Burns 7-21-11
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| Burns are direct contact with or exposure to any. | Thermal, Chemical, Electrical or Radiation
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| Severity Of Burns | Risk of Infection, Mortality, And cosmetic or functional disability.
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| Factors that Influence Severity | depth, %TBSA, Location, age, general Health, Mechanism of injury
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| Burn Size | %TBSA, est. helps predict the severity of physiological response
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| Rule of Nines | (burn size) divides body into 11 segments.. Each 9% and 1% for genitals
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| Lund & Browder | Standard table based on the parts of body burned according to age
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| Incidence | Males more than females, except of 70 years
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| Thermal | Flames, Hot liquids, Steams semisolid, hot objects.
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| Chemical | contact with or ingestion, inhalation or injection
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| electrical | electrical energy as it passes through the body
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| radiation | least common, caused by radioactive source
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| Risk Factors for Burns | 75% result from actions of injured person usually in home
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| Who is at highest risk? | Children under 3 years, and elderly over 70years.
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| Other Risk factors | rural location, mobile home, occupation, lack of smoke detectors, fireworks, and misuse of cig smoking
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| Amount of skin destructed depends on. | temp to which skin exposed, length of time of exposure, and type of injury
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| A tremendous amount of heat is not required to cause.. | Damage
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| below 111*F (44*c) | no damage, unless prolonged exposure
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| 111*F-124*F (44*C-51*C) | Rate of cellular death doubles with each degree in temp rise.
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| >124*F (51*C) | exposure time is brief for damage
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| SUPERFICIAL (1ST DEGREE) | Epidermal Burn, Cell damage only to the epidermis skin, mild-severe erythema, blanching, surface is dry, no blisters, minor swelling, painful, skin will heal with out scaring, 3-7days
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| PARTIAL THICKNESS (2nd DEGREE) | Superficial Partial Thickness & Deep Partial Thickness
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| SUPERFICIAL PARTIAL THICKNESS | VERY PAINFUL, INTACT BLISTERS(COMMON SIGN), EPIDERMIS IS DESTROYED, SUPERFICIAL DERMIS MIN DAMAGE, MODERATE EDEMA, BLANCHING, HAIR & SWEAT GLANDS PRESERVED, COMPLETE HEAL 14-21 DAYS, LITTLE OR NO SCARING
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| DEEP PARTIAL THICKNESS | DESTRUCTION OF EPIDERMIS & DOWN TO RETICULAR LAYER OF DERMIS, INJURY TO NERVE ENDINGS, HAIR FOLLICLES, AND SWEAT DUCTS; SENSITIVE TO COLD AIR, MIXED RED OR WAXY WHITE; WET SHINY AND WEEPING BROKEN BLISTERS; EDEMA; MAY REQUIRE SKIN GRAFT; HEAL 27+DAY
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| DEEP PARTIAL THICKNESS-- 2 SCARS | HYPERTROPHIC & KELOID SCAR
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| FULL THICKNESS BURN (3RD DEGREE) | ALL EPIDERMAL AND DERMAL LAYERS ARE DESTROYED, SUBCUTANEOUS FAT LAYER DAMAGED
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| ESCHAR | DEVITALIZED TISSUE CONSISTING OF DRIED COAGULUM OF PLASMA AND NECROTIC CELLS -FEELS DRY, LEATHERY, & RIGID --TAN OR YELLOWISH-BROWN COLOR OR BLACK
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| FULL THICKNESS BURN (CONT) | NO BLANCHING, DESTRUCTION OF HAIR FOLLICLES AND NERVE ENDINGS (NO PAIN), DECREASED SENSATION, DAMAGE TO PERIPHERAL VASCULAR SYSTEM, SKIN GRAFT
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| ZONE OF COAGULATION | IRREVERSIBLE DAMAGE, SKIN DEATH!, SKIN GRAFT NEEDED TO HEAL, INCREASED RISK OF INFECTION
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| ZONE OF STASIS | INJURED CELLS (DILIGENT TREATMENT OR CELL DEATH WITHIN 24-48HOURS) TOO TIGHT SPLINTS/COMPRESSION BANDAGES WILL DAMAGE
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| ZONE OF HYPEREMIA | MINIMAL CELL DAMAGE
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| CLINICAL MANIFESTATIONS | LOCATION INFLUENCES SEVERITY
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| PULMONARY COMPLICATIONS | HEAD, NECK & CHEST
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| CORNEAL ABRASIONS | fACE
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| PERMANENT PHYSICAL/VOCATIONAL DISABILITY | HANDS/JOINTS
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| EMERGENT | TIME OF INJURY UNTIL RESTORATION OF CAPILLARY PERMEABILITY
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| RESUSCITATION PERIOD | INITIATION OF FLUIDS AND ENDS WHEN CAPILLARY INTEGRITY RETURNS TO NEAR-NORMAL & LARGE SHIFTS HAVE DECREASED
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| ACUTE PHASE OF RECOVERY | HEMODYNAMICALLY STABLE, CAPILLARY PERMEABILITY RESTORED & DIURESIS BEGINS
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| REHABILITATION PHASE | FINAL PHASE- MAX FUNCTIONAL RECOVERY
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| MOST COMMON AND LIFE THREATENING COMPLICATION | INFECTION
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| OFTEN FATAL COMPLICATION | INHALATION INJURY WITH MAJOR BURNS AND STAPHYLOCOCCAL SEPTICEMIA
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| COMPLICATIONS OF CARDIOVASCULAR & PULMONARY | MULTIPLE ORGAN DYSFUNCTION SYNDROME AND DEATH
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| WOUND CLEANING GOALS | REMOVE DEAD TISSUE, PREVENT INFECTION (STERILE), PROMOTE REVASCULARIZATION &/OR EPITHELIZATION
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| DEBRIDEMENT | REMOVAL OF DEAD TISSUE
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| SHARP DEBRIDEMENT | USE OF SURGICAL SCISSORS OR SCALPEL & FORCEPS; BLEEDING KEPT TO MINIMAL
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| HYDROTHERAPY WITH DISINFECTANT IN WATER | TEMP 98*f -102*F, TOPICAL MEDS OR DRESSING APPLIED
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| PRIMARY EXCISION | REMOVAL OF ESCHAR
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| AUTOGRAFT | PTS ON SKIN USED TO COVER A BURNED AREA, PERMANENT COVERAGE
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| ALLOGRAFT (HOMOGRAFT) | SKIN TAKEN FROM AN INDIVIDUAL OF THE SAME SPECIES; USUALLY CADAVER SKIN, TEMPORARY
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| XENOGRAFT (HETEROGRAFT) | SKIN FROM ANOTHER SPECIES, USUALLY A PIG, TEMPORARY
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| BIO SYNTHETIC GRAFTS (SKIN SUBSTITUTIONS) | CULTURED AUTOLOGOUS SKIN, GROWN IN A LAB, HIGHLY SUSCEPTIBLE TO INFECTION
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| DERMATOME | INSTRUMENT FOR REMOVAL OF SKIN FOR GRAFTING
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| SPLIT-THICKNESS | CONTAINS EPIDERMIS & ONLY SUPERFICIAL LAYERS OF DERMIS, ADHERES BETTER
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| FULL-THICKNESS | CONSIST OF FULL DERMAL THICKNESS, LOOKS BETTER
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| DONOR SITE | SITE FROM WHICH SKIN GRAFT IS TAKEN, THIGHS, BUTTOCKS AND BACK
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| SHEET GRAFT | WITHOUT ALTERATIONS, FOR FACE, NECK AND HANDS
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| MESH GRAFT | ABLE TO EXPAND BEFORE APPLICATION
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| PROCEDURES TO ELIMINATE SCAR CONTRACTURES | SKIN GRAFTS, Z-PLASTY (LEGTHENS SCAR Y INTERPOSING NORMAL TISSUE IN LINE OF SCAR)
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| POSITIONING | DECREASE EDEMA, PREVENT TISSUE DESTRUCTION, MAINTAIN SOFT TISSUE IN AN ELONGATED STATE
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| SPLINTING | PREVENT CONTRACTURES, MAINTAINANCE OF ROM, CORRECTION OF CONTRACTURES, PROTECTION OF JOINT OR TENDON
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| ACTIVE OR PASSIVE EX | PROGRESS 2 STRENGTHENING
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| AMBULATION | AS EARLY AS POSSIBLE
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| SCAR MANAGEMENT | PRESSURE DRESSING, VASCULAR SUPPORT OF SKIN GRAFTS/DONOR SITES, TO CONTROL EDEMA AND SCARRING; MASSAGE TO ASSIST WITH ROM EX.
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| HIGHER MORTALITY RATE | FOR CHILDREN 4 & UNDER AND ELDERLY OVER 65YEARS
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| SURVIVAL RATE FOR ELDERLY | 70%
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| FACTORS THAT INCREASE COMPLICATIONS & MORTALITY IN ADULTS | OBESITY, ALCOHOLISM, CARDIAC DISORDERS (PVD)
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