Burns

Question 1

Skin Function

Answer 1

Barrier between internal organs and environment
Acidic skin (pH 4.2-5.6) and perspiration protect against bacteria
Thickened skin on palms and soles provide padding
Relatively impervious to chemicals
Receptors allow for monitoring of environment
Aesthetics

Synthesis of vitamin D3
Prevents electrolyte loss, prevents water absorption
Heat dissipates through skin; internal temperature regulated
Major site of immune complexes is at the epidermal-dermal junction
Monocyte/macrophage system mobilized by local tissue mediators

Question 2

Superficial burns

-1st degree

Answer 2

Destruction of epidermis only, skin function intact, tactile and pain sensors intact

Blisters only after 24-48 hours, normal or slightly reddened underneath, healing time 3-5 days, no scarring, commonly caused by sunburn

If large surface area involved, may have systemic response (chills, edema, n/v)

Question 3

Superficial Partial Thickness

-2nd degree

Answer 3

Destruction of epidermis and some dermis, skin function absent, tactile and pain sensors intact

Blisters within minutes, skin is red to pale ivory with moist surface, healing time 21-28 days, scarring may be present; genetically predetermined

Question 4

Deep Partial Thickness

-2nd degree

Answer 4

Destruction of epidermis and dermis, leaving only skin appendages (hair follicles and sweat glands), skin function absent, tactile and pain sensors intact but diminished

Blisters may appear but most commonly is layer of flat dehydrated “tissue paper” that lifts off in sheets

After debridement, wound is mottles with areas of waxy white, dry surface, healing time 30 days – many months, high incident of scarring, influenced by genetics; skin grafting may be necessary

Question 5

Full Thickness

-3rd degree

Answer 5

Destruction of epidermis, dermis, and underlying subcutaneous tissue. Very severe burns of this type can involve muscle and bone, skin function absent, tactile and pain sensors absent, no blisters

Appearance after debridement varies, will not heal on its own, skin grafting necessary

Question 6

Be able to compute body surface area for burns

Answer 6

Using “rule of nines”

Partial and full thickness burns included (not superficial)

Palmar surface of the hand (about 1% of body surface area)

Any burn >20% BSA in adults is considered a major burn and can systemic effects

Question 7

Describe burn shock and the effect on major systems

Answer 7

Cardiovascular:

Loss of fluid to interstitial space due to capillary leak

Loss of fluid due to evaporation and leakage from area of burn

Decreased cardiac output regardless of intravascular fluid volume – likely due to massive catecholamine release

Respiratory:

Inhalation injury common in major burns

Heat well dissipated by lungs so thermal injury is limited to upper airway and bronchi

Smoke or fume inhalation can lead to ARDS

Pulmonary edema from capillary leak and aggressive fluid resuscitation

Smoke inhalation can cause CO poisoning

Renal:

Hypoperfusion injury due to decreased circulating volume and cardiac output

Damage due to myoglobinemia

Also, rhabdomyolysis forms too

Mortaility rate >50% when ARF forms

Metabolic:

Huge release of catecholamines

HR 120-140

Hypermetabolic state of 150% of normal until BSA <20%

Immunologic:

Immune system suppressed, infection major cause of fatality

Massive release of cytokines causes systemic inflammatory response