Burns Flashcards
What is the definition of a burn?
An injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction, or contact with chemicals. Children under 5 and the elderly are more at risk.
What happens when skin is burnt?
-Interrupt the barrier function of the skin, impairing basic functions such as temperature regulation, infection prevention, maintenance of homeostasis, alteration in systemic circulation, loss of vascular wall integrity, and proteins are lost to the interstitial space.
-Denaturation: the proteins of the skin become severely damaged
-Swelling forms as fluid moves into interstitial space due to increased permeability of capillaries
-the loss of fluid can be dramatic, reducing circulating plasma volume, causing large oedema, and reducing cardiovascular function.
What is the zone of hyperemia?
The outermost zone of a burn. Blood flow is increased to this area. The tissue here will recover unless there is severe sepsis.
What is the zone of stasis?
The area of potentially salvageable tissue. There is decreased tissue perfusion here. A key aim of burns treatment is to increase perfusion to this area and prevent damage becoming irreversible. Prolonged hypotension, infection or oedema can cause this to be an area of irreversible damage.
What is the zone of coagulation?
The area of irreversible damage at the point of maximum injury.
What is a superficial partial-thickness burn?
-Damage to the epidermis, may involve the upper (papillary) dermis.
-usually appear red and painful but heal without scar tissue
What is a deep partial-thickness burn?
-severe damage to the epidermis and part of the dermis
-area is red, swollen, blistered, hypersensitive and painful
-in severe cases, the skin appears waxy with a reddened margin
-dead skin gradually sloughs off, and healing occurs by regeneration from the edges of the blistered areas and from epithelium lining
-grafts may be necessary to cover larger areas
-if they become infected, addition tissue damage may occur
What is a full-thickness burn?
-results in destruction of all skin layers and often underlying tissues as well
-the burn area is coagulated or charred, and so hard or dry on the surface
-area may be painless due to destruction of the nerves. adjacent tissue can be very painful and inflamed due to chemical mediators released by damaged tissue
-this damaged tissue shrinks, exerting pressure on the swollen (oedematous) tissue beneath it. If a burn covers the entire circumference of a limb or the torso, an escharotomy may be necessary
-require skin grafts for healing as there are no/very few viable skin cells available for the production of new skin
What is a subdermal burn?
Refers to a full-thickness burn that affects below the cutaneous layer to adipose tissue, muscle or bone
What are the types/features/considerations in chemical burns?
-Acid burns damage tissue by coagulative necrosis where cell death occurs due to ichemia/infarction
-alkali burns damage tissue by liquefaction necrosis, which results in the a transformation of tissue into a liquid viscous mass
-for chemical burns, try to determine the base of the chemical. irrigate the burns copiously whilst considering postural drainage. do not cover with clingfilm
-phosphorus burn must be kept continually wet
-lime burns must be kept continually dry
What happens in cold burns?
-Formation of extracellular and intracellular ice crystals which cause shift of water from within the cell, causing intracellular dehydration
-frostbite causes vasoconstriction
What are the considerations in an electrical burn?
-The pathway the current takes is crucial to survival: through more internal organs/the heart more dangerous
-ensure personal safety
-look for entry/exit wounds and evidence of other trauma
-always do a 12 lead
-Lichtenberg scarring may indicate direction the current travelled. They are blood vessels that burst from the electric discharge and heat.
What are the considerations in thermal burns?
-skin contact time and temperature will determine the depth of the burn
-hot fat and oil can cause worse burns
-record clothing type, eg wool retains hot water
What are the considerations in airway burns/smoke inhalation?
-risk of carbon monoxide poisoning in smoke inhalation. can confuse sp02 monitor. can give 02 even if sp02 reading is high
-sign/increased risk of airway burns: facial or neck burns, soot in nasal and oral cavities, coughing up blackened sputum, cough and hoarseness, diffiulty with breathing and swallowing, blistering around mouth and tongue, scorched hair, eyebrows or facial hair, stridor/altered breath sounds/wheezing, fire/blasts in an enclosed space
What are the consideration in paediatric burns?
- accidental burns often occur on head, anterior trunk, upper extremities and feet
-non-accidental burns often occur to the posterior trunk and are deep partial thickness or full thickness burns caused by hot tap water
