Burns
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Burn classifications based on
depth, surface area, location
superficial burns
only involve epidermis pain and swelling subsides in 48 hours healed in 7 days
partial burns
destruction of epidermis and superficial dermis appears blistered
superficial partial thickness burns
bright red and moist, very sensitive, heal in 2-3 weeks, minimal scarring
deep partial thickness burns
dark red or yellow white, more than 3 weeks to heal, hypertrophic scarring occurs
full thickness burns
involves epidermis and dermis including dermal appendages appears charred or pearly white, brown or black colours. dry and leathery normally without sensation healing only occurs with scarring or skin grafts
Minor burns
less than 10% TBSA in adults, less than 5% in young or eldery, less than 2% full thickness burns
Moderate burns
10-20% TBSA adult, 5-10% young or eldery, 2-5% full thickness
Major burns
greater than 10% in young or eldery, greater than 20% in adults, full thickness greater than 5%
thermal burns
soft tissue is burned when exposed to greater than 45 degrees causing coagulation of soft tissue
coagulation of soft tissue leads to:
soft tissue temp increase, capillary permeability increase, fluid loss, plasma viscosity increase, microthrombi formation
zones of injury
zone of coagulation - centre of wound zone of stasis - surrounds critically injuried area zone of hyperamia - at periphery of wound
Acids cause:
coagulation, formation of tough eschar that can limit further damage
Alkalis cause:
liquefactive necrosis, deeper penetration
Thickness of chemical burns
superficial: itching, burning, pain Partial: tissue oedema, bullae full: damage to dermis, extent depends on chemical and duration
Treatment of chemical burns
if liquid, irrigate with copious fluids if powder, dust of pt and remove clothing
Electrical injuries
low voltage high voltage lightening strikes
High voltage burns can cause:
flash burns: significant electrical charge causes combustible substances to ignite Direct contact burns: deep muscle damage may occur under apparently normal skin and may be very extensive and life threatening
Lightening strikes
signigicant injury especially with exit burns to feet
Severity of electrical burns related to:
current type, voltage, intensity, resistance, area, duration of contact, environmental factors
Symptoms of electrical burns
contact burns, thermal heating, flash arc and flame thermal burns, blunt trauma, prolonged muscle tetany, skin injury does not correlate with underlying damage, low V = VF, high V = asystole, dysrhythmias can occur up to 24-48 hours later
Non accidental injury
delay in call, vague or inconsistent history, presence of other trauma, certain patterns of injury, info should be passed into recieving hospital
Stop the burning process
sover burn with clean cool cloth soaked in cool water, continue cooling with running water, remove clothing not adhered to pt, cover burn with a clean sterile dressing or cling wrap
haemodynamic Instability
Hypovolaemic shock assoc with decreased venous return and CO, increase vascular resistance renal failure may occur due to haemolysis or rhabdo