GMED3009- Surface Trauma & Burns Flashcards
Define Burns
traumatic injury to the skin or other organic tissue primarily caused by heat or exposure to electrical discharge, friction, chemicals, and radiation.
Mechanisms of Burns
Heat, electical, radiation, friction, chemical, inhalation
What are the 3 types of Burns?
1) Superficial (1st)= epidermal layer only
2) Partial thickness (2nd) = epidermal and partial detmis- blistering occurs (1-3 weeks)
3) Full thickness (3rd) = detroys all layers of the dermis (3-4 weeks )
4) Deper (4th)= burns extend throgh the skin to other extremities - subcutatnous, fascia, bones ( 4+ weeks)
Aetiology of burns
- caused by mechanism of injury
- Falls, MVA, cuttinng/ piercing objects, enviromental factors, foreign bodies
Risk factors- young and elderly, males, occupuation
What are the 3 zones of tissue injury?
1)** central zone of coagulation **- dead or dying cells as a result of coagulation necrosis and absent blood flow. It usually appears white or charred.
2) The intermediate zone of stasis- red and may blanch on pressure, appearing to have an intact circulation. By the third day, the intermediate zone of stasis becomes white because its superficial dermis is avascular and necrotic
3) outer zone of hyperaemia is a red zone that blanches on pressure, indicating that it has intact circulation. By the fourth day, this zone has a deeper red colour. Healing is present by the seventh day
What happens to pts with 30%+ TBSA burn?
1) cytokines and other mediators are released into the systemic circulation, causing a systemic inflammatory response syndrome (SIRS).
2) Because vessels in burned tissue exhibit increased vascular permeability, an extravasation of fluids into the burned tissues occurs.
Define Hypervolemia
Hypervolemia is the immediate consequence of this fluid loss, which accounts for decreased perfusion and oxygen delivery.
What are 5 common effects of burns?
In patients with serious burns, release of catecholamines, vasopressin, and angiotensin causes peripheral and splanchnic bed vasoconstriction that can compromise in-organ perfusion (MODS)
Myocardial contractility also may be reduced by the release of inflammatory cytokine tumour necrosis factor-alpha.
Hypervolemia + Odema is the immediate consequence of this fluid loss, which accounts for decreased perfusion and oxygen delivery
Hypothermia
Clincal assessment performed with pt with burns
“rule of nines” is a practical technique for estimating the extent of TBSA involved in a burn injury. This approach divides the major anatomic areas of the body into percentages of TBSA
“lund bowder chart”- used in paediatrics
Define Escharotomy
Full-thickness circumferential burn of an extremity can result in vascular compromise- loss of doralis and pedis artery signals
- incision is made to relased pressure
Define Escharotomy
Full-thickness circumferential burn of an extremity can result in vascular compromise- loss of doralis and pedis artery signals
- incision is made to relased pressure
Purpose of calculating fluids needs
The goal of fluid resuscitation is to prevent hypovolaemic shock.
The purpose of fluid resuscitation is to restore effective plasma volume, avoid microvascular ischemia, and maintain vital organ function. The amount of fluid required varies with the patient’s age, body weight, and extent of burned TBSA.
Parklands formula for fluid resuscitation
lactate ringer solution administered IV first 24hrs
- 1 half first 8 hrs other half admistred over next 16 hrs
3-4ml x kg / TBSA
What is the purpose of acticoat
antimicrobial properties of the silver ion by coating the dressing material with a thin, soluble silver film. This dressing appears to maintain antibacterial levels of silver ions in the wound for up to 5 days
Nursing management for pt with burns
- A to E assssment
- fluid therapy
- monitor urine output/ vitals
- Lab studies- FBC and ABG’s
- O2 therapy
- pain assessment
