Mod 2 BURNs

Burns

100

Superficial-thickness burn 1ST degree

Sunburn, flash burn

a. Involves injury to the epidermis; the blood supply to the dermis is still intact.

b. Mild to severe erythema (pink to red) is present, but no blisters.

c. Skin blanches with pressure.

d. Burn is painful, with tingling sensation, and the pain is eased by cooling.

e. Discomfort lasts about 48 hours; desquamation(pealing skin) 2-3 days after burn, healing occurs in about 3 to 6 days.

f. No scarring occurs and skin grafts are not required.

200

Superficial partial-thickness burn- 2nd degree

-scald, flame, brief contact with hot object

-deeper into the dermis, blood supply reduced

-large blisters

-mottled pink to red with a wet, shiny weepy surface

-edema

-painful and sensitive to cold air

-heals 10-21 days w/ no scarring but pigment discoloration

- grafts may be used if the healing process is prolonged

300

deep partial thickness - 2nd degree

scald, flame, prolonged contact with hot object, grease, chemical, tar

- extends deeper into the dermis

- blister formation usually does not occur because dead tissue is thick and sticks to underlying viable tissue

- may or may not blanch, edema is moderate.

- can convert to full thickness if tissue damage increases by infection, hypoxia, or ischemia.

-heals in 3-6 wks, scar formation and skin grafting may be necessary

400

full thickness - 3rd degree

scald, flame, prolonged contact with hot objects, grease, tar, electricity, chemical

-destruction of dermis and epidermis into the subQ tissue, will not heal by re-epithelialization, grafting may be required.

-dry hard leathery eschar, crust and dead tissue must slough off or removed before healing can occur.

-waxy white, deep red, yellow whit or black in appearance

- edema under eschar

-sensation reduced or abesnt d/t nerve ending damage

- healing is wks -months, depends on blood supply

- requires removal of eschar and split or full thickness grafting

-scarring and wound contractures are likely

500

deep full thickness - 3rd degree

flames, electricity, grease, tar, chemical

-injury beyond skin to underlying fascia and tissues, muscle tendons bone are damaged

- appears black and zero sensation

-eschar is hard and inelastic

-no pain d/t nerve endings destroyed

- healing takes months and grafts are required d/t no regrowth of tissue

Initial skin assessment

100

Size and depth of injury

size- Rule of 9's, depth-classification

200

Rule of 9's

300

Parkland Formula

CALCULATED AT TIME OF INJURY

Crystalloid IV solution only

System consequences

100

Pulmonary

Pulmonary edema and failure related to INH injury

(Pay close attention 8-12 hours after fluid resuscitation)

200

GI

Curlings Ulcer and paralytic ilius
(USE PPI’S AND H2 BLOCKERS! FEED YOUR PATIENTS!)

300

Vascular

Vasodilation – WHAT HAPPENS AS A
RESULT?
3rd spacing and/or capillary leak syndrome
Decreases blood volume

400

Electrolyte Imbalance

HYPERkalemia(cell destruction), HYPOnatremia
CV CO

Phases of management

100

Resuscitation Phase!
Emergent

24 to 48 hours—until diuresis occurs (TBSA > 25%)

• Potential for decreased oxygenation

• Potential for shock

• Pain (acute and chronic)

• Potential for Acute Respiratory Distress Syndrome

(ARDS)

200

Surgical Management in Emergent
Phase

ESCHAROTOMY

Why is it performed?

• Compartment syndrome: Severe burns can cause tissue swelling that prevents blood from flowing easily. This can lead to compartment syndrome, which compresses blood vessels, nerves, muscles, and tissue. 

  
  

  
  

  
  

• Respiratory compromise: Burns to the chest and upper torso can make it difficult to breathe. 
• Loss of tissue perfusion: Burns can cause pressure to build up, which can lead to tissue perfusion loss.                                            How is it performed?

• A senior member of the burn medical team performs the procedure using sterile technique 
• Incisions are made through the eschar to release pressure 
• The incisions are not closed because the area needs to be monitored 
• The area is covered with sterile dressings and bandages 

 and FASCIOTOMY

300

Acute Phase

Diuretic Phase

36 to 48 hour after injury; until wound closure is

completed

(remobilization of fluid)

Goals of Management

• Continued systems assessments

• Burn wound care – SEPSIS RISK!

• Pain control

• Psychosocial interventions

Interventions

100

Resuscitation Phase
Emergent
Interventions

Resuscitation Phase
Emergent
Interventions
• Secure airway
• Support circulation—FLUID REPLACEMENT!
• Prevent infection
• Maintain body temperature
• Provide emotional support

300

Acute Phase

•Mechanical debridement

•Hydrotherapy

•Enzymatic debridement

•Autolysis

•Collagenase