Week 11: Burns

Question 1

What are the classifications of Burn Wound Depth?

Answer 1

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

Question 2

Define burn:

Answer 2

term that describes cutaneous injury

Question 3

Where does a 1st degree burn take place?

Answer 3

epidermis; superficial

Question 4

Where does a 2nd degree burn take place?

Answer 4

Dermis;
- superficial partial
- deep partial (almost full dermis damage)

Question 5

Where does a 3rd degree burn take place?

Answer 5

Full dermis damage; called full thickness

Question 6

Where does a 4th degree burn take place?

Answer 6

beyond the epidermis, dermis, and subcutaneous tissues.

Question 7

What does a 1st degree burn look like?

Answer 7

• dry
• no blisters
• initially, there is pain/redness

Question 8

What is the healing process like for 1st degree burns?

Answer 8

• 3-5 days, no scars

Question 9

What are the characteristics and symptoms of a 2nd degree burn (superficial partial)?

Answer 9

• blisters
• pain
• nerve exposed
  ex. scald injuries (boiling water)
  3-4 weeks healing, minimal scar

Question 10

What are the characteristics and symptoms of a 2nd degree burn (deep partial)?

Answer 10

• waxy white; skin may peel off in sheets :0
• takes weeks to heal…hypertrophic scaring (bumpy, elevated scar)

Question 11

What are the characteristics and symptoms of a 3rd degree burn? (7)

Answer 11

• white colour, or cherry red/black
• blisters rare
• edema
• no elasticity
• dry, leathery
• may involve muscle/bone
• no pain :0

Question 12

What are the characteristics and symptoms of a 4th degree burn?

Answer 12

• need huge surgery, flaps / amputation
• painless

Question 13

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

Answer 13

b

Question 14

How do we estimate extent of burn injury?

Answer 14

TBSA (total body surface area)

Question 15

What are the 2 burn injury phases?

Answer 15

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

Question 16

In the rule of nines, how are the numbers distributed?

Answer 16

1 = crotch
36 = torso
9 = head
9 + 9 = both arms
18 +18 = both legs

Question 17

Immediate (acute) consequences of major burn injuries include:

Answer 17

• 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.

Question 18

Cardiovascular response to burns include:

Answer 18

• 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

Question 19

Cell. response to burn injury includes:

Answer 19

apoptosis

Question 20

Metabolic response to a burn injury includes:

Answer 20

• 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.

Question 21

Define hypermetabolic state:

Answer 21

increase and resetting of thermal regulatory set point…vasodilation!

Question 22

Immunologic response consists of:

Answer 22

1. inflammation
2. suppressed immunity
3. changes in intestinal flora; cell death, concern for sepsis…

Question 23

In terms of evaporative water loss…

Answer 23

“water loss via lungs increases by hypermet. and hypervent.”

lots of vapour is produced when pt. in hypervent. mode! replace losses!!!

Question 24

whole body catabolism can lead to…

Answer 24

organ dysfunction , sepsis, death

Question 25

What is “capillary seal”?***

Answer 25

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…

Question 27

??Life-threatening hypovolemic shock…???

Question 28

??slide 19

Question 29

??evaporative water loss cslide 25

Question 30

??slide 28

Question 31

??Slide 30

Answer 31

• protect the airway
• edema in airway!
• fluid resuscitation causes edema

Question 32

???

Answer 32

watch for urine output, 1mL/kg/hour in kids weighing less than 30 kg.

Question 33

??slide 47***

Answer 33

• small degree edema
  —–> increased work of breathing in children
  —–> constriction of chest and impair. of resp excursion in very young children

Question 34

??slide 51

Question 35

??Immune function: what happens to kids after burns.

Answer 35

Proinflamm
immunosuppressed

Question 36

??when are grafts used

Answer 36

• deep 2nd degree
• 3rd degree

to close up a wound

Question 37

??When are flaps used?

Answer 37

4th degree burn