Burns
Classification of Burns
Burns are classified according to their depth of involvement: 1st-3rd degree.
Dysfunction of Other Organ Systems:Neurologic changes-
Caused by periods of hypoxia, hypovolemia, trauma, etc. May see confusion, memory loss, insomnia, lethargy, or combativeness.
Dysfunction of Other Organ Systems:Renal insufficiency-
May occur as a result of hypovolemia, damage to kidneys from burn, or medications
Dysfunction of Other Organ Systems:Sepsis
Severe, overwhelming, systemic infection. Skin is the body's first line of defense against infection.
Respiratory System Dysfunction
a. Common with smoke inhalation b. Irritation and ulceration of mucous membranes in the respiratory system, bronchospasm, and edema c. May have thermal injury to the respiratory passages
Second-Degree Full-Thickness
a. Entire epidermis and dermis b. Structures originating in the subcutaneous layer (hair follicles, sweat glands) remain intact c. Very painful d. Mottled pink, red, or waxy white with blisters and edema e. Blisters are flat and appear dry f. Tactile sensation may be lost or diminished g. Heal in approximately 1 month, usually with a scar, and there may be loss of some sensation.
Third-Degree Full-Thickness
a. Extend into subcutaneous tissue- may involve muscle and bone b. Thrombosed vessels may be seen under the skin c. Vary in color: waxy white, yellow, tan, brown, red, or black d. Hard, dry, and leathery e. Extensive edema to burned area and surrounding tissues f. No pain g. Regeneration, if possible (smaller areas), may take several weeks. Large areas may require skin grafts. h. Permanent scarring
Dysfunction of Other Organ Systems:Musculoskeletal effects
a. Fractures at the time of the incident, deep burns, scarring, and contractures.
Dysfunction of Other Organ Systems:GI-
a. Gastric dilation and decreased peristalsis. Potential complication: acute ulceration of stomach and duodenum (Curling ulcer)
second-Degree Superficial Partial-Thickness
a. Involve the epidermis and various degrees of the dermis b. Painful, moist, red, blistered c. Blisters are important to prevent the loss of water and superficial dermal cells. d. Underneath blisters: weeping, pink/red, sensitive skin e. Heal in approximately 1-2 weeks
hemodynamic instability
a. May begin almost immediately b. Capillaries are injured and fluid is lost from the vascular, interstitial, and cellular compartments c. Hypovolemic shock à Decrease in cardiac output and impaired perfusion to vital organs d. Electrical burns may cause cardiac arrhythmias
First-Degree Superficial
a. Only the outer layer of the epidermis. b. Red/pink, dry, painful- Usually no blisters c. Skin maintains ability to function d. Heals in 3-10 days e. Example: Mild sunburn
Hypermetabolic Response
a. Stress of burn injury increases metabolic demand and nutritional requirements b. Stress-related hormones (catecholamines and cortisol) are released c. Heat production is increased d. Increased oxygen consumption, increased glucose use, and protein and fat wasting e. Peaks 7-17 days after the burn f. Nutritional support is necessary
Manifestations of inhalation injury: Respiratory System Dysfunction
i. Hoarseness ii. Drooling iii. Unable to handle secretions iv. Hacking cough v. Labored, shallow breathing
