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Burns 2010

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pathophysiology

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Burns 2010

  1. 1. Burns
  2. 2. Types of Burn Injury <ul><li>Thermal Burns </li></ul><ul><li>Chemical Burns </li></ul><ul><li>Smoke Inhalation Injury </li></ul><ul><li>Electrical Burns </li></ul><ul><li>Cold Thermal Injury </li></ul>
  3. 3. Types of Burn Injury Thermal Burns <ul><li>Caused by flame, flash, scald, or contact with hot objects </li></ul><ul><li>Most common type of burn </li></ul>
  4. 4. Full-Thickness Thermal Burn Fig. 24-1, A
  5. 5. Partial-Thickness Burn to the Hand Fig. 24-1, B
  6. 6. Partial-Thickness Burns Due to Immersion in Hot Water Fig. 24-1, C
  7. 7. Types of Burn Injury Chemical Burns <ul><li>Result from tissue injury and destruction </li></ul><ul><li>from necrotizing substances </li></ul><ul><li>Most commonly caused by acids </li></ul><ul><li>Respiratory & systemic problems </li></ul><ul><li>Eye injuries </li></ul><ul><li>Tissue destruction may continue for up to 72 hrs after injury </li></ul>
  8. 8. Types of Burn Injury Smoke Inhalation Injuries <ul><li>Result from inhalation of hot air or </li></ul><ul><li>noxious chemicals </li></ul><ul><li>Cause damage to respiratory tract </li></ul><ul><li>Important determinant of mortality </li></ul><ul><li>in fire victims </li></ul><ul><li>CO poisoning </li></ul><ul><li>Inhalation injury </li></ul>
  9. 9. Types of Burn Injury Smoke Inhalation Injuries <ul><li> Carbon monoxide (CO) poisoning </li></ul><ul><li>• CO is produced by the incomplete </li></ul><ul><li> combustion of burning materials </li></ul><ul><li>• Inhaled CO displaces oxygen </li></ul>
  10. 10. Types of Burn Injury Electrical Burns <ul><li>Result from coagulation necrosis caused </li></ul><ul><li>by intense heat generated from an </li></ul><ul><li>electrical current </li></ul><ul><li>May result from direct damage to nerves </li></ul><ul><li>and vessels causing tissue anoxia and </li></ul><ul><li>death </li></ul>
  11. 11. Electrical Burn- Hand Fig. 24-2, A
  12. 12. Electrical Burn- Back Fig. 24-2, B
  13. 13. Types of Burn Injury Electrical Burns <ul><li>Severity of injury depends on the amount of voltage, tissue resistance, current pathways, surface area, and on the length of time of the flow </li></ul>
  14. 14. Types of Burn Injury Electrical Burns <ul><li>Electrical sparks may ignite the patient’s </li></ul><ul><li>clothing, causing a combination of </li></ul><ul><li>thermal and electrical injury </li></ul>
  15. 15. Types of Burn Injury Cold Thermal Injury <ul><li>Frostbite </li></ul>
  16. 16. Classification of Burn Injury <ul><li>Severity of injury is determined by </li></ul><ul><li>- Depth of burn </li></ul><ul><li>- Extent of burn </li></ul><ul><li>- Location of burn </li></ul><ul><li>- Patient risk factors </li></ul>
  17. 17. Classification of Burn Injury Burn Injury <ul><li>- In the past, burns were defined by </li></ul><ul><li>degrees: </li></ul><ul><li> • First-degree, second-degree, and third- </li></ul><ul><li>degree burns </li></ul>
  18. 18. Cross Section of Skin Fig. 24-3
  19. 19. Classification of Burn Injury Depth of Burn <ul><li>- Burns now classified according to depth of skin destruction: </li></ul><ul><li> • Partial-thickness burn </li></ul><ul><li> • Full-thickness burn </li></ul>
  20. 20. Classification of Burn Injury Depth of Burn <ul><li>- Superficial partial thickness </li></ul><ul><li> • Involves the epidermis </li></ul><ul><li>- Deep partial thickness </li></ul><ul><li> • Involves the dermis </li></ul><ul><li>- Full thickness </li></ul><ul><li> • Involves fat, muscle, bone </li></ul>
  21. 21. Partial Thickness (Superficial) <ul><li>Redness </li></ul><ul><li>Pain </li></ul><ul><li>Moderate to severe tenderness </li></ul><ul><li>Minimal oedema </li></ul><ul><li>Blanching with pressure </li></ul>
  22. 22. Superficial Burns
  23. 23. Partial Thickness Burns
  24. 24. Partial-Thickness (Deep) <ul><li>Moist blebs, blisters </li></ul><ul><li>Mottled white, pink to cherry red </li></ul><ul><li>Hypersensitive to touch or air </li></ul><ul><li>Moderate to severe pain </li></ul><ul><li>Blanching with pressure </li></ul>
  25. 25. Partial Thickness Burns
  26. 26. Full-Thickness <ul><li>Dry, leathery eschar </li></ul><ul><li>White, waxy, dark brown or charred appearance </li></ul><ul><li>Strong burn odour </li></ul><ul><li>Impaired sensation when touched </li></ul><ul><li>Absence of pain with severe pain in surrounding tissues </li></ul><ul><li>Lack of blanching with pressure </li></ul>
  27. 27. Full Thickness Burns
  28. 28. Full Thickness Burns
  29. 29. Full Thickness Burns
  30. 30. Partial & Full Thickness Burns
  31. 31. Classification of Burn Injury Extent of Burn <ul><li>- Two commonly used guides for </li></ul><ul><li>determining the total body surface area: </li></ul><ul><li> • Lund-Browder chart </li></ul><ul><li> • Rule of nines </li></ul>
  32. 32. Lund-Browder Chart Fig. 24-4, A
  33. 33. Rule of Nines Chart Fig. 24-4, B
  34. 34. Classification of Burn Injury Location of Burn <ul><li>Location of the burn is related to the </li></ul><ul><li>severity of the injury: </li></ul><ul><ul><li>Face, neck, chest  respiratory </li></ul></ul><ul><li>obstruction </li></ul><ul><ul><li>Hands, feet, joints, and eyes  self-care </li></ul></ul><ul><ul><li>Ears, nose  infection </li></ul></ul>
  35. 36. Classification of Burn Injury Location of Burn <ul><li>- Circumferential burns of the extremities </li></ul><ul><li>can cause circulatory compromise </li></ul><ul><li>- Patients may also develop compartment </li></ul><ul><li>syndrome </li></ul>
  36. 37. Circumferential Burns
  37. 39. Classification of Burn Injury Patient Risk Factors <ul><li>Older adults heal more slowly than young </li></ul><ul><li>adults </li></ul><ul><li>Preexisting cardiovascular, respiratory, </li></ul><ul><li>renal disease </li></ul><ul><li> Diabetes mellitus </li></ul><ul><li>Alcoholism </li></ul><ul><li>Drug abuse </li></ul><ul><li>Malnutrition </li></ul><ul><li>Concurrent fractures, head injuries, or </li></ul><ul><li>other trauma </li></ul>
  38. 40. Emergent Phase <ul><li>• Emergent phase is the period of time </li></ul><ul><li>required to resolve the immediate problems </li></ul><ul><li>resulting from burn injury </li></ul><ul><li>From burn onset to 5 or more days </li></ul><ul><li>• Usually lasts 24 to 48 hours </li></ul><ul><li>• The phase begins with fluid loss and edema </li></ul><ul><li>formation and continues until fluid mobilization and diuresis begin </li></ul>
  39. 41. Emergent Phase Pathophysiology <ul><li>• Fluid and Electrolyte Shifts </li></ul><ul><li>- Greatest threat is hypovolaemic shock, </li></ul><ul><li>caused by a massive shift of fluids out of </li></ul><ul><li>blood vessels as a result of increased </li></ul><ul><li>capillary permeability </li></ul>
  40. 42. Conditions Leading to Burn Shock Fig. 24-5
  41. 43. Emergent Phase Pathophysiology <ul><li>• Fluid and Electrolyte Shifts </li></ul><ul><li>- The net result of the fluid shift is </li></ul><ul><li>intravascular volume depletion </li></ul><ul><li> • Oedema </li></ul><ul><li> •  Blood pressure </li></ul><ul><li> •  Pulse </li></ul>
  42. 44. Emergent Phase Pathophysiology <ul><li>• Fluid and Electrolyte Shifts </li></ul><ul><li>- Normal insensible loss: 30 to 50 ml per </li></ul><ul><li>hour </li></ul><ul><li>- Severely burned patient: 200 to 400 ml per </li></ul><ul><li>hour </li></ul>
  43. 45. Emergent Phase Pathophysiology <ul><li>• Fluid and Electrolyte Shifts </li></ul><ul><li>- RBCs are haemolyzed by a circulating </li></ul><ul><li>factor released at the time of the burn </li></ul><ul><li>- Thrombosis </li></ul><ul><li>- Elevated haematocrit </li></ul>
  44. 46. Emergent Phase Pathophysiology <ul><li>• Fluid and Electrolyte Shifts </li></ul><ul><li>- Na+ shifts to the interstitial spaces and </li></ul><ul><li>remains until oedema formation ceases </li></ul><ul><li>- K+ shift develops because injured cells </li></ul><ul><li> and haemolyzed RBCs release K+ into </li></ul><ul><li>extracellular spaces </li></ul>
  45. 47. Effects of Burn Shock Fig. 24-6
  46. 48. Emergent Phase Clinical Manifestations <ul><li>• Shock from pain and hypovolaemia </li></ul><ul><li>• Blisters </li></ul><ul><li>• Adynamic ileus </li></ul><ul><li>• Shivering </li></ul><ul><li>• Altered mental status </li></ul>
  47. 49. Debriding Full-Thickness Burn Fig. 24-9
  48. 50. Acute Phase <ul><li>• The acute phase begins with the mobilization </li></ul><ul><li>of extracellular fluid and subsequent diuresis </li></ul><ul><li>• The acute phase is concluded when the burned </li></ul><ul><li>area is completely covered by skin grafts or </li></ul><ul><li>when the wounds are healed </li></ul>
  49. 51. Acute Phase Pathophysiology <ul><li>• Diuresis from fluid mobilization occurs, and </li></ul><ul><li>the patient is no longer grossly edematous </li></ul><ul><li>• Bowel sounds return </li></ul><ul><li>• Healing begins when WBCs have surrounded </li></ul><ul><li>the burn wound and phagocytosis occurs </li></ul>
  50. 52. Surgeon Harvesting Skin Fig. 24-11, A
  51. 53. Donor Site After Harvesting Fig. 24-11, B
  52. 54. Healed Donor Sites Fig. 24-11, C
  53. 55. Healed Split-Thickness Skin Graft Fig. 24-11, D
  54. 56. Application of Cultured Epithelial Autograft Fig. 24-12, A
  55. 57. Healed Cultured Epithelial Autograft Fig. 24-12, B
  56. 58. Escharotomy of the Lower Extremity Fig. 24-7
  57. 59. Acute Phase Complications <ul><li>• Infection </li></ul><ul><li>- Localized inflammation, induration, and </li></ul><ul><li> suppuration </li></ul><ul><li>- Partial-thickness burns can become full- </li></ul><ul><li> thickness wounds in the presence of </li></ul><ul><li>infection </li></ul>
  58. 60. Contracture of the Axilla Fig. 24-13
  59. 61. Contractures
  60. 62. Rehabilitation Phase <ul><li>• The rehabilitation phase is defined as </li></ul><ul><li>beginning when the patient’s burn wounds are </li></ul><ul><li>covered with skin or healed and the patient is </li></ul><ul><li>able to resume a level of self-care activity </li></ul>
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