LS week 4- Burns

epidemiology

worldwide:

• 180.000 deaths per year

• high-income countries burn death rates are decreasing

• rate of child deaths from burns is currently 7 times higher in low- and middle-income countries than in high-income countries

nederland:

• 80.000 burn victims go to GP

• 6000 go to ED

• 1800 hospital admission

• 600 burn centers

what causes a burn?

• scalds (liquid or gas)

• fire/flames

• contact

• electrical injury

• chemicals

anatomy of the skin:

• epidermis- skin

• dermis- hair follicles, glands, capillaries

• hypodermis- sweat glands

1st degree burn

epidermis

• redness, swelling, pain (no blisters or wounds)

• capillary refill +

• sensation +

• heals in 7 days

2nd degree superficial burn

may penetrate into dermis

• pale pink skin

• very painful

• blistered

• moist

• capillary refill +

• sensation +

• heals in 14 days

2nd degree deep burn

further into dermis- capillaries damaged

• blotchy red

• painful

• capillary refill - (absent)

• sensation - (absent)

3rd degree burn

fully penetrates dermis

• black or white

• waxy or leathery

• glands and follicles destroyed

• capillary refill -

• sensation -

4th degree burn

complete burn

• fascia, muscle and bone visible and damaged

• systemic toxic reactions and sepsis

Jackson’s Burn wound model

• zone 1- zone of coagulation= irreversible (4th + 3rd)

• zone 2- zone of stasis= salvageable tissue (3rd + 2nd)

• zone 3- zone of hyperaemia= reversible (1st + 2nd)

eschariatomie

surgically cutting through burned tissue (3rd + 4th degree)

fluid resuscitation

giving IV fluids to replace what the body has lost

• adult > 15%

• children > 10%

3 mL/kg/%burn per 24 hours

treatment

• prevention of worsening

• pain management

• infection prevention