Burns

Epidermal burn (1st degree) presentation

Pink or red skin, no blisters, delayed tenderness

Superficial partial-thickness burn (2nd degree) presentation

Bright pink or red, blanching with brisk refill, intact blisters, very painful

Deep partial thickness burn (2nd degree) presentation

Mixed red and waxy white, blanching with slow refill, broken blisters, wet surface, insensitive to light touch

Full thickness burn (3rd degree) presentation

White, tan, black, no blanching, thromboses vessels, leathery, hair pulls out easily

Subdermal burn (fourth degree) presentation

Charred, subcutaneous tissue evident, muscle damage

What burn wound classifications have spontaneous healing? Require skin grafts? Scarring?

Spontaneous- epidermal and superficial partial thickness

Skin grafts- full thickness and subdermal

Scarring- Deep partial thickness, full thickness, subdermal

Insenate

without feeling

Electrical burns- least resistance to most resistance

Nerves

Blood Vessels

Muscles

Bone

Electrical burns- entrance vs exit wounds

Entrance- charred and depressed, smaller

Exit- Typically at ground site, appears like an explosion out of the tissue

Electrical burns- viable vs not viable tissue

Due to attacks of vascular walls, and unpredictability, days are required to determine what tissues will be viable

Zone of coagulation

The area of the burn that received the most severe injury with irreversible cell damage

Zone of stasis

area of less severe injury that possesses reversible damage (may die in 24-48hrs without diligent treatment) and surrounds the zone of coagulation

zone of hyperemia

The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage

Rule of 9s

Calculations for assessing percentage of body surface burned.

Burn infection complication: what bacteria count constitutes infection and what is used to treat

10^5 bateria per gram of tissue

Systemic antibiotics

Burn pulmonary complication: signs of inhalation injury

facial burns, singed nose hairs, harsh cough, hoarseness, abnormal breath sounds, distress, sputum, hypoxemia

Burn pulmonary complication: diagnostic procedure

Bronchoscopy

Burn metabolic complication: what occurs

Metabolic rates increase rapidly with increase in TSBA burn, causing decrease in weight, decrease in muscle mass, negative nitrogen balance, decrease in energy stores

Burn metabolic complication: should room be kept warm or cool

Warm (86dgs F) to reduce metabolic rate

Burn cardiovascular complication: what occurs

Rapid fluid shift to interstitial, requiring fluid replacement therapy and significant edema

Burns and heterotrophic ossification

Uncommon complication following burns, but increases with increased TSBA burns

Burns and neuropathy: peripheral neuropathy and local neuropathy causes

Large TSBA burns can cause peripheral neuropathy that typically resolves over time

Local neuropathies result from compression bandage too tight, poor fitting splints, prolonged poor positioning

Common contracture for anterior neck burn

Flexion

Common contracture for shoulder-axilla burn

Adduction and IR

Common contracture for elbow burn

flexion and pronation

Common contracture for hand burn

Claw hand

Common contracture for hip and groin

Flexion and adduction

Common contracture for knee

Flexion

Common contracture for ankle

Plantarflexion

Critical burn classification

10% of body with 3rd dg burns and 30% with 2nd degree

Moderate burn classification

2-10% with 3rd dg burns and 15-30% with 2nd degree

Minor burn classification

Less than 2% with 3rd dg burns and less than 15% with 2nd dg

Hypertrophic scar

Raised scar that stays within boundary of burn

Keloid scar

Raised scar that extends beyond boundaries of original burn

Hypotrophic scar

flat & depressed below surrounding skin

Allograft

use of tissue from another person

xenograft

a graft from another species

Biosynthetic graft

combination of collagen and synthetics

Cultured skin

laboratory grown from patient's own skin

Autograft

skin graft from a person's own body

Split thickness graft

a skin graft that contains only a superficial layer of the dermis in addition to the epidermis

Full thickness graft

a skin graft that contains the dermis and epidermis

Autolytic dressings

use of moist dressings such as hydrogels or hydrocolloids to help remove eschar

Surgical or sharp debridement

excision of eschar using sterilized surgical instruments

Enzymatic debridement

using topical substances that break down dead tissue

Mechanical debridement

Physical removal of debris by irrigation, hydrotherapy or wet-to-dry dressing application