C.29

Question 1

The skin has THREE layers, what are these layers from the most superficial to the least? (top to bottom)

Answer 1

1. epidermis
2. dermis
3. hypodermis (subcantenous layer)

*note that the layers range in thickness from one cell to several layers of skin

Question 2

What is the primary function of the epidermis?

Answer 2

provides water tight and resilient barrier from the external environment

Question 3

What does the dermis contain?

Answer 3

contains small capillary beds and the sensory structures of the skin

Question 4

What is the hypodermis composed of?

Answer 4

connective fatty tissue and larger blood vessels

Question 5

What is the largest organ of the body?

Answer 5

The skin and it serves as a barrier against outside insult and injury

Question 6

What are the functions of the skin? (9)

Answer 6

• protects against water loss
• provides temperature regulation
• provides a physical barrier against the entrance of undesirable substances such as microorganisms and environmental toxins
  -protects underlying structures and organs against mechanical shock and forces applied to the body
• provides insulation and protects the body from extreme enviromental temperatures
• protects against ultraviolet light damage (UV rays AKA sun)
• provides sensory perception (hot, cold, pain, touch)
• aids in elimination of some of the body’s waste
• provides biochemical processes such as the production of vitamin D

*these functions can be destroyed or impaired with a burn injury

Question 7

What are the most common ways to classify burns?

Answer 7

By depth, severity, and surface area burnt

Question 8

Give me all the classifications of burns by depth?

Answer 8

superficial (1st degree)
partial thickness (2nd degree)
full thickness (3rd degree)

*There is also a 4th degree burn associated with electrical burns

*Only burns of partial thickness or full thickness are considered when calculating Body Surface Area (BSA) burn

Question 9

To what extent when talking about the layers of the skin does a superficial burn (1st degree) occupy?

Answer 9

involves only the epidermis

Question 10

What is a superficial burn (1st degree) typically caused by?

Answer 10

A flash (a sudden occurrence of heat or flame lasting only a few seconds), hot liquid, or the sun

Question 11

describe how the skin appears in a superficial burn (1st degree)?

Answer 11

pink to red and it is dry, in some cases, there is slight swelling

Question 12

describe how the skin feels in a superficial burn (1st degree)?

Answer 12

soft and tender to the touch

Question 13

are superficial burns painful, and if so why?

Answer 13

Yes because the pain receptors in the underlying dermis are still intact

Question 14

how long do superficial burns (1st degree) take to heal?

Answer 14

several days

*they do not require much medical care if only a small area was affected

Question 15

do first degree burns (superficial) cause scarring?

Answer 15

no. it can only cause the epidermis to peel

Question 16

To what extent when talking about the layers of the skin does a partial-thickness (2nd degree) occupy?

Answer 16

involves the epidermis and portions of the dermis

Question 17

What is a partial-thickness (2nd degree) typically caused by?

Answer 17

contact with fire (flame or flash), hot liquids or objects, chemical substances, or the sun

Question 18

Due to the damage to the small blood vessels in the dermis, in a second degree burns, what does this cause?

Answer 18

blisters, because the injury of the small blood vessels causes plasma and tissue fluid to collect between the layers of the skin, forming blisters

Question 19

do patients with 2nd degree burns experience pain? and if so, why?

Answer 19

yes because the pain receptors are still intact

Question 20

what are the classifications of partial thickness burns?

Answer 20

superficial partial-thickness or deep partial-thickness

Question 21

What are the S/S of superficial partial-thickness burns? (4)

Answer 21

-thin walled blisters result from superficial dermal layer damage
-skin is red and weeping (fluid oozing caused by the small leaks in the capillary bed)
-skin blanches with pressure
-skin is soft and tender to the touch (skin is more tender due to weeping)

Question 22

What characteristics does the skin have in an superficial partial-thickness burn? (2)

Answer 22

• skin is red and weeping (fluid oozing caused by the small leaks in the capillary bed)
• skin blanches with pressure
  -skin is soft and tender to the touch (skin is more tender due to weeping)

Question 23

What are the S/S of deep partial-thickness burns (5)

Answer 23

-thick walled blisters often rupturing
-skin can be a variable color with patchy areas that are red to cheesy white
-skin is wet or waxy dry
-the patient can still feel pressure at the site
-poor capillary refill to the burn site (increased edema compromises capillary beds around burn site)

Question 24

What characteristics does the skin have in an deep partial-thickness burns (3)

Answer 24

-skin can be a variable color with patchy areas that are red to cheesy white
-skin is wet or waxy dry

Question 25

To what extent when talking about the layers of the skin does a full-thickness (3rd degree) occupy?

Answer 25

all layers of the skin.

Question 26

What is a full-thickness (3rd degree) typically caused by?

Answer 26

extreme heat sources such as hot liquids or solids, flames, chemicals, or electricity

Question 27

How does the skin feel in an 3rd degree burns?

Answer 27

dry, hard, rough, tough, and leathery

Question 28

how does the skin look like in an 3rd degree burns?

Answer 28

white and waxy to dark brown or black and charred *NOTE THE SKIN DOES NOT BLANCH TO PRESSURE

Question 29

What is the tough and leathery dead soft tissue found in 3rd degree burns called?

Answer 29

eschar

Question 30

are 3rd degree burns painful?

Answer 30

according to the book, no because the nerve receptors are destroyed but the surrounding areas of the partial thickness and superficial burns, they are still painful

Question 31

Some full-thickness burns can be classifed as 4th degree burns, to what extent of the layers of the skin do 4th degree burns travel to?

Answer 31

beyond all layers, deep into the tendons, ligaments, muscle, bone, blood vessels, and nerve *associated with electrical injuries and requires extensive skin grafting for the site to heal

Question 32

What factors are most important to consider when determining burn severity? (5)

Answer 32

-depth -location -age -preexisiting medical condtions -percentage of burn surface area

Question 33

why are burns of the face considered critical?

Answer 33

potential for respiratory compromise and long term cosmetic concerns, as are injuries to ears and eyes

Question 34

why are burns to the hands or feet given special consideration?

Answer 34

due to potential for loss of function

Question 35

why are burns to areas with major joint function concerning? (ex: hips/shoulders)

Answer 35

may be considered critical due to loss of joint function

Question 36

why burns to genital areas concerning?

Answer 36

potential for loss of genitourinary function and increased risk of infection

Question 37

what are circumferential burns?

Answer 37

burns that encircle a body area. ex: arms, legs, chest, joint areas (hips) * circumferential burns to the chest can cause issues with chest expansion, limiting respiratory function

Question 38

partial-thickness or full-thickness burns can cause compartment syndrome, what is this?

Answer 38

When the burn is so severe, the extensive swelling starts compressing nerves and vessels, leading to nerve damage or reduction of circulation to that area being affected

Question 39

For these age groups, when is it considered a mild burn? (hint TBSA percentages) pediatrics, adult, elderly, all ages

Answer 39

Ped: less than 5% partial thickness adult: less than 10% partial thickness eld: less than 5% partial thickness all: less than 2% partial thickness *transport to emergency department for mild burns

Question 40

For these age groups, when is it considered a severe burn? (hint TBSA percentages) pediatrics, adult, elderly, all ages

Answer 40

Ped: more than 10% partial thickness adult: more than 20% partial thickness eld: more than 10% partial thickness all: more than 5% full thickness, burns to the face, eyes, ears, gentiliia, or joints, significant asscioated truama, electrical burns, lighting strikes *transport to specialized burn units for severe burns

Question 41

For these age groups, when is it considered a moderate burn? (hint TBSA percentages) pediatrics, adult, elderly, all ages

Answer 41

Ped: 5-10% partial thickness adult: 10-20% partial thickness eld: 5-10% partial thickness all: 2-5% full thickness, inhalation injury, circumferential injury, comoroid factors, electrical injury *transport to emergency department for moderate burns

Question 42

is the rule of nines applied to superficial burns?

Answer 42

no, only partial thickness or full thickness

Question 43

when considering the rule of nines, for a child above 1 years of age, what should we do?

Answer 43

add 0.5% to each of the legs and subtract 1% from the head for each year above 1 they are *you can also use the lund and browder system to estimate BSA, which is much more accurate as it maps the burned area on a chart that is appropriate to the age of the patient

Question 44

What is the rule of ones and when do we use it?

Answer 44

for patients with less than 5% TBSA burned and it is when you curl up the fist of the patient, which helps estimate TBSA since the fist curled is approximately 1% in relation to the patients body *ALSO CALLED THE RULE OF PALMS

Question 44

rules of nine: infant

Answer 44

head and neck: 18% chest and abdomen: 18% (same as adult) entire back: 18% same as adult each upper extremity: 9% same as adult each lower extremity: 14%

Question 45

rule of nines: adult

Answer 45

head and neck: 9% the upper extremity: 9% the chest: 9% the abdomen: 9% the upper back: 9% the lower back: 9% back of each lower extremity: 9% front of each lower extremity: 9% genitalia: 1%

Question 46

Removing the patient from a burn source does not completely stop the burning process, what else do you need to do?

Answer 46

cool it ASAP, approximately within the first 10 minutes of injury. you stop the burning process with water or saline, unless dry chemicals are involved and if they are, wipe/brush them off and then use water. remove any smoldering clothing and constricting jewelry, which produce heat and may constrict swollen extremities. *DO NOT REMOVE ADHERED CLOTHING *ONLY COOL THE BURN FOR 60-120 SECONDS, BEYOND THAT CAN CAUSE HYPOTHERMIA

Question 47

emergency medical care for burn patients

Answer 47

1.remove patient from source of burn and stop burning process. stop burns by using water but be cautious with semisolid or liquid (tar, grease, oil) do not remove these burn liquids as it can cause further damage but still rinse. dry chems should be brushed away. remove shouldering clothes or jewelry. cut around adhered clothing, do not remove. 2. establish and maintain an airway, adeaquate breathing and oxygenation 15 LPM NRM if toxic gases are suspected. otherwise, you can do 10-15 if they need it. 3. claffisy servity of burn and transport ASAP if critical 4. cover the burn area with dry sterile dressing (you can use a burn sheet). this decreases pain by reducing airflow across exposed nerves. do not use a wet dressing, increase hypothermia. you can however use a high concertrative antimictrobial coated dressing due to its layer of silver aiding in antimicrobial protecting but do NOT apply antimicrobial cream as this makes inspection and debridement of injury difficult 5.keep the patient wamr and treat other injuries 6.transport to appropriate facility

Question 48

how to treat burns of the eye?

Answer 48

don't open eyes and determine type of burn. thermal or chemical. with thermal, apply a dry sterile dressing to BOTH eyes to prevent movement of both eyes since they move together. with chemical, flush with water in large quantities while en route to hospital. flush medially to lateral sides to avoid flushing chemicals to other eyes

Question 49

Electrical burns

Answer 49

cardiac issues, electricity seeks to exit the body in the least resistant path to the ground, be safe, electricty could still be running and be a danger to you