Superficial - epidermis
Superficial partial thickness - epidermis and upper part of the dermis
Deep partial thickness - epidermis and into the lower dermis
Full thickness - burn into the subcutaneous tissue
A sunburn is a good example.
Typically heals in 2-5 days.
(Not included in burn calculations)
Superficial Partial Thickness
Blistering is evident. Pink-red, moist, moderate swelling.
Extremely painful as the papillary layer of the dermis has been destroyed, but the reticular layer (where the nerves are) is intact.
Healing within 7-10 days usually does not produce scarring. Healing of longer than 3 weeks typically produces scarring.
Deep Partial Thickness
All of the epidermis is burnt and into the reticular dermis.
Skin is red to white (white because the blood vessels in the reticular dermis have been destroyed so the tissue no longer has blood supply).
Usually takes 3-8 weeks to heal and will result in hypertrophic scarring.
Full Thickness Burns
All of the epidermis, dermis, and subcutaneous tissue.
White or black (blood vessels are gone), charred, and leathery.
Healing will take a long time, if at all. Will definitely scar.
Calculating Burn Size - Adult
Rule of nines.
Chest / Abdomen: 18
Arms: 9 + 9
Legs: 18 + 18
Calculating Burn Size - Scattered Areas
The patient's palmar surface of their hand is approximately 1% of their total body surface area.
Major Burn Definition
Greater than 10% of the total body surface area constitutes a major burn in children under 10 years old or in patients over 50 years old.
Greater than 20% of the total body surface area constitutes a major burn in patients between 10 and 50 years old.
Zone of Coagulation
The area at the center of a burn.
The zone of stasis (good) and the zone of hyperaemia (bad) can change. With proper resuscitation, the goal is to get the zone of stasis to be maintained and allow easier healing.
With inadequate resuscitation, the zone of stasis will disappear and the zone of coagulation will increase in size.
Burn Physiology - Before and During Fluid Resuscitation
Decreased cardiac output
Increased systemic vascular resistance
Decreased number of RBCs
Impaired host defenses
Decreased perfusion of kidneys
Decreased perfusion of gut
Fluid leaks out. If you do not treat the patient adequately, the patient will go into hypovolemic shock and die.
Burn Physiology - After Fluid Resuscitation
In this second stage, usually around day 2 or 3, the body goes through a LOT of nutrients. You need to adequately replace proteins and fats.
Initial Management of Major Burns
1) Airway and breathing
3) Wound management
Used worldwide to calculate the amount of fluid given to a burn patient...
Amount of Ringer's Lactate = 4cc x weight (kg) x %TBSA burn
Half of the fluid is given in the first 8 hours of the burn, and the other half is given over the following 16 hours.
Be aiming for 0.5 - 1.0 cc/kg/hr urine output.
Urine Output - Foley Catheter
Aiming for 0.5 - 1.0 cc/kg/hr
If you are getting more than this, you need to reduce your fluids. Otherwise, you can induce life-threatening edema to the patient.
Surgically cutting the skin along its folds to prevent the swelling from the burn from compressing arterial circulation and causing death.
The burnt skin becomes leathery and loses its elasticity. The subsequent swelling from the burn as well as the fluid can compress arteries and cause distal portions to undergo necrosis and require amputation. Escharotomy releases pressure and prevents this from occuring.