Lecture 7 - Burns

Question 1

How many people are injured as a result of burns per year? what percentage at home? what percentage at work?

Answer 1

220,000
69%
9%

Question 2

What does skin do

Answer 2

protects against bacteria
prevents fluid loss
regulates temperature
initiates immune response
sensation 
aesthetics

Question 3

What are the common mechanisms for a burn in adults and children

Answer 3

flame (44%), scald, contact, chemical, friction, electric, radiant

scald (55%) …. same as above

Question 4

True of false: >44 degrees causes denaturation of proteins and loss of plasma membrane integrity and cell tissue damage

Answer 4

true

Question 5

What is burn severity determined by

Answer 5

% total body surface area (TBSA)
location
depth

Question 6

Describe the classification of a severe burn. Severe burns = ….

Answer 6

>20% TBSA adults, >10% old or young 
>5% full thickness 
inhalation injury 
high voltage 
significant burns to hands, feet, genitalia, joints

Question 7

What is a superficial burn

Answer 7

1st degree
epidermis only
Sunburn

Question 8

What is a partial thickness burn

Answer 8

• 2nd degree
• superficial dermal (2-3 w to heal), mid dermal, deep dermal (3 w to heal)
  blistering painful
  increased blood flow due to vasodilation
  capillary refill slow

Question 9

what is a Full thickness burn

Answer 9

3rd/4th degree
down to subcutaneous tissue - fat, muscle, bone
leathery
capillary refill absent

Question 10

What is circumferential full thickness

Answer 10

excessive swelling under rigid eschar compromises underlying circulation

Question 11

How do you determine the prognosis of a burn

Answer 11

age + %TBSA

<80 = good
80-100 = life threatening 
>100 = poor

Question 12

What is the treatment for a full thickness burn and a partial thickness burn

Answer 12

full = graft 
partial = debridement/graft

Question 13

what are the 2 types of grafts

Answer 13

meshed

sheet

Question 14

what are some factors associated with poor healing

Answer 14

age, smoking, circulation issues, diabetes, patient non-compliance with orders of immobilization

Question 15

who is at greater risk of scar

Answer 15

mid dermal burns 14-21 may scar, >21 days will scar
full thickness = scar
younger the patient the more active the scar
skin type - dark pigment
genetics
length of time to healing

Question 16

what are 2 types of scars

Answer 16

hypertrophic - above level of surrounding skin, hard/dry, highly contractile

keloid scar - delayed onset, beyond initial wound area

Question 17

Burn management

Answer 17

1. positioning/splints to prevent contracture
2. exercise - reduce effects of immobilization, maintain jt ROM, stretch scar tissue
3. pressure - dampen blood flow, short term - edema management, long term - scar management
4. softening and moisturizing - dressings

Question 18

What is the rule of 9s

Answer 18

Head - 9 - front 4.5 back 4.5 
thorax - 18 - front 9 back 9 
arms - 9 - front 4.5 back 4.5 
legs - 18 - front 9 back 9 
abdomen - 18 - front 9 back 9 
weiner - 1

Question 19

What is jacksons burn model

Answer 19

Zone of coagulation = zone nearest heat source is primary injury - irreversible tissue necrosis
Zone of ischaemia = surrounds coagulation, reduction in dermal circulation
Zone of hyperaemia = reversible increase in blood flow and inflammation

Question 20

what percentage of patients suffer from inhalation injury

Answer 20

30%