Burns

Question 1

Burns associated with exposure to fire, scalding or other heat sources.

2nd degree in nature. Usually involves partial thickness injury (epidermal and dermal layers).

Answer 1

Thermal Burns

Question 2

Burns associated with exposure to chemicals such as acid, alkaline or organic compounds.

Predominantly classified as second degree burns and involve partial thickness of tissue.

Answer 2

Chemical Burns

Question 3

Severity of a chemical burn is associated with 4 factors:

Answer 3

The duration of contact.
The concentration of the compound.
The volume of chemical the person is exposed.
The chemical’s mechanism of action.

Question 4

What precaution is required when neutralizing chemical burns?

Answer 4

In general, neutralization of the agent with another chemical is not recommended unless the exact mechanism is known because the reaction may generate more heat and result in further tissue destruction (American Burn Association, 2011).

Question 5

Burns associated with exposure to electricity passing through the body. Occurs at various ranges of voltage.

Must assess point of entry and exit. Often result in 4th degree (full thickness of all layers of skin and tissue)

Answer 5

Electrical Burns

Question 6

Severity of an electrical burns is associated with 4 factors:

Answer 6

• Strength and type of current
• Pathway of electrical current
• Local tissue resistance
• Duration of exposure

Question 7

Classification of electrical injuries:

Answer 7

high voltage (>1000 V)
low voltage (<1000 V)
lightning strikes
electric arc without passage of current through the body.

Question 8

What procedure is recommended by practical guidelines for electrical burn management?

Answer 8

An electrocardiogram for high or low voltage injuries. (risk for arrhythmias)

Question 9

Burns that are the result of friction between the skin and another surface because friction generates heat.

Answer 9

Friction Burns

Question 10

Characteristics of frictions burns.

Answer 10

• Loss of epidermal and dermal layers of the skin
• Exudative [serosanguinous] and - High risk for infection due to debris and exposure to material that may be caustic/toxic to the cells (ex., tar).

Question 11

Burns due to exposure to ionizing radiation, sun exposure or radio frequencies involved in cancer treatments.

Can involve all layers of the skin (superficial to deeper structures)

Question 12

What layers of skin are involved in first degree burns?

Answer 12

First degree burns typically involve the superficial thickness of the epidermis with no break in the skin.

Typically, they do not involve scarring (in relation to the normative phases of healing).

Question 13

What layers of skin are involved in second degree burns?

Answer 13

Superficial partial thickness and superficial full thickness injury (epidermis + dermis)

Question 14

Pain partial thickness injury?

Answer 14

In a partial thickness injury, there’s more pain involved because of the sensory protection features of the skin.

Question 15

Pain full thickness injury?

Answer 15

The sensory neurons are part of the epidermal and dermal layers of the skin.

In the context of full thickness injury, the presence of pain is not a usual characteristic, because of the extensive damage and loss of sensory neurons in the epidermal and dermal layers.

Question 16

What layers of skin are involved in third degree burns?

Answer 16

Deep partial thickness injuries.

They will involve the epidermal (epidermis), dermal (dermis) and subcutaneous layers of the skin.

Question 17

Pain deep-partial thickness injury?

Answer 17

They are typically painless as they are insensate because of the extent of the damage.

Question 18

Healing deep-partial thickness injury?

Answer 18

They will also involve severe edema and healing will not be spontaneous. Injuries of this severity will require grafting and advanced therapies.

Let’s think back in terms of the pathophysiological processes, the tissue that is involved, and how skin cells regenerate. When there is deep partial thickness injury, we know that there is no possibility of spontaneous regeneration in this tissue type (subcutaneous).

Grafting is required because the key building blocks (the cells that are involved in the dermal layers of the tissue) have been compromised and can’t participate in the normal replication of skin cells.

Question 19

Zones of tissue damage

Answer 19

• Zone of coagulation
• Zone of stasis
• Zone of hyperemia

Question 20

Zone of coagulation

Answer 20

It is the area of greatest damage.

It is also the area that has been exposed closest to the heat source resulting in the coagulation of cells (Evans, 2016).

The zone of coagulation is coagulation necrosis. The tissue is nonviable due to cellular death. This particular area, in terms of cellular recovery, entails irreversible damage.

Question 21

Zone of stasis

Answer 21

“The zone of stasis surrounds the zone of coagulation. It involves the vascular system in the area.

Thrombosis and vasoconstriction cause transient dermal ischemia. Circulation will return if the area is adequately perfused and protected from further damage from infection, desiccation, and mechanical stress during transfers and repositioning.” (Evans, 2016, p. 448)

Question 22

Zone of hyperemia

Answer 22

“The zone of hyperemia is the outermost area. Usually, no cellular death occurs because this area is only minimally damaged. Cells in this zone recover in 7 to 10 days. The area is reddened because of vasodilation and inflammation.

The zone of hyperemia is similar to a superficial partial-thickness burn.” (Evans, 2016, p. 448)

Question 23

Wound Conversion

Answer 23

Wound conversion is an important concept that was elaborated by Singh et al. (2007) that describes how damage can spread to initially unburned tissue in certain circumstances.

Question 24

Wound Conversion Risk Factors

Answer 24

Risk factors for wound conversion are similar to factors that impair other acute and chronic wounds (Example: oxygenation, infection, mechanical trauma, malnutrition).

Patients who sustain severe burns must have interventions to preserve the tissue that is viable. Optimal care includes increasing oxygenation and perfusion to the tissue and decreasing the risk of infection, mechanical trauma, while ensuring optimal nutrition.

Question 25

Sub-acute period?

Answer 25

3-5 days following injury.

Question 26

What does the acronym “TBSA” stand for?

Answer 26

Total Body Surface Area

Question 27

What rule do we use to evaluate severity of burns using the proportions of body parts affected?

Answer 27

Rule of Nines (9%)

Question 28

Scale based on age to determine burn severity?

Answer 28

Lund-Browder chart

Question 29

Criteria for Referral: Outpatient Treatment

Answer 29

Burn severity: Minor

Criteria:
- Adults: < 10% TBSA
- Children and elderly: < 5%
- Full thickness burns not involving cosmetic or functional risk or impairment of face, ears, eyes, feet, hands, perineum

Question 30

Criteria for Referral: Hospital Admission

Answer 30

Burn Severity: Moderate

Criteria:
- Adults: 10% to 20% TBSA, mixed partial
- Children < 10 years or adults > 50 years: 5-10% TBSA
- Children < 10 years or adults up 50 years: ≥ 20% TBSA
- 2-5% TBSA full thickness
- Full thickness burns not involving cosmetic or functional risk or impairment of the face, ears, eyes, feet, hands, perineum