Multiple Interacting Systems Flashcards
is defined as a traumatic injury to the skin, primarily caused by thermal or other acute exposures such as extreme cold, electricity, radiation or chemicals.
a burn
Almost _% of the burn injury patients die
6%
what is the most common type of burn injury?
a thermal injury
___ are dead and act as protection and forms water tight seal
outer cells in epidermis
____ divide to produce stratum corneum and also contains pigment to protect against UV radiation.
deeper layers of epidermis
Tough, elastic connective tissue which contains specialized structures including: nerve endings, blood vessels, sweat glands, oil glands, and hair follicles.
dermis
- epidermal layer
- no blister
- pain, dry, red and blanch with pressure
superficial
- blisters between epidermis and dermis
- painful, red or pink, moist and has a shiny appearance
- blanch with pressure
superficial partial-thickness
- blister deep into dermis
- damage to hair follicle and glandular tissue
- can have variable mottled colour from pale ivory to red
- does NOT blanch with pressure
deep partial-thickness
- all layers of dermis and often subcutaneous tissue
- eschar
- scarring
- hospitalization
full-thickness
Is the most accurate method for estimating TBSA for both adults and children
Lund-Browder Chart
is the area where tissue necrosis is irreversibly lost due to coagulation of the skin proteins and is evidenced by clotted blood and thrombosed blood vessels.
The zone of coagulation or necrosis
- is deep and peripheral to the necrosis zone
- at risk due to the decrease blood flow but it is potentially salvageable if perfusion is maintained and infection or edema is prevented
the zone of stasis or injury
characterized by minimal cellular injury with increased blood flow and should recover unless an invasive infection or profound tissue inflammation occurs
zone of hyperemia
Children have a proportionately ____ body surface area in relation to their height or weight
larger
This maintains a patent airway and is attached to a breathing machine or ventilator.
endotracheal tube
Removal of ___, of deep dermal and full-thickness burns, should occur within 48 hours of injury
eschar, devitalized tissue
It often requires a procedure called an escharotomy to release the constriction and this can be required early in the resuscitation.
a circumferential full-thickness burn
___ is the most prevalent plasma protein and this is decreased in burns
Albumin
Initially, with a major burn there will be a fluid shift phase lasting - hours with a peak around - hours
18-24 hours
6-8 hours
The greatest loss of intravascular fluid occurs in the first ___ hours
8-12 hours
often used to indicate the end of burn shock.
the capillary seal
With burns, there are 2 different mechanisms occurring simultaneously…
the loss of skin integrity and the systemic pathological response to the burn.
characterized by a hyperdynamic circulatory, physiologic, and immunologic response, that leads to a persistent and increased metabolic state that can least for days to weeks and even up to one year for a major burn.
hypermetabolic response
___ can actually inhibit the healing process so should not be used
Disinfectants
For deep partial-thickness and full-thickness burns, ____ should be removed early, usually within __ hours of injury.
eschar
48 hours
have potent antimicrobial properties, but do not penetrate eschar well.
silver-based agents
rapidly diffuses through eschar, and therefore a good agent for deep wounds when infection is suspected.
Mafenide acetate
When the pressure inside the burned area increases due to edema/fluid overload, it can lead to a
compartment syndrome
is an incision through the eschar (the dead dermis layer) only
escharotomy
is an incision through all involved fascial layers
fasciotomy
___ is a constant feature in severely burned patients, reflecting both increased glomerular permeability and decreased tubular absorption of filtered proteins
proteinuria
is associated acute tubular necrosis due to volume alterations, electrolyte disturbances, hormones, inflammatory mediators and toxic breakdown products such as myoglobin and hemoglobin.
early ARF
usually is secondary to hemodynamic changes associated with other burn complications such as sepsis or MODS.
late ARF
uses a pressure gradient, with dialysate fluid that facilitates the removal of toxic waste products.
hemodialysis (HD)
is the waste removal due to concentration gradients and ultra-filtration or convection is when fluid is removed based on pressure gradients namely the hydrostatic pressure of the blood in the dialyzer
diffusion
- contains thousands of hollow capillary membranes (tubes)
- allows for well controlled and predictable diffusion and ultrafiltration
hollow fibre dialyzer
is the progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury
MODs
is the immediate local or mild systemic response to the triggering event or illness
primary MODs
is the excessive systemic inflammatory response particularly to TNF, IL-1, nitric oxide and the influx of macrophages and neutrophils, which develops after a latent period and results in organ dysfunction.
secondary MODs
What does the onset of MODs begin with?
low-grade fever
tachycardia
dyspnea
altered mental status
what is the therapeutic management of MODs?
prevention and support
