Case 10 Burns Flashcards
What are some sub layers of dermis?
- Thin papillary layer
Fibroblasts arrange in papillae/finger like projections –> produce collagen
Papillae contains blood vessels and nerve –> nerve sense pain and fine touch - Deeper reticular layer (thicker)
Fibroblasts produce collagen (packed tightly together) and elastin (inc flexibility)
Oil glands, sweat glands, hair follicles, lymphatics and nerves
Nerve sense pressure/vibration
What makes up hypodermis?
- Made of fat and connect tissue
- Insulate and pads deeper tissue
- Anchor skin to muscles
What are some causes of burns?
thermal
electrical
chemical
What is thermal burns?
- UV light, flame, steam
- Remove all clothing and jewellery + running cold water for 20 min (NO ICE) + cover burn with clingwrap NOT circumferentially
What is electrical burns?
- Power source (lightning or electrical), voltage (high or low)
- Electricity travels along path of least resistance –> nerve tissues, muscles, blood vessels are easier to travel than fat/bones
- Entrance and exit wound –> skin look fine
- Greater skin resistance (dry skin) –> local skin burn, lesser resistance (wet skin) –> deep tissue and systemic effects
- Muscle is injured, heart can be damaged, brain/spinal cord damage
What is chemical burns?
- Acids: drain cleaners, coagulative necrosis caused by ischemia/infarction + denature proteins
- Bases: rust removers, swimming pool cleaners, in CEMENT, can penetrate deeper than acids –> liquefactive necrosis + cells dehydrate and collagen are denatured
- Redness/irritation, pain and numbness, formation of blisters of black dead skin at the site of contact, vision changes if gets into eyes, SOB, vomiting
- Wear protective gloves and glasses, cold running water
What are different severity of burns and which skin layers do they affect?
1st degree burns/Superficial burns –> only epidermis
2nd degree burns –> epidermis and dermis
- superficial partial thickness burn –> only affect papillary layer of dermis
- deep partial thickness burn –> affect papillary and reticular layer BUT NOT the whole thickness
3rd degree/full thickness –> all thickness of epidermis and dermis
4th degree/deeper injury –> epidermis, dermis and hypodermis
What does 1st degree burn look like?
- Red, dry, localised pain
- Wound blanching on pressure + rapid refill, erythema, no blisters
- Replaced with cells from stratum Basale without significant scarring
- Healing within 3-6 days
What does 2nd degree burn look like?
Superficial partial thickness burn: only affect papillary layer of the dermis
- Wound blanching on pressure + slow refill, more painful
- Red and with clear blisters, wet/weeping
- Healing within 1 to 3 weeks
Deep partial thickness burn: affect reticular layer but not the whole thickness
- Vary in colour from yellow to white to red
- Damage to nerve and blood vessels –> no wound blanching on pressure + sluggish refill, minimal pain on apply pressure
- 3 weeks to a few months + scar
What does 3rd degree burn look like?
- Waxy white to grey or black
- Wound blanching doesn’t occur, Elastin damage causes the burn to be stiff or inelastic
- Pain feels like deep pressure –> relatively painless due to nerve damage
- Burn does not heal by itself
What does 4th degree burn look like?
- Charred black, dry, painless, significant oedema, numbness
- Patches of dead skin
- Minor healing at edges, often require skin grafting or possible amputation
What are different zones of burns?
Zone of coagulation
- A central zone of irreversible, coagulative necrosis (due to ischemia)
Zone of stasis
- Surrounds the central zone and is comprised of damaged but viable tissue with decreased perfusion
Zone of hyperaemia
- savable with enough fluid resus
- Surrounds the zone of stasis and is characterised by inflammation and inc blood flow
What are some complications of burns?
- Infections ESPECIALLY pseudomonas aeruginosa 4 days after burns most common cause of sepsis Staphylococcus aureus is the first pathogen to enter - Water loss Systemic complications - Haemodynamic instability --> SHOCK - Resp function - Hypovolaemia - Hypothermia - Hypermetabolic state - Major organ dysfunction such as kidneys - Infection sepsis
What are different stages of healing?
- Reactive
Haemostasis and inflammation - Proliferative/repair
Granulation tissue
- Vascular granulation tissue –> network of newly formed capillaries, macrophages
- Fibrovascular granulation tissue –> proliferating fibroblasts, capillaries and macrophages
- Fibrous granulation tissue –> fibroblasts synthesise collagen and align themselves into uniform pattern - Maturing/remodelling
- Macrophages move into the tissue to remove dead cells
- Fibroblasts create new collagen to heal the damaged skin
Collagen accumulation
What are some ways to measure burns?
Rule of nines (11 regions of body parts, each is 9% + 1% of groin region)
Lund and Browder chart
Palmar method
What is the Rule of nine?
- First degree of burns is not calculated, ADULT ONLY
- CHILDREN: larger head and smaller limbs –> LUND AND BROWDER CHART + age of the child
- Not suitable for children or obese people
head front back --> 9% (front: 4.5%) chest: 9% back: 9% front abdomen: 9% back abdomen: 9% left arm: 9% (front: 4.5%) right arm: 9% (front: 4.5%) left and right leg front: 9% EACH left and right leg back: 9% EACH
Why is lund browder chart more accurate?
- Age specific
- More accurate methods for both adults and children
What is palmar method?
- Palmar surface of the patient’s hand
- Including palm and fingers
- 1% of TBSA
What are some clinical symptoms of shock?
Hypotension, poor urine output, dyspnoea
What are some symptoms for circumferential burns?
Circumferential burns around limbs
- Compartment syndrome
- Features of acute limb ischemia: weak/absent pulse, paraesthesia, pallor
Circumferential burns around abdomen
- Abdominal compartment syndrome: oliguria, acute pulmonary decompensation, hypoperfusion
- Signs of inc intraabdominal pressure: raised JVP, hypotension, tachycardia