Beruflich Dokumente
Kultur Dokumente
Chapter 39
Written by : Melissa Dearing LSC-Kingwood
Epidemiology
In the U.S.
Results in 60,000 hospitalizations
annually
6000 deaths annually
Mortality the highest in
Young children
elderly
Epidemiology
Highest when:
Burn exceeds 30% body surface area.
See figure 39-1
Associated with smoke inhalation
Child younger than 4 years old
Pathophysiology
Composed of 2 layers
Epidermis thin outer layer
Dermis deeper, thick inner layer
Dermis contains:
Hair follicles
Sweat glands
Sebaceous glands
Sensory fibers for touch, pain, pressure and temp
Beneath the dermis
Subcutaneous tissue composed of connective
tissue and fat
Classification of Burn
1st Degree
Superficial
Involves only the dermis
Skin is red
No blisters
Painful and sensitive to touch
Classification of Burn
2nd Degree
Involve the epidermis and part of the
dermis
Very painful due to nerve endings that
survive the insult
Blistering is common
Healing occurs quickly
Classification of Burn
3rd Degree
Full thickness burns
Involve injury and necrosis below the
hair follicles thru the entire thickness of
skin and into subcutaneous tissue
Area swells slowly and appears blanched
Sensory nerves are destroyed causing
local anesthesia
Management
Systemic effects:
Increase in RAW
V/Q mismatch
Increase in oxygen consumption
Decrease in compliance
Decrease in oxygenation
Decreased surfactant production
Carbon Monoxide Poisoning
Oxygen Therapy
Airway Maintenance
Bronchial Hygiene Therapy
Pharmacologic Management
Mechanical Ventilation
Conventional
High frequency
Management
Oxygen Therapy
Initially give 100%
Wean by blood gas values
Analyze COHB with co-ox
Management
Airway maintenance
Intubation by most skilled clinician
Nasalintubation is easier for securing a tube
to a burned face
Burns to the neck can cause tightening of
the tissue causing restriction to the airway
Escharotomies to reduce the pressure exerted
to the area
Management
Pharmacological Management
Inhalation
injury creates intense
bronchospasm and wheezing
Manage with B2 agonists
Racemic epinephrine to promote vasoconstriction
(trx edema), bronchodilation, and breaking up of
secretions
Mucomyst to break down mucus in the airway
Heparin/mucomyst nebulizer may reduce pts
mortality
Management
Mechanical Ventilation
Forresp failure associated with inhalation
injury
Ptswith this type of injury are at increased
risk of ventilator associated injury
Management