BURNS Flashcards
Describe the anatomy and function of the skin
Anatomy
Upper layer: epidermis
Middle: dermis
Deepest: subcutaneous tissue
Functions of Skin
- Temp regulation
- Immune response/protection from bacterial invasion
- Control fluid loss
Describe the pathophysiology of burns (talk about circulatory and metabolic response)
Burn injuries impact all 5 major functions of skin:
1. Thermoregulation
2. Fluid and electrolyte imbalance
3. Immune response
4. Protection from bacterial invasion
5. Neurosensory interface
Circulatory effects cause an increase in capillary permeability resulting in a loss of fluid from the body’s circulation, a loss of albumin from the circulation resulting in oedema formation. The metabolic effects include secretion of stress hormones (tachycardia), neural response via SNS and hypothalamus (hyperthermia), suppression of anabolic hormones and development of massive catabolic response (protein wasting) and depression of the immune response (susceptibility to infection)
Main causes of burns?
- Scalds (spilling hot drinks/liquids) = tend to be superficial
- Flame = tend to be deep dermal or full thickness
- Contact (object touched is extremely hot) = deep dermal or full thickness
- Electrical (travel through one point and out another)
- Chemical (industrial accidents, household products)
Importance of early management in burns and what should be done?
- Stop the burning
- Remove all clothing, avoid hypothermia
- Cool the burn (20 minutes for 3 hours)
- Primary survey (trauma patients) – A-E
- Intubation (swelling, oedema) – sit up back of bed when c-spine cleared
Early management is important to prevent the burn from worsening and becoming deeper. The severity will be minimised and healing time shortened.
Why is fluid resus important to consider with burn patients?
The goal of fluid resuscitation is to maintain tissue perfusion in the early phase of burn shock and also prevent hypovolaemia which can be caused by leakage of fluid from the intravascular compartments.
Fluid shifts need to be compensated for the first 8-12 hours
Fluid resus = total surface body area (TBSA%) x weight (kgs) x3 = modified hartmann’s formula
What is the TBSA assessment?
- The extent of injury using the percentage of the total surface area that is affected by a burn
- Rule of nines - head & neck (9%) Arms (2x9%) Trunk front (18%) trunk back (18%) legs (2x18%) Perineum (1%)
- Paediatric - for every year of life take 1% from the head and ass ½ to each leg, at 9 years old – proportions same as adult
- Palmar method - patients palm and fingers = 1% - useful for small and scattered burns & to minus
Modified Parkland Formula
Area burnt (TBSA) x weight x 3
- Use hartmann’s solution
- Half in first 8 hours
- other half in next 16 hours
- add maintanence and glucose for children
- Revise according to urine output
Nursing implications and responsibilities in pt’s with burns
Acute phase:
Fluid resus
TBSA calculation
Wound care management
Analgesia
Burn depths
Referral to specialists
Longer term:
Cleaning
Chemoprophylaxis
Wound dressings
Identify the various burn depths and highlight the characteristics of each
Epidermal burns: skin intact, red, brisk capillary refill. Heal spontaneously within 3-7 days.
Superficial dermal burns: blisters present with a brisk capillary refill. Heal within 7-14 days with minimal dressing requirements
Mid dermal burn: heterogenous, variable depths, dark pink with sluggish cap refill. Heal within 14-21 days
Deep dermal burn: heterogenous, variable depths with almost absent cap refill. Surgical intervention and referral to specialist unit
Full thickness burn: outer skin and some underlying tissue is dead. Skin is white, brown, red or black with no cap refill and surgical intervention and long term scar management is required.
What is the rule of 9’s?
Head and neck = 9%
Arms (2x9) = 18%
Trunk (front) = 18%
Trunk (back) = 18%
Legs (2 x18) = 36%
Perineum = 1%
Total = 100%
What are circumferential burns and how are they managed? List the nursing responsibilities
Circumferential burns occur when there are full thickness burns across the whole circumference of a digit, extremity or torso. These burns cause compromised perfusion, airway obstruction, poor respiratory effort etc.
Nursing responsibilities:
Escharotomy → incising through areas of burnt skin to release eschar and constrictive effects
Analgesia
Elevation - reduces swelling
A-G
Fluid balance chart
Wound dressings
What is the impact of circumferential burns?
Burnt skin –> rigid = eschar
Around limbs –> venous occlusion
Venous occlusion –> arterial occlusion
Around chest –> restricted expansion
Child’s front –> restricts diaphragm
