Burns

Question 1

Epidermis

Answer 1

Protective outer layer
- hair

Question 2

Dermis

Answer 2

2nd layer
- capillaries
- nerves
- sebaceous gland
- hair follicle

Question 3

Hypodermis

Answer 3

3rd layer
- fat
- smooth muscle
- nutrient deposit
- heat insulator
- shock absorber

Question 4

Skin’s Function

Answer 4

• Maintain body temp
• Barrier to evaporative water loss
• Metabolic ativity
  > vit D production
• 1st line against microbes
• Protect against envirn’t
• Sensations
  > touch, pressure, pain

Question 5

Pathophysiology of a Burn

Answer 5

• Intravascular fluid vol deficit due to loss of fluids from the intravascular space to the extravascular space results in
  > incrs blood viscosity; blood more like syrup, hard on heart = more resistance = incrd afterload
  > incrd afterload
  > dcrd peripheral & capillary flow; blood too thick to get into these smaller spaces, oxygen exchange & ventilation affected
  > multiple organ systems are affected

Question 6

Patho of a Burn - Multi Organ Systems Affected

Answer 6

• CV
  > heart goes into over-drive
• Renal
  > hypoperfused; AKI
• Pulmonary
• GI
• Immunological

Question 7

Zones of Injury

Answer 7

• Immediately after injury, the burn wound can be divided into 3 zones
  > what areas can be saved vs what areas are going to die
• Zone of Coagulation
• Zone of Stasis
• Zone of Hyperemia

Question 8

Zones of Injury - Zone of Coagulation

Answer 8

Is the central portion with the most damage, bc its usually the site of greatest heat transfer, leading to irreversible skin death
surrounded by zone of stasis

Question 9

Zones of Injury - Zone of Stasis

Answer 9

or Zone of Ischemia: characterized by dcrd perfusion tht is potentially salvageable if edema is controlled & perfusion is incrd
yellow skin

Question 10

Zones of Injury - Zone of Hyperemia

Answer 10

The outermost region of the wound characterized by incrd inflammatroy vasodilation
pinkish/red skin

Question 11

All burns cause

Answer 11

Tissue destruction due to energy transfer

Question 12

Causes of Burns

Answer 12

• Thermal
• Chemical
• Radiation
• Electrical
  > direct current (DC)
  > alternating current (AC)

Question 13

Causes of Burns - Thermal

Answer 13

Steam, scalds, contact w/ heat, fire

Question 14

Causes of Burns - Chemical

Answer 14

• Acidic agents: cause coagulation necrosis, tissue looks dry
• Alkali agents: cause colliquative necrosis, tissue looks wet

Question 15

Causes of Burns - Radiation

Answer 15

• Exposure to industrial equipment, equipment used for medical treatment
  > don’t appear immediately

Question 16

Causes of Burns - Electrical

Answer 16

• Direct Current (DC)
  > everything tht runs off a battery, plugs in to the wall w/ an AC adapter, or uses a USB cable for power relies on DC (dry cell battery, car battery, DC generator, radio, television, defibrillator)
  > DC causes a single convulsion or contraction, usually propelling the person away from the electrical source
  > exposure is not very long
• Alternating Current (AC) (maintain contract until source is cut off)
  > AC is used to deliver power to houses, office buildings (electrical outlets, power lines)
  > maintain contract w/ the source
  > may present w/ only superficial burns, many devasting injuries if there is prolonged contract or muscle tetany
  > low-voltage AC injuries may potentially result in cardiac or resp arrest, arrhythmias (v-fib), or seizures tht are unwitnessed
  > high-voltage AC injuries are more likely to result in highly destructive thermal burns

Question 17

Causes of Burns - Electrical: Lightning

Answer 17

• Has both the properties of an AC and DC signal
  > it has polarity and always travels in a single direction (DC)
  > voltage of lightning is not constant, it has variable amplitude

Question 18

1st Degree Burns

Answer 18

• Burns tht affect the uppermost layer of skin (epidermis only) are classed as superficial (1st degree) burns; the skin becomes red/pink and the pain is limited in duration
  > sunburns & minor steam burns

Question 19

2nd Degree Burns - Superficial Partial Thickness

Answer 19

• Burns tht involve all the epidermis and part of the underlying dermis
• Appearance: light to bright red or mottled appearance may appear wet and weeping, may contain bullae (blister), are extremely painful and sensitive to air currents, blanch painfully
• microvessels are injured = leaving plasma into interstitial space = blisters
• brief contact w/ flames, hot liquid, or exposure to dilute chemicals
• heal in 7-21 days, expect minimal scarring, generally don’t need surgery
• may turn into full-thickness injuries if they become infected,

Question 20

2nd Degree Burns - Deep Partial Thickness

Answer 20

• Involves the entire epidermal layer & deeper layers of the dermis
• Appearance: red w/ patchy white areas tht blanch w/ pressure, appearance of deep-dermal wound changes over time, dermal necrosis & surface coagulated protein turn wound from white to yellow
  > don’t usually see blisters
  > long exposure to heat source
• May require a skin substitute or surgial excision and grafting for wound closure
• Treatment: surgical excision & skin grafting
  > maintain adequate perfusion
  > avoid infection

Question 21

Full-Thickness (3rd Degree) Burn

Answer 21

• Involves the destruction of all the layers of the skin down to and including the subcutaneous fat and is poorly vascularized
  > full-thickness burns usually are painless & insensitive to palpation
  > bc all the epithelial elements are destroyed, the wound does not heal by re-epithelialization
  > appears pale white or charred, red or brown, and leathery. The surface of the burn may be dry, and if the skin is broken, fat may be exposed
• Treatment: require sin grafting for closure

Question 22

3rd Degree pts are high risk for

Answer 22

• Infections
• Fluid & electrolyte imbalances
• Alts in thermoregulation
• Metabolic disturbances

Question 23

4th Degree Burn

Answer 23

Involves injury to deeper tissues, such as muscle or bone is often blackened, and frequently leads to loss of the burned part

Question 24

Inhalation Injury - Carbon Monoxide Poisoning

Answer 24

• CMs
  > early: headache, dizziness, nausea, vomitting, dyspnea, tachycardia, tachypnea, confusion, & lightheadedness
  > late: dcrd end-organ perfusion
  > heart: myocardial ischemia & cardiac dysfunction
  > CNS: dcrd LOC, unconsciousness, coma, unresponsiveness
  > resp: resp failure
• Treatment: high-flow oxygen admin at 100% through a tight-fitting nonrebreathing mask or endotracheal intubation
  > esp. if airway is compromised

Question 25

Inhalation Injury - Upper Airway Injury ## Footnote assessment

Answer 25

- **Burns (from heat or chemicals) of the upper resp tract include burns involving the pharynx, larynx, glottis, trachea, and larger bronchi** - **Assessment**: extent of injury to face & neck, pressure of blisters on or redness of posterior pharynx, signs of singed nose hairs, incrd HbCO lvls, incrd RR, dcrd depth of breathing, hoarseness, stridor, incrd amnt of sputum > frequent airway assessment during hosp stay is essential in this pop as supraglottic edema may be delayed until fluid resus begins & 3rd spacing occurs

Question 26

Inhalation Injury - Upper Airway Injury ## Footnote CMs treatment

Answer 26

- **CMs** > hoarseness > stridor > audible airflow turbulence > production of carbonaceous sputum - **Treatment** > early intubation > after airway is secure: HOB elevated, deep breath & cough, suctioning, ambulation, pulm hygiene, meds for bronchospasm

Question 27

Inhalation Injury - Lower Airway Injury

Answer 27

**Chemical injuries to the mucosal surfaces**