Week 10 Flashcards
what is a burn?
a burn is an injury to the skin or tissue caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals
what are the WHO recommendations for treating burns?
- stop burning process - remove clothes and irrigate (20mins)
- extinguish flames, drop & roll, apply blanket, use water
- use cool running water to reduce temp of burn
- chemical burns - remove or dilute the agent by irrigating with large volumes of water
- wrap patient in clean cloth or sheet, transport to the nearest appropriate facility for medical care
what are the common burns for adults and paeds?
paeds - scalds (13-24mths)
adults - flames (20-29 yrs)
mostly at home
what is the burn rate for indigenous?
double in major cities
quadruple in regional areas
what is a burn injury?
more heat is absorbed by the body’s tissue than can be managed,
What are the types of burn?
thermal chemical mechanical friction radiation electrical exposure
What is the depth of the burn proportional to?
the duration of the exposure and the conductivity of the tissue
what are the layers of the skin?
epidermis
dermis
subcutaneous tissue
What is a superfiscial epidermal burn?
first degree burn?
superfiscial epidermal
eg. sunburn
Pathology: involves dermis only Appearance: dry and red Sensation: maybe painful Circulation: normal, increased Colour: red, warm Blisters: none
What is a superfiscial dermal thickness burn (partial)?
second degree burn
Superfiscial dermal thickness (partial)
Pathology: involves epidermis and upper dermis, most adnexal structures intact
Appearance: pale pink, small blisters, wound base blanches with pressure
Sensation: increased sensation, very painful and tender
Circulation: hyperaemic, rapid cap refil
Colour: pink
Blisters: yes (within hours)
What is a mid dermal thickness burn (partial)?
second degree burn
Pathology: involves epidermis and upper dermis, most adnexal structures intact
Appearance: pale pink, small blisters, wound base blanches with pressure
Sensation: increased sensation, very painful and tender
Circulation: hyperaemic, rapid cap refil
Colour: pink
Blisters: yes (within hours)
What is a deep dermal thickness burn (partial)?
second degree burn
Pathology: involves epidermis and significant part of dermis, only deeper adnexal structures in place
Appearance: blotchy red or pale deeper dermis where blisters have ruptured
Sensation: decreased sensation
Circulation: Sluggish cap refil
Colour: white/pale pink/blotchy red
Blisters: Early, usually large which rupture
What are full thickness burns (3rd degree)
Pathology: epidermis, dermis and cell adnexal structures destroyed
Appearance: white waxy charred. no blisters. no cap refil
Sensation: none
Circulation: none
Colour: white/charred/black
Blisters: epidermis and dermis destroyed. No blisters
what are the burns zones?
Zone of coagulation
Zone of stasis
Zone of hyperaemia
What is the zone of coagulation
occurs at the point of maximal damage
irreversible tissue loss due to coagulation of the constituent proteins
What is the zone of stasis?
decreases tissue perfusion
tissue is potentially salvagable. Aim of burn mgmt is to increase tissue perfusion & prevent further damage
What is the zone of hyperaemia?
Outermost tissue zone, perfusion is increased and tissue will likely recover
What is the systemic response to burns
over 30% TBSA:
- cytokines & other inflammatory mediators released from burn site
Cardiovascular system:
- capillary permeability
overall result: systemic hypertension and organ hypoperfusion
what is the cardiovascular system response to burns?
capillary permeability:
- loss of intravascular proteins and fluids into interstitial space
- peripheral & splanchnic vasoconstriction
- decreased myocardial contractility
- fluid loss from burns
what is the respiratory systemic response to burns
bronchoconstriction ARDS (adult resp distress syndrome)
what is the metabolic systemic response to burns
basal metabolic rate 3x normal rate
what is the immune systemic response to burns?
decreased regulation of response
- cell mediated and humoral pathways
wat should you consider with electrical burns?
- extent of injury may not be apparent
- look for entry and exit points
dmage occurs deep - damage progresses
- electricity contracts muscles so look for other injuries
- cardiac arrythmias may occur
- compartment syndrome is common
how do you treat chemical burns?
brush off powder
prolonged irrigation
