LU 5.1 Burns

What are the factors that impact burn wound healing? / What are things to focus on when treating burn wounds

• Metabolic responses to injury

• Nutritional status

• Presence of systemic infection

• Other systemic insults such as pain and stress

What are the types of burn?

• Burns : caused by radiation, dry heat, electric current, extreme cold, friction

• Scalds : thermal injuries caused by wet heat or vapor

• Inhalation burns : inhaling hot soot

What are the functions of skin?

• As a barrier

• Stress response

• Fluid balance

• Electrolytes balance

• Temperature control

• Neurosensory

What are the function of epidermis ?

• neurosensory

• fluid balance

• protection from toxins

• protection from bacterial injury

what are the functions of dermis?

• protection from trauma

• fluid balance

• thermoregulation

what are the pathophysiology of burns?

• skin loss

• airway & lung injuries

• inflammatory & circulatory changes

• other changes : kidneys & stomach

Explain about the pathophysiology of burns in terms of skin loss / effects of skin loss

• skin loss lead to loss of protective barrier

• this can cause i) entry of microorganisms ii) loss of fluids iii) loss of heat iv) immunosuppresion

explain about the pathophysiology of burns in terms of injuries to the airway & lungs / effects of injuries to the airway & lungs

• injuries to the airway and lungs are caused by fire or blast

• this can lead to inhalational injury, carbon monoxide poisoning and mechanical block on rib movement

explain about the pathophysiology of burns in terms of inflammatory & circulatory changes / effects to the inflammatory & circulatory changes

• the changes are loss of skin and increase vessels permeability

• loss of skin cause direct fluid loss while the increased vessels permeability cause third space fluid collection and non burn tissue oedema

• both of this will lead to circulatory shock

Explain the physiology of burn wounds according to Jackson’s burn model

• zone of coagulation: zone of severe damage

• zone of stasis : comprises less damaged tissue

• zone of hyperemia : tissue with intense vasodilation and increased blood flow

What are the complications of burn induced skin barrier loss?

• increased heat loss

• increased infection risk

• loss of skin elasticity

• loss of sensation

• increased evaporative water loss

• wound dehydration

What are the effects of burn injuries to the renal system?

• it can cause metabolic acidosis due to poor renal perfusion

• it can cause acute kidney injury (AKI) . AKI can occur due to hypovolemia (due to severe burns that cause fluid loss due to plasma leakage)

• cause oliguria as a response to hypovolemia and reduced renal perfusion

• if untreated, can lead to complete renal failure

what are the burn severity assessments?

• Rule of Nines

• Palmar Method

• Lund and Browder Chart

What is the burn size for adults based on total body surface area according to Rule of Nine?

What is the burn size for children based on total body surface area according to Rule of Nine?

What is Palmar Method?

What are the type of burn depth according to traditional classification?

• first degree burn : epidermis only

• second degree burn : epidermis & dermis

• third degree burn : epidermis & dermis & subcutaneous

What are the type of burn depth according to descriptive system / Australian and New Zealand Burn Association (ANZBA)?

• Epidermal : classified as superficial epidermal & heal within 3-7 days

• superficial dermal : classified as superficial partial thickness & heal within 14 days

• mid dermal : classified as partial thickness & heal within 14-21 days

• deep dermal burn : classified as deep partial thickness & heal over 21 days

• full thickness : healing need surgical intervention

What are the pre-hospital care in emergent care?

• stop the burning process

• cool the burn wound

• wash the wound

• cover the wound

• cover patient with blanket

• check for other injuries

In emergency department care, what are the things need to be initiated when receiving patients with burn injuries?