Clinical Management of Burn Injuries Flashcards
USAISR
US Army Institute of Surgical Research Burn Center (where all significant US Military burns are treated)
Criteria for Coming to Burn Center
Burns > 10% full thickness sig burn to hands, face, feet inhalation chemical/electrical burns in children concomitant trauma ***patients with special socieconomic needs
Epidemiology of Burns
2million burns per year
2001 (500k nonfatal burns reported; 3423 fatalities)
mostly men
Prevalence of Burn Location
25%--Arms and Hands 16%--Legs and Feet 6%--Upper Trunk 3%--Lower Trunk 5%--Other areas
High Risk Populations
Children
Elderly
Disabled
Military
Skin Anatomy
Body's Largest Organ 5 Layers (CLGSB) Basement membrane---super important
Basic Functions of SKin
protection from infection,puncture/UV rays conservation of body fluids temp regulation excretion/absorbtion vitamin D production sotrage of fat physical appearance
Burn Injury Types
Thermal–most common, cover with clean/dry cloth, no ice or cold water soaks (flame/flash)
Electrical–cutaneous and internal injury, cardiac monitoring X 24hours
Chemical
Radiation Burns–sunburn
What Leads to Burn Depth
Temperature
Duration of Contact
Dermal Thickness
Blood Supply
(time temp factor for Cellular Death(down to dermis:)--worse for pediatrics/geriatrics 120deg, 5min 130deg, 30s 140deg, 5s 150deg, 1.5s
Burn Depth Terminology
Superficial
Superficial Partial (papillary)
Deep Partial (reticular)
Full Thickness
Superficial Burn Charcteristics
Epidermis only
Heal less that 10days
red
incovenience
Superficial Partial (PTB)
epidermal and papillary pain,blisters, moist capillary refill present MOST PAINFUL ---analgesia, elevation, ROM (can heal on own--minimize edema)
Deep Partial Characteristics
Less pain no blisters dry mottled (blotchy white/red) absent/slow capillary refill
all dermal healing–granulation tissue from fibroblasts
about 30days
hypertrophic scar (so graft w/ static stress)—avoids contracture
Full Thickness
entire thickness of epidermis and dermis decreased pain dry/leathery/white absent capillary refill many have thrombosed vessles skin graft is absolutely needed escharotomy
—–excision and grafting (heals by contracture & epithelial ingrowth from edges)
Sub-Dermal Burns
Similar to FT but involves muscle, tendon, and or bone
What matters about burn severity
Age % Body Surface area Depth of Injury Location (face, hands, genitalia) Associated disease
Calculating Body Surface Area
Rule of Nines–See diagram
Better—-patient’s palmar surface=1%
Epithelial Wound Healing
begins within 24 hours
on surface of wound
Phase 1. migration 2. proliferation 3. differentiation (but don't initially have rete pegs--more likely to shear)
Dermal Healing
no your own skin---its scar formation Inflammatroy Phase 1.Vascular--vasoconstrict/vasodilate 2. Hemostatic 3. Cellular 4. Immune Proliferation 1. collagen synthesis Maturation
SKin Graft
taking a papillary layer from another tissue and grafting on top
Escharotomy
cut skin to relieve pressure (use specific lines)
primarily for circumferential burn, FT burn, loss of pulse, restricted skin excursion
Reconstructive Surgery Main Purposes
return to function
but also for astetic purposes (getting ear back)
Wound Excision and Grafting Characteristics
Done all of the time
Burns > 30% TBSA require several operative sessions
remove devitalized tissue
and then graft
Graft Priority
- Survival: get wound closed
- Function: hands,feet,joints, face
- Appearance: sheet graft on neck,face, and hands
