LEC 1.2 (BURNS) Flashcards by BIJAY KENT HIRATA

Most common cause of burns for Children (1-5 years)
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

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Most common cause of burns for Adolescent and adults
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

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Leading cause of burns in other age groups
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

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Common cause of death
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

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Males between 16-40 have the highest injury (T/F)

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SLIDE 4-5

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RISK FACTORS OF FIRE

-Occupations that increase exposure to fire
-Poverty, overcrowding, and lack of safety measures
-Placement of young girls in household roles such as
cooking and care of small children
-Underlying medical conditions including epilepsy,
peripheral neurophathies, physical and cognitive
disabilities
-Alcohol abuse and smoking
-Easy access for chemicals used for assault (such as
acid violence attacks)
-Use of kerosene as a fuel source for non-electric
domestic appliances
-Inadequate safety measures for liquefied petroleum gas and electricity

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SLIDE 8-12

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Largest organ

Skin

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Functions of the skin:

-Protective shield against heat, light, injury, and
infection
-Regulation of body temperature
-Storage of water and fat
-Prevents entry of bacteria

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SLIDE 14

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Surface or outer layer; also serves as a barrier between our body and the environment

Epidermis

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Layers of the Epidermis:

Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Germinativum/Basale

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SLIDE 16

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Layer of the skin beneath the dermis

Dermis

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How many times does the Dermis thicker
A. 10-20
B. 20-30
C. 30-40
D. 40-50

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The dermis contains DERMAL appendages (T/F)

F, EPIDERMAL

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The dermis is comprised mainly of ____ and _____
fibers

interwoven collagen
elastin

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TWO LAYERS OF DERMIS

PAPILLARY AND RETICULAR

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KRAUSE END BULB
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

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MERKEL’S DISKS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

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PACINIAN CORPUSCLES
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

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FREE NERVE ENDINGS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

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RUFFINI’S ENDINGS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

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MEISSNER'S CORPUSCLES A. Pain & itch B. Touch C. Warm Receptors D. Cold Receptors E. Pressure and Vibration

FREE NERVE ENDINGS A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

RUFFINI'S ENDINGS A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

KRAUSE END BULB A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

MERKEL'S DISKS A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

PACINIAN CORPUSCLES A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

MEISSNER'S CORPUSCLES A. Epidermis and Dermis B. Epidermis (Stratum Spinosum) C. Papillary Dermis D. Reticular Dermis

SLIDE 20

Lies below the dermis It consists of loose connective tissue and elastin

Hypodermis/Subdermis

WATER serves as padding and insulation for the body (t/f)

F; FAT

MOI OF BURNS

Alteration of vascular integrity → Edema → LOM

Skin Destruction will depend on:

Temperature Length of Time Type of Insult (Flame, liquid, chemical, electrical) Extremes of age

*THERMAL BURNS A. Scalds B. Flames 1. Spilling hot drinks/liquid, hot water in baths 2. 50% of adult burns 3. Inhalation and concomitant trauma 4. Cause superficial to superficial dermal burns 5. 70% of burns in children 6. Deep or full thickness

1. A 2. B 3. B 4. A 5. A 6. B

-The depth of heat injury depends on the degree of heat exposure and depth of heat penetration -Deep dermal or full thickness

Contact

SLIDE 25 PIC

Most devastating type of burn

Electrical burn

An electric current will travel through the body from one point to another, creating "_____" or "_____" points

entry/exit

Electrical burns vary according to:

Type of current Intensity of the current Area of the body that the current passes through

SLIDE 27 PIC

Ranking of the electrical resistance of various tissues (Most Resistant to Least Resistant)

a. Bone b. Cartilage c. Tendon d. Skin e. Muscle f. Blood g. Nerve

Two types of electrical burns

Low voltage E.B. High voltage E.B.

A. Low voltage E.B. B. High voltage E.B 1. Greater than 1000volts 2. Apnea, deep tissue destruction, renal failure 3. Exposure to 500-1000 volts of current 4. True/Flash 5. VFib

1. B 2. B 3. A 4. B 5. A

SLIDE 30

MECHNAICAL burns cause extensive muscle and soft tissue necrosis often result in amputation (T/F)

F; Electrical

UE most common, (R) UE for electrical burns (T/F)

At high voltage, PNS and CNS problems may not be present initially but may occur late after (T/F)

Electrical burns d/t Lightning

-Myelopathy -Sensorineural and Mechanical hearing loss

Electrical burns d/t Ocular complications

-Cataracts -Macular holes

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Electrical burns d/t Cardiac manifestations

-Immediate cardiac arrest -Pseudo infarction -Myocardial ischemia without necrosis -Dysrhythmia -Conduction abnormalities -Acute hypertension -Nonspecific ECG abnormalities -Sinus tachycardia

Electrical burns d/t Other manifestations

-Diaphragm paralysis -Inhibition of the breathing centers in the midbrain -Extensive fluid loss -Loss of consciousness -Impaired recall and PTSD -Blood clotting -Compartment syndrome -Rhabdomyolysis

Burn usually as a result of an industrial accident

Chemical burn

May occur with household chemical products

Chemical burn

For chemical burns: _____ products > _____ products

Alkali; acidic

-Classified as carbon monoxide poisoning, heat, or smoke inhalation injuries -Account for more than half of the burn related deaths per year -One of the leading causes of death

Inhalation Injuries

Signs of inhalation injuries:

-Facial burn -Singed nasal burn -Harsh cough -Hoarseness -Abnormal breath sounds -Respiratory distress -Carbonaceous sputum -Hypoxemia

SLIDE 41

A. Zone of coagulation B. Zone of stasis C. Zone of Hyperemia 1. Occurs at the point of maximum damage 2. Goal: Increase perfusion 3. Irreversible tissue loss 4. Outermost zone 5. Decreased tissue perfusion 6. Tissue will recover unless there is severe sepsis

1. A 2. B 3. A 4. C 5. B 6. C

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-Superficial injury -Epidermis -Red and sometimes painful

FIRST DEGREE (OLD CLASSIF)

-Epidermis and parts of the dermis -Skin may be red and blistered and swollen -Very painful

SECOND DEGREE (OLD CLASSIF)

-Epidermis and dermis -Whitish, charred or translucent -No pin prick sensation on burned area

THIRD DEGREE (OLD CLASSIF)

-Deep and potentially life-threatening -Extend into skin and underlying tissues

FOIURTH DEGREE (OLD CLASSIF)

Min. edema A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

DRY A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

BLANCHING A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

MARKED EDEMA A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Muscle and bone → Necrosis (when burned) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Eschar - Hard, parchment like, black/brown covering the area A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Mod. erythema & Extremely painful A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Discrimination but retains deep pressure A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Peels of and desquamates in 3-4 days A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Desquamation d/t topical agents A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Complete destruction of all tissue from the epidermis to the subcutaneous tissue A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

All nerve endings destroyed A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Mixed or Waxy white A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Hair follicles (completely destroyed) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Most of the nerve endings, hair follicles and sweat ducts will be injured A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

(-) blisters A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Residual skin color change d/t melanocytes destruction A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Heals in 3-5 weeks (not infected) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Cell damage (epidermis only) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Large amount of evaporative water loss (15-20x) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

(+) Intact blisters A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Prolonged contact c heat source & result of contact c electricit A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Epidermis → papillary layer of the dermis A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

↓ sensation to light touch or sharp/dull A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Min. scarring A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Spontaneous healing A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Peripheral vascular system damage A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Healing occurs through scar formation and re-epithelialization A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Pain delay A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Complete healing in 7-10 days A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Epidermal & dermal layers (completely destroyed) A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

(-) scar tissue A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Epidermis & papillary dermis with damage to reticular dermal layer A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Hypertrophic scar formation A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

Skin is erythematous A. Epidermal B. Superficial Partial thickness Burns C. Deep Partial thickness Burns D. Full thickness burns E. Subdermal Burns

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SLIDE 53

SLIDE 54

SLIDE 55

SLIDE 56

The Rule of 9 -Divides the body into areas of 9% -More practical in the emergent triage of a patient with an acute burn injury

TOTAL BODY SURFACE AREA (TBSA)

SLIDE 58

-Tool divides the body into much smaller areas and gives you sizes that are associated with differently aged patients -Modified the percentages of body surface area to account for a continuum age and to accommodate for growth of different body segments -More accurate means to determine extent of burns

Modified Lund and Browder Method

SLIDE 60

SLIDE 61

CRITERIA FOR ADMISSION

-Partial and full thickness burns >10% TBSA in patient <10 and >50 -Partial and full thickness burns >20% of TBSA in other age groups -Full thickness >5% TBSA in any age group -Partial and full thickness burns involving the hand, feet, face, perineum, or skin overlying major joints -Electrical burns and lightning injuries -Chemical burns -Patient with inhalation injury

Leading cause of mortality of burns

Infections (Pseudomonas aeruginosa and Staphylococcus aureus)

Pulmonary complications

-Suspected in patients burned in a close space -Inhalation injury -Primary complications include carbon monoxide poisoning, tracheal damage, upper airway obstruction, pulmonary edema, pneumonia -Damage to the lungs = lethal

Metabolic complications

-Thermal injuries cause a great metabolic and catabolic change to the body -Rapid decrease in body weight and decrease in energy stores that are vital to the healing process

Cardiovascular complications

-Severe burns where there are hemodynamic changes from the loss/shifting of fluids -15% decrease in cardiac output

Heterotrophic Ossification

->20% TBSA -Occurs in areas of full thickness burns or sites that remain unhealed for a prolonged period of time -Immobilization, microtrauma, high protein intake, sepsis -Elbow (most common), hips, shoulders

Neuropathy

-Compression bandages applied to tight, poorly fitted splints, inappropriate positioning -Brachial plexus, ulnar, common peroneal

SLIDE 66

Pathologic Scar

-Deep partial thickness burns allowed to heal -Full thickness burns that have been skin grafted -Hypertrophy, contracture, or both

Epithelial healing - If there are viable cells lining the skin appendages Contact inhibition

Epidermal healing

Epidermal healing is most clinically evident in _______ wounds that have intact____ and ______

Partial Thickness wounds Hair follicles Glands

Slide 69

Three phases of Dermal Healing

Inflammatory, Proliferative, Maturation

A. Inflammatory B. Proliferative C. Maturation 1. > Collagen breakdown (Hypertrophic scarring) 2. Ratio of collagen breakdown to production determines the type of scar that forms 3. Characterized by redness, edema, warmth, pain,and decreased ROM 4. Fibroblast formation

1. C 2. C 3. A 4. B

A. Inflammatory B. Proliferative C. Maturation 1. Wound Contraction 2. = or slightly > than collagen breakdown (Pale, flat and pliable scar) 3. Re-epithelialization is occurring at the surface of the wound, while deep within the wound, fibroblasts are migrating and proliferating 4. 3-5 days

1. B 2. C 3. B 4. A

A. Keloid Scars B. Contracture scar C. Hypertrophic 1. Are characterized by extremely tight skin that can restrict your ability to move 2. Excessive collagen deposits appear raised, but not to the degree observed with keloids 3. Can appear as a firm, rubbery lesion or shiny fiber nodules

1. B 2. C 3. A

LTG

To restore skin integrity, function and appearance

Immediate goal (post resucitation)

-Prevent infection -Decrease pain -Prepare wounds for grafting -Prevent contracture and scarring -Maintain strength and function

Acute of Initial Medical Management

-Transport -Fluid replacement -Determining the extent and depth of injury -Wound cleansing -Proper positioning for optimal joint placement

Goal of Acute Medical Management

-To remove dead tissue, prevent infection, and promote revascularization/reepithelialization

To help reduce the number of bacteria

Topical Antibacterial Agent

-Most commonly used -against pseudonomas

Silver sulfadiazine

-Antibacterial -against gram-negative/positive -diffuses easily c eschar

Mafenide acetate (sulfamylon)

-Antimicrobial -Moist environment -Antiseptic germicide/astringent -penetrate 1-2 mm eschar -useful for surface area -black

Mafenide acetate solution (sulfamylon 5% solution) silver nitrate

-bland ointment -against gram positive

Bacitracin/Polysporin

-Enzymatic selectively debrides necrotic tissue -no antibac action

Collagenase, Accuzyme

-Removal of eschar -Removal of necrotic tissue -Helps by preventing bacterial proliferation

Debridement (Wound Cleansing) Wound coverage

DRESSING

-To prevent wound contamination -Keep microorganisms at bay -Prevent further injuries -Apply pressure to control the hemorrhage -Absorb wound drainage -Assist in wound healing

Open Technique

-Applying a topical cream or ointment with or without dressings -Allows for ongoing inspection of the wound and examination of the healing process -The topical medication must be reapplied throughout the day

SLIDE 80

SLIDE 81

Acute or Initial Medical Management that is wound coverage by applying dressings over topical agents

Closed Technique

Purpose of closed technique

-Hold topical antimicrobial agents on the wound -Reduce fluid loss -Protect the wound

SLIDE 83

Closed technique should be changed one or twice a day (T/F)

Closed technique layers

1st - Non-adherent 2nd - Cotton padding 3rd - Gauze or elastic bandage 4th - Roller gauze 5th - Elastic wrap

SLIDE 85

Types of grafting

Autograft -Patient's own skin, taken from an unburned area -Permanent coverage Homograft/Allograft -Taken from cadaver of own species Heterografts/Xenografts -Non-human (Pigs)

A. B. C. D.