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Coming to the Burn Center
When you arrive at the Burn Center, the medical team quickly focuses on three things: controlling any immediate physical dangers, starting intravenous infusion (IV) lines to replenish fluids that may have been lost as a result of the burns, and starting wound care.
This describes in greater detail what happens when you are admitted to the Burn Center:
Determine burn size
Burns are judged by their size in relation to the whole body and by their depth. The most common method to quickly estimate burn size is the “Rule of Nines,” where the body is divided into areas equaling multiples of nine percent of the total body surface area (TBSA). For example, the palm of your hand is equal to about one percent of your body’s surface area. The head and arms are each equal to nine percent of the body surface. The chest and back are each 18 percent (two x nine percent). Each leg is 18 percent (two x nine percent). This totals 11 nines, or 99 percent (these proportions are different for children). A patient might have the diagnosis of a 45 percent TBSA thermal burn, for example. The TBSA and burn depth are recorded on a hospital chart called a “burn diagram.” Determining the TBSA is important for correct fluid resuscitation, replacing fluids lost due to a burn injury.
Begin intravenous fluids
Skin keeps water out of the body and keeps bodily fluids in. Burned, skin is not able to keep body fluids in, so the fluids that have been lost after a burn must be replaced. This process is called fluid resuscitation. Doctors use the TBSA to figure out the amount of fluid the body has lost. In larger burns, the fluids are put into the body through an IV placed into a vein. A machine regulates the amount of fluid pumped into the body through the IV line. If a burn is small (for example, less that 15 percent TBSA), fluids can generally be replaced by drinking liquids such as Pedialyte, juice, water, etc.
Edema is another word for swelling. Cells and blood vessels in the body contain fluids. When a burn occurs, these fluids leak out which causes swelling. The swelling can be around only the area burned (local) or throughout the entire body (systemic). The larger the burn, the more swelling usually occurs. Generally, the symptoms of edema are limited to the area of the burn itself as long as the total burn is less than 25 percent TBSA or the patient is less than 60 years old. When the burn is larger or the patient is older, local reactions become systemic ones.
If patients suffer facial burns, their eyes may swell shut. This can be scary for the patient as well as family members because the burned person no longer looks like their loved one. Fortunately, this swelling will usually start to decrease in two to three days.
Monitor breathing or respiration
Respiration is the process by which cells use oxygen to release energy from food. At the same time, carbon dioxide and water are released as waste products. If burns are on the face or neck, or the patient has a smoke inhalation injury, breathing may be a problem. To help make breathing easier, oxygen may be given through a mask. Intubation may also be necessary. This is when a small tube is placed through the mouth or nose directly into the windpipe. The patient can breathe through this tube, but cannot talk because the tube is below the vocal cords. If more help is needed, the tube can be attached to a ventilator (breathing machine). Oxygen, intubation and a ventilator are used only when necessary and removed when the patient’s breathing improves.
Provide pain control
Medications are used to relieve pain and lower anxiety for burn patients. Pain medication can be given by IV through IM (in a muscle) injections or swallowed in a pill or liquid. The amount of pain medications given are gradually decreased as burn wounds heal and pain decreases.
Insert a Foley catheter
Most patients with large burns, and some with small burns, will have difficulty going to the bathroom (urinating). A Foley catheter helps with this problem. The Foley catheter is a small rubber tube that is put into the bladder. Once in place, a small balloon on the end of the catheter is filled with a small amount of sterile water. This balloon prevents the tube from falling out. The catheter drains the urine produced by the body’s bladder and keeps it empty. The amount of urine that drains into a bag outside the body can be measured. This is very important because it tells the physician if the patient needs more or less fluids through the IV.
Doctors routinely order X-rays for patients in the Burn Center to make sure tubes or IVs are in the correct position. Daily lung X-rays are taken when patients have an endotracheal tube (ET) in place to watch for signs of infection such as pneumonia.
Insert a feeding tube
To help skin heal burn patients need to eat more than usual, in fact, sometimes twice their normal calorie intake. Patients may not be able to eat or may not feel like eating very much. A feeding tube is a small tube placed through a nostril that descends into the stomach or small intestine. The patient doesn’t have to swallow because liquid food is put into the stomach all day and all night. Feeding tubes are usually put in place within 24 hours of admission.