burns 2010
DESCRIPTION
pathophysiologyTRANSCRIPT
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BurnsBurns
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Types of Burn InjuryTypes of Burn Injury
• Thermal Burns• Chemical Burns• Smoke Inhalation Injury• Electrical Burns• Cold Thermal Injury
• Thermal Burns• Chemical Burns• Smoke Inhalation Injury• Electrical Burns• Cold Thermal Injury
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Types of Burn InjuryThermal Burns
Types of Burn InjuryThermal Burns
• Caused by flame, flash, scald, or contact with hot objects
• Most common type of burn
• Caused by flame, flash, scald, or contact with hot objects
• Most common type of burn
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Full-Thickness Thermal Burn
Fig. 24-1, A
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Partial-Thickness Burn to the Hand
Fig. 24-1, B
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Partial-Thickness Burns Due to Immersion in Hot Water
Fig. 24-1, C
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Types of Burn InjuryChemical Burns
Types of Burn InjuryChemical Burns
• Result from tissue injury and destruction from necrotizing substances • Most commonly caused by acids• Respiratory & systemic problems• Eye injuries• Tissue destruction may continue for up to 72 hrs after
injury
• Result from tissue injury and destruction from necrotizing substances • Most commonly caused by acids• Respiratory & systemic problems• Eye injuries• Tissue destruction may continue for up to 72 hrs after
injury
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Types of Burn InjurySmoke Inhalation InjuriesTypes of Burn Injury
Smoke Inhalation Injuries
• Result from inhalation of hot air or noxious chemicals • Cause damage to respiratory tract• Important determinant of mortality in fire victims CO poisoning Inhalation injury
• Result from inhalation of hot air or noxious chemicals • Cause damage to respiratory tract• Important determinant of mortality in fire victims CO poisoning Inhalation injury
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Types of Burn Injury Smoke Inhalation Injuries
Types of Burn Injury Smoke Inhalation Injuries
Carbon monoxide (CO) poisoning• CO is produced by the incomplete combustion of burning materials• Inhaled CO displaces oxygen
Carbon monoxide (CO) poisoning• CO is produced by the incomplete combustion of burning materials• Inhaled CO displaces oxygen
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Types of Burn InjuryElectrical Burns
Types of Burn InjuryElectrical Burns
• Result from coagulation necrosis caused
by intense heat generated from an
electrical current
• May result from direct damage to nerves
and vessels causing tissue anoxia and
death
• Result from coagulation necrosis caused
by intense heat generated from an
electrical current
• May result from direct damage to nerves
and vessels causing tissue anoxia and
death
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Electrical Burn- Hand
Fig. 24-2, A
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Electrical Burn- Back
Fig. 24-2, B
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Types of Burn Injury Electrical Burns
Types of Burn Injury Electrical Burns
• Severity of injury depends on the amount of voltage, tissue resistance, current pathways, surface area, and on the length of time of the flow
• Severity of injury depends on the amount of voltage, tissue resistance, current pathways, surface area, and on the length of time of the flow
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Types of Burn Injury Electrical Burns
Types of Burn Injury Electrical Burns
• Electrical sparks may ignite the patient’s
clothing, causing a combination of
thermal and electrical injury
• Electrical sparks may ignite the patient’s
clothing, causing a combination of
thermal and electrical injury
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Types of Burn Injury Cold Thermal Injury
Types of Burn Injury Cold Thermal Injury
• Frostbite
• Frostbite
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Classification of Burn InjuryClassification of Burn Injury
• Severity of injury is determined by
- Depth of burn
- Extent of burn
- Location of burn
- Patient risk factors
• Severity of injury is determined by
- Depth of burn
- Extent of burn
- Location of burn
- Patient risk factors
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Classification of Burn InjuryBurn Injury
Classification of Burn InjuryBurn Injury
- In the past, burns were defined by
degrees:
• First-degree, second-degree, and third-
degree burns
- In the past, burns were defined by
degrees:
• First-degree, second-degree, and third-
degree burns
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Cross Section of Skin
Fig. 24-3
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Classification of Burn InjuryDepth of Burn
Classification of Burn InjuryDepth of Burn
- Burns now classified according to depth of skin destruction:
• Partial-thickness burn
• Full-thickness burn
- Burns now classified according to depth of skin destruction:
• Partial-thickness burn
• Full-thickness burn
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Classification of Burn InjuryDepth of Burn
Classification of Burn InjuryDepth of Burn
- Superficial partial thickness
• Involves the epidermis
- Deep partial thickness
• Involves the dermis
- Full thickness
• Involves fat, muscle, bone
- Superficial partial thickness
• Involves the epidermis
- Deep partial thickness
• Involves the dermis
- Full thickness
• Involves fat, muscle, bone
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Partial Thickness (Superficial)
• Redness
• Pain
• Moderate to severe tenderness
• Minimal oedema
• Blanching with pressure
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Superficial Burns
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Partial Thickness Burns
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Partial-Thickness (Deep)
• Moist blebs, blisters
• Mottled white, pink to cherry red
• Hypersensitive to touch or air
• Moderate to severe pain
• Blanching with pressure
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Partial Thickness Burns
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Full-Thickness
• Dry, leathery eschar• White, waxy, dark brown or charred
appearance• Strong burn odour• Impaired sensation when touched• Absence of pain with severe pain in
surrounding tissues• Lack of blanching with pressure
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Full Thickness Burns
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Full Thickness Burns
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Full Thickness Burns
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Partial & Full Thickness Burns
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Classification of Burn InjuryExtent of Burn
Classification of Burn InjuryExtent of Burn
- Two commonly used guides for
determining the total body surface area:
• Lund-Browder chart
• Rule of nines
- Two commonly used guides for
determining the total body surface area:
• Lund-Browder chart
• Rule of nines
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Lund-Browder Chart
Fig. 24-4, A
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Rule of Nines Chart
Fig. 24-4, B
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Classification of Burn InjuryLocation of Burn
Classification of Burn InjuryLocation of Burn
Location of the burn is related to the
severity of the injury:– Face, neck, chest respiratory
obstruction
– Hands, feet, joints, and eyes self-care – Ears, nose infection
Location of the burn is related to the
severity of the injury:– Face, neck, chest respiratory
obstruction
– Hands, feet, joints, and eyes self-care – Ears, nose infection
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Classification of Burn InjuryLocation of Burn
Classification of Burn InjuryLocation of Burn
- Circumferential burns of the extremities
can cause circulatory compromise
- Patients may also develop compartment
syndrome
- Circumferential burns of the extremities
can cause circulatory compromise
- Patients may also develop compartment
syndrome
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Circumferential Burns
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Classification of Burn Injury Patient Risk Factors
Classification of Burn Injury Patient Risk Factors
• Older adults heal more slowly than young adults• Preexisting cardiovascular, respiratory, renal disease• Diabetes mellitus• Alcoholism• Drug abuse• Malnutrition• Concurrent fractures, head injuries, or other trauma
• Older adults heal more slowly than young adults• Preexisting cardiovascular, respiratory, renal disease• Diabetes mellitus• Alcoholism• Drug abuse• Malnutrition• Concurrent fractures, head injuries, or other trauma
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Emergent PhaseEmergent Phase
• Emergent phase is the period of time required to resolve the immediate problems resulting from burn injury• From burn onset to 5 or more days• Usually lasts 24 to 48 hours • The phase begins with fluid loss and edema formation and continues until fluid mobilization
and diuresis begin
• Emergent phase is the period of time required to resolve the immediate problems resulting from burn injury• From burn onset to 5 or more days• Usually lasts 24 to 48 hours • The phase begins with fluid loss and edema formation and continues until fluid mobilization
and diuresis begin
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Emergent PhasePathophysiology
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts
- Greatest threat is hypovolaemic shock,
caused by a massive shift of fluids out of
blood vessels as a result of increased
capillary permeability
• Fluid and Electrolyte Shifts
- Greatest threat is hypovolaemic shock,
caused by a massive shift of fluids out of
blood vessels as a result of increased
capillary permeability
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Conditions Leading to Burn Shock
Fig. 24-5
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Emergent PhasePathophysiology
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts
- The net result of the fluid shift is
intravascular volume depletion
• Oedema
• Blood pressure
• Pulse
• Fluid and Electrolyte Shifts
- The net result of the fluid shift is
intravascular volume depletion
• Oedema
• Blood pressure
• Pulse
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Emergent PhasePathophysiology
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts
- Normal insensible loss: 30 to 50 ml per
hour
- Severely burned patient: 200 to 400 ml per
hour
• Fluid and Electrolyte Shifts
- Normal insensible loss: 30 to 50 ml per
hour
- Severely burned patient: 200 to 400 ml per
hour
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Emergent PhasePathophysiology
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts
- RBCs are haemolyzed by a circulating
factor released at the time of the burn
- Thrombosis
- Elevated haematocrit
• Fluid and Electrolyte Shifts
- RBCs are haemolyzed by a circulating
factor released at the time of the burn
- Thrombosis
- Elevated haematocrit
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Emergent PhasePathophysiology
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts
- Na+ shifts to the interstitial spaces and
remains until oedema formation ceases
- K+ shift develops because injured cells
and haemolyzed RBCs release K+ into
extracellular spaces
• Fluid and Electrolyte Shifts
- Na+ shifts to the interstitial spaces and
remains until oedema formation ceases
- K+ shift develops because injured cells
and haemolyzed RBCs release K+ into
extracellular spaces
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Effects of Burn Shock
Fig. 24-6
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Emergent PhaseClinical Manifestations
Emergent PhaseClinical Manifestations
• Shock from pain and hypovolaemia
• Blisters
• Adynamic ileus
• Shivering
• Altered mental status
• Shock from pain and hypovolaemia
• Blisters
• Adynamic ileus
• Shivering
• Altered mental status
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Debriding Full-Thickness Burn
Fig. 24-9
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Acute PhaseAcute Phase
• The acute phase begins with the mobilization
of extracellular fluid and subsequent diuresis
• The acute phase is concluded when the burned
area is completely covered by skin grafts or
when the wounds are healed
• The acute phase begins with the mobilization
of extracellular fluid and subsequent diuresis
• The acute phase is concluded when the burned
area is completely covered by skin grafts or
when the wounds are healed
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Acute PhasePathophysiology
Acute PhasePathophysiology
• Diuresis from fluid mobilization occurs, and
the patient is no longer grossly edematous
• Bowel sounds return
• Healing begins when WBCs have surrounded
the burn wound and phagocytosis occurs
• Diuresis from fluid mobilization occurs, and
the patient is no longer grossly edematous
• Bowel sounds return
• Healing begins when WBCs have surrounded
the burn wound and phagocytosis occurs
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Surgeon Harvesting Skin
Fig. 24-11, A
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Donor Site After Harvesting
Fig. 24-11, B
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Healed Donor Sites
Fig. 24-11, C
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Healed Split-Thickness Skin Graft
Fig. 24-11, D
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Application of Cultured Epithelial Autograft
Fig. 24-12, A
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Healed Cultured Epithelial Autograft
Fig. 24-12, B
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Escharotomy of the Lower Extremity
Fig. 24-7
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Acute PhaseComplicationsAcute PhaseComplications
• Infection
- Localized inflammation, induration, and
suppuration
- Partial-thickness burns can become full-
thickness wounds in the presence of
infection
• Infection
- Localized inflammation, induration, and
suppuration
- Partial-thickness burns can become full-
thickness wounds in the presence of
infection
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Contracture of the Axilla
Fig. 24-13
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Contractures
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Rehabilitation PhaseRehabilitation Phase
• The rehabilitation phase is defined as
beginning when the patient’s burn wounds are
covered with skin or healed and the patient is
able to resume a level of self-care activity
• The rehabilitation phase is defined as
beginning when the patient’s burn wounds are
covered with skin or healed and the patient is
able to resume a level of self-care activity