YOUR SKIN
- largest organ
- three layers
- epidermis
- thin
- body vs environment - dermis
- hair follicles
- sweat/oil glands
- sensory nerves
- capillaries - SQ tissue/ fat pads
FUNCTIONS OF YOUR SKIN
- immunologic defense
protection from infection and injury - barrier
prevention of body fluid loss - thermoregulation
regulation of body temperature - neurosensory
provides sensory contact with the environment
CAUSES OF BURNS
- inhalation
- thermal
- electrical
- chemical
- radiation
- cold thermal
PREVALANCE
BIRTH - 2 YEARS
- scald
- contact burns
5- 20 YEARS
-thermal burns (suns)
-20% pediatric burn r/t abuse or neglect
INHALATION
- results from hot air, noxious chemicals
- major predictor of mortality
- requires quick treatment
INJURY TYPES
- carbon monoxide poisoning
- inhalation injury above the glottis
- inhalation injury below the glottis
CARBON MONOXIDE POISONING
- incomplete combustion of burning materials
- CO displaces O2
- hypoxia
- death
- carboxyhemoglobinemia
- skin has “cherry red” appearance
- treatment:
100% humidified O2
hyperbaric oxygen therapy
INJURY ABOVE THE GLOTTIS
-steam inhalation
-aspiration of scalding liquid
- hot smoke/air
- mucosal burns
oropharynx
larynx
- causes mechanical obstruction
- medical emergency
- TREATMENT:
- ABG’s, O2, intubation (stridor)
SIGNS OF INHALATION BURN
- facial / neck burns
- singed nasal hair /beard, eyelashes, eye brows
- hoarsness, painful swallowing
- darkened oral/nasal membranes
- hyper secretions
- respiratory distress (stridor, wheezes)
INJURY BELOW THE GLOTTIS
-usually chemical injury
smoke, toxic fumes
- pulmonary edema may be instant or 12-24 hours later
1. impaired cillary action
2. hypersecretion
3. edema
4. ulceration of mucous membranes
5. spasm of bronchi and bronchioles
TREATMENT: intubation
THERMAL BURNS
- most common type of burn
- caused by :
- flame(dry heat)
- scald (moist heat)
- sun/radiation
- hot objects
THERMAL BURNS
- only 1/2 sec for 3rd degree burn in 150 degrees of water
- hot water accounts for 24% of all scalds in children
- US -65% of all children <4 is from hot tap water
- 1million/ year in US suffer from thermal burns
- 45,000 are admitted to the hosipital
- must evaluate for S/S abuse
INITIAL TREATMENT THERMAL BURNS
SMALL BURNS
-cover with clean cloth , cool tap water
LARGE BURNS
- ABC’s
- do not immerse in cold water or ice
- wrap in clean , dry sheet or blanket
- remove burned clothing unless adhered to site
ELECTRICAL BURNS
- results of coagulation necrosis
- direct damage
severity depends on :
- amount of voltage
- type of voltage
- tissue resistance
- current pathway
- surface area
- duration of flow
ELECTRICAL CONT
-entry and exit points
- passes through vital organs
- sparks
thermal , electrical
- inability to assess damage
- HIGH RISK
- dysrhythmias
- metabolic acidosis
- myoglobinuria
INTIAL TREATMENT ELECTRICAL BURNS
- assure source is shut off
- remove the patient from the source (VS, neuro check , etc)
- rescuer must be protected
CHEMICAL BURNS
DESTRUCTION - acids - alkalis -organic compounds (the worst) topically inflammatory systemically toxic
SEVERITY
- agent
- concentration
- volume
- duration of contact
CHEMICAL
DESTROYS TISSUE PROTEINS
-leads to necrosis
ALKALI’S MORE DIFFICULTS TO NEUTRALIZE
- cause deeper penetration
- cause protein hydrolysis and liquefication
- damage continues
RESULTS IN INJURY TO :
- skin
- eyes
- respiratory system
- liver and kidney damage
CHEMICAL
- remove quickly from the skin
- remove saturated clothing
- brushing from skin if a powder
- irritating with copious water
- burning process and tissue injury can last 72 hours
COLD THERMAL
Varied degrees
- frostbite
- systemic hypothermia
FROSTBITE
1 degree- white/ yellow firm plague
-accompanying pain
2 degree- superficial blistering
- very painful
- clear or milk fluid
3 degree- deep blistering
-red or purple fluid
CIRCUMFERENTIAL BURNS
- chest or extremity
- completely surround the extremity or torso
- cause respiratory / circulatory compromise
- as fluid enters the circumferential burn pressure increases
COMPARTMENT SYNDROME
- eschar is stiff and non-flexible
- high enough pressure impedes blood flow or respiratory effort
- creates ischemia
- can progress to necrosis
- requires “escharotomy”
- cut down to fat pads
Jackson’s burn model
ZONE OF COAGULATION
- severest damage
- will not recover
- slough out over time
- will leave scar
ZONE OF STASIS
- less damaged tissue
- inflammation occurs
- vascularity damaged
- potential for full recovery ( unless further stress is put on burn)
ZONE OF HYPERAEMIA
- intense vasodilation and increased blood flow
- invades the other zones under appropriate conditions to help heal
SEVERITY OF BURNS
1st= superficial 2nd= superficial or deep partial thickness 3rd= full thickness
