LO9 Burns (Chapter 17) Flashcards
epidermis
dermis
epidermis is the surface layer
dermis is a thick layer of collagen connective tissue under the epidermis
–Contains the important sensory nerves and also support structures such as hair follicle sweats glands and oil glands
Superficial (first degree)
minor tissue damage to the outer epidermis layer only
Partial thickness (second degree)
cause damage through the epidermidis and into a variable depth of the dermis
Will heal often without scarring because the cell lining the deeper portions of the hair follicle and sweat glands when multiplying grow new skin for healing
Emergency care involves cooling the burn and covering it with a clean dry dressing
full thickness (third degree)
caused damage to all layers of the epidermidis and dermis no more skin cells are left so healing by regrowth is impossible
Leave scars usually result in skin proteins becoming hard and forming a firm leather like covering
Critical problems in burn patients that require immediate intervention:
Airway compromise
Altered LOC
Prescence of major injuries
Rapid trauma for burns
Directed towards identification of causes of breathing and circulatory compromise after controlling any possible major haemorrhage
Clues from the mechanism of injury finding such an alert to respond to potential airway problems
are the presence of facial and scalp burns Sooty septum and singed nasal hair and eyebrows
Ask a patient to speak
hoarseness, strider and persistent cough suggest involvement of deeper airway structure and indicate the need for aggressive airway management
Wheezing or rails
should alert you to the presence of lower airway injury from inhalation
Patient management
Cool burn with tap water at room temperature for no more than 5 to 10 minutes
Managed to burn by covering the patient with a clean dry sheets and blankets to help keep the patient warm
Patient should never be transported on wet sheets wet towels or wet clothing and ice is absolutely contraindicated
If available lactated ringer’s solution is preferred for fluid resuscitation and major burns
Circumferential burns
Full thickness burns result in the formation of an eschar that is tough and unyielding if the full thickness burn is circumferential the eschar can act like a tourniquet and result in loss of circulation to the extremity it burn Edema develops
Flash burns
Virtually always superficial partial thickness burns the flash burn occurs when there is some type of explosion but no sustained fire a single heat wave travelling from the exposure results in short patient he contact that full thickness burns almost never occur
Inhalation injury
Inhalation injuries are classified as carbon monoxide poisoning, heat inhalation injury or smoke inhalation injury
Occur when a patient is injured in a confined space or trapped
Carbon monoxide poising
And asphyxiation are by far the most common causes of early death associated with burn injury
Spo2 will remain high and cannot be used to assess patients for carbon monoxide poisoining
Death usually occurs because of either cerebral for myocardial ischaemia myocardial infarction due to progressive cardiac hypoxia
It takes up to — hours to reduce the carbon monoxide
It takes up to seven hours to reduce the carbon monoxide/hemoglobin complex to a safe level having patients breathe 100% oxygen decreases this time to about 90 to 120 minutes
Cyanide and smoke inhalation
Highly toxic and causes cellular hypoxia by preventing the cell from using oxygen to generate energy to function
Heat inhalation injuries
Confined to the upper airway because breathing in flamen hot gases does not result in heat transport down to the lung tissue itself
Steam inhalation is an exception to this rule because steam is super heated water vapour
If the patient has inhaled a flammable gas that then ignites and causes thermal injury to the level of the alveoli
airway swelling
Hypopharynx is where the swelling occurs and it can easily progressed to complete airway obstruction
Be aware that once the swelling begins the airway can obstruct rapidly
Development of a horse voice or strider is an indication for immediate protection of the airway an endotracheal intubation if possible the oxygen being administered should be humidified air
Aggressive fluid resuscitation can cause faster swelling of the airway
Smoke inhalation injuries
The results of inhale toxic chemicals that cause structural damage to the lungs
They can precipitate bronchospasm or coronary artery spasm
Chemical burns
May not only injure the skin but can also absorb into the body and cause internal organ failure
Factors that lead to tissue damage include chemical concentration, amount, manner and duration of skin contact, and the mechanism of action of the chemical agent
The pathological process causing the tissue damage continues until the chemical is either consumed in damage process, detoxify by the body or physically removed
Electrical burns
Damage is caused by electricity entering the body and travelling through the tissues
Injury results from the effects of electricity on the function of the body organs and from the heat generated by the passage of the current
Determine severity of electrical injury include the following:
Type and amount of current
Path in current through the body
Duration of contact with the current source
The most serious immediate injury that results from electrical contact
is cardiac arrhythmia
PVCs, V tach and V fib
Continuous monitoring of cardiac activity
Due to the potential for arrhythmia development IV access should be initiated along with continuous cardiac monitoring IV fluid resuscitation should be started during transport
Lightning injuries
Lightning injuries very different from the other electrical injuries in that lightning produces extremely high voltage and current but has a very short duration
The most serious effect of lightning strike is cardio respiratory arrest
The respiratory drive centres of the brain are depressed by the current discharge and take longer to recover and resume the normal respiratory drive patient remains in spite her arrest which is followed by cardiac arrest
Essential component of the management of lightning strike patient is restoration of cardiorespiratory function while protecting the C-spine
Radiation burn
Skin burns and radiation look exactly like thermal burns and cannot be differentiated by their parents however radiation burns develop slower over days and heals very slowly
Not radioactive unless they are contaminated with radioactive material
Non-contaminated radiation burn patients are initially treated the same way as any burn patient
Circumferential burns
Circumferential full thickness burns can lead to neurovascular compromise
Burns that are circumferential on an extremity can act as a tourniquet as edema
Parkland burn formula
4ml x %burn area x body weight kg= amount for first 24hrs half given in first 8hrs
Rule of 10s fluid resuscitation
Estimate Burnside to the nearest 10%
Multiply percent of burn times 10 = initial fluid rate in ml/hr patient weighing 40 to 80 kg
For every 10 kg above 80 kg increase the rate by 100 mL per hour
