burns and HCAI Flashcards
Most common cause in burn
cutaneous thermal burns
acidic chemical burn
coagulative necrosis
alkaline chemical burn
liquefactive necrosis
types of inhalation injury
smoke: pharynx
sting: epiglottis
chemical: further airway
radiation burn
photo-energy and DNA damage
non-accidental burn
abuse
factors determining burn tissue response
- degree of temp elevation
- rate of temperature change
- duration of contact
- thickness of skin
degree of burn
- superficial epidermal
- superficial dermal
- deep dermal
- full thickness
- 4th degree burn
would you see nay lister in full thickness burn?
No
which burn will destroy blood vessel and not blanch?
deep dermal and full thickness
which burn will have anaesthesia or hypo- anaesthesia?
deep dermal and full thickness
Jackson burn wound model 3 zones?
- zone of coagulation
- zone of stasis
- zone of hyperaemia
what level of burn will only have regeneration not repair?
only superficial epidermal
stages of wound healing?
- haemostats
- finalisation
3, repair( reepithelilizatoin, angiogenesis, firbogenesis) - remodelling( vessel regression dan collagen deposition)
superficial epidermal
no blister, pain, dry, red, blanchable, no necrosis,no scarring +/- inflammation, vasodilation, oedema
superficial dermal
blisters, pain, red, sweeping blanch able, exudate and necrosis
deep dermal
blister, no blanching, minimal pain
full thickness
loss of cells structure, eschar on granulation tissue, anaesthesia
4th degree
fasciae, muscle and bone affected
complication of wound healing
wound dehiscence and ulceration ( deficient scar) excessive repair( keloids, exuberant granulation, proud flesh) infection and sepsis, contracture
when will wound contraction happen
within 6 wk
what hormones increased after burn
cortisol, glucagon, glucose
what decreased in burn
immune response, myocardial contractility, Na, electrolytes albumin, muscle mass
common causes of burn in adults and kids
kids: Scald>contact>flame
adults: scald>flame>contact
common place of burn
home for both adults and kids( then work place and outdoor)
CVS responses to burn
capillary permeability increased –> loss of intravascular proteins and fluid into intersitium
resp responses to burn
bronchoconstriction
severe burns can cause rep distress syndrome
what happens after burn
systemic responsive to burn: release of cytokines or inflammatory mediators at site of injury
metabolic response to burn
BMR increased by 3X
increased glucose turnover –>hyperglycemia
increase catabolic hormone; adrenaline, cortisol, glucagon
- increased rate of gluconeogensis, glyocgenolysis and muscle proteolysis
- temp set point raised
increased protein turnover and synthesis
metabolic acidosis: loss of water causing PH imbalance
immunologic response to burn
down regulation of immune response
SIRS if burn>20% TBSA causing
bronchconstriction increased cap permeability reduced immune response increased BMR peripheral and splanchnic vasoconstrction( hypoperfusion)
inhalational injury
increase mortality - above larynx( inhale hot gases or steam) - onset 4-24hr below larynx - chemical burn - immediate to 5d systemic intoxication - systemic absorptio nof CO, HCN
how to treat hypermetabolic response
propranolol
oxandrolone
where does epidermal keratinocytes regeneration from
skin appendages ( hair sheath cell, bulge stem cells, basaloid cells of sebaceous glands) - speed of regeneration of depend on depth of injury
risk factors for hypertrophic scar
>2-3wk healing time depth of burn time to heal genetics/ skin types - mixed depth burns so need grafting
how to treat burn
epidermal: moisture
superficial dermal: dressing
deep dermal and full thickness: surgery and grafting
features of superficial dermal burn
- necrosis confined to upper 1/3 of dermis
- zone of necrosis lifted off viable wound by edema
- small zone of injury
features of mid dermal burn
- necrosis to mid dermis
- large zones of injury
- eschar separated from viable tissue by edema layer
features of deep dermal burn
- necrosis involving majority of skin layers
- zone of necrosis adherent to zone of injury
- smaller edema layer
full thickness burn features
no remaining viable dermis
how to assess burn severity
- wallace rule of nines
- Lund and Browder chart
- palm= 1% TBSA
