Burns and Thermal Injuries Flashcards
Children - Most common injury and death
Scalds and hot liquids
Adolescents - Most common injury and death
Flammable liquids
Adult - Most common injury and death
Building and vechicle fires
____% of burns occur in/around the home
75%
Male ____ years of age have the highest incidence of burn injuries
16-20
More risk taking behavior and general behaviors/jobs putting them at higher risk. Ex: Working with chemical or electrical
Types of burns
- Heat
- Frostbite (Acute and late)
- Radiation
- Electric
Left: Frostbite; Right: Radiation
ABA Criteria for Admission to Burn Center
- Total burns Greater than 10% of BSA:
– Age less than 10 OR greater than 50 - Total burns greater than 20% of BSA:
– All other age groups - Full thickness burns greater than 5% BSA
- Critical locations:
– Face, hands, feet, genitalia, perineum, major joints
– Circumferential burns of extremities, chest
Epidermis - Function
- Prevents moisture loss
- Maintains integrity against bacterial invasion and is a physical barrier
Dermis - Location and Function
Papillary Layer:
* Location: Underneath the epidermis
* Function: Sensation (Sensory receptors), Blood Flow (Capillaries), Nutrients (Capillaries), Lymphatics (Drain fluid), Temperature Regulation (Capillaries)
Reticular Layer
* Location: Below Reticular layer, above muscle
* Function: Structure, Strength, extensibility and elasticity (Collagen), Roots of hair, glands, nails and blood vessels
* Langer’s lines lie here (Wound healing)
Arrector pili muscle
- Located on the bottom of the hair follicles; creates goosebumps (Dermis)
Classifications of Burn Injury
- First degree = superficial (epidermis)
- Second Degree = Superficial partial thickness OR deep partial thickness
- Third Degree = Full thickness
- Fourth degree = Subdermal
Relationship between length of heat exposure and intensity of heat exposure
First Degree - Superficial Burn
- Epidermis ONLY
- Pain and blanching
- No scar
- Heals quickly
Ex: Sunburn
Second Degree - Superficial Partial Thickness
- Papillary Layer
- Pain and blanching
- Skin color changes
- 7-10 days to heal
- May have scarring
Ex: Severe sunburm that causes blistering
Second Degree - Superficial Burn: Proliferative Phase
Epithelization
Replication and migration of epithelial cells across the skin edges in response to growth factors
Regrowth begins at anywhere with kertinocytes such as hair follicles (most common), sweat glands, etc.
Second Degree - Deep partial thickness
- Reticular layer
- Exposed nerve endings
- Decreased deep pressure
- Wet or dry eschar
- Scarring
- 3-5 weeks to heal
Ex: Significant scalding burns or flame/fire burns
Eschar Progression
- Dry to wet
- Generally want to get rid of eschar (few circumstances you don’t)
Third degree - full thickness
- Through dermis to subcutaneous tissues but not to muscle tissue
- No blanching
- May be insensate (insensitive)
- Requires skin gragy or lengthy period of secondary healing
- Scarring
- Recovery takes MONTHS
Fasciotomy
- Surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat resulting loss of circulation to an area of tissue or muscle
- Most common with electrical burns
Escharotomy
- Surgical procedure with incision through the escar to espose the fatty tissue
- Due to the residual pressure the incision with often widen substantially
- Commonly done with circumferential bruns (trunk/chest, arm, leg, etc.)
Fourth Degree - Subdermal Burn
- Necrosis
- Requires surgical intervention
- Grafting/Amputation
- Involves muscle, bone,e tc.
- No spontaneous healing
How many stages of frostbite are there?
3
1st degree frostbite
irritation of skin
2nd degree of frostbite
blistering but no major damage
3rd degree frostbite
- Involves all layers of the skin
- Permanent tissue damage
- Interventions are often similar to 4th degree (Amputation)
3rd degree cold vs 4th degree burn
- Frostbite surgery you wait and see the response of tissues of what is necrotic and what comes back during the warming period
- 4th degree heat interventions are done immediately
Demarcation
- Boundaries of the vascular injury cause a “demarcation” line to occur where normal and damaged tissue meet.
- Occurs with frostbite.
- Tissue up until line is salvageable, everything else is not.
Degree of burn and healing considerations
- Skin involvement
- Signs
- Sensation
- Healing Capacity
- Healing Time
- Scar Formation
Rule of 9s
- Assigns a % that’s either 9 or multiple of 9 to determine BSA damaged
- Used for: 2nd deep thickness and 3rd degree.
- Quick Assessment by Physician
- Adult and Pediatric Values are different (A: Genitalia, Head and neck, Legs; P: Head and neck, Legs)
Lund Browder Chart
- More complicated BSA measurement
- Considers age and body composisition of the person (Head, thigh and legs are dependent on the age of the child)
- More accurate for pediatrics
Zones of injury and conversion of burn depth
- Zone of coagulation: point of maximum damage, irreversible tissue loss due to constituent proteins.
- Zone of stasis: decreased tissue perfusion, potentially alvageable. Want to increase tissue perfusion and decrease the amount of damage. Hypotension, infection and edema can cause more damage.
- Zone of hyperaemia: outermost layer, tissue perfusion is increased. Tissue will recover unless severe sepsis or hypoperfusion.
