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HCR240-Chapter42Burns.pptx

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Chapter 42

Burns

Burn Severity

Depth

Body surface percentage

Total body surface area (TBSA)

Patient age

Systemic involvement

Thermal Burns

Fire, hot objects, scalding liquids, grease, and steam

90% of burn traumas

Superficial to full-thickness

Temperatures of 40 degrees Celsius or greater

Flames can create temperatures of thousands of degrees in a confined space

May result in inhalation injury to lungs

Scald Burns

Specific type of thermal burn

Hot liquids or grease

70 degree Celsius or higher can lead to cell death within seconds

Accidental scalding

Characteristic pattern

Hot liquids conduct heat better than air

Inhalation of steam can also cause injuries

Chemical Burns

Less than 10% of burns

Induce protein coagulation

Gray coloring of skin

Type, quantity, and concentration of chemical linked to burn severity

Remove clothes, vigorously irrigate area, and neutralize chemicals

Electrical Burns

Mild injury: household current 110–220 volts

Death: 1000 volts

Entrance/exit wounds may be present

Damage

Amount of voltage, length of contact, pathway of current (across heart may lead to death)

Nerve and muscle create less resistance (suffer more damage) than other tissues

Radiation Burns

Possible bioterrorism concern

Can produce thermal burns and internal/external radiation contamination

Visible symptoms may not appear for weeks

Measurement

Rads

Radiation dose absorbed by tissue

Rems

Biological risk of the exposure

Radiation Burns (continued_1)

Diagnosis of cutaneous radiation injury (CRI)

Visible damage, dose of radiation, depth of penetration

4 stages

Prodromal

Latent

Manifest illness

Third wave erythema

Radiation Burns (continued_2)

Acute radiation syndrome (ARS)

Ingestion, inhalation, or entry of radioactive materials via open wounds

Initial treatment

Patient decontamination

Remove clothes and shoes

Localized Responses to Burn Injury

Three zones of injury

Zone of coagulation

Deepest point of injury

Most irreversible damage

Zone of stasis

Decreased tissue perfusion

Potentially reversible damage

Zone of hyperemia

Outer zone

Reddened due to vasodilation

Minimal tissue damage

General Systemic Responses to Burns

Normal organ function disrupted if Total Body Surface Area (TBSA) greater than 30%

Cell damage and death release vasoactive substances

Increase vascular permeability, with fluid and protein shift from ICF to ECF

Greatest 6–8 hours post-injury

Cell damage

Leak of potassium into ECF increases risk hyperkalemia

General Systemic Responses to Burns (continued)

Hypotension, tachycardia, decreased urine output

Specific hypovolemic shock: burn shock

Fluid resuscitation critical

Hypermetabolic state

Energy needs increase 50%–100%

BMR 1.3X greater than normal on average

Nutritional supplementation calculated as:

25 kcal × body weight (kg) + % TBSA

Pulmonary Responses to Burns

Increased respiratory rate, pulmonary capillary permeability, pulmonary vascular resistance

Airway edema

Rapid progression

If stridor present, immediate intubation

Inhalation injury

Impaired gas exchange

Assess for carbon monoxide (CO) poisoning

GI Tract Responses to Burns

If greater than 35% TBSA, decreased blood flow to GI tract, secondary to hypovolemia

Decreased motility

Decreased nutrient absorption

Paralytic ileus

Fluid resuscitation and blood pressure maintenance needed

GI Tract Responses to Burns (continued)

To protect gastric mucosa:

Enteral feedings

Proton pump inhibitors (PPI’s) and H2 blockers

Help to prevent Curling’s ulcer (gastric ulcer in severely burned individuals)

Immune Responses to Burns

Negative impact on immune function

Reduction

Complement system

Ig production

Decreased WBC production and function

Decreased T-helper cells

Immune Responses to Burns (continued)

Increased infection risk due to damaged skin barrier

Debridement

Used to stimulate blood flow to area of injury, decreasing risk of infection

Opportunistic infections are a concern

Renal Responses to Burns

Reduced blood flow to kidneys affects renal function

RAAS activated along with ADH

Restore fluid volume and avoid nephrotoxic medications

If electrical burn, muscle breakdown may increase myoglobin levels, which may damage kidneys

Assessment

Size and depth of burn must be determined

Provides information on injury severity

Guides fluid resuscitation

Determines surgical procedures

Mortality predictor

Long-term cosmetic implications

Assessment (continued)

Traditional classification

First, second, third, fourth degree

Replaced with categories that describe depth of destruction

Superficial

Partial thickness

Full thickness

Superficial Burns

Damage only to epidermal layer

Vasodilation causes redness to skin

No blisters

Healing in less than 1 week

Partial-Thickness Burns

Superficial partial-thickness

Char the epidermis and papillary dermis

Edema and epidermal blisters

Skin is wet, raw, and pink or white

Painful, will heal in 3–6 weeks, scarring may occur

Deep partial-thickness

Through epidermis and dermis

Skin may be mottled

Blistering

Full-Thickness Burns

Damage to epidermis, dermis, hair follicles, and all underlying structures

Nerve endings destroyed, so pain is rare

Skin

White, black, brown, or red

Significant edema in surrounding tissues

MODULE 8

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