Burns Flashcards
Layers of the skin
Epidermis –> Dermis –> SubQ
Outer most layer, melanin
Epidermis
2nd layer, contains blood vessels, nerves, lymphatic vessels, hair follicles, sweat glands, sebaceous
Dermis
Cushions body, insulation
SubQ (fatty tissue)
- Inner zone with the greatest amount of damage
- Irreversibly damaged cells that become necrotic from the direct injury
Coagulation zone
- Medial zone that may recover
- Damage to microcirculation
- Clotting and vasoconstriction causing cells to be ischemic
Stasis/ischemia zone
- Outer zone, unburned area
- Increased tissue perfusion d/t local inflammatory mediator released
- Blanches on pressure
- Will heal
Hyperemia zone
Results from fluid shifts into the tissues
Hyponatremia
Increases in blood as it moves out of damaged cells and into the bloodstream
Hyperkalemia
What part of the skin is damaged in 1st degree/superficial burns?
Epidermal layer
What does a superficial burn look like?
- Pink, red areas
- Mild edema
- No blisters
What sensation does a superficial burn have?
- Pain, tender
- Sensitive to heat
How long does it take for a superficial burn to heal?
3-6 days
What is the treatment for superficial burns?
OTC topical lotion with no dressings
What part of the skin is damaged in 2nd degree/partial thickness burns?
Entire epidermis and parts of the dermis
How does a 2nd degree/partial thickness burn look? (5)
- Blisters
- Pink to red
- Weeping
- Blanches with pressure
- Mild to moderate edema
How does a 2nd degree/partial thickness feel like?
Pain to temperature and air
How long does it take for a 2nd degree/partial thickness burn to heal?
3 weeks
What is the treatment for 2nd degree/partial thickness burns?
Cleaned with topical antibiotic
What parts of the skin are damaged in 2nd degree/deep partial thickness burns?
Entire epidermis and deep into the dermis
How does a 2nd degree/deep partial thickness burn look like?(4)
- Wet/waxy dry
- Patchy red to white
- No blanching to pressure
- Moderate edema
What does a 2nd degree/deep partial thickness burn feel like?
- Painful
- Sensitive to touch
How long does it take for a 2nd degree/deep partial thickness burn take to heal
2-6 weeks
What part of the skin is damaged in 3rd degree/full thickness burns?
Entire epidermis and dermis and extending to subq fat
What does a 3rd degree/full thickness burn look like? (4)
- Various colors - waxy white, deep red, yellow, brown
- Dry, leathery, charred
- No blanching with pressure
- Severe edema
What does a 3rd degree/full thickness burn feel like?
No pain or pain to deep pressure d/t nerve endings destroyed
How long does it take for 3rd degree/full thickness burns to heal?
weeks to months
What parts of the skin are damaged in 4th degree/deep full thickness burns?
All layers and extending into muscle, bone, and tendons
What does a 4th degree/deep full thickness burns look like?(3)
- Blackened, charred
- Dry, leathery eschar
- No edema
What does a 4th degree/deep full thickness burn feel like?
No pain
What is the time frame for the emergent phase of burn care?
Time of injury to 24-72 hours
What is the time frame for acute phase?
36-48 hours after fluid shift resolves and ending with wound closure
What is the time frame for the rehabilitative phase?
Begins with most burned areas healed and ends with the highest level of functioning
What is the fluid restoration protocol for burns?
1/2 the amount of fluids in 1st 8 hours and then the other half over the next 16 hours
Hgb levels in burns
Increased
Hct levels in burns
Increased
BUN levels in burns
Increased
Glucose levels in burns
Increased
Na levels in burns
Decreased
K levels in burns
Increased
Total protein levels in burns
Decreased
Albumin levels in burns
Decreased
pH levels
Low metabolic acidosis
PaO2 levels in burns
Slightly decreased
PaCO2 levels in burns
Slightly increased
Carboxyhemoglobin in burns
Elevated >10%
