17 - 99 - BURNS Flashcards
involve only the epidermis
SUPERFICIAL BURN (FIRST-DEGREE BURN)
Like a sunburn, the skin is warm, erythematous, painful, blanching, and dry without blisters or eschar (Fig. 99-1).
The epithelium remains intact, but will begin to slough within 7 to 14 days.
They are self-limited and have no potential for scar.
Partial thickness burns involve
epidermis and penetrate to the dermis, but do not completely penetrate through the dermis or down to the subcutaneous tissue
These burns appear wet, weeping, and erythematous, and are exquisitely painful, with blisters or sloughing epidermal remnant (Fig. 99-2).
Superficial partial thickness burn involves
epidermis and papillary dermis
Blanching, more painful, hyperemic and erythematous, typically heal in approximately 2 weeks with appropriate wound care, low risk of scar and pigment change.
These can be managed conservatively with dressing changes or xenograft.
Deep partial-thickness burn involves
epidermis, papillary dermis, and reticular dermis
nonblanching, less painful, pink or pale, require more than 3 weeks to heal, high risk of hypertrophic scar and pigment change, outcomes may be improved by excision and grafting
These typically require debridement and grafting.
Full-thickness burns involvement
penetrate to the subcutaneous tissue and beyond, affecting all dermal layers.
These burns are dry, leathery, waxy, nonblanching, insensate, and eschar is frequently shades of brown, white, gray, or black. The transition from adjacent partial-thickness burn is clear by the lack of tissue edema.
They will not heal without surgical excision with skin grafting or tissue transposition. Sequela, such as contractures and hypertrophic scars, are common.
Zones of injury in burn
Full-thickness burn of the back demonstrating zones of injury according to Jackson’s thermal wound theory.
A, Zone of hyperemia (cells that will recover from injury);
B, zone of stasis (cell injury that can either recover or transform into zone of coagulation);
C, zone of coagulation (cell death)
“fourthdegree burn” has been used to refer to burn injuries that penetrate to and/or expose deep structures (eg, bone, muscle, tendon) (Fig. 99-3). Skin grafting alone is not adequate treatment for burns of this severity, and limb loss may occur.
Third-degree burns should be debrided within the first _____ days to avoid cellulitis and wound infections.
3 to 5 days
excess resuscitation can cause abdominal compartment syndrome, which is defined as bladder pressure
> > 30 mm Hg
most common cause of death in burn patients
infection and sepsis
highest risk of death and complications compared to all other burn etiologies
Thermal injuries
most common mechanism of burns in the pediatric population
SCALD BURN
Type of burns included to calculate TBSA
Only partial-thickness and full-thickness burns are totaled to calculate TBSA.
Parkland Formula
- It is extremely important to note that the original timing of the injury is what is used in the calculation, not the time of initial presentation.
- Half of this volume is administered in the first 8 hours after the injury and the second half is administered over the next 16 hours.
type of fluid recommended to avoid complications associated with metabolic acidosis with normal saline or abnormal fluid shifts with colloid fluids.
Lactated Ringer Solution
urine output goal for adults
0.5 mL/kg/h
urine output goal for children
1 mL/kg/h
adult rule-of-nines
- head and neck is given 9%,
- each lower extremity is given 18%,
- each upper extremity is given 9%,
- anterior and posterior torso are each given 18%
