week 11-burns

Question 1

Superficial Partial Thickness Burn (used to be 1st degree)

Answer 1

• Localised epidermis injury
• blanching on pressure, mild swelling, tender, usually no vesicles or blistering
• Skin maintains function as water vapour & bacterial barrier
• not included in burn coverage calculation

Question 2

Partial Thickness Burn (used to be 2nd degree)

Answer 2

-Divided further into partial thickness & deep partial thickness
-Partial thickness: destruction of epidermis & upper layers of dermis, so barrier function of skin lost
presents as fluid-filled vesicles: red, shiny, moist, severe pain, Underneath vesicles: weeping, bright pink/red skin sensitive to temperature changes, air exposure, & touch
heal in 1 -2 weeks
-Deep partial thickness: destruction of epidermis & more of dermis
Very painful as pain sensors remain intact
Tactile sensation may be absent/greatly diminished
Mottled pink, red, or waxy white areas with vesicles & oedema
Vesicles resemble flat, dry tissue paper, rather than bullous blisters, up to a month to heal

Question 3

Full Thickness Burn (used to be 3rd degree)

Answer 3

-destruction of epidermis & dermis into subcutaneous tissue
-Fourth degree burn: damages muscle, bone & interstitial tissues
-Affect every body system & organ
-Dry, waxy, white/yellow to tan/brown, red or black leathery/hard skin
-Thrombosed vessels can be seen under burned skin, indicating underlying vasculature involved
-No pain – nerves destroyed
But: almost always surrounded partial thickness & superficial burns
-Oedema extensive in burn area & surrounding tissues
Within hours, fluids & protein shift from capillary to interstitial spaces  oedema

Question 4

layers of skin

Answer 4

epidermis
dermis
hypodermis
connective tissue

Question 5

burn zones

Answer 5

-Zone of Coagulation: middle of burn
Devitalised, necrotic, white, no circulation
Zone of Stasis: ‘circulation sluggish’
May convert to full thickness, mottled red
Zone of Hyperemia:
Outer rim; good blood flow, red

Question 6

pathophysiology of burn

Answer 6

• burn denatures all cellular proteins
• Some cells die due to traumatic/ischaemic necrosis
• Circulatory disruption occurs at site immediately after injury
• Causes abnormal osmotic & hydrostatic pressure gradients, forcing intravascular fluid into interstitial spaces
• Fluid lost from vascular, interstitial & cellular compartments, fluid shift occurs after initial vasoconstriction, then dilation

Question 7

Rule of Nines

Answer 7

Head & neck: 9%
Each upper extremity (arms): 9%
Each lower extremity (legs): 18%
Anterior trunk: 18%
Posterior trunk: 18%
Genitalia (perineum): 1%