Burns Flashcards
Pathophysiology of Burns
Temp + exposure duration = amount post tissue damage
Zone of coagulation:
area exposed to the most amount of heat and ensues the most damage; irreversible tissue destruction.
Zone of stasis:
decreased tissue perfusion, may be salvageable;
the main goal of burn resuscitation is to increase tissue perfusion
here and prevent any further irreversible damage
Zone of hyperemia
outer zone, often recovers / heals with care
Aim of care after a burn injury
-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.
Superficial
-1st degree, only epidermal layer
-redness and pain; dry and does not form blisters.
Depth of burn:
Partial-Thickness:
-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
Inhalation injury
Thermal injury, often in an enclosed space
Carbon monoxide toxicity
Asphyxia
Cyanide toxicity
Burn shock
-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
Hypermetabolism
Prolonged stress response releases hormones = increased energy expenditure / protein
turnover
Infections
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
Scars
Fibrous tissue that replaces normal tissue after injury
Hypertrophic scar formation
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
Keloids
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
Contractures (Final Stage of Wound Healing)
- Shortening and tightening of the burn scar
- Approximately 40% will develop scar contractures
- Most problematic over large joints.
Burns Course and Prognosis
- 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
Burns Diagnosis
Burn depth and burn size will guide medical and therapeutic
management of the burns
* Burn depth is often not accurately assessed.
Total body surface area (TBSA)
- The Lund and Browder scale
- The rule of nines
- The rule of palms
Fluid resuscitation
- Administration of intravenous fluid
- Goal is to maintain the intravascular volume in sufficient amounts to
ensure adequate perfusion and oxygenation to all tissues
Debridement
Cleansing and removal of nonadherent and nonviable tissue.
Hydrotherapy
- 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
Topical dressing and creams
- 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
Splinting
- The antideformity position for a palmar or circumferential burn places the wrist in 30 to 40 degrees of extension and 0 degrees
Autograft
Grafts from an uninjured donor site of the patient
