burn lecture

• • Prevention
• • Institution of lifesaving measures for the severely burned person
• • Prevention of disability and disfigurement through early specialized and individualized care
• • Rehabilitation through reconstructive surgery and rehabilitation programs

dermis from a human cadaver for skin grafting

a graft from one part of the body to another part

same patient's body

• less scarring and contractions
• freeze dried
• better if pt has large TBSA burn

• own skin
• less chance for rejection

costly

have 2 sites (graft site and donor site)

cells froma  pt grown in a culture plate and regrafted to the pt

when collagen matures, the burn scar shrinks

• also called an allograft
• graft from one human to another either living or cadaver

• may be called a xenograft
• graft from an animal or species other than the recipient

• readily available
• long shelf life
• help to protect wound
• temporary wound coverage

• can be rejected
• temporary
• can only be used on noninfected areas and certain thicknesses

linear inceision through the non-viable tissue to release constriction of the underlying tissue

• incision made through the fascia to release pressure from the muscle
• deeper than escharotomy

• thermal/electrical
• radiation
• chemical
• inhalation

• flames
• lightening
• outlets
• scalds/steam
• contact w/ hot items
• most common type of burn

• damage to tissues, nerves, muscles
• muscle and tissue can break down and cause myoglobin to be released
• dysrhythmias

an EKG monitor

release of myoglobin

can cause the to go into ARF

UOP

• sunburns
• tanning beds
• problems w/ gamma radiation in cancer treatments

• meth labs
• facial treatments (orange peel burns)

• smoking
• smoke from fire

• bronchodilators
• give 100% oxygen
• possible ventilation if striddor/difficulty breathing
• b-scope

• dizziness
• HA
• nausea/vomiting
• decreased vision

usually occurs in extremities (nose, finger tips, toes)

• outer layer:  edpidermis
• inner layer:  dermis

• -outter layer of skin
• -has 2 layers
• -no blood vessels, gets nutrients from the underlying dermis

wrap on package

• -95% of skin
• -most complex and has 2 layers
• -one layer is thin loose connective tissue capillaries elastic fibers and collagen
• -second layer has dense connective tissue, large blood vessels, mast cells, fibroblasts, nerve endings, lymphatics, and epidermal appendages (sebaceious glands, sweat glands, hair follicles)
• -varies in thickness depending on location, age and gender

package

• how injury occured?
• causative agent?
• temperature of agent?
• duration of contact w/ the agent?
• thickness of skin?

• -superficial partial-thickness
• -deep partial-thickness
• -full thickness

might run across transmural or 4th degree

epidermis; possibly portion of dermis

taking wrapping off the package

• sunburn
• low-intensity flash

• tingling
• hyperesthesia (supersensitivity)
• pain that is soothed by cooling

• reddened; blanches w/ pressure; dry
• minimal or no edema
• possible blisters

• complete recovery w/in a week; no scarring
• peeling

epidermis, upper dermis, portion of deeper dermis

• scalds
• flash flame
• contact

• pain
• hyperesthesia
• sensitive to cold air

• blistered, mottled red base; broken epidermis; weeping surface
• edema

• recovery in 2-4 weeks
• some scarring and depigmentation contractures
• infection may convert it to full thickness

• epidermis, entire dermis, and sometimes SC tissue
• may involve connective tissue, muscle and bone

• flame
• prolonged exposure to hot liquids
• electric current
• chemical
• contact

• pain free
• shock
• hematuria and possibly hemolysis (blood cell destruction)
• possible entrance and exit wounds (electrical burn)

• rule of nines
• Lund and Browder method
• Palm method

body is broken into 9 areas which total 100%

9%

4.5%

4.5%

18%

9/9

18%

9/9

18%

4 1/2 a piece for each side

18%

9 a piece for each side

1%

• emergent/resuscitative
• acute/intermediate
• rehabilitation

from time of trauma to end of fluid resuscitation

• ABC's (now CAB)
• circulatory assessment
• neurological assessment

• ABC's (now CAB)
• humidified air
• encourage to cough or suction w/ bronchodilators
• intubate if needed
• obtain burn scenario hx
• large bore (16-18g) access or central line placement
• if nauseated or major burns place NGT for gastric decompression/paralytic ileus

• clean technique of inital wound assessment
• assessment percent burned using the rule of nines for fluid resuscitation
• clean sheet under and over patient
• foley (hourly output) 30-50 mL/hr
• baseline wt, ht, labs, EKG
• tetanus prophylaxis due to wound contamination
• physical stabilization
• meet psychological needs
• transfer to burn center

• generalized dehydration (fluid moving from intravascular to interstitial)
• reduced blood volume and hemoconcentration (^ hct and decreased hgb = thick blood = prolonged PTT)
• decreased urine output (muscle damage = release of myoglobin = renal tubules blocked = acute renal failure)

• trauma causes release of K+ into extracellular fluid (hemolysis)
• increased capillary permeability = Na+ and protein traps in edema fluid and shifts into cells as K+ is released
• metabolic acidosis

NO consensus so use Parkland/Baxter Formula

• -LR
• -4mL x kg in wt x % TBSA = total fluid
• -day 1: 1/2 amt in first 8 hours of post burn and rest over next 16 hours
• -day 2:  varies

4mL x wt in kg x % TBSA = total fluid

• adequate airway
• maintain temperature
• control pain
• provide emotional support

• resp distress
• ulcers
• shock
• compartment syndrome
• paralytic ileus