Burns Flashcards
Criteria for admission to burn center
1) full thickness and partial thickness burn more than 10% BSA (less than 10 yrs, over 50 - others are 20% BSA)
2) Face, hands, feet or perineum involved
3) Full thickness over 5% any age
4) Electrical (lightening included) or chemical burn
5) Inhalation injury
6) Other injuries (fractures, head injury..)
7) Existing systemic diseases
8) Suspicion of abuse
Emergency care focus
1) stop any ongoing issues
2) Airway management
3) Fluid resuscitation - getting IV access
4) Circulation assessment
5) Life threatening injuries
6) Severity of burn
Superficial burn affects what
Epidermis
Superficial dermal includes what
Epidermis and superficial dermal layer
Deep dermal includes what
Epidermis and dermis
Full thickness includes what
Epidermis, dermis, and into the subcutaneous tissue
Epidermal (first degree) burn
Correlates with superficial Encompasses the epidermis only Dry, red skin May have small blisters Painful!
Epidermal (first degree) burn - healing
2 to 7 days to heal
No scars, but may have pigmentation changes (temp)
Superficial partial thickness (second degree) burn
Epidermis and papillary dermis
Moist, large blisters
May be mottled looking
Very painful! Tends to be sensitive to stimulation
Superficial partial thickness (second degree) burn - healing
10 to 14 days
Primarily through epithelialization
Change in skin pigmentation in the area, once healed (more permanent pigment changes)
Deep partial thickness (deep second degree) burn
Epidermis and papillary dermis layers are completely involved
Reticular dermis is damaged
Might have blisters that are leaky
More fluid loss than superficial
Significant edema
Mottled red and white skin color
Pain and sensitivity is less than a superficial
Deep partial thickness (deep second degree) burn - healing
More than 30 days
May need grafting depending on how large the area is
Full thickness (third degree) burn
All layers of skin including subQ layers Eschar forms Might have marble appearance Not as painful as other depths, but surrounding tissue can be pretty painful Will not heal without grafts!!!
Zones of a burn - A
Central zone of coagulation = This is the central part of burns with complete coagulative necrosis - it is dead
Zone of a burn - B
Zone of stasis = Located at the periphery of zone of coagulation - the circulation is sluggish in this zone but it can recover after early and adequate resuscitation, and proper wound care
Dec perfusion in this zone but the tissue can be saved
Zone of a burn - C
Outer most zone of hyperemia - peripheral to the zone of stasis - result of intense vasodilation as is seen in inflammatory process after trauma
Response from fluid/blood coming in - turns red and swells - this will heal
Determination of BSA
Lund and Browder chart - best
Rules of nines
Rule of one
Determination of BSA - Lund and Browder chart
Most common
Split body into percentages
Accounts for youth and uses more sections than others like Rules of nines
Determination of BSA - Wallace rules of nines
Used if lund-browder chart is not available
Does not account for all age groups
Does not ask that the severity of the burn be included
Determination of BS - rule of 1
Use the pt hand (including digits) as 1%
Causes of burns
Thermal, flame, contact Hot liquid, scald, steam Electrical Chemical Hypothermal (frostbite) Inhalation
Thermal
Depends on the agent, mechanism, time
Protein denatures at 160 degrees
Hot liquid
Common with kids
Think abuse if all creases are saved
Hot material
Tar = ex
Does not come off easily and it won’t cool fast - so it will keep burning the tissue
Electrical
Direct electrical burns have an entrance and an exit
Cardiac arrhythmia needs to be looked out for - you don’t know the path of the electricity (usually takes path of least resistance - internal organs can be impacted)
Chemical
Key to this is to take care of saving the tendons and muscles - do NOT let them dry out
Hypothermal
LIke frostbite
Warm them up slowly and prevent cells from bursting (liquid in the cells freezes)
Degree of temp they are exposed to will impact how long the inflammatory response goes for
After re-warming then you determine what tissue is still viable
Inhalation
Nasal hair burn = inhalation burn
coughing, hoarseness = inhalation burn
Thermal burns around the head, neck, trunk = inhalation burn
Trachea becomes burned and gets inflammation within the airway and it can become obstructed
Escharotomy
Scalpel to open them up and remove the eschar
Some tissue does better than others
Need to remove the thick, bad tissue to prevent infection
Escharotomy is defintiely needed when
Eschar on trunk - will limit breathing!
Pain
Medications will generally be given IV (not IM or orally - too hard to find a good site, and you do not know how it will metabolize)
IM and oral will likely not be absorbed as expected
Positioning
Position of comfort = position of dysfunction! They will go to a comfort position and then lose function
Need to position them in the way that they do not want to be positioned to help maintain motion
Splinting - why
Need to prevent contractures!
Burn care - treatments
Hydrotherapy (special for burns) Debridement Dressing changes Monitor fluids Prevent infection
Exercise
ROM is critical
Ambulation - do this asap
Resp. system - esp. with upper body burn
Strengthening
Functional activities
Home care issues
Occupational considerations
Adaptive equipment
Psychological considerations
Threat to life Disfiguration (self-image) Fear of loss of affection Inability to perform life roles Also the reason for the burn (their fault, someone else?)
Grafts - Homograft (allo) =
Cadavers are the usual source
this is usually a temporary graft
Grafts - Xenograft =
Pig skin is the usual source
Usually a temporary graft
Grafts - Autograft
Pt own skin
Can be meshed or sheet
Grafts - Autograft - Meshed
take 1 in piece and put it through something to cut holes in it and stretch it out
Makes it grow 3x bigger!
Grafts - autograft - sheet
Usually from the epidermis
sometimes some of dermis too
Skin substitutions in burn care -
CEA
Synthetic substitutes
Cultrued dermis
Alloderm
Skin substitutions in burn care - CEA
Cultured epithelial autografts - keratinocytes are obtained, cultered, and used to grown into skin sheets!
Skin substitutions in burn care - synthetic substitutes
Temporary
Biobrane, apligraft, dermagraft…
Skin substitutions in burn care - Cultured dermis
integra
Skin substitutions in burn care - alloderm
treated cadaver skin
Complication (just one of them) and what helps
Keloid formation
compression garment can help
