly affected the epidermis which you can see there and it's pink in appearance so this is just the top layer of skin that's just been affected when we start to move into more severe burns like a superficial partial and then a deep partial these two you can think of them together that they're going to go into the dermis The Superficial partial is going to be more of the upper layer of the dermis and then the deep partial is going to be the lower layer of the dermis so let's talk about The Superficial partial superficial partial burn is going to go through the Derm or epidermis and into some of the dermis typically it's going to be pink or red in appearance and the the selling point the key note you want to look for in your NCLEX questions is are there blisters so when you're looking at your patient or you're reading the NCLEX question you're going to be assessing is this a partial a superficial partial burn I'm going to be looking for blisters because I need to figure out is this just a superficial or is it a partial okay and that's what we're looking for in this thickness is it superficial thickness or is it superficial partial thickness so in this one right here we can see that it's pink and it goes into red and if you imagine it I left it uncolored a little bit so we can kind of see this whole area then being burned and you can see what would be all affected all this epidermis and into some of the dermis here so we're affecting maybe some hair follicles we have some blisters going up then we go into our deep partial our deep partial is going to be the entire epidermis and deep into the dermis hovering may be right above our hypodermis it's going to be red to White appearance and there's going to be no blisters so if we look here there's no blisters on top there's this burn it's red and white obviously the appearance would be up on the superficial so just for the sake of this diagram let's outline the burn here so this burn here is affecting what a sweat gland it's going down it's almost into our hypodermis and the last one we have here on our diagram is our full thickness which is our entire epidermis and dermis and it goes into our subcutaneous or our hypodermis and what we can see here is it can be colors of white yellow red brown or black and it can include nerve damage so these are the patients that the burn is so bad they actually aren't feeling any type of sensation because we have affected a nerve so you can see here in this diagram there is a nerve coming up and it has been affected by this full thickness burn so I'm not going to color all the way in awesome and then we have one more that I'm drawn here that is our Deep full thickness that means it's going to go through all the layers it could extend to our muscle our tendons and our bone which is the biggest and most severe so let's talk about the different types of burns and what can be going on how can we get a burn how are we going to classify them so some classifications of burns we have the first one here that's like an open flame or an explosion and that can be called a dry heat burn we have ones from like a scalding hot liquids or Steam those are a wet heat burn we have a Super Mario pipe there or a pipe you come in contact with something that's really really hot what kind is that it's a contact Fern like you burn your leg on the muffler I'm sure you've done one of you have done that before I have this right here is any type of chemical or cleaner you inhale or ingest or get it on your skin and you can create Burns in the respiratory Airway along with the skin we have electrical so if you get electrocuted and then we have our radiation our radiation can be our sun or even some cancer treatments so there's different types and different ways that we can get Burns and this is important because when we talk about the severity of the burn we also need to know the depth of the burn what's been going on and also the type because some of them will impact other things in the body other than just the skin so let's look at the severity how do we figure out the severity of the burn the first is the biggest thing and what the NCLEX like to sit on is the rule of nines or when how we figure that out is the total body surface area that is effective particularly the percentage of the total body surface area so it's an initial abbreviated here as tbsa so we have the percent of tbsa and we also want to pay particular attention to the type of burn when we talk about this as well because you can have your sunburn all over your body and be okay but if the burn is a little deeper and it goes into our dermis then we could have some other issues going on over dehydrated things like that so we're going to be looking at the depth so it's not only the type of burn and the total but the depth how many of the layers are affected what layers are affected are we losing our sensation are we losing our ability to sweat are we losing our ability to um move or breathe because we have pain and we have restriction the location so we have thick and thin skin here so think about this if a patient gets burned on the face we have really thin layers on our eyelids we get burned all the way through all those we could be inhaling it into our mucosal and into our respiratory tract we also want to be thinking about are we burned on the Torso where we have nice accessory muscles to breathe and if we now have Burns there it's going to restrict our breathing and we're not going to like to take a deep breath in so location is really important we also want to look at age of the patient when we're assessing our patient they have a deep burn it's it's on their face maybe and we're going to be looking also at their age because with age we're not going to talk about it in this video but there's the rules of nines can go with different for adult child and then obese patients so with the age it can also change our percentages around our causative causative agent or type what was the type of burn remember with different types of burns you can have different types of complications for contact it may just strictly be right with the skin or if you ingest the hot liquid you can get a wet scalding in the mouth you could have dry heat a Burns which you can ingest some something within the air and inhalation or smoke chemicals same thing you can have some type of infection in the respiratory tract so we're always thinking about what it was the agent and then the most important one is electrical because with electrical Burns you can actually have a Iceberg effect where the outside is a burn that you can see a little bit but within the inside of the body there's a bigger burn or a bigger injury and you want to also think about our heart runs on electricity so if we are getting electrocuted what are other things that could be affected other injuries as well was there something else that went on like a fracture or a laceration what had what had occurred during this whole incident again with respiratory we're always concerned about breathing because when we have some issues or we inhale something or we have burning we can have a lot of swelling and we have that infliction with our skin or with our breathing that swelling can then cause an issue with us being able to breathe because remember all of our area of breathing you know our nose and our mouth are right here on our face so if we get a burn on our face or on our respiratory tract we kind of got nothing else to go for so we want to make sure we're keeping an eye and assessing our patient on their respiratory and then their overall health patients overall health do they have any comorbidity comorbidities do they have any other breathing issues or problems with mobility and things like that so with that once we've looked at the type of the severity we have the depth location age we're going to be doing the rule of nines and you may be starting to sweat already and be like oh the rule of nines you can never get it I never do it right so let's talk about it the first thing to remember with the rule of nines is that there will be no let's put it in pink here this does not include superficial so just get that out of your head remember superficial is just when the epidermis has a little pink appearance so we're not going to be including that in the rule of nines when you read a question on a test or you have a patient that you need to assess you're going to need to know what the severity or the type of burn is on the depth so that way we can consider our rule of nines that way we can adequately figure out what was the total body surface area burned and how much fluid are we going to be giving back to them so for me what I like to do before this is like how I take my tests if I have a rule of nines question I know I'm going to be using I draw my little stick man and I just write my numbers so we have 9 9 9 36 for the Torso 18 for each leg and one for the groin now if you don't like that that's fine but this is the way I do it so that way when I have a question that I really need to dive into I can then look at those numbers as a reference so we're looking at the total body surface area we're going to get to 100 and we have an anterior and posterior here the first thing I like to do is put one for my anterior in the groin perfect wonderful one percent for the groin area then we know that we have head right and with our head we have an anterior of 4.5 and a posterior of 4.5 then we have our arms we have our anterior 4.5 4.5 4.5 and 4.5 we have our torso which half of 16 is 18 and 18 percent and then for the legs because our legs are bigger than our arms we have 999. so we have our rule nines diagram drawn up and remember when we read some of the questions they may indicate like upper chest so you would just you know take half of 18 which is 9 or the upper leg so take a half of 9 which is 4.5 so the rule of nines everything's in nines right and we're doing this why why are we trying to figure out the total bodice body surface area that's affected and burned what is the purpose of all this the purpose is to First within the first 24 hours our patient can go into hypovolemic shock so they have all of these full thickness Burns or these deep partial Burns and we need to make sure that we are giving them fluid resuscitation because we don't want them to go in hypovolemic shock because remember we have these issues here where we have sensory function that's decreased sweat function is decreased we can't regulate our body temperature maybe they have an inhalation injury or a burn on the face they're not going to want to drink fluids they're in a lot of pain we also need to figure out this percentage of is this patient suitable for our Burn Unit if your facility has a burn unit there's policies put in place at a certain amount of percentage of tbsa that they need to be sent to that unit specifically our right Ninja nerds in this video we talked about burns the next one we're going to talk about how we assess our patient and take care of our patient and give them education with their Burns and as always until next time [Music] thank you [Music]