9.1 Burn Injuries Flashcards
(23 cards)
Highest Risk for Burn Injuries
- Young children and older adults
Goals of Managing Burns
- Prevention
- Institution of life saving measures for severely burned patients
- Prevention of disability and disfigurement through early specialized and individualized care
- Rehabilitation through reconstructive surgery and rehabilitation programs
Thermal Burn
- Caused by dry heat (fire) or moist heat (steam/hot liquids)
- Cause cellular destruction that result in charring of vascular, bony, muscle and nervous tissue.
Chemical Burn
- Caused by direct skin contact with acids, alkaline, or organic compounds
- Destroy tissue protein resulting in necrosis
- ALKALINE ARE MORE DIFFICULT TO NEUTRALIZE, HAVE DEEPER PENETRATION AND DO MORE DAMAGE THAN ACIDS
- Organic Compounds (Petroleum Distillates) cause cutaneous damage through fat solvent (may cause renal/hepatic failure if absorbed)
Electrical Burn
- Severity depends on how much voltage and duration of current
- Electricity follows the path of least resistance (muscle, bone, bone vessels, nerves) so it is difficult to assess extent of injury
- Alternating currents are worse (person clamps down due to tetanic muscle contractions)
- Direct currents (lightning) is very high voltage but short lasting.
- MOST COMMON CAUSE OF DEATH FROM LIGHTNING INJURIES IS CARDIOPULMONARY ARREST
Radiation
- Sunburns or radiation treatment in cancer.
- Usually only superficial
Nuclear Power Accidents
- Leads to same degree of tissue damage and multisystem effects
Patterned Burns
- Always a suspicion for abuse and should be reported to CPS or APS
- Zebra stripe or doughnut hole burns are signs of abuse (scalding water)
Toasted Skin Burns
- People who work extremely close to high heat
- Can also be a sign of abuse from heated pads or blankets
1st Degree Burn
1st degree
- Superficial
- Only epidermis
Manifestations
- Tingling/, soothed by cooling, peeling, itching
Appearance
- Blanchable with pressure
- Dry
Examples
- Sun burn, superficial scald
Treatment
- Complete recovery within a few days
- Oral pain medication
- Cool compress
- Skin lubricants
- NO NEED FOR ANTIMICROBIALS
2nd Degree Burn
2nd degree
- Entire epidermis and parts of dermis
Manifestations
- Pain
- Sensitive to air currents
- Hyperesthesia
Appearance
- Blisters
- Mottled red skin
- Weeping surface
- Edema
Examples
- Scalds, Flash Flame, Contact
Treatment
- Recovery 2-3 weeks
- Some scarring and depigmentation
- May require grafting
3rd Degree Burn
3rd degree
- Total destruction of epidermis and dermis
Manifestations
- Insensate (no sensation)
- Shock
- Myoglobinuria (red pigmented urine) and possible hemolysis
- There may be entrance or exit wounds from electrical shock
Appearance
- Dry
- White/Red/Brown
- Leathery/Charred
- Coagulated Vessels may be noticed
Examples
- Flame, prolonged exposure to hot liquids, electrical currents, chemical, contact
Treatment
- Eschar may be slough
- Grafting necessary
- Scarring and loss of contour and function
4th Degree Burn
4th degree
- Deep tissue, muscle, and bone (tissue necrosis)
Manifestations
- Shock
- Myoglobinuria (red pigmented blood)
- Hemolysis
Appearance
- Charred
Examples
- Prolonged exposure to high voltage electricity
Treatment
- Amputation
- Grafting may not benefit depending on depth and severity
Minor Burn Injuries (ABA)
- Partial thickness less than 15% TBSA
- Full thickness less than 2% TBSA
Moderate Burn Injuries (ABA)
- Partial Thickness 15-25% TBSA
- Full Thickness less than 10% TBSA
Major Burn Injuries (ABA)
- ALL ELETRICAL BURNS
- MULTIPLE TRAUMA INJURIES
- ALL CLIENTS HIGH RISK
- Partial thickness greater than 25% TBSA
- Full thickness greater than 10% TBSA
Types of ways to estimate TBSA Burned
- Rule of 9
- Lund and Browder Method
- Palmer Method
Physiologic Change with Burns
- Major burns (greater than 25%) produce local and systemic effects
- This includes release of cytokines into systemic circulation
- Fluid shifts and shock results from hypoperfusion and organ hypoperfusion
EFFECTS OF MAJOR BURNS
- Fluid/Electrolyte Shifts
- Cardiovascular effects
- Renal/GI Alterations
- Immunologic Alterations
- Thermoregulation Alteration
Pulmonary
- Upper/Lower Airway
- Carbon Monoxide Poisoning
- Restrictive Defects
Cardiovascular Effects
- Cardiac Depression
- Edema
- Hypovolemia
- Dysrhythmia
- Peripheral vascular compromise
- Compartment Syndrome
Pulmonary Effects
Direct inhalation or systemic response
- Inflammation
- Interstitial pulmonary edema
- Vasoconstriction
GI Effects
- Impaired motility and absorption
- Vasoconstriction
- Increased pH
- HIGH RISK FOR STRESS ULCERS (CURLINGS ULCERS) - in stomach/duodenum
- Loss of mucosal barrier and translocation of bacteria caused by ischemia to the intestines and increased intestinal permeability. (MAJOR SOURCE OF SEPSIS AND MODS)
Kidney Effects
- Reduced renal blood flow and GFR
- Muscle Damage (Myoglobinuria which causes acute tubular necrosis (ATN) and acute rheumatic fever (ARF)
Immune Effects
- Compromised humoral and cell-mediated immunity (acquired immunodeficiency)
- Vulnerable for 1-4 weeks (opportunistic infections are fatal)
Metabolic Effects
EBB Phase (First 3 days)
- Decreased oxygen consumption, fluid imbalance, shock
Flow Phase
- Adequate burn resuscitation has been reached
Metabolic demand increases
Bodyweight and heat drops
Hypermetabolism persists until wound closes (may flair with complications)
