Burns and Skin Layers

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Questions and Answers

What condition results from the abnormal production of glucose during burns?

  • Insulinoma
  • Hyperglycemia (correct)
  • Hypoglycemia
  • Diabetes Mellitus

Why is oxygen important for maintaining consciousness in patients?

  • It prevents glucose production.
  • The brain requires 20% of the body's oxygen. (correct)
  • It promotes insulin resistance.
  • It increases metabolic acidosis.

What is typically involved in the assessment of a burn patient’s condition?

  • Monitoring respiratory rate
  • Documenting injury exposure (correct)
  • Eye examination
  • Calculating blood glucose levels

What should be considered for monitoring in burn patients?

<p>Arterial and Central Venous Pressure lines (A)</p> Signup and view all the answers

What is a consequence of decreased glucose uptake in burn patients?

<p>Hyperglycemia (C)</p> Signup and view all the answers

What is the primary cause of burns?

<p>Radiation (B), Friction (D)</p> Signup and view all the answers

Which layer of skin is involved in thermoregulation?

<p>Dermis (C)</p> Signup and view all the answers

What characterizes a 2nd degree superficial dermal burn?

<p>Blisters and redness (C)</p> Signup and view all the answers

What is the zone of coagulation in burn injuries?

<p>Area of maximum damage with clotting (C)</p> Signup and view all the answers

What does the zone of stasis indicate after a burn?

<p>Decreased tissue perfusion with potential for salvage (C)</p> Signup and view all the answers

Which degree of burn is characterized by complete destruction of the epidermis and dermis?

<p>3rd degree (C)</p> Signup and view all the answers

What happens to nerves in a 3rd degree burn?

<p>They are destroyed (B)</p> Signup and view all the answers

How does the epidermis respond to injury from burns?

<p>New cells migrate from deeper layers (C)</p> Signup and view all the answers

What procedure should be considered when a patient presents with stridor, wheeze, and low oxygen saturation levels?

<p>Consider RSI with ET tube (C)</p> Signup and view all the answers

How does a 3rd degree burn around the chest affect breathing?

<p>It restricts chest expansion (A)</p> Signup and view all the answers

What is the primary trigger for a patient to breathe when they are experiencing dyspnoea due to poor gas exchange?

<p>Build-up of carbon dioxide (B)</p> Signup and view all the answers

In the context of burns, what is the role of cytokines and inflammatory mediators on circulation?

<p>They lead to increased vascular permeability (A)</p> Signup and view all the answers

What is a significant consequence of losing the dermis layer in burn patients?

<p>Inability to regulate body temperature (A)</p> Signup and view all the answers

What is the recommended room temperature for a patient with a significant burn injury?

<p>Above 29°C (C)</p> Signup and view all the answers

What does the lethal triad of hypothermia, coagulation, and metabolic acidosis signify for burn patients?

<p>A high risk of mortality (A)</p> Signup and view all the answers

What should be included in the management of a burn patient besides fluid replacement?

<p>Nutritional support (C)</p> Signup and view all the answers

What is the main aim of burns resuscitation?

<p>To increase tissue perfusion (C)</p> Signup and view all the answers

What effect do burns have on organ perfusion?

<p>Reduced blood flow to organs (C)</p> Signup and view all the answers

What can convert the zone of stasis into an area of complete tissue loss?

<p>Prolonged hypotension (C)</p> Signup and view all the answers

What condition can occur in severe burns affecting the lungs?

<p>Adult respiratory distress syndrome (B)</p> Signup and view all the answers

In the zone of hyperaemia, what is the characteristic of blood flow?

<p>Blood flow is increased (B)</p> Signup and view all the answers

What systemic effect is observed when the burn reaches 30% of total body surface area?

<p>Increased systemic hypotension (D)</p> Signup and view all the answers

How much can the basal metabolic rate increase in burn patients?

<p>Up to three times (C)</p> Signup and view all the answers

What happens to capillary permeability during a systemic response to burns?

<p>It increases (A)</p> Signup and view all the answers

What is a consequence of high insulin resistance in burn patients?

<p>Decreased glucose clearance (B)</p> Signup and view all the answers

What is one of the first steps in assessing burns?

<p>Assess burn depth and surface area affected (D)</p> Signup and view all the answers

What occurs as a result of peripheral vasoconstriction during burn injury?

<p>Blood is redirected to main organs (D)</p> Signup and view all the answers

What is a potential consequence of increased vascular permeability in burn injuries?

<p>Fluid loss into surrounding tissues (C)</p> Signup and view all the answers

What hormonal changes occur due to burns?

<p>Increase in cortisol and adrenaline (B)</p> Signup and view all the answers

What does the release of cytokines mainly affect in a burn injury?

<p>Overall inflammatory response (B)</p> Signup and view all the answers

What physiological process is increased to generate glucose in burn patients?

<p>Gluconeogenesis (D)</p> Signup and view all the answers

What should be considered if burns affect the airway areas?

<p>Airway management (A)</p> Signup and view all the answers

Flashcards

Epidermis

The outermost layer of skin, composed of 5 sub-layers, responsible for protecting the body from external factors and shedding dead cells.

Zone of Hyperaemia

This is the outermost zone of a burn, where blood flow is increased. It's like a natural response to inflammation, where the body sends blood to the injured area.

Dermis

The middle layer of skin, containing blood vessels, nerves, and glands. It plays a critical role in thermoregulation and regenerating the epidermis.

Zone of Stasis

In this zone of a burn, blood flow is reduced, but not completely stopped. This is a dangerous zone, as prolonged lack of blood flow can lead to tissue death.

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1st Degree Burn

A burn affecting only the epidermis, characterized by redness, pain, and swelling. It heals quickly without scarring.

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Zone of Coagulation

The innermost zone of a burn, where tissue has already died due to lack of blood flow. This area requires surgical intervention.

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2nd Degree Burn

A burn affecting both the epidermis and dermis, resulting in blisters, pain, and possible scarring. Healing time varies depending on the depth of the burn.

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Cytokines

These are chemical messengers released by the body in response to injury, inflammation, or infection. They play a critical role in the body's immune response.

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Systemic Response

A burn affecting 30% or more of the body surface area can lead to a systemic response, meaning that the effects extend beyond the site of the burn.

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3rd Degree Burn

The deepest type of burn affecting all layers of skin, reaching the subcutaneous tissue or even bone and muscle. It is characterized by black, leathery, and waxy appearance.

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Zone of Coagulation

The area of a burn where tissue is irreversibly damaged due to coagulation (clotting) of proteins. This area is not salvageable.

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Capillary Permeability

Increased permeability in blood vessels leads to fluid leaking out and accumulating in surrounding tissues. This can cause swelling and decrease blood volume.

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Zone of Stasis

The area surrounding the zone of coagulation in a burn, where tissue perfusion (blood supply) is impaired but still potentially recoverable.

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Vasoconstriction

Reduced blood flow to the extremities and organs can cause damage and complications.

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Systemic Hypotension

Low blood pressure due to loss of fluid and decreased heart function can lead to organ damage.

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Thermoregulation

Refers to the body's ability to regulate its temperature, a crucial function of the dermis.

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Hypoperfusion of organs

Decrease in blood flow to organs caused by reduced blood volume and pressure. This occurs because burns demand more fluid to help with healing, leaving less for regular bodily functions.

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Increased metabolic rate

The body's metabolic rate increases significantly (up to 3 times normal) after a burn injury. This means the body is burning energy much quicker, requiring more resources to maintain function.

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Gluconeogenesis

Increased glucose production in the body, often due to the burn damage.

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Insulin resistance

Burn patients experience resistance to insulin, meaning their cells cannot effectively absorb glucose from the bloodstream.

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Hyperglycemia

High blood sugar levels due to increased glucose production and poor insulin sensitivity in burn patients.

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Airway management

The airway management protocol for burn patients, prioritizing the assessment of the airway for any obstruction or distress.

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Burn assessment

The process of assessing burn severity by looking at the affected area and the depth of tissue damage.

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What is hyperglycemia in burn patients?

Hyperglycemia, or high blood sugar, occurs in burn patients due to the body's abnormal glucose production and resistance to insulin, leading to decreased glucose uptake and clearance.

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Why are blood tests particularly important in burn patients?

During burn assessment, it's crucial to monitor vital signs, including blood glucose levels, as this might indicate hyperglycemia. Use arterial lines, central venous pressure lines, and gas analysis to get accurate measurements.

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Why is consciousness level important after a severe burn?

The brain heavily relies on oxygen, consuming about 20% of the body's total oxygen supply. Therefore, oxygen deficiency can lead to a decreased level of consciousness in burn patients, as the brain is deprived of its essential fuel.

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How does a burn impact blood volume?

Burns can lead to a systemic inflammatory response with the release of cytokines, causing increased capillary permeability. This results in fluid loss from the blood vessels into surrounding tissues, leading to a decrease in blood volume and potentially low blood pressure.

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Why is blood pressure constantly monitored after a burn?

After a burn, monitoring blood pressure is critical as fluid loss can lead to systemic hypotension, a dangerous drop in blood pressure. This can affect vital organs and worsen burn complications.

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Stridor

A breathing difficulty marked by a high-pitched whistling sound, often heard during inhalation, commonly associated with airway obstruction.

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Wheezing

A sound produced during breathing, especially during exhalation, caused by narrowed or obstructed airways.

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Dyspnoea

A series of rapid breaths, usually shallow and short,often a sign of respiratory distress or difficulty breathing.

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Respiratory Acidosis

The buildup of carbon dioxide in the blood, often due to inadequate breathing or impaired gas exchange in the lungs, leading to acidity in the blood.

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Hypoxemia

A condition characterized by low blood oxygen levels, often occurring during respiratory distress or inadequate oxygen delivery.

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Hypovolemia

A condition characterized by a decrease in blood volume, leading to a drop in blood pressure and potentially affecting organ function.

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Lethal Triad

A dangerous combination of three medical conditions: hypothermia, coagulation problems, and metabolic acidosis, often leading to death.

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Study Notes

Burns

  • A burn is an injury to skin or other tissue caused by heat, radiation, electricity, friction, or chemicals.
  • Understanding skin layers is crucial for managing burns (homeostasis).

Skin Layers

  • Epidermis: Five layers, deeper layers constantly divide and migrate to the surface.
  • Dermis: Crucial for thermoregulation (sweat, piloerection), nerve function, blood vessels and glands responsible for skin regeneration.
  • Dermal Vascular Plexus: Important for sweating, piloerection, skin regulation, blood flow and skin regeneration.

Burn Classifications

  • 1st Degree: Superficial epidermal, rash, sunburn (no dermis damage).
  • 2nd Degree:
    • Superficial dermal: blisters, red, peeling skin, blanch when pressed, capillary refill present.
    • Deep dermal: dry, mottled, red skin, may blister; no blanch on capillary refill.
  • 3rd Degree: Full thickness (epidermis and dermis damaged, nerves destroyed, black leathery appearance).

Local Response (Pathophysiology)

  • Zone of Coagulation: Maximum damage, tissue damaged at the point of injury due to clotting of proteins.
  • Zone of Stasis: Surrounding zone; decreased tissue perfusion, potentially salvageable.
  • Zone of Hyperaemia: Outmost zone; increased tissue perfusion, inflammation.

Systemic Response (Pathophysiology)

  • The release of cytokines impacts the entire body.
  • Systemic effect when burns are 30% or higher total body surface area.
  • Cardiovascular changes, capillary permeability increases, vessels leak, (reduced blood flow to extremities).
  • Release of hormones (adrenaline, noradrenaline, cortisol).

Metabolic Changes

  • Basal metabolic rate increases up to three times normal.
  • Gluconeogenesis: increased glucose production.
  • Insulin resistance: reduced glucose uptake.
  • Hyperglycemia: high blood sugar.

Treatment Steps

  • Assess the burn's extent and severity.
  • Classify burns (superficial, deep).
  • Establish airway, breathing, and circulation.

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