Lecture 6 Burns Flashcards
Severity of a thermal burn injury is related to?
- temperature
- duration of exposure
- thickness of involved skin
Frostbite
- caused by direct cellular damage & death from direct cold insult
- typical distribution in patient is distal
- often associated with alteration in mental status
Risk factors of Frostbite
- prolonged exposure to below-freezing temp
- Wind chill factors
- wet/constricting clothing
How long can tissue destruction occur for chemical burns?
- up to 72 hours
What are chemical burns?
- Reaction between tissue components & chemicals > Release of thermal energy absorbed by the skin
Acid Chemical Burns
- Superficial injuries
- Coagulation and necrosis
- induces protein breakdown
Alkali Chemical Burns
- “soupy” wound
- continues dissolving the skin until neutralized
- can induce further chemical reactions causing a deeper injury
Entrance site & exit site of Electrical injury
- Entrance site: electricity meets skin’s resistance
- Exit site: electricity leaves the body to find its ground
What is the iceburg effect of Electrical Injury?
- Damage can be hidden under intact skin
- May require immediate surgical intervention
Pathophysiology of Inhalation Injury
- Inflammation
- Necrosis of epithelium
- Mucosal slough
How is Burn Size measured?
- in percent of the total body surface area
- include areas of partial & full thickness only
Degrees of Burn
first degree - superficial
second degree - superficial / deep
3rd / 4th degree - full thickness
1st degree Burn
- Epidermis
- erythema
- Moisturizer to reduce pain
- Reepithelization within 48 hours
2ed degree burn - Superficial
- Upper level of dermis
- blister, eschar with severe pain
- Epithelialization within 10-14 days
2ed degree burn - Deep
- Delayed healing
- Absence of blisters
- Superficial nerve endings damaged
- Increased risk of hypertrophic scarring
Full thickness Burn
- white, yellow, brown
- no pain
- Grafting necessary
Antibiotic dressing is used for?
- superficial partial thickness burn that have minimal to no adherent eschar
- small, clean granulating wounds & facial burns
Goals of Burn wound care
- Prevent infection
- Provide clean and moist environment
- Temporary wound coverage
- Protect exposed tendons
Split Thickness Skin Graft
- Epidermis and part of dermis
- From thigh or abdomen
- Sensory recovery begins 4-5 weeks
- Hair rarely grows
Full Thickness Skin Graft
- Epidermis and entire dermis
- Higher quality of skin cover
- less wound contraction
- Donor requires graft
- Mostly used for palm and sole of feeet
Escharotomy
- Circumferential burn
Fasciotomy may be required in?
- Delayed escharotomies with prolonged ischemia
- Electrical injuries
- Associated burn & soft tissue trauma
Precautions/Considerations During Acute Burn Management
- Exposed tendon/bone
- Circumferential Burns
- Areas for high risk of contractures
- Heterotopic Ossification
- Amputation
- Pins
What is not a predictor of Hypertrophic Scarring
- Gender
Principles of Hypertrophic Scarring
- 1st & 2nd degree burns usually do not scar
- Early healing/ grafting decreases scarring
- Race may predict severity of scarring
Hypertrophic Scars
- Remain within boundaries of wound
- Collagen synthesis > normal skin
- Aligned collagen with decreased tensile strength
Keloid Scar
- Extends beyond boundaries of wound
Atrophic Scar
- Depressed wound area
- Skin attaches to deeper structures
How long is Pressure Garments applied for?
- 23 hours per day for approximately 1 year until scars mature
When can custom garments be initiated?
- when burn injury is almost healed and no edema is present
How many sets of garments should patient wear?
- 2, one to wash and one to wear
