Unit 1 - Week 3 - Wound Etiology - Burns

Types of burns

thermal, chemical, electrical, radiation

what is the severity of thermal burns based on?

Contact time and temperature

Are alkaline or acidic burns more severe?

Alkaline burns

Superficial burn

Bright red skin that blanches with pressure, resolves in 3-5 days without a scar.

superficial burn degree

1

superficial burn pattern

pattern B

Superficial partial thickness burn

Painful, moist, weeping, blistering. Blanches with immediate capillary refill. Resolves in 10-14 days with minimal or no scarring

Brief contact burn, flash burn, brief contact chemical burns

Superficial partial thickness pattern

PT pattern C

Superficial partial thickness degree

2 superficial

Deep partial thickness burn

Mottled areas of red white eschar, blistering, may have areas of insensitivity due to the killing of receptor cells. 3 or more weeks to heal. Scarring, pigment changes, contractures.

severe sunburns, scald, flash burn, brief contact with dilute chemicals

deep partial thickness PT pattern

Pattern C

deep partial thickness degree

deep superficial 2

Full thickness Burn pattern

PT Pattern D

Full thickness Burn DEGREE

third degree

Full thickness burn

Initially red, then mottled white/black, dry leathery eschar, and very painful. Scarring and contractures are likely, and surgical debridement and grafting are likely. Insensate to light touch

Prolonged contact with flame, immersion scald injury

Subdermal burn

Charred, mummified appearance that exposed deep tissue. Possible permanent nerve damage, requires surgery and possible amputation.

electrical and strong chemical

Subdermal burn PT pattern

Pattern E

Subdermal burn PT DEGREE

4TH DEGREE

Zone of coagulation

central portion, irreplaceable damage. coagulation, ischemia, necrosis.

Zone of stasis

Area of cellular injury and compromised perfusion

Conversion: widening and deepening of necrosis

Zone of hyperemia

Outer edges, minimal cellular injury

Rule of 9 for burns

Estimate percentage of body surface area burned

Lund-Browder

scale used to assess surface area of burns in children under 16

How is the cardiovascular system effected with burns?

Fluid resuscitation is important because fluids are severely drained

How is the respiratory system compromised with burns?

damage from smoke inhalation, carbon monoxide poisoning, pulmonary edema, PNA, ARDS

ARDS

adult (acute) respiratory distress syndrome

______ injuries cause up to 20% of burn deaths

Inhalation

How is metabolism effected with burns?

BMR doubles to triples.

How is the immune system effected with burns?

Infection is common. Aggressive and early debridement is important.

Orthopedic effect from burns

fractures and muscle injuries.

Management techniques for burns

-Screen for domestic violence

-anticipate/prevent

-pain management

-debridement

-topical antimicrobials are standard.

-Sterile techniques.

-Monitor for infection

With burns, do you want open or closed blisters? why?

Open. Fluid is a breeding ground for infection

What type of dressings for burns?

-Topical antimicrobial covered with non-adherent impregnated gauze, bulky, gauze dressing.

-Splints

-Short stretch compression to decrease edema and scarring.

Compression is mandatory for burn wounds if it takes how long to close?

3+ weeks

Management for scars from burns

moisturizer, scar mobilization

Area susceptible to contracture with burns

anterior neck, axilla/shoulders, cubital fossa, ankle, posterior knee.

surgical treatment for burns

-Debridement

-Escharotomy

-Fasciotomy

When to debride a burn

Early for medium, and large full thickness

Escharotomy

Incision through eschar and subcutaneous tissue to release tissue constricting circulation

Fasciotomy

incision through fascia to release pressure/improve distal circulation

Skin grafting is done for what stage burn?

Full thickness, and deep partial thickness

autograft

transplantation of healthy tissue from one site to another site in the same individual

allograft

skin graft from another person or a cadaver

Xenograft

a graft from another species

Split thickness graft

removes epidermis and part of dermis, meshed with sheet

Full thickness graft

Durable and mostly cosmetic

Skin substitutes

bilayer dressings with epidermal and dermal analog. uses donor sites and wounds.

Cultured epithelial autographs

cultures patient's' own cells. Grown in lab and stapled/sutured in place.