Burns Ppt Sept 2006
-
Upload
northtec -
Category
Health & Medicine
-
view
298 -
download
1
description
Transcript of Burns Ppt Sept 2006
Burns
Types of Burn Injury
• Thermal Burns• Chemical Burns• Smoke Inhalation Injury• Electrical Burns• Cold Thermal Injury
Types of Burn InjuryThermal Burns
• Caused by flame, flash, scald, or contact with hot objects
• Most common type of burn
Full-Thickness Thermal Burn
Fig. 24-1, A
Partial-Thickness Burn to the Hand
Fig. 24-1, B
Partial-Thickness Burns Due to Immersion in Hot Water
Fig. 24-1, C
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
Types of Burn InjurySmoke 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
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
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
Electrical Burn- Hand
Fig. 24-2, A
Electrical Burn- Back
Fig. 24-2, B
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
Types of Burn Injury Electrical Burns
• Electrical sparks may ignite the patient’s clothing, causing a combination of thermal and electrical injury
Types of Burn Injury Cold Thermal Injury
• Frostbite
Classification of Burn Injury
• Severity of injury is determined by- Depth of burn- Extent of burn - Location of burn- Patient risk factors
Classification of Burn InjuryBurn Injury
- In the past, burns were defined by degrees:
• First-degree, second-degree, and third- degree burns
Cross Section of Skin
Fig. 24-3
Classification of Burn InjuryDepth of Burn
- Burns now classified according to depth of skin destruction: • Partial-thickness burn • Full-thickness 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
Partial Thickness (Superficial)
• Redness• Pain• Moderate to severe tenderness• Minimal oedema• Blanching with pressure
Superficial Burns
Partial Thickness Burns
Partial-Thickness (Deep)
• Moist blebs, blisters• Mottled white, pink to cherry red• Hypersensitive to touch or air• Moderate to severe pain• Blanching with pressure
Partial Thickness Burns
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
Full Thickness Burns
Full Thickness Burns
Full Thickness Burns
Partial & Full Thickness Burns
Classification of Burn InjuryExtent of Burn
- Two commonly used guides for determining the total body surface area:
• Lund-Browder chart • Rule of nines
Lund-Browder Chart
Fig. 24-4, A
Rule of Nines Chart
Fig. 24-4, B
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
Classification of Burn InjuryLocation of Burn
- Circumferential burns of the extremities can cause circulatory compromise
- Patients may also develop compartment syndrome
Circumferential Burns
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
Emergent 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 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
Conditions Leading to Burn Shock
Fig. 24-5
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts- The net result of the fluid shift is
intravascular volume depletion • Oedema
• ↓ Blood pressure
• ↑ Pulse
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts- Normal insensible loss: 30 to 50 ml per
hour- Severely burned patient: 200 to 400 ml per
hour
Emergent PhasePathophysiology
• Fluid and Electrolyte Shifts- RBCs are haemolyzed by a circulating
factor released at the time of the burn- Thrombosis- Elevated haematocrit
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
Effects of Burn Shock
Fig. 24-6
Emergent PhaseClinical Manifestations
• Shock from pain and hypovolaemia• Blisters• Adynamic ileus• Shivering• Altered mental status
Debriding Full-Thickness Burn
Fig. 24-9
Acute Phase
• The acute phase begins with the mobilizationof extracellular fluid and subsequent diuresis
• The acute phase is concluded when the burnedarea is completely covered by skin grafts orwhen the wounds are healed
Acute PhasePathophysiology
• Diuresis from fluid mobilization occurs, andthe patient is no longer grossly edematous
• Bowel sounds return• Healing begins when WBCs have surrounded
the burn wound and phagocytosis occurs
Surgeon Harvesting Skin
Fig. 24-11, A
Donor Site After Harvesting
Fig. 24-11, B
Healed Donor Sites
Fig. 24-11, C
Healed Split-Thickness Skin Graft
Fig. 24-11, D
Application of Cultured Epithelial Autograft
Fig. 24-12, A
Healed Cultured Epithelial Autograft
Fig. 24-12, B
Escharotomy of the Lower Extremity
Fig. 24-7
Acute PhaseComplications
• Infection- Localized inflammation, induration, and suppuration- Partial-thickness burns can become full- thickness wounds in the presence of
infection
Contracture of the Axilla
Fig. 24-13
Contractures
Rehabilitation Phase
• The rehabilitation phase is defined asbeginning when the patient’s burn wounds arecovered with skin or healed and the patient isable to resume a level of self-care activity