RA II Burns and Excisions

Define burn

To oxidize or be oxidized by fire or equivalent means, creating a tissue reaction or injury:

a. Heat or flame

b. Extreme cold (frost bite)

c. Caustics

d. Radiation

e. Friction

f. Electricity (lightning strike)

Define inflammation

Reaction to tissues to injurious agents; usually characterized by heat, redness, swelling and pain.

Define blister

Thin vesicle on the skin containing watery matter

Define singe

To burn superficially, as the hair, which shows partial destruction from scorching heat.

Define charred

Reduced to carbon; state of tissue destroyed by burning.

What are the characteristics of a first degree burn?

• Pink or red skin

• Unbroken skin

• No tissue destruction

• Possible odor; controllable

What are the techniques to treat a first degree burn?

• Typically present no unusual degree of difficulty

• May need a stronger than normal arterial injection solution

• Precaution against edema and/or skin slip

What are the characteristics of second degree burns?

• Acute inflammation with blistering or

• Complete absence of the epidermis

• Red tissue discoloration

• No charring and no major tissue destruction

• Hair may be singed

• Odor

What are the techniques to treat second degree burns?

• Open blisters and remove loose or excess skin

  • Recommended pre-embalming

• Apply surface pack with topical gel (cauterize and dry)

• Seal the area to prevent seepage

• Cosmetize

What are the characteristics of a third degree burn?

• Charring

• Destruction of surface and deep tissue (expanding/splitting)

• Muscle is not usually very affected

• Potential to be “non-viewable”

• Odor

What are the techniques to treat third degree burns?

Viewable Areas:

• Excise charred tissue

• Cauterize and dry excision tissue with surface pack

• Cover with sealer

• Suture with basket-weave, apply wax, create pore-effect and cosmetize

What are the characteristics of fourth degree burns?

• Charring

• Black, crumbling tissue

• Partially missing tissue

• Very discolored (black)

• Very dehydrated

• Complete incineration of tissue

• Muscle greatly affected

• Expansion and splitting of lesser charred areas

• Odor

Not appropriate for restoration attempts or viewing

What are the characteristics of singed hair?

• Shrunken

• Completely missing

  • Brows, lashes, facial hair, hair of head

What are the techniques to treat singed hair?

• Cosmetic, such as eyebrow pencil, eye shadow or mascara can be used to recolor singed areas.

• Completely missing hair must be replaced with hair replacement techniques (Ch. 10L).

Define excision

An area from which something has been cut out.

Define excise

To remove by cutting.

Define undercut

An angled cut of the borders of an excision, which is made so that the skin surface will overhang the deeper tissue.

How should you handle excisions that happened before death?

Treat the wound

How should you handle excisions after death?

• Know proper techniques for removal

• Know proper treatment requirements for the exposed deep tissue, following excision

when should you excise tissue pre-embalming?

Only when the tumor is blocking circulation

What are some things that may be necessary when performing an excision before embalming?

• Bridge sutures may be necessary to hold margins of the incision together

• Bridge suture may be necessary to support the margins of a large area of excised tissue

Excision is recommended ______ embalming

post

How should excision occur on the face and why?

Within the buccal cavity (unexposed) whenever possible so that leakage will occur within the mouth and drain into the throat.

Undercutting may prove beneficial as opposed to ______________ cuts

perpendicular

What are the uses of undercutting?

• To lock the wax under the edge of the wound

• To allow tapering of the wax over the edge of the wound

• To lower the level of ligature when performing a basket weave suture