Burn Wounds Flashcards
What type of burn can cause direct injury to cell membranes in addition to heat transfer?
chemical/electrical
What are the different causes of burns?
flames, scald, contact, chemical, electrical
What does the depth of the burn depend on?
temperature
time exposed
specific heat
In what ways do burns cause a severe inflammatory reaction?
capillary leak intravascular fluid loss high fevers organ malperfusion MSOF
Where do we get edema from a burn?
in burned and unburned skin
In the characteristic ebb and flow model what is ebb and what is flow?
ebb- low metabolism/cardiac output, decreaseed temp
flow- hypermetabolism, high cardiac output, hyperglycemia, increased heat production
What are the burn classifications?
1st degree- superficial
2nd degree- superficial-partial thickness AND deep-partial thickness
3rd degree- full thickness
4th degree
What layer of skin does a 1st degree burn go to?
epidermis
Describe a 1st degree burn:
over 2-3 days the erythema and pain subside. By the fourth day, the injured epithelium peels
Dry, minor blisters, erythema, brisk capillary return
What is an example of a 1st degree burn?
sunburn
How do we treat a 1st degree burn?
no need for skin grafting, treat with topical antibiotics/supportive
What layer of skin does each second degree burn go to?
Superficial-partial- papillary dermis
Deep-partial- reticular dermis
Describe a 2nd degree burn (superficial-partial):
Specifically it shows as a blister with fluid collected at interface of the epidermis and dermis. Tissue is pink and wet; hair follicles intact. It is red and painful
Describe a 2nd degree burn (deep-partial):
Burn has gotten to some nervous tissue, it blisters and the tissue is molted, dry and decreased in sensation.
Moist, reddened with broken blisters, brisk capillary return
How does a 2nd degree superficial partial heal?
heals spontaneously in less than 3 weeks and does so with out functional impairment. They rarely cause hypertrophic scarring, but in pigmented individuals the healed burn may never completely match the color of the surrounding normal skin.
How does a 2nd degree deep partial heal?
Heals in 3-9 weeks but invariably does so with considerable scar formation. Unless active physical therapy is continued through outh the healing process, joint function can be impaired and hypertrophic scarring is common
What is the treatment for a 2nd degree superficial-partial?
Silvadene cream or Xenograft
What is a Xenograft?
Implementation of pig skin in the healing process that is not incorporated in to the new skin but just lays over the skin helping it to scab.
What is the treatment for a 2nd degree deep-partial?
skin grafting
What layer of skin does a 3rd degree burn get to?
the dermis; full thickness
Describe a 3rd degree burn:
Leathery, firm skin that does not blanch under pressure. It is insensate, white and not painful. This has burned all the layers of the dermis
Moist white slough, red mottled, sluggish capillary return
How does a 3rd degree burn heal?
Develops a classic burn eschar. It can only heal by wound contracture, epithelialization from the wound margin or skin graft
What is an eschar?
A structurally intact but dead and denatured dermis that if you left in situ over days and weeks, separates from underlying viable tissue
How do you treat a 3rd degree burn?
Skin graft- have to take the skin off because of the risk of infection
What layer of skin does a 4th degree burn go to?
subcutaneous fat, muscle and/or bone
How does a 4th degree burn heal?
will not heal if left alone
How do we treat a 4th degree burn?
reconstructive surgery, tissue flaps
CANNOT skin graft over bone or fat; need a better blood supply
What is the break down of the rules of Nine’s?
Head- 9% Arm (each 9%) Torso (anterior- 18%, posterior- 18%) Genitalia- 1% Legs- (each 18%)
What is another method we can use for determining the TBSA?
The palm of the hand is 1%
What is the basis of fluid resuscitation and care plans?
the size and the depth of the burn
How long does it take for a burn to fully evolve? What does this mean?
72 hours, our initial calculation may be off
What are the criteria for a burn center referral?
- partial thickness >10% in people 50
- partial thickness >20%
- involving the face, hands, feet, genitals or joints
- full thickness >5%
- electrical injury
- chemical burn
- inhalational injury
- comorbidities (CHF)
- concomitant trauma
- children
- special emotional, social or rehab needs
What is significant about a burn center?
Usually the only place that does skin grafts, people there are trained in burns
What is the most common type of burn?
scald burn
What do we need to look for with an electrical burn?
an entry and exit wound, also do heart monitoring
What are we looking for while heart monitoring an electrical burn victim?
rhabdo/compartmental syndrome