Burn History

Injury & Poisoning, Subjective/History Elements
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Burn Injury
Onset [text] prior to evaluation
Onset while: [text]
Injury at [text]

Caused by: [text]
Prior to injury, wound site covered with (e.g. clothing) [text]
After the injury, prior to arrival, wound was treated with [text]

Inhalation injury risks
[select value="no|YES"] <-- smoke inhalation
[select value="no|YES"] <-- Loss of consciousness
[select value="no|YES"] <-- shortness of breath
[select value="no|YES"] <-- cough productive of soot

Pitfall evaluation:
[select value="no|YES"] <-- wound contamination
[select value="no|YES"] <-- distal numbness
[select value="no|YES"] <-- distal weakness
[select value="no|YES"] <-- distal cold sensation, pallor, or cyanosis
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- wound discharge
[select value="no|YES"] <-- local redness

Pertinent PMH:
Last Tetanus vaccine: [text]
[select value="no|YES"] <-- Diabetes Mellitus
[select value="no|YES"] <-- Peripheral Vascular disease
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: contributed by Dr. Scott Moses, creator/author of the <a href="http://www.fpnotebook.com" target="_blank">Family Practice Notebook</a>[/html][/conditional]
Burn Injury
Onset prior to evaluation
Onset while:
Injury at

Caused by:
Prior to injury, wound site covered with (e.g. clothing)
After the injury, prior to arrival, wound was treated with

Inhalation injury risks
<-- smoke inhalation
<-- Loss of consciousness
<-- shortness of breath
<-- cough productive of soot

Pitfall evaluation:
<-- wound contamination
<-- distal numbness
<-- distal weakness
<-- distal cold sensation, pallor, or cyanosis
<-- fever
<-- wound discharge
<-- local redness

Pertinent PMH:
Last Tetanus vaccine:
<-- Diabetes Mellitus
<-- Peripheral Vascular disease

display/hide references
Result - Copy and paste this output:

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