Burn Injury Response

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Questions and Answers

What is the primary characteristic of the Zone of Coagulation?

Compromised tissue perfusion

Vasodilation and erythema

Minimal cellular injury

Irreversible tissue loss due to coagulation of constituent proteins (correct)

What is the primary concern in the Zone of Stasis?

Conversion of the area into one of complete tissue loss

Restoration of tissue perfusion (correct)

Prevention of infection

Vasodilation and erythema

What is the outermost zone of the burn injury?

Zone of Coagulation

Zone of Stasis

Zone of Necrosis

Zone of Hyperemia (correct)

What is the term for the process of widening and deepening of the original area of necrosis?

Conversion Signup and view all the answers

What is a common symptom of hypovolemic shock in burn patients?

Restlessness and anxiety Signup and view all the answers

What is the primary goal of burn evaluation?

To plan and implement an effective treatment Signup and view all the answers

What is a key component of burn evaluation?

Patient demographic data and history Signup and view all the answers

What is the typical duration of recovery for tissues in the Zone of Hyperemia?

7-10 days Signup and view all the answers

What is the primary purpose of the Abbreviated Burn Severity Index (ABSI)?

To estimate the burned patient mortality rate Signup and view all the answers

What does the assessment of joint ROM fall under?

Joint ROM assessment Signup and view all the answers

What type of information is included in the patient demographic data and history?

Information about the patient's personal history and medical history Signup and view all the answers

What is the purpose of assessing the patient's neurological and psychological factors?

To assess the patient's cognitive function and emotional well-being Signup and view all the answers

What is included in the assessment of flexibility?

Joint ROM and mobility Signup and view all the answers

What is the primary purpose of assessing the patient's past medical history?

To identify potential underlying conditions that may affect treatment Signup and view all the answers

What is included in the assessment of function?

Activities of daily living Signup and view all the answers

What is the purpose of assessing the patient's associated injuries?

To identify potential underlying conditions that may affect treatment Signup and view all the answers

What is the most critical period for patients with inhalation injuries?

24 to 48 hours post-burn Signup and view all the answers

What is a sign of smoke inhalation?

Singed nasal hairs Signup and view all the answers

What is the purpose of triage in burn patients?

To decide on admission or discharge Signup and view all the answers

What is a characteristic of a 2nd degree deep burn?

Deep partial thickness burn Signup and view all the answers

What is a complication of inhalation injury?

Airway edema and increased airway resistance Signup and view all the answers

When should a patient with a burn be admitted to the hospital?

In major burns, electrical or chemical burns, inhalation injury, burns of vital areas, or deep burns Signup and view all the answers

What is a characteristic of a 1st degree burn?

Superficial burn Signup and view all the answers

What is a sign of burn injury?

All of the above Signup and view all the answers

What is the primary purpose of calculating the total body surface area (TBSA) burned in a patient?

To determine the severity of the burn and calculate the amount of fluid needed for resuscitation Signup and view all the answers

What is the advantage of using the Lund and Browder chart over the rule of nines?

It takes into account the variations in body surface area with age Signup and view all the answers

What is the percentage of TBSA represented by the size of the palm?

1% Signup and view all the answers

What is the formula used to calculate the amount of fluid needed for patient resuscitation?

(2 or 4) ml x kg bodyweight x % TBSA Signup and view all the answers

What is the disadvantage of using the rule of nines?

It consistently overestimates the size of a burn injury Signup and view all the answers

What is the most suitable method for measuring burn areas on the anterior thigh and trunk?

Palmar method Signup and view all the answers

What is the primary purpose of using the Lund and Browder chart?

To determine the percentage of TBSA burned in children under 16 years of age Signup and view all the answers

What is the disadvantage of using the palmar method?

It is an unreliable method Signup and view all the answers

Study Notes

Local and Systemic Response to Burn Injury

The local effect of a burn injury involves three burn zones:
- Zone of coagulation: the point of maximum damage, characterized by coagulation, ischemia, and necrosis, resulting in irreversible tissue loss.
- Zone of stasis: surrounds the central necrotic region, representing an area of cellular injury and compromised tissue perfusion.
- Zone of hyperemia: the outer edges of tissue affected by the burn injury, characterized by erythema due to vasodilation, and generally recovers within 7-10 days of injury.

Systemic Effect of Burn Injury

Signs and symptoms of hypovolemic shock:
- Restlessness and anxiety
- Pale, cold, and clammy skin
- Temperature below 37°C
- Weak and rapid pulse, with low systolic blood pressure
- Urinary output < 20 mL/hr and urine specific gravity >1.025
- Thirst
- Hematocrit 35% and blood urea nitrogen (BUN)

Burn Management

Evaluation of Burned Patient

Components of evaluation:
- Patient demographic data and history
- Burn severity assessment
- Edema and limb circumference assessment
- Sensory assessment
- Muscle strength assessment
- Joint range of motion (ROM) assessment
- Flexibility assessment
- Endurance assessment
- Mobility and ambulation assessment
- Neurological and psychological factors assessment

Patient Demographic Data and History

Patient demographic data:
- Date of burn
- Date of admission
- Date of initial P.T.
- Date of operation
- Extent and depth of burn
- Associated injuries
- Previous disease
- Trauma
- Surgery and burn history
Personal history:
- Vision and hearing acuity
- Balance and coordination
- Neuromuscular or skeletal deficit

Burn Severity Index (BSI)

Abbreviated Burn Severity Index (ABSI) is a five-variable scale to assess burn severity:
- Percentage of total body surface area (TBSA) burned
- Presence of a full-thickness burn
- Age
- Sex
- Presence of inhalation injury

Extent of Burn

To determine whether it is a major or minor burn (triage)
Direct relation between the BBSA and the number of anticipated contractures to develop
To calculate the amount of fluid needed for patient resuscitation: {(2 or 4) ml x kg body weight x % BBSA} + 2000 ml saline, with 50% to be administered in the initial 8 hours.

Methods to Calculate TBSA

Rule of nine:
- Divides the integument into areas roughly equivalent to 9% of TBSA
- The fastest and easiest method of determining the percent of TBSA involved in a burn wound
- Universally recognized method of assessing burn size
Lund and Browder chart:
- Considers the variations in the distribution of body surface area with age
- Appropriate for children under 16 years of age
Palmar method:
- Uses the area of the palmar surface of the patient's hand to determine the burn size
- The size of the palm represents 1% of TBSA
- Preferred for small burn areas
- Most suitable to measure burn at anterior thigh and trunk

Depth of Burn

Subjective assessment of the characteristics of the burn to diagnose its depth
Characteristics:
- Sensation (pinprick test)
- Colour and appearance
- Bleeding
Depth of burn injury:
- 1st degree burn
- 2nd degree superficial burn
- 2nd degree deep burn
- 3rd degree burn
- 4th degree burn

Inhalation Injury

Signs and symptoms:
- Burns to the head and neck
- Singed nasal hairs
- Darkened oral and nasal membranes
- Carbonaceous sputum
- Stridor
- Hoarseness
- Difficulty swallowing
- History of being burned in an enclosed space
- Exposure to flame, including having clothing catch fire near the face outdoors
Critical period: 24-48 hours post-burn
Airway edema and increased airway resistance
Respiratory mucosa sloughs, along with loss of ciliary function and poor diffusion of gases

Triage

Decision-making about admission of patients to hospital or discharge
Patients should be admitted to hospital in cases of:
- Major burn
- Electrical or chemical burn
- Inhalation injury
- Burn of vital areas (face, hand, foot, and genitalia)
- Deep burns

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Description

Understanding the local and systemic effects of burn injuries, including the three burn zones: coagulation, stasis, and hyperemia.