Burns

Question 1

Pathophysiology of Burns

Answer 1

Temp + exposure duration = amount post tissue damage

Question 2

Zone of coagulation:

Answer 2

area exposed to the most amount of heat and ensues the most damage; irreversible tissue destruction.

Question 3

Zone of stasis:

Answer 3

decreased tissue perfusion, may be salvageable;
the main goal of burn resuscitation is to increase tissue perfusion
here and prevent any further irreversible damage

Question 4

Zone of hyperemia

Answer 4

outer zone, often recovers / heals with care

Question 5

Aim of care after a burn injury

Answer 5

-Reduce or prevent dermal ischemia, thereby avoiding further tissue death.
* The residual necrotic layers of skin destroyed by direct heat damage or the
injury occurring secondary to heat damage is referred to as eschar.

Question 6

Superficial

Answer 6

-1st degree, only epidermal layer
-redness and pain; dry and does not form blisters.

Question 7

Depth of burn:
Partial-Thickness:

Answer 7

-Partial-Thickness:
-2nd degree, destroys epiderm, extends into derm layer
-Superficial: damage to upper papillary derm
-Deep: damage to entire epiderm / derm, not base of hair follicle
-Full-Thickness: 3rd degree, destroys entire epiderm, derm, & reaches subcutaneous fat
-Deep Full-Thickness: 4th degree, destroys all skin layers & reaches muscle, tendon, and
skeletal system

Question 8

Inhalation injury

Answer 8

 Thermal injury, often in an enclosed space
 Carbon monoxide toxicity
 Asphyxia
 Cyanide toxicity

Question 9

Burn shock

Answer 9

-A complication that may occur in patients with burns in excess of 20% total body surface
-Immediately following a burn injury, an increase in capillary permeability allows fluid
in the intravascular space to shift into the interstitial space producing burn wound
edema

Question 10

Hypermetabolism

Answer 10

Prolonged stress response releases hormones = increased energy expenditure / protein
turnover

Question 11

Infections

Answer 11

The leading cause of death due to lack of defense from the skin.
* Infection symptoms are commonly observed in persons with burn injuries,
without the presence of an infection

Question 12

Scars

Answer 12

 Fibrous tissue that replaces normal tissue after injury

Question 13

Hypertrophic scar formation

Answer 13

 Result from uncontrolled production of fibroblasts and excess in deposition of collagen tissue
 Red, raised, and rigid and generally do not extend past the injury site
 Remain within the boundary of the original wound and will eventually fade in color, flatten, and become more pliable as they mature

Question 14

Keloids

Answer 14

 Excessive fibrosis, nodular proliferations that project beyond the margins
of the original injury.
 Tender and painful and can be difficult to treat.
 Cause physical, cosmetic, psychological, and social concerns

Question 15

Contractures (Final Stage of Wound Healing)

Answer 15

• Shortening and tightening of the burn scar
• Approximately 40% will develop scar contractures
• Most problematic over large joints.

Question 16

Burns Course and Prognosis

Answer 16

• Superficial burn healing time ~ 3-4 days - No scar
• Superficial partial-thickness healing time ~ 2wks - No scar but pigmentation changes
• Deep partial-thickness healing time 3wks or > Scaring and Contracture
• Full-thickness
• Affects all bodily systems
• The wound will not heal spontaneously

Question 17

Burns Diagnosis

Answer 17

Burn depth and burn size will guide medical and therapeutic
management of the burns
* Burn depth is often not accurately assessed.

Question 18

Total body surface area (TBSA)

Answer 18

• The Lund and Browder scale
• The rule of nines
• The rule of palms

Question 19

Fluid resuscitation

Answer 19

• Administration of intravenous fluid
• Goal is to maintain the intravascular volume in sufficient amounts to
  ensure adequate perfusion and oxygenation to all tissues

Question 20

Debridement

Answer 20

Cleansing and removal of nonadherent and nonviable tissue.

Question 21

Hydrotherapy

Answer 21

• Water is used as a means of decontamination of the burn site
• Concern for infection with deep burns
• Showering is also used to clean burns, but in limited amounts

Question 22

Topical dressing and creams

Answer 22

• Topical dressings are used to provide protection from contamination and
  from physical damage, allow gas exchange and moisture retention,
• Silver-containing topical agents have antimicrobial properties

Question 23

Splinting

Answer 23

• The antideformity position for a palmar or circumferential burn places the wrist in 30 to 40 degrees of extension and 0 degrees

Question 24

Autograft

Answer 24

Grafts from an uninjured donor site of the patient

Question 25

Allograft

Answer 25

Donor skin taken from another living or deceased person

Question 26

Xenograft

Answer 26

Tissue graft or organ transplant from a donor of a different
species from the recipient