Burns Quiz: Classifications and Effects

Burns

• Classified by etiology (thermal, electrical, chemical, radiation)
• Thermal burns: flash, scald, house fires, cooking accidents
• Electrical burns: arc between two objects
• Chemical burns: 3% of all burn admissions
• Radiation burns: least common, severity depends on exposure location, depth, and duration.
• Depth of tissue damage: superficial, superficial partial-thickness, deep partial-thickness, full-thickness
• Superficial: epidermal damage, erythema, resolves in 24-72 hours
• Superficial partial-thickness: involves epidermis and minimal dermis
• Deep partial-thickness: involves epidermis and deeper layers of dermis
• Full-thickness: destroys epidermis, dermis, and portions of subcutaneous tissue
• Total Body Surface Area (TBSA): crucial for fluid resuscitation and treatment calculation.
• Adults: TBSA starts at 20%
• Elderly and Pediatrics: TBSA starts at 10%
• Severity: factors include the extent of the burn, age of the patient, medical history, and location of the burn.
• Burn Zones include Coagulation, Stasis and Hyperemia zones.

Rule of Nines

• Commonly used method for estimating TBSA burned.
• Diagram showing body segments and their percentage of TBSA.
• Anterior view and posterior view body diagrams showing percentage per body part.

Fluid Resuscitation Using Parkland Formula

• 4 ml LR x weight in kg x %TBSA
• LR (Lactated Ringers) is the crystalloid of choice
• One half of calculated fluid infused in 8 hours
• The other half infused over 16 hours.

Anatomical Changes

• Zone of Coagulation: most severe damage from heat source, extensive protein coagulation. Eschar (dead tissue) frequently present.
• Zone of Stasis: surrounds Coag, with damaged cells and impaired circulation.
• Zone of Hyperemia: outermost layer. Blood flow increases to deliver nutrients for tissue recovery. Location over joints or other sensitive areas requires heightened care.

Systemic Effects of Burns

• Significant consequences on multiple organ systems due to cytokine and mediator release
• Impact on respiratory, cardiovascular, renal, and gastrointestinal systems
• Metabolic changes including increased caloric needs and impaired wound healing.
• Immunological responses with high risk for infection
• Systemic inflammatory response syndrome (SIRS)

Sepsis

• Leading cause of death in burn patients after first 24 hours.
• Infection control is paramount
• Approximately 28-65% of burn patients die due to sepsis.

Special Considerations for Special Burns (Inhalation, Electrical, Chemical)

• Inhalation: often involves carbon monoxide and CO2 poisoning, requiring immediate high oxygen therapy.
• Electrical: extent of injury isn't always apparent, necessitating attention to spinal cord injuries and compartment syndrome.
• Chemical: immediate flushing with water and further specialist assessment and intervention is critical.

Burn Phases

• Emergent Phase: airway management, fluid resuscitation, addressing life-threatening injuries, stabilization, and early intervention
• Intermediate Phase: wound care, infection control, and managing secondary complications
• Rehabilitative Phase: preventing contractures, managing lingering physical and psychological effects.

Endocrine System

• Complications of Diabetes Mellitus (DM): inadequate insulin impacting normal cellular metabolic processes
• Diabetic Ketoacidosis (DKA): rapid breakdown of fat, producing ketones, triggering lower pH, and metabolic acidosis.
• Hyperosmolar Hyperglycemic Syndrome (HHS): high glucose, dehydration, but not high ketones, commonly resulting from infection.
• Diagnoses for DKA or HHS: serum glucose >250mg and/or ketones in the urine, pH <7.3, bicarbonate <18mEq/L, possible altered level of consciousness (LOC) or coma.

Diabetic Ketoacidosis (DKA)

• High blood sugar, dehydration, without ketones, result of infection
• Pathophysiology: less insulin. Fat is broken down for energy; ketones result in lower pH
• Manifestations: high blood sugar, dehydration
• Diagnostics: glucose > 250, serum ketones and pH <7.3, HCO3 levels <18.
• Treatment: fluid and electrolyte replacement, insulin.
• Potential consequences include hypotension, tachycardia, kussmal respirations.

Hyperosmolar Hyperglycemic Syndrome (HHS)

• High blood glucose, severe dehydration
• Pathophysiology: Enough insulin to prevent ketones, but not enough to regulate blood sugar and cause dehydration
• Manifestations: profound dehydration, altered level of consciousness possible
• Diagnostics: glucose > 600, serum osmolality > 320
• Treatment: fluid replacement, insulin.

Thyroid Cancer

• Classification: papillary, follicular, medullary, anaplastic
• Manifestations: nodule
• Diagnosis: ultrasound, biopsy
• Treatment: radiation, surgery, lifelong hormone replacement. Common in females

Gastrointestinal System: Inflammatory Bowel Disorders

• Types: Crohn's disease and Ulcerative colitis
• Incidence higher in US, Canada, UK, Sweden and Norway, with Canada's incidence being the highest globally.
• Management: controlling symptoms (diarrhea, abdominal pain, cramping), addressing fluid/electrolyte imbalance and stool blood, potentially requiring colectomy in severe cases.
• Complications: increased risk of small bowel or colon cancer.

Esophageal, Stomach, Colorectal Cancer

• Different types of GI cancers requiring specific knowledge of anatomy, physiology, diagnostics, treatment, and patient education.

Hepatic and Pancreatic System

• Hepatitis (viral and non-viral): Types HepA thru HepG, with different routes of contagion and treatment options. Hepatitis is caused by several viruses and is transmitted through fecal-oral, blood, or bodily fluids. Chronic cases can potentially lead to liver cancer.
• Cirrhosis: HepC leading cause, followed by chronic excessive alcohol consumption. Pathophysiology involves altered blood flow within liver. Potentially leading to scarring and liver failure.

Liver Cancer

• Risk factors include age > 65, male, history of chronic hepatitis B/C and heavy/prolonged alcohol abuse.
• Usually fatal within 6-12 months
• Manifestations: often asymptomatic until advanced, including pain, weight loss, anorexia, weakness, fatigue, jaundice, and ascites
• Management: early diagnosis is difficult, treatments are varied and range in effectiveness. Often only effective treatment involves surgery (if appropriate), and/or transplantation.

Pancreatitis

• Acute: reversible inflammation, risk factors include ETOH, gallstones, or trauma.
• Chronic: irreversible. Risk factor: prolonged alcohol use, causes digestive enzymes to autodigest surrounding tissues and pancreas.
• Manifestations: severe epigastric pain radiating to back, intensity peaks minutes after eating or drinking, tender abdomen,guarding, rebound tenderness, and Cullen's sign, Grey Turner's sign.
• Management: pain relief, fluid/electrolyte management, supportive care, nutritional support, and surgical interventions (if needed).

Pancreatic Cancer

• Quick to spread and high mortality rate
• Risk factors: age/gender, history of chronic pancreatitis, high fat diets, smoking, and/or diabetes.
• Often asymptomatic until advanced, presenting with dull pain in epigastric/back areas, weight loss, jaundice, and possible vague symptoms similar to other GI disorders.
• Treatment: ERCP (endoscopic retrograde cholangiopancreatography), combined radiation and chemotherapy. Sometimes a Whipple procedure.

Autoimmune Disorders

• Includes arthritis and rheumatic diseases
• Arthritis: primary affects joints, also muscles, bone, ligaments, and cartilage
• Classification: monoarticular or polyarticular. Inflammatory or noninflammatory
• Marked by inflammation, autoimmunity, and degeneration

Diffuse Connective Tissue Diseases

• Group of chronic disorders causing inflammation and degeneration in connective tissues
• Unknown cause, likely immunologic
• Characterized by periods of exacerbation and remission
• Includes conditions like rheumatoid arthritis and systemic lupus
• Specific symptoms and diagnoses will vary for each condition.

Rheumatoid Arthritis

• Development: ages 20-40, more common in females
• Pathophysiology: synovial tissue moves into the joint leading to inflammation
• Symptoms: morning stiffness longer than an hour, pain, warmth, swelling of the joints.
• Management: ROM exercises, protection of bony prominences, immunosuppressants or anti-inflammatory medications

Systemic Lupus Erythematous (SLE)

• Combo of genetic, immunologic, and environmental factors involved.
• Manifestations: fever, malaise, weight loss, commonly affects muscles, renal systems, nervous system, cardiovascular system, and respiratory system. Butterfly rash.
• Diagnostics: no specific unique test. Table 20.9 (pg. 398 - 399) useful for differential diagnosis.
• Management: anti-inflammatory medications, corticosteroids, cytotoxic agents for controlling inflammation and immune response.