Burn Management: Types, Assessment, and Treatment

• Integumentary Pathophysiology, covering traumatic injuries, infectious/inflammatory conditions, and skin conditions

Traumatic Injuries

• Includes burns, lacerations, avulsions, and abrasions

Burns

• Classified as first, second, or third degree depending on the layer affected, level of pain, the way it presents and healing time

Types/Sources of Burns

• Thermal burns from fire or heat sources at temperatures higher than 44 degrees C, depending on the concentration, amount of heat energy, and duration of exposure
• Chemical burns occur when skin contacts strong acids, alkalis, bases, or corrosive materials
• Electrical burns are from power sources, often contact burns
• Radiation burns involve alpha, beta, and gamma ionizing radiation

First Degree Burns

• Also known as superficial burns
• Involves only the outer layers of the epidermis
• Presents as pink, dry, and painful
• Skin maintains its function as a water vapor and bacterial barrier
• Usually heals in 3-10 days

Second Degree Burns

• Also known as partial thickness burns
• Involves the epidermis and various degrees of the dermis
• Presents as painful, moist, red, and blistered
• The skin underneath the blisters is pink or red and sensitive to temperature changes, air exposure, and touch
• Heals in approximately 1-2 weeks

Third Degree Burns

• Also known as full thickness burns
• Can extend into the subcutaneous tissue and involve muscle or bone
• The presentation may be waxy white, yellow to tan, brown, deep red, or black
• Burns appear hard, dry, and leathery
• Nerve sensors are destroyed
• Healing time varies and can take weeks or months

Burn Combinations

• Combinations of burn types are common

Rule of Nines

• Is used to estimate the total body surface area (TBSA) affected by burns.

Lacerations

• Are cuts inflicted by a sharp instrument
• Can be clean or jagged incisions through the skin surface and underlying structure
• 'Laceration' usually refers to jagged wounds, while 'incision' usually refers to clean wounds
• Severity depends on the depth and damaged structures
• Treatment priority is to control bleeding via direct manual pressure over the wound

Avulsions

• Are flaps of skin torn loose, either partially or completely
• May be accompanied by profuse bleeding
• The primary risk is loss of blood supply to the avulsed flap
• Treatment involves irrigating with normal saline and placing the flap into its anatomical position

Abrasions

• Superficial wounds
• Occur when skin is rubbed or scraped
• Typically ooze small amounts of blood
• May be painful and contaminated
• Avoid cleaning in the prehospital environment

Allergy/Uticaria

• Is a response to an allergic reaction or anaphylaxis
• Multiple small raised areas on the skin
• Are also known as "Hives"
• Can be itchy

Infections/Infestations

• Includes conditions such as lice, cellulitis, and impetigo

Lice

• Small insects that live in hair and feed on blood through the skin
• Three types: head louse (Pediculus humanus capitis), body louse (P humanus corporis), and pubic louse (Phthirus pubis)
• All types are acquired through direct contact with a person with an infestation
• Head and body lice can be acquired from objects like hats, combs, or clothes infested with lice
• Pubic or crab lice transmitted through intimate physical or sexual contact
• The communicable period ends when all lice and eggs are destroyed

Cellulitis

• A deeper bacterial infection affecting the dermis and subcutaneous tissues
• Commonly caused by group A strep
• Can also be specific to activities such as fish handling, swimming in fresh/salt water, or animal bites or scratches.
• Pre-existing wounds are often entry points
• Presents as expanding red, swollen, tender plaque with an indefinite border
• Often accompanied by fever, erythema, heat, edema, and pain.

Impetigo

• A common, superficial bacterial infection caused by group A strep
• Most commonly occurs in infants and young children and is rare in adults
• Appears as a small vesicle/pustule (can be itchy & painful) on the face or elsewhere on the body
• As the lesion ruptures, it leaves a honey-colored crust
• Highly infectious

Types of Skin Cancer

• Basal cell carcinoma
• Squamous cell carcinoma
• Malignant melanoma, the most serious type of skin cancer, with early metastases being common

ABCD Rules for Melanoma Recognition

• A: Asymmetry
• B: Border
• C: Color varying within the lesion
• D: Diameter greater than 6 mm

Abnormal Skin Conditions

• Cyanosis: Blue colour due to lack of oxygen in hemoglobin because of respiratory or cardiac problems
• Erythema: Redness due to increased blood supply from exercise, fever, hemorrhage under skin, or inflammation
• Pallor: Paleness or blanching due to decreased blood supply or hemoglobin (e.g., anemia)
• Jaundice: Yellowish tones in skin and eyes due to increased bilirubin in the blood, related to liver disease or obstructed bile duct, preventing bile removal

Explore burn types, from first to third degree, focusing on characteristics, pain levels, and skin damage. Understand the nuances of chemical and electrical burns, emphasizing internal injury risks. Learn to differentiate burn depths and the critical factors influencing burn severity in trauma situations.