Burn Wound Management Flashcards
Notes for teaching chapter
Objectives (Slide 1)
Here are the objectives:
Differentiate the burn depth (partial vs full thickness burn)
Explain the principles of wound care
Describe Indications for escharotomies
Discuss management of burns in specialized areas
Introduction (Slide 4)
Burn injuries can be distracting often times there is a lot going on and someone without experience may be distracted.
The key things here are:
1. Always start with your ABCs (airway, breathing, circulation)
2. Remember that proper wound management is critical throughout all phases.
3. Both survival and the functional outcome for the patient is going to be based on the healing of the burn/wound.
Functions of the Skin (Slide 5)
The skin: protects fron infection and injury, prevents loss of body fluids, regulates body temperature and managed sensory contact with the environment.
With a major burn, the functions are effected - meaning - the patients are automatically at risk for infection, fluids weep through the surface of the wound and results in evaporative hat loss and cools in the body temp. Obviously their is going to be pain. Lastly it is important to remember that it also effects appearance and the patients body image from initial injury through healing.
Layers of the skin (Slide 6)
who can tell me the layers of the skin?
Epidermis, Dermis, Subdermal fat and Muscle.
Things to remember:
dermis contains hair follicles, sebaceous glands, capillaries and nerve endings. As a result burns to the interlayer of skin can be more painful because the nerve endings are exposed to air. Deeper burns can affect hair growth, sweat glands and nerve endings.
Differentiating Burn Depths (Slide 8)
Things to consider:
- sometimes burn wounds are covered in dirt or soot and it may be difficult to determine the depth.
- depth determines the necessary wound care
- deeper injuries are often treated with surgical interventions
-depth may determine functional and cosmetic outcomes.
*a lot of you have experience with assessing depths - does anyone want to share a time when it was difficult to assess and maybe why our initial assessment was off?
Superficial Thickness: First Degree Burn (Slide 9)
A first degree burn is a superficial injury and it affects the epidermis only
- there will be pain and redness
- typically heals in a few days
- treated with lotion and NSAIDS
- not included in TBSA calculations
Partial Thickness: Superficial Second Degree Burn (Slide 10)
this is when the burn goes into the epidermis and the superficial dermis
Signs: red, blisters that are either intact or partially collapsed, moist pink/red wound surface, brisk capillary refill, soft, pliant tissue.
Partial Thickness: Deep Second-Degree (Slide 11)
this is when the burn goes into the deeper dermis
Signs: appear more white, drier and/or hemorrhagic. -
There may be less pain. why?
(it damages the nerve endings in the skin)
Healing of Second-Degree Burn (Slide 12)
*** how long do you guys think it takes for a superfical second degree burn to heal?
2-3 weeks - with proper wound care.
deeper partial thickness burns may require surgical intervention if not healed in 3 weeks.
If it does heal within 2-3 weeks - there is less likely to scar.
If it is going to be open longer, grafting is indicated to reduce scarring and healing time.
Full Thickness: Third Degree Burn (Slide 13)
this is when the burn is through the entire dermis
Signs: white/brown/red or black, charred, leathery eschar, coagulated vessels, no capillary refill, and dull sensations.
Pain is much less severe
Full Thickness: Third Degree Burn
May heal by:
epithelial in-growth from edges (up to 1cm in any direction)
***someone want to explain what epithelial in-growth is?
- your normal barrier is disrupted so it allows epithelial cells can migrate to the wound site - if excessive would cause issues.
or
contraction - which is just when the edges of the skin pull together naturally.
Complications:
-scarring and functional contractures - also due to the potential effect on body image there may be psychological impacts.
Surgical treatments are going to be skin grafting.
Fourth Degree Burn (with deep tissue loss) (Slide 15)
this is when the burn involves fat, fascia, muscle or bone
complex coverage is going to involve grafting and is at risk of scar contractures.
this is either going to require complex coverage or possibly amputation if the limb is not salvageable.
***What going to make a limb not salvageable?
Depend on condition of blood vessels, nerve involvement, extent of soft tissue and bone loss.
Zones of Injury: (Slide 16)
Hyperemia
- inflammatory response to injury presents as the erythematous (redness) to the outer perimeter of the wound that typically resolves over the first few days
Stasis
- an area of burn in which cells are damaged and either heal or die over time. Cell death results in a larger zone of coagulation. The final depth of injury is dependent on treatment like fluid resuscitation to prevent tissue hypoperfusion.
Coagulation or necrosis
- The portion of the burn wound that has the longest exposure time to burning insult.
This is characterized by coagulation necrosis of the cells.
Wound Conversion (Slide 17)
** some or most of you has heard of burns converting, right?
When we talked about zones - that stasis zone is at risk of converting to a zone of necrosis
Things that contribute to wound conversion are:
- improper resusitation and hypothermia during initial resuscitaiton.
** too much resuscitation is going to cause what?
*** too little resuscitation is going to cause what?
elder patients are more likey to convert to a deeper injury - thinner skin and comorbidites
untreated burns can become too dry, become infected - which will cause further conversion as well as longer heal times
sufficient calories and protein helps to heal wounds
*** what are some additional risk factors?
age of patient, comorbidites (diabetes or cardiovascular) and poor nutrition.
Wound conversion example
This is a span of 5 days - look how the base of the wound has extended.
