Burns - Summary of the skin

Question 1

Skin layer - Epidermis

• Composition
  
  • Stratified squamous epithelium
  • Keratinocytes
    -Melanocytes
    -Langerhans cells
  • Merkel cells

Function
- Immune defense
- Filter out UV damage
- Produce pigmentation
- Defense against pathogens
- Moderate temperature.

Question 2

Skin layer - Dermis

-Composition
- Collagen fibrils
- Fibroblasts
- Phagocytes
- Lymphocytes
- Langerhans cells
- Mast cells

function
- Pliability
- Tensile strength
- Elasticity

Question 3

Skin layer - hypodermis

• composed of
  
  • Subcutaneous Fat

Function
- Insulation
- Calorie reserve
- Cushioning and shock absorption.

Question 4

A burn is an injury to the skin or other organic tissue, primarily caused by heat or due to radiation, radioactivity, electricity, friction, or contact with chemicals.

Question 5

Epidemiology of burns

• The exact prevalence of burn injuries is not known as some people will self-treat and do not seek medical attention.

Answer 5

Estimated that:

• 250,000 people receive burns each year.
• 175,000 people with burns attend a&e.
• 16,000 people with burns are admitted to the hospital for specialist care.
• In the UK 90% of burn injuries are non-complex wounds.

Question 6

Epidemiology of burns in kids

Answer 6

• Children under 5 and the elderly are more at risk of burn injury.
• Elderly are at an increased risk due to reduced mobility, sensory impairment, and slower reaction times.
• Burns is the 11th most common cause of death in children aged 1-9 years.
• Burns is the 5th most common cause of non-fatal childhood injuries.

-Boys are more likely to be affected than girls.

Question 7

Pathophysiology of the burn.

The pathophysiology of the burn wound is characterized by an inflammation reaction leading to rapid edema formation due to increased microvascular permeability, vasodilation and increased extravascular osmotic activity.

Question 8

Zone of injury

• Burns cause loss of plasma and denaturation of proteins.
• Injury can be immediate or delayed:
• immediate is due to plasma loss.
• Delayed is due to inadequate resuscitation.

Zones of burn injury: coagulation stasis and hyperemia
-Central zone - Coagulation has great destruction.
- This is necrotic tissue.

Adjacent zones- stasis has a lesser injury and has both viable and non-viable cells (tenuous blood flow requiring timely care and resuscitation).

• Outer zone - hyperemia: less injury with high blood flow

Question 9

Superficial partial thickness burns:

-Will appear as a blister or denuded skin.
-Superficial dermal burns extend into papillary dermis.
- Blanh with pressure and painful due to areas of dermis surviving.
- Heal in approx 3 weeks

Question 10

Partial thickness burns:

• can be subdivided into superficial or deep.

Deep full thickness burns:
- No blisters due to the thickness of non-variable tissue.
-blood flow is compromised and difficult to differentiate between deep partial-thickness and full-thickness burns.
- Can be identified via sensation of touch.
-Deep partial thickness burns if not healed within 3 weeks should be grafted.
- superficial will heal with care.

Superficial burns (1st degree).
- superficial burns - only epidermis and is red (erythema) and painful.
- may extend to the papillary dermis and have small blisters.
- blanch with pressure.
- Blood flow is increased.
- usually, heal within 2-3 weeks.

Question 11

Partial thickness burn (2nd degree)

• Redness with clear blister
  -painful moist burn
• blanches with pressure
• don’t be in a hurry to break blisters
• heals in 14-21 days
• blisters provide biologic dressing comfort
• one the blister breaks, red raw surface will be very painful,

Question 12

Full thickness burn

3rd degree: destroy epidermis and dermis burns have a dense white, waxy or even charred appearance. sensory nerves in the dermis destroyed in a full thickness burn.

Question 13

Full thickness burn

3rd degree: destroy the epidermis and dermis burns have a dense white, waxy or even charred appearance. sensory nerves in the dermis destroyed in a full-thickness burn.

Question 14

Full thickness burn

3rd degree: destroy the epidermis and dermis burns have a dense white, waxy or even charred appearance. sensory nerves in the dermis are destroyed in a full-thickness burn.

Question 15

Subdermal burns - 4th degree:
Burns through fatty tissue bone and muscle or organ - they are full thickness with deep tissue damage.

Question 16

Aetiology of burns (Cause)

Answer 16

• Dry heat-
• wet heat

burn types
- Chemical
- cold
- electrical
- friction
-radiation
-thermal

cause of burn injuries
- thermal
- chemical
- electrical
- radiation

Question 17

Thermal burns and scalds

• skin contact time and temperature will determine the depth of the burn.
• Scalds with boiling water are frequently of short duration when compared to hot fats or liquids.

Question 18

Chemical burns

• destroys tissue
• Acid vs Alkalis: chemical agents are either acid or alkali based.
• Acid burns damage tissue via coagulative necrosis
• alkali burns destroys the tissue via lisuefaction necrosis.

-When dealing with chemical burns it is important to consider:
-the chemical causing the burn
- to irrigate copiously with postural draining.
- DO NOT COVER IT WITH CLING FILM.

Question 19

Eletrical burns

• devastating injuries that can be underestimated.
• The pathway of current takes is crucial to survive.

When dealing with electrical burns it is important to:
- Ensure personal safety
- search for entry and exit wounds
- evidence of other traumas
- 12 lead ECGS

Question 20

Cold injury

• Formation of Extracellular and intercellular ice crystals which causes a shift of water from within the cell leading to intracellular dehydration.

-Frostbite causes vasoconstriction
- phosphorus and lime burns
- phosphorus burns must be kept continually wet
- lime burns must be kept continually dry.

Question 21

Airway burns cause.

-Exposure to fire and smoke in an enclosed setting.

Question 22

Sign of airway burns

Answer 22

• hoarseness or change in voice
• harsh cough
• stridor
• facial burns
• head and neck swelling
• inflamed oropharynx
• soot in the nasal and oral cavity
• coughing up blackened sputum
• difficulty breathing or swallowing
• blisters in or around the mouth and tongue
• altered breathing sounds like a wheeze
• loss of consciousness
• fire/blasts in enclosed spaces

Question 23

Pediatric and burns
Non-Accidental burns

• usually have a stocking type or gloved effect.

Question 24

Pediatric burns

Accidental burns

• often occur on the head, trunk or palmer surface

Question 25

Circumferential burns

• in cases where a full-thickness burn affects the entire circumstances of a digit, extremity or even the torso, this is called circumferential burn.
• can be life or limb threatening injuries
• create a tourniquet-like effect for limbs.
• create an asphyxiation-like effect for limbs.

-Escharotomies are required to allow deeper expansion of the deeper tissue.

• require immediate transportation.

Question 26

Burns assessment tools

• Wallace rule of nine
  -mersey burns score
• patient palmer surface
  -lund and browser chart
• serial halving