·   Flame

·   Scald: contact with hot liquids or steam

·   Heat contact: contact with a motorcycle muffler or touching a hot stovetop

·   Chemical: bleach, lye, or hydrofluoric acid. 

·   Electrical: electrical current travels through the body.  Commonly, electrical injuries will include 2 wounds: the entrance wound and the exit wound, the exit wound usually being larger in size. 

·   Frostbite

·   Sunburn: heat contact injury

·   Smoke inhalation and carbon monoxide poisoning

these are characteristics of what type of burn:

Involves epidermis only

•Red color, dry skin

•No blisters

•Painful bc nerve endings irritated

•Will heal spontaneously in 1-2 weeks

•Pigment change

•No scarring

these are characteristic of what type of burn:

superficial partial thickness burn wound

•Involves entire epidermis and upper third of dermis (hair follicles and sweat glands not involved)

•Blisters slough to reveal pink to red, moist wound

•Painful bc nerve endings irritated

•Spontaneous healing in 1-2 weeks

•Pigment change

•No scarring

these are characteristics of what type of burn:

 deep partial thickness burn wound

•Involves entire epidermis and at least two thirds of dermis

•Pink to red to white (mottled), moist wound

•Less painful

•May heal without surgery; spontaneous healing is slow (3-12 weeks)

•Pigment change

•Scarring is possible

these are characteristics of what type of burn:

Both layers of skin completely destroyed

•Leathery, dry, waxy eschar (eschar brown to yellow to white color)

•Hair follicles and sweat glands affected

•Painless

•Requires skin grafting to heal

•Pigment change

•Scarring will occur

these are characteristic of what type of burn:

Extends through all layers of skin to involve ligaments, muscle, and bone

•Black, charred eschar

•Painless

•Usually requires amputation but can sometimes be treated with skin grafting

these are sxs of what:

headache and dizziness to nausea, confusion, dyspnea and syncope, hypotension, seizures, and coma.

Above glottis: thermal or chemical injuries.  The structures injured include the nasopharynx, oropharynx, and larynx. 

Below glottis: are always caused by chemical injuries

This causes impaired ciliary activity, inflammation, hypersecretion, edema, ulceration, and spasm

–Arterial or venous carboxyhemoglobin saturation

–Routine ABG and pulse oximetry not useful bc give falsely normal Hgb saturation

these are indicative of what type of injury:

Carbonaceous sputum

•Facial burns

•Singed nasal hairs

•Signs of hypoxemia: agitation, anxiety, stupor, cyanosis

•Rapid respiratory rate

•Nasal flaring or intercostal retractions

•Hoarse voice

•Grunting; rales or rhonchi

•Erythema or edema of oropharynx or nasopharynx

•Inability to swallow

2nd and 3rd degree burns:

an adult:

Head = 9%

Back, chest = 18% each

Upper extremities = 9% each

Perineal area = 1%

Lower extremities = 18% each

Total is 100%

A child’s head accounts for 18% because it has a large surface area.  A child’s lower extremities have a smaller surface area

•The size of the patient’s entire hand represents approximately 1% of total body surface area of burn,is known as the ?

palmar method

The palmar method is an alternative to the Rule of Nines to determine percent total body surface area affected by a burn injury.

Fluid Resuscitation

GOAL: maintain tissue perfusion and organ function while avoiding complications of inadequate or excessive fluid therapy

–Fluid resuscitation 24 hours post-burn

–2-4cc LR x body weight (kg) x %TBSA (total body surface area)burned

–Maintain adequate urine output

deep circumferential trunk burn

circumferential extremity burn

these are signs and sxs of what type of burn:

cyanosis of unburned skin on a limb,

paresthesia or pain in extremity,

progressive decrease or absence of pulse.

in this type of burn the chest cannot expand for adequate respiration. 

Escharotomy incisions are required to allow the chest to expand. 

Deep circumferential trunk burns,

Escharotomy incisions are made in the bilateral anterior axillary lines. 

If the burn extends onto the abdominal wall, extend the escharotomy lines onto the abdomen and connect them by a transverse incision along the costal margin.

Circumferential extremity burns,

Escharotomy incisions are made in the mid-medial or mid-lateral aspect of the extremity.  Extend the incisions through the eschar to the subcutaneous fat.  The incisions should cross joints

these are causes of what?

Massive fluid resuscitation

•High-voltage electrical injury

•Delayed escharotomy

•Crush injury

this is an enzymatic debriding ointment that contains the enzyme collagenase. 

santyl

This enzyme specifically targets collagen and digests it in necrotic tissue.  The enzyme is derived from fermentation by Clostridium histolyticum.  The enzyme does not harm normal tissue. 

Advantages:

•Once daily application

•If infection is present, antibiotic powder can be mixed with Santyl

•Patient may shower

Disadvantages:

•Contraindicated in patients with local or systemic hypersensitivity to collagenase

•Patient may shower, which can be painful due to the open wound

•Once daily application is difficult for some patients or when wounds are located on difficult body parts such as the back

MepilexAg

When wound fluid contacts the silver ions in the foam, the ions are released into the wound.  The silver causes bacterial cell wall rupture.  The silver also binds to bacterial enzymes, disrupting bacterial replication.  MepilexAg is used for 1^st and 2^nd degree wounds.

Advantages:

•Once weekly dressing change

•No pain

•Almost no contraindications

Disadvantages:

•Must stay dry

What is this?

 It contains 2 antibiotics: silver and sulfadiazine.  _ is used for 1^st degree to superficial 2^nd degree wounds. 

Advantages:

•Antimicrobial

•Patient may shower

•Once daily application

Disadvantages:

•Sulfa allergy

•Patient may shower, which may be painful

•Once daily application is difficult for some patients or when wounds are located on difficult body parts such as the back

what is this?

It contains 3% bismuth tribromophenate in a special petrolatum blend on a fine mesh gauze and promotes moist wound healing. 

Advantages:

•Bacteriostatic

•Non-adherent

•Occlusive

•Protective

Disadvantages:

•Must stay dry

•Removal may be painful because the dressing dries out and adheres to the wound

what does this describe:

For a skin graft, skin is harvested from a donor site, usually on the thigh. The skin at donor site regenerates from the hair follicles and sebaceous glands.  The donor skin contains epidermis and a portion of the dermis. 

Advantage: fastest method by which to achieve wound healing

Disadvantages:

To treat carbon monoxide poisoning, administer 100% O2 by face mask or ET tube.  Insert an ET tube if airway obstruction is imminent, indicated by hoarseness, stridor, or a diminished level of consciousness that impairs airway protective reflexes.  Treat hypotension, seizures, and coma accordingly. 

Indications for hyperbaric oxygen to treat carbon monoxide poisoning include:

 a history of loss of consciousness,

carboxyhemoglobin > 25%,

metabolic acidosis,

age > 50,

or cerebellar findings on neurologic exam.

moisturizer

Massaging with moisturizer cream also helps promote pigment return.  Moisturizer also relieves pruritis.

Continuous pressure garment (CPG

•Physical therapy: aggressive to prevent loss of ROM

•Plastic surgery

Psychosocial Needs

•Abuse

•Acute Stress Disorder / Post-Traumatic Stress Disorder

•School and job re-entry

•Family support-education