{ "assessment_info": { "title": "10 Point Burn Assessment", "assessment_id": "ASS_20181005071734_b71ff52e-a4a1-47e0-b", "aspect_id": "ASP_20181005071734_8d9d8561-2292-49ab-b", "description": "Practical Skills Assessment - Management of and 10 point Burn assessment", "time_limit": "10 minutes", "performance_level": "Level 4 - Must perform without assistance at appropriate pace with basic understanding of theory and practice principles", "instruction": "YOU CAN NOT PROCEED WITHOUT A QUALIFIED ASSESSOR LOGGING IN.\n\nPlease ensure you have completed the study unit on wound assessment in order to show proficiency. Good Luck !\n\nBRIEF: The assessor will give you clear and accurate feedback identifying any knowledge or skill gaps and the need for re-evaluation if required.\n\nPRE-REQUISITE: This is a timed assessment. (Not facilitation)\n\nTIME FRAME - You have 10 minutes.\n\nPERFORMANCE LEVEL - (4 )- You must perform this activity without assistance at an appropriate pace with a basic understanding of theory and practice principles.\n\nVALIDITY - Scores are computer generated. On completion you may be required to record a maximum voice message or video following the 10 step wound assessment simulating report via Radio medical advice.\n\nCANDIDATE DIRECTIVE: Identify the wound given to you by the assessor and perform a methodical 10 point burn assessment." }, "burn_assessment_points": [ { "point": 1, "sortcode": 1, "description": "Identifies patient status", "item_id": "ITM_20181005071734_ed51d5ba-5a66-4baa-8", "guidance": { "method": "Use AVPU scale assessment", "key_elements": [ "Alert - Patient is awake and responsive", "Verbal - Patient responds to verbal commands", "Pain - Patient only responds to painful stimuli", "Unresponsive - Patient does not respond to any stimuli" ], "burn_specific": [ "Assess level of consciousness", "Look for signs of shock due to burn injury", "Monitor for signs of respiratory distress", "Check for confusion or altered mental state" ], "notes": "Burns can cause significant physiological stress affecting patient consciousness and stability" } }, { "point": 2, "sortcode": 2, "description": "Identifies the mechanism of injury", "item_id": "ITM_20181005071734_340ef873-6dc6-4eaa-b", "guidance": { "definition": "Determine what caused the burn injury", "key_elements": [ "Source of heat or energy", "Duration of exposure", "Environmental factors", "Circumstances of injury" ], "burn_mechanisms": [ "Thermal burns (flame, hot objects, steam, hot liquids)", "Chemical burns (acids, alkalis, solvents)", "Electrical burns (high/low voltage, arc burns)", "Radiation burns (UV, ionizing radiation)" ], "importance": "Understanding the mechanism helps predict burn depth, extent, and associated injuries" } }, { "point": 3, "sortcode": 3, "description": "Identifies the forces involved: Any evidence of inhalation burns or smoke inhalation (heat, smoke or toxic vapor)", "item_id": "ITM_20181005071734_319408b1-57dc-4cf1-b", "guidance": { "assessment_focus": "Determine if patient has inhaled hot gases, smoke, or toxic vapors", "signs_of_inhalation_injury": [ "Singed nasal hairs or eyebrows", "Burns around mouth, nose, or throat", "Soot in nose or mouth", "Hoarse voice or stridor", "Difficulty swallowing", "Coughing up dark sputum" ], "respiratory_assessment": [ "Listen for respiratory distress", "Check for wheezing or stridor", "Assess breathing pattern and rate", "Monitor oxygen saturation" ], "critical_importance": "Inhalation injuries can be life-threatening and require immediate airway management" } }, { "point": 4, "sortcode": 4, "description": "List the types of Burn - Thermal, electrical, chemical, Radiation", "item_id": "ITM_20181005071734_2c7f02bc-fe4f-4bc5-8", "guidance": { "burn_types": { "thermal": { "description": "Caused by heat sources", "examples": ["Flames", "Hot liquids", "Steam", "Hot objects", "Explosions"], "characteristics": "Most common type, depth depends on temperature and duration" }, "electrical": { "description": "Caused by electrical current", "examples": ["High voltage lines", "Lightning", "Faulty wiring", "Arc flash"], "characteristics": "Can cause internal tissue damage, entry and exit wounds" }, "chemical": { "description": "Caused by corrosive substances", "examples": ["Acids", "Alkalis", "Industrial chemicals", "Cleaning agents"], "characteristics": "Continue to cause damage until neutralized or diluted" }, "radiation": { "description": "Caused by radiation exposure", "examples": ["UV radiation", "X-rays", "Nuclear radiation", "Laser"], "characteristics": "May have delayed onset, can affect internal organs" } }, "assessment_approach": "Identify the specific type to guide appropriate treatment and decontamination procedures" } }, { "point": 5, "sortcode": 5, "description": "Name the different depths of burns", "item_id": "ITM_20181005071734_6315f949-bc56-45a8-a", "guidance": { "burn_depths": { "first_degree_superficial": { "description": "Affects only the epidermis", "appearance": "Red, dry, painful, no blisters", "examples": "Mild sunburn", "healing": "3-6 days without scarring" }, "second_degree_partial_thickness": { "superficial": { "description": "Affects epidermis and upper dermis", "appearance": "Red, moist, very painful, blisters form", "healing": "7-21 days, minimal scarring" }, "deep": { "description": "Affects epidermis and deep dermis", "appearance": "Pale, less painful, may have blisters", "healing": "3-8 weeks, likely scarring" } }, "third_degree_full_thickness": { "description": "Destroys epidermis and dermis", "appearance": "White, brown, or black; dry, leathery; painless", "healing": "Requires skin grafting, significant scarring" }, "fourth_degree": { "description": "Extends to muscle, bone, or organs", "appearance": "Charred, may see underlying structures", "treatment": "Requires surgical intervention, may need amputation" } }, "assessment_technique": "Examine color, moisture, pain response, and capillary refill to determine depth" } }, { "point": 6, "sortcode": 6, "description": "Identifies the extent - Total Body Surface Area (TBSA) affected", "item_id": "ITM_20181005071734_d6481e6a-4721-484f-a", "guidance": { "calculation_methods": { "rule_of_nines": { "adult": { "head_neck": "9%", "each_arm": "9%", "chest": "18%", "back": "18%", "each_leg": "18%", "genitals": "1%" }, "pediatric": "Modified percentages due to larger head proportion" }, "palm_method": "Patient's palm = approximately 1% TBSA", "lund_browder_chart": "Most accurate, accounts for age-related body proportions" }, "documentation": [ "Calculate percentage for each burn depth", "Note location of burns on body diagram", "Consider only partial and full thickness burns in TBSA calculation", "Document mechanism and estimated time of injury" ], "clinical_significance": "TBSA determines fluid resuscitation needs and evacuation requirements" } }, { "point": 7, "sortcode": 7, "description": "List which burns are critical", "item_id": "ITM_20181005071734_65e4c372-7d47-4b6c-9", "guidance": { "critical_burn_criteria": [ "Partial thickness burns >20% TBSA in adults", "Partial thickness burns >10% TBSA in children or elderly", "Full thickness burns >5% TBSA at any age", "Burns involving hands, feet, face, genitals, perineum, or major joints", "Electrical burns (including lightning)", "Chemical burns", "Inhalation injury", "Burns in patients with significant comorbidities", "Burns with associated trauma" ], "evacuation_criteria": [ "Any critical burn requires immediate evacuation", "Burns >15% TBSA require burn center care", "Inhalation injury requires immediate airway management", "Electrical burns need cardiac monitoring" ], "immediate_threats": [ "Airway compromise from inhalation injury", "Shock from fluid loss", "Infection risk in large burns", "Compartment syndrome in circumferential burns" ] } }, { "point": 8, "sortcode": 8, "description": "Demonstrate or verbally indicate the presence of the pulse, movement and sensation (PMS)", "item_id": "ITM_20181005071734_22d5f466-4a9b-4b7f-9", "guidance": { "pms_components": { "pulse": "Check distal pulses in burned extremities", "movement": "Assess active and passive range of motion", "sensation": "Test light touch and pain sensation" }, "burn_specific_concerns": [ "Circumferential burns can compromise circulation", "Deep burns may damage nerves affecting sensation", "Swelling can compress vessels and nerves", "Eschar formation may restrict movement" ], "assessment_technique": [ "Compare affected to unaffected areas", "Check pulses proximal and distal to burn", "Test sensation in burned and unburned areas", "Assess for compartment syndrome signs" ], "red_flags": [ "Absent or diminished pulses", "Loss of sensation in burn area", "Inability to move fingers/toes", "Severe pain with passive movement" ] } }, { "point": 9, "sortcode": 9, "description": "Can discuss the potential risk of infection", "item_id": "ITM_20181005071734_ced0833c-9b57-4bfd-a", "guidance": { "infection_risk_factors": [ "Burn depth and extent", "Location of burn", "Patient age and immune status", "Presence of other injuries", "Contamination of burn wound" ], "high_risk_burns": [ "Full thickness burns", "Burns >20% TBSA", "Burns in immunocompromised patients", "Contaminated burns", "Burns with delayed treatment" ], "prevention_measures": [ "Early cleaning and debridement", "Appropriate wound dressing", "Tetanus prophylaxis", "Consider prophylactic antibiotics for high-risk burns", "Maintain sterile technique" ], "signs_of_infection": [ "Increased pain, redness, swelling", "Purulent drainage", "Fever and systemic signs", "Delayed healing", "Change in burn appearance" ] } }, { "point": 10, "sortcode": 10, "description": "Predict the need for evacuation (time and method)", "item_id": "ITM_20181005071734_f8a448ea-52e3-43c7-a", "guidance": { "evacuation_indications": [ "Critical burns as defined above", "Inhalation injury", "Electrical burns", "Chemical burns", "Burns with associated trauma", "Burns in high-risk patients" ], "timing_urgency": { "immediate": [ "Airway compromise or inhalation injury", "Severe shock or cardiovascular instability", "Associated trauma requiring surgery" ], "urgent_within_4_hours": [ "Burns >15% TBSA", "Full thickness burns >5%", "Electrical burns", "Chemical burns" ], "within_24_hours": [ "Partial thickness burns 10-15% TBSA", "Burns to face, hands, feet, genitals", "High-risk patients" ] }, "method_selection": [ "Air evacuation for remote locations", "Ground transport if suitable", "Consider weather and patient stability", "Ensure appropriate medical escort" ], "preparation_for_transport": [ "Secure airway if inhalation injury", "Establish IV access for fluid resuscitation", "Pain management", "Wound dressing and protection", "Temperature regulation" ] } } ], "burn_management_principles": { "immediate_care": [ "Stop the burning process", "Remove from heat source", "Cool with tepid water for 20-40 minutes", "Remove non-adherent clothing and jewelry", "Assess airway, breathing, circulation" ], "cooling_guidelines": [ "Use tepid water (15-20°C)", "Cool for 20-40 minutes minimum", "Avoid ice or very cold water", "Be careful of hypothermia in large burns", "Chemical burns may require specific neutralization" ], "wound_care": [ "Cover with clean, dry dressing", "Use non-adherent materials", "Separate burned digits", "Avoid cotton or fluffy materials", "Consider specialized burn dressings" ], "fluid_resuscitation": { "parkland_formula": "4ml x weight(kg) x %TBSA burn", "timing": "Half in first 8 hours, half in next 16 hours", "monitoring": "Urine output, vital signs, mental status", "adjustment": "Based on patient response" } }, "grading": { "pass_threshold": "7.5", "scoring_type": "Computer generated", "grade_scale_id": "AGS_20181005071734_6f131760-11fb-45a4-b", "scoring_options": [ "Competent", "Knowledge Gap", "Skill gap", "Not Yet Competent" ] }, "additional_requirements": { "radio_medical_advice": "Simulate radio medical advise and describe the burn", "documentation": "Complete accurate documentation, sign and dated", "retests_allowed": 1, "auto_activate": true }, "key_learning_points": { "systematic_approach": "Follow all 10 points methodically for comprehensive burn assessment", "safety_first": "Ensure scene safety and prevent further injury", "airway_priority": "Inhalation injury is the most immediate life threat", "tbsa_calculation": "Accurate TBSA calculation is critical for treatment decisions", "cooling_importance": "Immediate and prolonged cooling reduces burn depth and pain", "evacuation_timing": "Early recognition of evacuation needs improves outcomes", "documentation": "Thorough documentation essential for continuity of care and legal purposes" } }