Burns: Classifications of Burns

Question 1

What is classified as a burn?

Answer 1

A burn is an injury to tissue caused by contact with dry heat (fire), moist heat (steam or hot liquid), corrosive chemicals, electric current, or radiation

Question 2

A burn is influenced by: (3)

Answer 2

1. Temperature of burning agent
2. Duration of contact time
3. Type of tissue that is injured

Question 3

Types of Burn: Thermal Exposure or Contact (3)

Answer 3

Flame
Scalding
Contact with hot objects

Question 4

Types of Burns: Chemical Burns

Answer 4

contact, concentration, volume and type are significant factors
- Alkalis
- Acids
- Organic

Question 5

Types of Burns: Smoke and Inhalation Injury

Answer 5

Smoke inhalation is a major predictor of mortality in burn patients
Related to severity and type of gases or smoke inhaled

Question 6

3 types of smoke and inhalation injury

Answer 6

1. carbon monoxide poisoning and asphyxiation
2. Inhalation injury above the glottis
3. Inhalation injury below the glottis

Question 7

Carbon Monoxide poisoning and asphyxiation

Answer 7

• Skin colour is cherry red when a patient has been exposed to carbon monoxide poisoning.
• Carbon monoxide replaces O2 on the hemoglobin causing hypoxia at the tissue level. Carboxyhemoglobinemia.
• Death occurs when CO levels exceed 60% but the pt is symptomatic at 10%
• CO binds to hemoglobin with 200x more affinity to oxygen
• CO decreases cellular respiration at cytochrome a3 - no ATP is made, no muscle function, stop attempting to breathe and die.
• Treat with 100% oxygen via non-rebreather

Question 8

Upper airway injury: Signs

Answer 8

Thermally produced from hot air or smoke. Looks like edema, blistering or redness of the oral pharynx or larynx, mechanical obstruction can occur quickly. SIGNS: facial burns, singed nasal hair, hoarse voice, darkened membranes, thick black sputum, clothing burns.

Question 9

Lower Airway Burns

Answer 9

Usually chemically produced d/t duration of exposure to the smoke or toxic fumes. Chemicals that are in the fine particulate matter. Gets into the airways and causes inflammation. Manifestations: acute respiratory distress.
Tissue injury to the lower respiratory tract, clinical manifestations may not happen until 12-24 hours after surgery

Question 10

What are we most worried about with inhalation burns?

Answer 10

Swelling and Edema

Question 11

What is the treatment for smoke and inhalation injury?

Answer 11

High flow 100% oxygen in non-rebreather mask. For at least 80 minutes

Question 12

Electrical Burns: Types

Answer 12

Lightening or contact with high voltage wire produces heat as electricity moves through the body
Extent of damage can be difficult to determine since damage is mostly below the skin (iceberg effect)
Remember they may have fallen
Usually an entry and exit where it grounded out

Question 13

Electrical Burns: Cause of immediate death

Answer 13

Cardiac failure
want to have AED on them to see if there is a shockable rhythm

Question 14

Electrical Burns: Influenced by (5)

Answer 14

Duration of contact
Intensity of current (voltage)
Type of current (direct or alternating)
Pathway of current
Resistance of tissues as it passes through the body

Question 15

Electrical Burns: effect on muscle and internal organs

Answer 15

• contact with electrical currents can cause muscle contractions strong enough to fracture the long bones and vertebrae
• current that passes through vital organs will produce more sequelae than current that passes through other tissues
• due to this and possible falls all patients with electrical burns should be placed on spinal precautions - hardcollar

Question 16

Electrical burns: Myglobinemia

Answer 16

Damage of the muscles beneath level of skin - Myoglobin is released - large proteins. could end up with obstruction of kidneys and AKI secondary to breakdown of proteins caused by burn. seen in high CK blood test.

Question 17

Radiation Burns: most common source
influenced by: (5)

Answer 17

Sunburns - skin erythema, edema, pain.
1. distance from radiation
2. strength of radiation source
3. duration of exposure
4. extent of body surface area exposed
5. amount of shielding between person and source

Question 18

Severity of Injury is determined by: (4)

Answer 18

Treatment of burns is related to the severity of the injury
1. burn depth
2. extent of burn
3. location
4. patient risk factors

Question 19

Partial-thickness:
First degree burn

Answer 19

partial-thickness burns involve injury to epidermis and dermis
- first-degree burn - superficial: epidermis; painful, appear red, with no blistering initially (after 24h, skin may blister and peel)

Question 20

Partial thickness burn: second degree

Answer 20

second degree partial thickness burns: epidermis and dermis involved; appear wet or blistered and are extremely painful but can heal on their own if area small and there is no infection

Question 21

Full thickness: third degree

Answer 21

damage throughout dermis into subcutaneous tissue; unless area small and no infection, grafting is necessary
nerve endings destroyed. dry, waxy white.

Question 22

Full thickness: fourth degree

Answer 22

involves skin, fat, muscle, and sometimes bone
sensation is lost in full thickness. dead skin has leathery appearance (eschar), burned skin is painless but the surrounding skin is very painful. need graft

Question 23

Extent of Burn

Answer 23

Burn size expressed as a percentage of total body surface area (TBSA) using the:
- Lund Brower Chart
- “Rule of 9’s”

Question 24

Concern with burns on the face, neck, circumferential chest or back?

Answer 24

• mechanical obstruction related to edema or leathery scar tissue might inhibit respiratory function

Question 25

Concern with burns on the hands, feet, joints, or eyes:

Answer 25

makes functioning difficult and inhibits future functioning

Question 26

Concern with burns on the ears, nose, buttocks and perineum?

Answer 26

high risk for infection. Ears, nose - poor blood supply and exposure to bone

Question 27

Concern with burns on the extremities?

Answer 27

cause circulatory impairment distal to burn and subsequent neurologic impairment. Compartment syndrome - circumferential burning of an extremity

Question 28

The Burn patient with heart disease and/or COPD?

Answer 28

Pneumonia
Fluid overload
Older adults heals slowly
Significant demands placed on the body by a burn injury
Mechanism of injury: history of the type of burn and injuries beyond the burn. What was the fine particulate matter that would cause chemicals to be released
Comorbidities

Question 29

What causes edema immediately following direct injury to the tissue?

Answer 29

• immediately following burn injury vasoactive substances are released from injured tissue (these substances initiate changes in capillary integrity and allow plasma to seep into surrounding tissue) - edema
• direct damage to vessels from heat further compromises vascular integrity and sodium-potassium pump fails causing cellular edema
• the burn-injured client’s hemodynamic balance, metabolism and immune status is altered

Question 30

If the tissue is not cooled:

Answer 30

and continues to heat up cell necrosis occurs