Week 11: Burns Flashcards
What are the classifications of Burn Wound Depth?
Epidermis - Superficial - 1st Degree
Dermis
—-> superficial partial - 2nd degree
—-> deep partial - 2nd degree (almost full dermal damage)
—–> full-thickness - 3rd degree (full dermis damage)
Subc. fat & below: 4th degree
Define burn:
term that describes cutaneous injury
Where does a 1st degree burn take place?
epidermis; superficial
Where does a 2nd degree burn take place?
Dermis;
- superficial partial
- deep partial (almost full dermis damage)
Where does a 3rd degree burn take place?
Full dermis damage; called full thickness
Where does a 4th degree burn take place?
beyond the epidermis, dermis, and subcutaneous tissues.
What does a 1st degree burn look like?
- dry
- no blisters
- initially, there is pain/redness
What is the healing process like for 1st degree burns?
- 3-5 days, no scars
What are the characteristics and symptoms of a 2nd degree burn (superficial partial)?
- blisters
- pain
- nerve exposed
ex. scald injuries (boiling water)
3-4 weeks healing, minimal scar
What are the characteristics and symptoms of a 2nd degree burn (deep partial)?
- waxy white; skin may peel off in sheets :0
- takes weeks to heal…hypertrophic scaring (bumpy, elevated scar)
What are the characteristics and symptoms of a 3rd degree burn? (7)
- white colour, or cherry red/black
- blisters rare
- edema
- no elasticity
- dry, leathery
- may involve muscle/bone
- no pain :0
What are the characteristics and symptoms of a 4th degree burn?
- need huge surgery, flaps / amputation
- painless
A person arrives at the ER with a burn injury. The burn area is covered with thin-walled, fluid-filled blisters and is very painful. The nurse suspects this is a:
a) first-degree injury
b) superficial partial-thickness injury
c) deep-partial-thickness injury
d) full-thickness injury
b
How do we estimate extent of burn injury?
TBSA (total body surface area)
What are the 2 burn injury phases?
Ebb phase
- occurs during immediate postburn period; continues for 72-96 hrs
- HYPOmetabolic state; “everything goes low”
——-> low O2 consump., low intravas. V, Low CO, poor tissue perfusion, cell. shock
Flow (catabolic) phase
- after resolution of shock & restoration of circ. V
- HYPERmetabolic state; “everything OVERDRIVE”
—–> increased O2 consump., BP up, insulin resistance,
—–> up: catecholamines, gluco…
Persists until wound closes
In the rule of nines, how are the numbers distributed?
1 = crotch
36 = torso
9 = head
9 + 9 = both arms
18 +18 = both legs
Immediate (acute) consequences of major burn injuries include:
- LIFE-THREATENING hypovolemic shock within few hours of burn injury
——> massive fluid losses from circ. blood V
——> caused by INCREASE in cap. perm. (continues for 24hrs after burn injury)
2 components:
- cadiovas.
- cell.
Cardiovascular response to burns include:
- leads to hypometabolic response
—–> low CO - increased levels of NITRIC OXIDE after burn
——> can DEPRESS cardiac function
*heart doesn’t pump as hard, pt. has LOW CO…big problem b/c pt. is already losing so much fluid…can be back into shock :( - but then stress mediators (ex. catecholamines, glucocorticoids, and cytokines) released!!!
——-> heart goes into overdrive, up circ. and blood flow…up O2 and nutrient deliver :D
Cell. response to burn injury includes:
apoptosis
Metabolic response to a burn injury includes:
- recognizing that there is a pump malfunction, so ions are imbalanced, which leads to the following problems:
—–catecholamines up
—–gluconeogenesis, lipolysis, proteolysis up
—–plasma free fatty acids up
—–etc.
Define hypermetabolic state:
increase and resetting of thermal regulatory set point…vasodilation!
Immunologic response consists of:
- inflammation
- suppressed immunity
- changes in intestinal flora; cell death, concern for sepsis…
In terms of evaporative water loss…
“water loss via lungs increases by hypermet. and hypervent.”
lots of vapour is produced when pt. in hypervent. mode! replace losses!!!
whole body catabolism can lead to…
organ dysfunction , sepsis, death
What is “capillary seal”?***
forms at the endpoint of burn shock; forms when urine output goes back to normal
- fluid is circulating back into the vessel
- seal, fluid no longer lost…can draw water back in…
??Life-threatening hypovolemic shock…???
??slide 19
??evaporative water loss cslide 25
??slide 28
??Slide 30
- protect the airway
- edema in airway!
- fluid resuscitation causes edema
???
watch for urine output, 1mL/kg/hour in kids weighing less than 30 kg.
??slide 47***
- small degree edema
—–> increased work of breathing in children
—–> constriction of chest and impair. of resp excursion in very young children
??slide 51
??Immune function: what happens to kids after burns.
Proinflamm
immunosuppressed
??when are grafts used
- deep 2nd degree
- 3rd degree
to close up a wound
??When are flaps used?
4th degree burn
