Burn Rehab Flashcards
(13 cards)
Burn Epidemiology
- Majority are male (70%); mean age 33 years
- Most burn injuries covered less than 10% of TBSA
- Most common etiologies of burn injuries were flames and scalds
- Negative predictors for survival after burn injury: increasing age, burn injury over a higher TBSA, presence of inhalation injury
- In elderly pts, the presence of medical comorbidities, inhalation injury, and burn size best predict mortality within 1 year of burn injury
Burn definition
-Body response to soft tissue insult from external agent (heat, cold, chemicals, electricity, radiation)
-10-15% from frostbite, chemical and electrical
-1.5-2.0 million sustain burns each year
85-90% caused by heat
-60,000-80,000 hopitalizedisability 2.2 burnsanent perm ord
-5,000 die each year
-35,000-50,000 temporary
Burns and kids
- # 1 cuase of accidental deaths in children under 2. Majority of burns this age group result of abuse
- # 2 cause of accidental deaths in children under 4
- # 3 cause of accidental deaths in chldren under 19
Cellular response to burns
- exposed collagen cuases plt activation
- intense vasoconstriction 2/2 epi, prostaglandins, serotonin and leukotrienes
- within few hrs, histamine release causes vasodilation and increased capillary permeability, allowing protein and albumin into the extravascular space. Followed by fluid extravasation, which causes severe edema
- late capillary permeability 2/2 leukotrienes
- swelling and rupture of damaged cells
- plt and leukocyte aggreataion w/ clot formation from tissue thromboplastin, endotoxin, interleukin-1 and Hageman factor
- establishment of a hypermetabolic state
Systemic Response to burns
- Loss of fluid into extravascular compartment resulting in hypovolemia and shock
- Hyperventilation w/ increased O2 demand
- -Inhalational injury cuasing decreased oxygenationa and ARDS
- Initial decrease followed in several days by a significant increase in cardiac output
- increase in blood viscosity
- gastric dilation and ileus occurs in 1st 3 days post burn
- Mulit-organ system failure
Thermal burns
-Heat: creates a zone of coagulation, where tissue is destroyed, and zone of stasis, an area of decreased blood flow. May improve or get worse depending on treatment
=Cold: damage occurs as a combination of actual freezing plus decreased blood flow and ischemia. Commonly EtOH is involed
Electrical
- Superficial damage may appear minimal. Deeper tissues (muscle and bone) may have severe injuries. Current follows path of least resistance (nerves, arteries, veins and bones.
- Often significantly more extensive damage at exit wound than entrance given smaller cross section area, there is relatively greater resistance at exit site, cuasing greater build up of heat, often leads to an explosive release of built up energy
Injuries associated with electrical burns
- Radiculopathy from hyperextension caused by tonic/clonic contractions during electrocution
- periperal neuropathy caused by direct injury from current
- cognitive impairment
- Spinal cord injury
- Formation of heterotopic bone around joints and in residual limbs
- Cardiopulmonary arrest
- Will be at risk of develping early onset of cataracts and hearing loss, both amenable to usual treatments.
Chemical injuries
- Acid or alkali exposure.
- Typically underestimated. Frequently appear to be mild in severity.
- Inappropriate or insufficient removal of the the cuasative agent allows injury to progress
Radiation injury
-risk and severity of burn depend on duration and intensity of exposure. Response vary from mild erythema to blistering and skin sloughing over period of hours to days. If exposure is high enough, treatment can only be palliative.
Depth of Burn Injury Classification:
Traditional Terminology
- First Degree: involves injury to epidermis but not dermis; erythema but no blistering.
- Second Degree: Involves epidermis into superficial dermis but basal layer of the dermis remains. Blistering
- Third Degree: Invoves destruction of epidermis and both superficial and deep layers of the dermis; only white eschar remains.
- Fourth Degree: muscle, nerve and bone damaged in addition to skin involvement
Depth of Burn Injury Classification:
Newer Terminology
- Superficial partial thickness: epidermis and upper part of dermis injured
- Deep partial thickness: epidermis and large upper portion of dermis injured
- Full thickness: all layers destroyed
Size of burn
- Rule of 9s: An approximate way of estimating Adult Total Body Surface Area (BSA)
- Head
