BURNS

Most burns are caused by hot objects, explosions, or scalding. They may also be
caused by electrical mal- functions, contact with harmful chemicals, or abrasion.
Burns are assessed in terms of the depth of damage and the percentage of body
surface area (BSA) involved. Depth of tissue destruction is categorized as follows:
Supercial partial-thickness, which involves the epidermis and perhaps a portion of
the dermis. The tissue is reddened and may blister, as in cases of sunburn. Deep
partial-thickness, which involves the epidermis and portions of the dermis. The
tissue is blis- tered and broken and has a weeping surface. Causes include scalding
and ash ame. Full-thickness, which involves the full skin and sometimes
subcutaneous tissue and underlying tis- sues as well. The tissue is broken and is dry
and pale or charred. These injuries may result in loss of digits or limbs and require
skin grafting. The above classication replaces an older system of ranking burns as
rst-, second-, and third-degree ac- cording to the depth of tissue damage. The
amount of BSA involved in a burn may be estimated by using the rule of nines, in
which areas of body surface are assigned percentages in multiples of nine (Fig. 212). The more accurate Lund and Browder method divides the body into small areas
and estimates the proportion of BSA that each contributes. Infection is a common
complication of burns because a major defense against invasion of microorganisms
is damaged. Respiratory complications and shock may also occur. Treatment of
burns includes respiratory care, administration of uids, wound care, and pain
control. Mon- itoring for cardiovascular complications, infections, and signs of
posttraumatic stress are also important.
PRESSURE ULCERS
Pressure ulcers are necrotic skin lesions that appear where the body rests on skin
that covers bony projec- tions, such as the sacrum, heel, elbow, ischial bone of the
pelvis, or greater trochanter of the femur. The pres- sure interrupts circulation,
leading to thrombosis, ulceration, and death of tissue. Poor general health,
malnutrition, age, obesity, and infection contribute to the development of pressure
ulcers. Lesions rst appear as redness of the skin. If ignored, they may penetrate
the skin and underlying muscle, extending even to bone, and may require months
to heal. Pads or mattresses to relieve pressure, regular cleansing and drying of the
skin, frequent change in posi- tion, and good nutrition help to prevent pressure
ulcers. Other terms for pressure ulcers are decubitus ulcer and bedsore. Both of
these terms refer to lying down in bed, although pressure ulcers may appear in
anyone with limited movement, not only those who are conned to bed.