Burns Vocabulary

Burns Vocabulary

• Autograft involves grafting skin from one part of a patient's body to another area on the same patient.
• Carboxyhemoglobin is the result of carbon monoxide (CO) bonding with hemoglobin in the blood.
• Collagen is a key protein found in skin, tendon, bone, cartilage, and connective tissues.
• Contracture references the shrinking of burn scars as collagen matures.
• Débridement refers to the removal of any foreign material and dead tissues from a wound, exposing healthy tissue.
• Donor site is the area on the body from which skin is taken for a skin graft.
• Eschar signifies the dead tissue that results from burns or wounds.
• Escharotomy is a surgical cut through eschar to relieve tissue constriction.
• Excision involves the surgical removal of tissue.
• Fasciotomy references a surgical incision through the fascia to relieve muscle constriction.
• Homograft involves grafting tissue from one human, living or deceased, to another, also referred to as an allograft.
• Xenograft involves using animal tissue for grafting onto a human, such as pigskin, also known as a heterograft.

Burn Injuries and Statistics

• Burn injuries result from damage to skin or tissues from heat, chemicals, electricity, or radiation, often at home or work.
• Patients usually need long hospital stays, multiple surgeries, pain management, immobilization, rehabilitation, and IV medications like opioids and antibiotics.
• Historically, hospital stay length was estimated at one day per percentage of total body surface area (TBSA) burned.
• Older adults face higher burn injury risks due to mobility issues, instability, weakness, sensory decline, and memory problems.
• Lethal dose 50 indicates the TBSA burn percentage resulting in 50% mortality; it remains 30-35% TBSA for older adults.
• Patients aged 60+ experience the highest rates of burn-related complications.
• Pneumonia is most common complication, followed by UTIs, respiratory failure, septicemia, cellulitis, wound infections, kidney injury, and arrhythmias.
• Older adults possess thinner, less elastic skin, affecting injury depth and healing.
• Age-related pulmonary function decline and smoking history worsen the effects of burn.
• Decreased cardiac output and cardiovascular compensatory response increase risk of complications in older adults.
• A fine line exists between adequate fluid resuscitation and fluid overload for older adults.
• Kidney and liver function decline affects medication dosing.
• Malnutrition impacts morbidity and mortality, especially in institutionalized older adults.
• Mental capacity varies, complicating pain, anxiety, and delirium assessment.
• Comorbidities and treatments can lead to polypharmacy, increasing complications and facility discharge.
• Nurses assess older adults' ability to do activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
• Educating community and home caregivers about burn prevention is crucial, as nearly all burns are preventable.
• Mortality factors include increased TBSA burned, inhalation injury, and increased age.
• Multiple factors determine burn injury severity: patient age, burn depth, surface area burned, inhalation and other injuries, burn location, and comorbidities.
• Young children and older adults show increased morbidity and mortality, complicated by thinner skin.

Classification and Assessment of Burns

• Burns are classified by tissue damage depth like first, second, third and fourth degree.
• First-degree burns are superficial, involving only epidermis, causing pain and redness with an intact epidermis,.
• Nikolsky's sign is negative, the burned tissue does not separate from the dermis, sunburns and scalds are typical.
• Second-degree (partial-thickness) burns affect the entire epidermis and varying dermis portions, causing pain, blisters.
• Healing ranges from 2–3 weeks, and hair follicles remain intact; wound bed is moist.
• Third-degree (full-thickness) burns destroy the epidermis, dermis, and underlying tissue and the wound color varies widely
• The deeply burned area lacks sensation, and the wound is leathery/dry, and organelles are affected.
• Fourth-degree burns (deep burn necrosis) extend into deep tissue, muscle, or bone.
• Burn depth impacts re-epithelialization.
• Depth depends on burn cause (flame or scalding liquid), temperature, contact duration, and skin thickness.
• TBSA is estimated via the rule of nines, the Lund and Browder method, and the palmer method.
• The rule of nines estimates burns in adults based on anatomic regions, each ~9% TBSA.
• More precise estimation is achieved via the Lund and Browder method, accounting for age.
• Initial evaluation should be revised within 72 hours because the wound's depth becomes clearer.
• American Burn Association criteria indicate burn center referral, including partial-thickness burns covering 10%+ TBSA.
• Additional criteria include burns involving the face, hands, feet, genitalia, perineum, or major joints.
• Additional criteria include third-degree burns, electrical/chemical burns, inhalation injury and burns with trauma.
• Additional criteria include children at non-specialized facilities and patients needing social, emotional, or long-term rehabilitation
• The palmar method estimates extent for scattered or minimal burns via patient's hand size (~1% TBSA).

Pathophysiology and Types of Burns

• Burns cause tissue destruction through coagulation, protein denaturation, or cellular ionization, initial injury worsens.
• Tissue necrosis is central, viability is peripheral, with the central zone termed the coagulation zone.
• The stasis zone contains injured cells, and may necrose within 24–48 hours, the outermost zone, the zone of hyperemia, suffers minimal injury.
• Skin and upper airway mucosa are the most common sites of tissue destruction, but deep tissue damage can occur.
• Local mediators, blood flow changes, edema, and infection worsen the burn injury.
• Radiation injuries have a thermal effect, and cause cellular DNA damage that is dose-dependent.
• The depth of a burn is affected by the burning agent and the contact duration, exposure to 54°C for 30 seconds causes injury.
• Recognize that injuries affecting 20%+ TBSA are severe, and cause local and system effects.
• Systemic inflammatory response signals release of cytokines, causing hypermetabolism, potentially resulting in organ dysfunction/mortality

Electrical Injuries

• Electrical injuries are complex, with heat causing damage, visual examination doesn't predict severity
• It is helpful to know circumstances to anticipate damage, superficial injuries are contact points.
• Deep tissue injuries may not be visible on initial exam.
• Mechanisms include flash, conductive, and lightning injuries.
• A flash generates heat/light, causing a thermal burn, conductive injuries occur as current overcomes skin resistance.
• Damage depends on current strength, contact time, organs along pathway, and current type
• Electricity via nerves, vessels & bones generates heat, damaging adjacent tissues, deep muscle injury masks true injury extent
• Current contracts muscles, causing skeletal/joint injuries, high-voltage injuries are more common, with DC associated with explosions
• AC passes back/forth, holding victim, compartment syndrome is common due to edema & fluid volumes.
• Invasive therapies such as fasciotomies & nerve/ocular/abdominal releases may be needed.
• Lightning can cause immediate deep polarization of the myocardium, which causes cardiac arrest
• Respiratory arrest is also expected due to brain respiratory center.
• Survivors report permanent morbidity including neurologic disabilities, depression, sleep disorders, and chronic pain.
• Resuscitation fluid calculations are inaccurate for electrical injuries.
• It is difficult to quantify injury without exploration, Serum CK levels determine muscle injury,.
• Myoglobinuria may cause kidney failure requiring IV fluids with bicarbonate to alkalinize urine.
• Serial surgical débridement is often required to address progressive tissue necrosis.

Cardiovascular and Pulmonary Alterations

• Burn injury causes immediate decrease in cardiac output.
• Systemic inflammation releases free oxygen radicals increasing permeability, plasma loss, and edema.
• Sympathetic nervous system releases catecholamines, increasing resistance/pulse rate, decreasing perfusion
• Hypovolemia results in decreased perfusion and oxygen delivery causing early burn shock.
• Plasma is mainly lost in burn injuries, not blood. prompt fluid sustains blood pressure and cardiac output
• Cardiac filling pressures stay low in early shock, distributive shock occurs if vascular volume is not maintained,
• Greatest intravascular fluid leak occurs in first 24–36 hours, peaking 6–8 hours post-burn
• As capillaries regain integrity, shock resolves, and fluid shifts back into vascular compartment, intrinsic diuresis begins

Edema, Electrolytes and Pulmonary Issues.

• Edema forms rapidly after burns and superficial burns cause edema within 4 hours/ with deeper occurs 18 hours post-injury.
• Increased perfusion and permeability reflect tissue damage & with >20% TBSA shifts fluid, electrolytes/proteins into interstitium.
• Monitor circulation & taut burned tissue acts like tourniquet.
• As edema increases, pressure obstructs blood flow causing ischemia/compartment syndrome.
• Elevation, escharotomy (cutting eschar)/fasciotomy (cutting fascia) can restore perfusion.
• Reabsorption starts ~4 hours post-injury and can become complete ~4 days post-burn, but is dependent on tissue injury depth.
• Adequate fluid restores perfusion, excessive fluid increases edema.
• Hyperkalemia may result from cell destruction & hypokalemia occur later.
• Serum sodium varies with fluids and hyponatremia may occur.
• Red blood cells are destroyed, and early hematocrit may be elevated with fluid, thrombocytopenia, and prolonged times also may occur.
• Inhalation injuries involving thermal/chemical irritants affect upper/lower airways.
• History of flame in enclosed space and clinical signs like singed hair or carbonaceous sputum indicate smoke inhalation
• Bronchoscopy is the standard test; initial chest x-rays are normal.

Types of Airway Injuries

• Upper airway occurs in the from severe edema and protective intubation is warranted.
• Lower airway results from inhaling combustion products causing loss of ciliary action and inflammation.
• Reduction in surfactant leads to atelectasis, particles in sputum is a cardinal sign, and toilet is critical.
• Noxious gases cause contributes to injuries & CO combines to form carboxyhemoglobin, treatment is 100% oxygen.
• Bronchoconstriction and chest constriction may worsen conditions and escharotomy may be necessary.

Kidney and Immunologic Alterations

• Kidney function is altered due to decreased blood volume; adequate fluids restore blood flow.
• The destruction of red blood cells and muscle damage releases hemoglobin/myoglobin into urine, inadequate flow causes acute tubular necrosis.
• Increased abdominal pressure causes kidney ischemia.
• Immunologic: Damaged skin exposes the patient to infection, burn causes cytokine release.
• Thermoregulatory: Integumentary loss causes an inability to regulate body temperature so often heat sources are used.

Gastrointestinal Alterations

• Impaired enteric and inadequate perfusion cause GI dysfunction, Indicators include increased pressure and feeding intolerance
• In patients are paralytic, Curling's ulcer, and bacteria, leads to distention/nausea may necessitate decompression.
• Gastric bleeding may be signaled by occult blood or bloody vomitus.
• Probiotics are maintain function may be used.
• Thermal damages liver through hepatic edema, and pancreatitis is common.
• ACS is increased fluid and TBSA put patients at risk and Increased pressure in abdomen contributes to Gl tract and organ ischemia.
• Burn recovery happens in emergent/resuscitative, acute/intermediate, and rehabilitation including problems and complications.

Emergent/Resuscitative Phase

• First management step in rescuers must remove the patient from source to prevent any kind of further injury.
• Workers prioritize includes airway, oxygen (100% if CO suspected), IV catheter insertion, and covering wound with dry cloth/gauze
• Continuous irrigation is a must for chemical injury and immediate primary assessment considers: airway (A including cervical spine), gas exchange (B), circulation (C), disability (D), and exposure (E while keeping a warm environment

Medical Management

• Initial ED priorities remain and circulation and mild requires 100% oxygen, patients should be able to cough freely or should be given suction.
• Sever conditions include bronchial suctioning and Continuous may quickly deteriorate, and rate should be as indicated.
• Daily weights and tests help determine the state and are with both conditions relating to negative in patient outcomes.
• TBSA is calculated with mL of fluid and adults should include and In electrical ,
• Timing is one of the most things and the point is the time of the and not time .
• Output continues to assess and injuries are considered following established and catheter needs to be as function is the to be effective as of such , must also be as there, drug and might become if the is unkown
• Can be ,

Additional Nursing and Medical Management

• Management targets and status
• Extremities may complicate determination and are used; are also possible
• Urine suggest caused and
• Also a to the role of due to

Acute/Intermediate Phase of Care

• Occurs 48-72 hours follows and focuses on function & balance
• Main cares: function, care
• Airway issues can take as long as develop
• Elevation lessens and are signs
• Ideal intubation is however can occur
• Late include cast
• With it has inflammation
• VAP is a patients in and can happen . Bundled strategies may

Medical Interventions

• Fluid from , if may occur. Fluids must be managed.
• Needed as. Blood Loss &
• Can happen. Shifts cause
• Site must be prevented here so must be
• A trigger the
• Excisions can

Infection Control

• The with is made in response
• With is has so for is needed
• Care include the or from and
• Equipment is direct and
• Are cultured has and

Wound Cleaning and Therapy

• The remove tissues
• Are with soap
• Is to for through to prevent
• With the and and is at to the The is and to to

Topical Antibacterial Therapy

• The effective is:
• Is effective and
• Is available, and
• Is and
• Are use due to and there are best use of

Wound Dressing

• Use on to and and . Dressing can be distal with .