BURNS

Tiffany Silan Kimberlee Tan

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology Management of burns
Emergent phase Acute phase Rehabilitative phase

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology

Burns
Definition
transfer of energy from heat source to the body cell destruction of the layers of the skin

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology

Burns
At risk: High risk for Burns
Very Old (60yrs and above) Very Young (3-5 yrs of age) People who live in manufactured homes and rural areas

Burns
At risk: Greater risk of Mortality due to Burns
Patients <5yrs of age Patients >40 yrs old

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology

Burns

Prevention
Keep all matches and lighters away from children Do not leave children alone around fires Install and maintain smoke detectors Set water heater temperature no higher than 120F (48.9C)

Burns

Prevention
Do not smoke in bed or fall asleep while smoking Use caution when cooking Keep a working fire extinguisher at home

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology

Burns

Thermal
Electrical

Types of burns

Chemical
Radiation

Thermal
>exposure to hot substances (e.g. exposure to flames, hot liquids, steam or hot objects) > e.g. Scald Burns -wet burns - injury to the skin by touching a very hot liquid or steam -most frequent thermal injury

 >contact with live current >caused by heat generated by electrical energy as it passes through the body >electricity travels through areas of least resistance and destroys everything in its path (nerves and blood vessels first. >internal damage maybe more severe than expected from external injury

Electrical

 >Principle: -the stronger the current + the longer the contact=the more severe the injury >important to note: voltage, type of current, contact site and duration of contact

Electrical

High Voltage
True Electrical Injury

Electrical

Arc injury
Cutaneous

injury

High Voltage
True Electrical Injury

Arc injury
Cutaneous

injury

 >caused by contact with strong acids or strong bases or prolonged contact with most chemicals >systemic toxicity may occur from cutaneous absorption

Chemical

 >exposure to high doses of radioactive material, ultraviolet light or X-ray

Radiation

Burns
Definition At risk Prevention Types of Burns Classifications of Burns Patophysiology

Burns

According to Depth

According to Extent

Classifications of Burns

According to Depth

>determines whether epithelialization will occur >factors +how the injury occurred +causative agent such as flame or scalding liquid +temperature of burning agent +duration of contact with agent +thickness of skin

According to Depth

According to Depth

According to Depth

According to Extent

estimating Total Body Surface Area (TBSA) affected by burns a. Rule of Nines -quick away to estimate extent of burns -system where body parts are assigned with percentages in multiples of 9

According to Extent

b. Lund and Browder chart -more precise method of estimating extent of burn -recognizes the percentage surface area of various anatomic parts especially the head, legs and thighs which vary according to age -divide the body into very small areas providing estimate of the proportion of TBSA

According to Extent

c. Palm Method -scattered burns -principle: the size of the patients palm is approximately 1% of TBSA

 Determine if the burn is:

Minor Burn Injury Moderate Uncomplicated Burn Injury Major burn Injury

Minor Burn Injury

Second degree burn <15% TBSA in adults OR <10% TBSA in children 3rd Degree<2% TBSA note involving special care areas (eyes, ears, face, hands, feet, perineum, major joints) Excludes patient with electrical injury, inhalation injury and concurrent trauma and all poor risk patients (extremes of age and intracurrent disease

Moderate Uncomplicated Burn Injury

Second degree burn 15-25% TBSA in adults OR 10-20% TBSA in children 3rd Degree<10% TBSA note involving special care areas (eyes, ears, face, hands, feet, perineum, major joints) Excludes patient with electrical injury, inhalation injury and concurrent trauma and all poor risk patients (extremes of age and intracurrent disease

Major Burn Injury

Second degree burn >25% TBSA in adults OR >20% TBSA in children All 3rd Degree Burns >10% TBSA All burns involving special care areas (eyes, ears, face, hands, feet, perineum, major joints) All patients with electrical injury, inhalation injury and concurrent trauma and all poor risk patients (extremes of age and intracurrent disease

Patophysiology of Burns
Modifiable >Occupation >Place of living >Contact with burn agents >Duration of contact with source Non-modifiable >age >voltage (e.g. lightning) >duration of contact (e.g.lightning)

Coagulation, Protein Denaturation, Ionization of cellular contents and exposure to noxious gasses

Tissue Destruction
CV F&E Renal Immunologic Cellular/Metabolic Thermoregulatory GI

Inhalation

Pulmonary

Pulmonary Alterations
Inhalation Injury -prolonged hospitalization -major cause of morbidity and mortality in pts c burn injury -can occur in people trapped inside a burning structure

Categories of Inhalation Injuries

>Upper airway injury -caused by direct heat or edema -manifested by mechanical obstruction of the upper airway >Inhalation injury below the glottis -results from inhaling the product of incomplete combustion of noxious gases *Carbon monoxide Poisoning >restrictive defects -Arise when edema develops under full thickness burns encircling the neck and thorax

Indicators for Inhalation injury

Hx of burns that ocurred in an enclosed area Burns of face and neck Singed nasal hair Hoarseness, voice change, dry cough Bloody sputum Labored breathing, tachypnea and signs of hypoxia Erythema & blistering of pharyngeal mucosa

Diagnostic procedures
Serum carboxyhemoglobin levels ABG Fiberoptic bronchoscopy Xenon133 ventillation-perfusion scans

Complications
Acute Respiratory Failure (ARF) Adult Respiratory Distress Syndrome (ARDS)

Patophysiology and Management of Burn Injury

>Tiffany<