Exam 3 - Burns Flashcards
Functions of the Epidermis, Dermis, and Subcutaneous tissue
Epidermis – repels pathogens prevents fluid loss
•Dermis- largest portion of skin – gets structure and strength- contains a lot of nerve endings and sweat glands
•Subcutaneous tissue- cushion between skin and muscle and bone- helps regulate body temp
Functions of the skin:
• Protection – invasion of bacteria
• Sensation- temp, pain, pressure, light touch
• Fluid balance – has the ability to absorb water, insensible perspiration
• Temperature regulation
• Vitamin Production – synthesize vitamin D 5-30 min sun exposure twice a week
• Immune response
Effects on skin while we age
• Dryness
• Thinning of skin
• Loss of sub q tissue- loss of temp regulation – loss of protection of muscles and bones
• Sweat and sebaceous glans decrease
Factors the determine burn severity are
age, depth of burn, how much body surface area was involved, was it and inhalation injury, where is the burn at, as well as previous medical hx
Burn depth
- First degree – superficial, outermost layer of skin, epidermis is still intact (sun burn, touching stove)
- Second decree- Involved entire epidermis and some of the dermis – blisters – scalds, direct contact injury, flash flame
- Third degree- total destruction of the epidermis and dermis- damage of nerve fibers, leathery skin, hair follicles and sweat glands are destroyed – full thickness
- Fourth degree- deep burn necrosis, injury extends into deep tissue and bone – leads to amputations
Once burn goes past _____ of total surface area it will produce both local and systemic effects.
30%
Burns cause
-wound edema
–generalized edema
–increased O2 and glucose consumption
Zone of Burn Injury – (burns can evolve over time)
- Zone of Coagulation – right in the middle – cell death – necrotic tissue
- Zone of Stasis – right outside the middle of the burn- injured cells that may be viable if they get persistent profusion, if not it will die off in 24-48 hours
- Zone of Hyperemia – outside zone – minimal injury- likely to have full recovery of this skin tissue
What are the most common sites of injury
Skin and mucosa of upper airway are most common sites of injury
Electrical burns
Most complex of all the burn injuries because you cannot tell the extent of damage just by looking at the burn like you would be able to with other burn injuries- some of the burn could be occurring interiorly
Types of electrical burns
Flash injury
Conductive injury
Lightning injury
Flash injury
- Has to do with light and heat without current, ball of fire, quick and hot
- Fewer complications
Conductive injury
- Electrical current that travels through the body (could go into the hand, through the body and out the foot)
- Skeletal muscle injury
- Compartment syndrome
Lightning injury
- Direct strike of lighting or a side flash of lightning
- Messes with electrical system of the heart, may cause pts to cardiac arrest
- Can cause respiratory arrest
Compartment syndrome
the development of fluid/swelling around a bone blocking blood flow from any distal limbs. Their distal extremities will not have capillary refill, or their extremities will be cool to the touch. To treat this Drs may do an escharotomy (opens up skin and relieves pressure) – or a fasciotomy (cuts through fascia to relieve that pressure).
Labs for electrical burns
- CK levels- tells us muscle damage – myoglobin gets released which plugs up the kidney and caused burgundy colored urine. Increase fluids to flush out myoglobin
Systemic complications from burns: cardiovascular
decrease in CO, decreased plasma volume (leads to hypovolemia and hypotension) increased workload on the heart because of increased O2 demand, capillary leaking
Systemic complications from burns: fluid and electrolytes
edema forming, inflammatory mediators are getting released causing fluid and electrolytes to move into the interstitial fluid. These fluid shifts lead to compartment syndrome. Increased potassium levels, as time goes on fluid will shift again and you will see low potassium levels
Systemic complications from burns: Pulmonary Alterations
involve upper or lower airway. Upper airway involved when there is direct thermal injury to face or neck. Lower airway is when there is and inhalation injury and happens below the glottis.
Systemic complications: Upper airway assessments/signs
- Assess trachea
- Strider
- Drooling
- Difficulty swallowing
Tina Doesn’t Stop Drooling
Systemic complications: Lower airway assessments/signs
- Impaired gas exchanges
- Collapsed alveoli
- Crackles due to increased mucous production
- Bronchi may constrict causing wheezes
- Ineffective airway clearance
- Carbon monoxide poisoning- give 100% O2 to replace carbon monoxide molecule
Systemic complications: Kidney Alterations:
acute kidney injury (due to hypovolemia, not enough blood to the kidneys). Acute tubular necrosis (intra renal kidney injury because myoglobin in the urine is plugging up the kidneys). Observe for signs and symptoms of acute kidney injury.
Systemic complications: Immunologic Alterations:
pt looses their first couple layers of skin, puts them at a higher risk of infection
Systemic complications: Thermoregulatory Alterations
loss of skin pt looses ability to regulate body temp, may become hypothermic
