Beruflich Dokumente
Kultur Dokumente
405090066
PATHOPHYSIOLOGY OF BURNS
Burn coagulative necrosis of the epidermis
and underlying tissues
depth depending
temperature to which the skin is exposed
duration of exposure
BURN CLASIFICATION
Depths
First degree : Injury localized to the epidermis
Superficial second degree : to the epidermis and
superficial dermis
Deep second degree : through the epidermis and
deep into the dermis
Third degree : full-thickness injury through the
epidermis and dermis into subcutaneous fat
Fourth degree : through the skin and
subcutaneous fat into underlying muscle or bone
BURN CLASIFICATION
Causes
Flame :damage from superheated, oxidized air
Scald : damage from contact with hot liquids
Flash : damage from explosion
Contact : damage from contact with hot or cold
solid materials
Chemicals : contact with noxious chemicals
Electricity : conduction of electrical current
through tissues
FLAME BURNS
second most common mechanism of thermal
injury
e/:
- smoking-related fires
- improper use of flammable liquids
- motor vehicle collisions
- ignition of clothing by stoves or space
heaters
SCALD BURNS
Most common
Usually from hot water
- (60C) deep partial-thickness or full-thickness
burn in 3 seconds
FLASH BURNS
e/:
- Explosions of natural gas
- propane, butane, petroleum distillates, alcohols
- other combustible liquids
CONTACT BURNS
e/:
- result from contact with hot metals, plastic, glass,
or hot coals
- irons, ovens, and wood-burning stoves
- exhaust pipes of motorcycles
ELECTRICAL BURNS
Electrical injury is unlike other burn injuries
the visible areas of tissue necrosis represent
only a small portion of the destroyed tissue.
CLASSIFICATION
Injuries are divided into :
Low-voltage injury is similar to thermal burns
without transmission to deeper tissues; zones of
injury extend from the surface into the tissue
causes only local damage
High-voltage injury consists of varying degrees of
cutaneous burn at the entry and exit sites,
combined with hidden destruction of deep tissue
PATHOPHYSIOLOGY
Electrical current enters a part of the body proceeds
through tissues with the lowest resistance to current
(bllod vesssels) Heat generated by the transfer of
electrical current injures the tissues.
Muscle sustains the most damage.
Blood vessels proceed to progressive thrombosis
the cells die or repair themselves tissue loss from
ischemia
CHEMICAL BURNS
Chemicals cause their injury by protein
destruction, with denaturation, oxidation,
formation of protein esters, or desiccation of
the tissue
Alkali: potassium hydroxide, bleach, sodium
hydroxide
Acid: hydrofluoric acid, formic acid
Initial Assessment
divided into a primary and secondary survey.
Primary survey : immediately life-threatening
conditions are quickly identified and treated
Secondary survey : a more thorough head-to-toe
evaluation of the patient is undertaken
AIRWAY + BREATHING
hoarseness sign of impending airway
obstruction endotracheal intubation needs to
be instituted early before edema distorts the
upper airway
massive burns, who may appear to breathe
without problems early resuscitation (several
liters of volume are given to maintain
homeostasis and significant airway edema)
CIRCULATION
monitors arterial pressure and urine output.
Explosion cervical collars to keep the head
immobilized until the condition can be
evaluated.
WOUND CARE
Prehospital care of a burn wound clean dry
dressing or sheet to cover the involved part
diminishing pain
wrapped in a blanket to minimize heat loss and
for temperature control during transport.
IM or SC narcotic injections for pain are never
used vasoconstriction
Transport
uncontrolled transport of a burn victim is not a
priority
ground transportation and helicopter transport
greatest use
For distances >150 miles, transport by fixed-wing
aircraft
Whatever the mode of transport, it needs to be of
appropriate size and have emergency equipment
available
Resuscitation
IV access is best attained through short
peripheral catheters in unburned skin
Saphenous vein cut-down is useful in patients
with difficult access and is used in preference
to central vein cannulation lower
complication rates.
Adult RL without DX
Children < 2 yr RL + 5 % DX
burns greater than 10% TBSA 0.5 mL of
tetanus toxoid.
If previous immunization is absent or unclear
or the last booster dose was given longer than
10 years ago 250 units of tetanus IG
Escharotomies
The entire constricting eschar must be incised
longitudinally to completely relieve the impediment
to blood flow.
escharotomies are safest to restore perfusion to the
underlying nonburned tissues until formal excision is
performed
The most common complications blood loss and
transient hypotension