Академический Документы
Профессиональный Документы
Культура Документы
Burns
Topics
Introduction to Burn Injuries
Anatomy and Physiology of the Skin
Pathophysiology of Burns
Assessment of Thermal Burns
Management of Thermal Burns
Assessment and Management of Electrical,
Chemical, and Radiation Burns
Bla bla bla bla
Introduction to Burn Injuries
Introduction to Burn Injuries
1.25–2 million Americans treated for burns
annually
– 45,000 require hospitalization
– 90% of burns can be prevented
– 3–5% considered life threatening
– 2nd leading cause of death for children <12
– Half of all tap-water burns occur to children <5
Introduction to Burn Injuries
Greatest Risk
– Very young and very old
– Infirm
– Firefighters
– Metal smelters
– Chemical workers
Drugs and alcohol play major role
Alcohol plays a major role
Introduction to Burn Injuries
Reducing burn injuries
– Improved building codes
– Safer construction techniques
– Sprinkler systems
– Use of smoke detectors
– Educational campaigns aimed primarily at school
children
Anatomy and Physiology
of the Skin
Anatomy and Physiology
of the Skin
Layers
– Epidermis
– Dermis
– Subcutaneous
– Underlying
structures
Fascia
Nerves
Tendons
Ligaments
Muscles
Organs
Anatomy and Physiology
of the Skin
Functions of the Skin
– Protection from infection
– Sensory organ
Temperature
Touch
Pain
– Controls loss and movement of fluids
– Temperature regulation
– Insulation from trauma
– Flexible to accommodate free body movement
Pathophysiology of Burns
Pathophysiology of Burns
Disruption of proteins in the cell membranes
Causes
– Thermal
– Electrical
– Chemical
– Radiation energies
Thermal Burns
Molecular structure changed by heat
Extent of burn damage depends on:
– Temperature of agent
– Concentration of heat
– Duration of contact
Thermal Burns
Jackson’s Theory of Thermal Wounds
– Zone of Coagulation
Area in a burn nearest the heat source
Suffers the most damage as evidenced by clotted blood and
thrombosed blood vessels
– Zone of Stasis
Characterized by decreased blood flow
– Zone of Hyperemia
Increased blood flow
Jackson’s Theory of
Thermal Wounds
Zone of Hyperemia
Jackson’s Theory of
Thermal Wounds Zone of Stasis
Zone of Coagulation
Thermal Burns
Emergent Phase (Stage 1)
– Pain response
– Catecholamine release
Tachycardia
Tachypnea
Mild hypertension
Mild anxiety
Thermal Burns
Fluid Shift Phase (Stage 2)
– Length 18–24 hours
– Begins after emergent
phase
Reaches peak in 6–8 hours
– Damaged cells initiate
inflammatory response:
Vasodilation
Increased capillary permeability
Intravascular hypovolemia
Extravascular edema
Thermal Burns
Hypermetabolic Phase (Stage 3)
– Large increase in the body’s need for nutrients as
it repairs itself
– Fluid and electrolytes begin to move back into the
vasculature
– Influx of fluid within vascular space causes the
GFR to increase, leading to diuresis
– Fluid shifts may lead to hypernatremia and
hypokalemia
– Cardiac workload and O2 consumption increase
Thermal Burns
Resolution Phase (Stage 4)
– Scar formation
– General rehabilitation; progression to normal function
Electrical Burns
Terminology
– Voltage – the pressure
Difference of electrical potential between two points
Different concentrations of electrons
– Amperes – the velocity
Strength of electrical current
– Resistance (Ohms) – the friction
Opposition to electrical flow
Electrical Burns
Greatest heat occurs at the points of
resistance:
– Entrance and exit wounds
– Dry skin = greater resistance
– Wet Skin = less resistance
Longer the contact, the greater the potential
of injury
– Increased damage inside body
Smaller the point of contact, the more
concentrated the energy, the greater the
injury
Electrical Burns
Electrical Current Flow
– Tissue of less resistance
Blood vessels
Nerve
– Tissue of greater resistance
Muscle
Bone
Chemical Burns
Chemicals destroy tissue
– Acids
Form a thick, insoluble mass
where they contact tissue
Coagulation necrosis
Limits burn damage
– Alkalis
Destroy cell membrane
through liquefaction necrosis
Deeper tissue penetration and
deeper burns
recorded by a
device called a
dosimeter
– Cyanokit®
Binds cyanide by freeing it
from the cytochromea3
enzyme
Excreted in urine