T2-Burns: Pathophysiology-Local Response

Question 1

Damage to human skin by heat results in 2 types of injury. What are they?

Answer 1

1. Immediate direct cellular response

2. Delayed response cause by dermal ischemia

Question 2

When does irreversible cellular damage from protein denaturation occur?

Answer 2

Burns from temps exceeding 113 F (45C)

Question 3

Edema formation: Vasodilation causes an increase in hydrostatic pressure within the capillaries. The increased hydrostatic pressure combined with the increase in capillary permeabilities causes what?

Answer 3

A loss of water, protein, and electrolytes from the circulating volume into the interstitial spaces

Question 4

Edema formation: Burn injury does not only cause edema at the site, but ____ & ____ fluid and ____ also enters non burned tissue

Answer 4

Extravasated and sequestered fluid and protein

Question 5

Edema formation: The directly injured cells have a damaged _____ that leads to an increase in _____ and ____ shift, resulting in cell swelling

Answer 5

Damaged cell membrane

Increase in sodium and potassium

Question 6

Edema formation: Intracellular water and sodium increase. This process not only occurs in injured cells, but also with those that are not directly heat injured. What develops when the rate of fluid being filtered from micro vessels exceeds that of lymph flow?

Answer 6

EDEMA DEVELOPS

Question 7

Edema formation: What does the amount of edema depend on?

Answer 7

Type and extent of burn injury

Question 8

Fluid loss: What can happen if fluid is not replaced?

Answer 8

Shock

Question 9

Fluid loss: Normal capillary barriers that separate the intravascular and interstitial compartments are disrupted, which results in what?

Answer 9

Severe depletion of plasma volume AND

Increase in extracellular fluid

Question 10

Fluid loss: A severe depletion of plasma volume and an increase in extracellular fluid, is clinically manifested as _____

Answer 10

Hypovolemia (shock, renal failure)

Question 11

Circulatory status: Where do significant circulatory alterations take place?

Answer 11

Zone of stasis located around the dead coagulated tissue

Question 12

Circulatory status: What do heated red blood cells become?

Answer 12

Spherical

Question 13

Circulatory status: Heat damaged cells + hemoconcentration from fluids + depressed CO + tissue edema= ____________.

Answer 13

Reduce the blood flow in the burned area resulting in capillary stasis

Question 14

Circulatory status: Reducing the blood flow in the burned area results in capillary stasis. What else may develop?

Answer 14

Thrombi

Question 15

Circulatory status: What happens if thrombi develop after capillary stasis has occurred?

Answer 15

Further impedes circulation and produces tissue ischemia and necrosis

Question 16

Circulatory status: What substances cause the production of micro emboli, platelet adhesion and aggregation, and increased pain and edema?

Answer 16

Thromboplastic and clot-activating factors from damaged cells

Question 17

Circulatory status: Circulation in the area around partial thickness wounds ceases _____ after injury but is usually restored within _____.

Answer 17

Ceases immediately, restored in 24-48 hours

Question 18

Circulatory status: Ful thickness burns, the vascular supply is completely ______, and no appreciable circulation is reestablished until _____ takes place at the interface between burned and unburned skin

Answer 18

Occluded; granulation

Question 19

Tissue repair: What kind of burns heal spontaneously within 14 days with minimum scarring?

Answer 19

Superficial partial thickness (2nd)

Question 20

Tissue repair: What burns heal more slowly by regeneration from the epithelial lining of skin appendages, sweat glands, and hair follicles?

A thin, epithelial covering develops in ___ days this type of burn may require several months to heal. Is scarring common?

Answer 20

Deep partial thickness (2nd)

25-35 days; yes

Question 21

Tissue repair: What can easily convert a partial thickness wound to a full thickness injury, especially in the normally thinner skin of young children?

Answer 21

Infection, trauma, or severe hypothermia

Question 22

Tissue repair: What burn has cell destruction by coagulation necrosis?

Answer 22

Full thickness burns

Question 23

Tissue repair: Full thickness burns, dead tissue and exudate convert to a thick, leathery eschar in ____; the eschar liquefies and begins to separate in _____ if not surgically excised. What is this process a result of?

Answer 23

leathery eschar= 48-72 hours
Eschar liquefies= 12-21 days

Process is a result of: autolysis, leukocyte digestion, and disintegration of collagen fibers

Question 24

Tissue repair: Full thickness burns

What does dead avascular tissue provide?

Answer 24

An ideal environment for bacterial growth

Question 25

Tissue repair: Full thickness

What happens if tissue is not grafted? What does this mean?

Answer 25

New granulation tissue forms on the wound bed

The wound heals slowly by proliferation from the edges–> HIGH RISK OF INFECTION AND SEVERE SCARRING

Question 26

Tissue repair: Full thickness burns result in ____ edema with ____ shifts and extensive ____ changes

Answer 26

Severe edema
Fluid and electrolyte shifts
Extensive metabolic changes