GMED3009 Burn Injury Module Quiz

Applied Bioscience for Health Complexity 2 (GMED3009) - Burn Injury Module

• Learning Outcomes: Define burns, describe burn injury mechanisms, classification, pathophysiology, methods of estimating burn injury extent, complications, and management of a patient with burns.

• Definition of Burn: A traumatic injury to the skin or other organic tissue, primarily caused by heat, exposure to electrical discharge, friction, chemicals, or radiation.

• Burn Mechanisms:

  • Heat: Associated with flames, hot liquids, hot objects, and steam. Most thermal burns involve the epidermis and part of the dermis. Thermal injury depends on contact temperature, duration of contact, and heat source thickness.
  • Electrical Discharge: Electrical energy transforms into heat as current passes through poorly conducting tissue. The severity depends on the current pathway, resistance, and duration.
  • Friction: Mechanical disruption of tissues and heat generation from friction.
  • Chemicals: Caustic reactions cause injury, severity depends on exposure duration and chemical type. Acid causes coagulation necrosis, while alkalis cause liquefaction necrosis.
  • Radiation: Radiofrequency or ionizing radiation can damage skin and tissues. Sunburns are a common example.

• Inhalation Injury:

  • Toxic Inhalation: Exposure to substances like synthetic resin combustion, cyanide, and hydrogen sulfide can cause systemic poisoning. Carbon monoxide poisoning is a significant concern, due to higher affinity for hemoglobin.
  • Airway Thermal Burn: Supraglottic structures absorb heat, preventing lower airway burns. Injury common from steam. Risk factors include standing or being trapped in burn environments. Symptoms include stridor, singed hair, black sputum, and swelling.

• Classification of Burns by Depth:

  • Superficial (Epidermal): Involves only the epidermis.
  • Partial-thickness: Involves the epidermis and portions of the dermis.
  • Full-thickness: Extends through all layers of the dermis.
  • Deep (Fourth-degree): Extends into underlying soft tissues (fascia, muscle, and/or bone).

• Pathophysiology - Thermal Burns:

  • Molecular Changes: Heat alters tissue's molecular structure, denaturing proteins.
  • Damage Factors: Temperature, concentration of heat, and duration of contact determine burn extent.
  • Jackson's Theory: Three zones: Coagulation (direct heat area), Stasis (decreasing blood flow), and Hyperemia (increased blood flow).
  • Body's Response: Emergent (pain, catecholamine release, tachycardia), Fluid Shift (peak in 6-8 hours, fluid shift, inflammation, swelling), Hypermetabolic (days-weeks, large nutrient needs), and Resolution (scar formation, rehabilitation).

• Signs and Symptoms: Pain, changes in skin condition, blisters, sloughing, hoarseness, dysphagia, dysphasia, burnt hair, edema, hemorrhage, other soft tissue injury, musculoskeletal injury, dyspnea, and chest pain.

• Extent of Burn Injury: Thorough estimation of burn size is crucial for guiding therapy and transfer decisions. Percentage of body surface area (TBSA) is used.

• Methods of Estimating Burn Injury Extent:

  • Lund-Browder: The preferred method for children because it accounts for growth differences.
  • Wallace Rule of Nines: A simpler method for adults, dividing the body into regions with fixed percentages.

• Assessment of Thermal Burns (Initial): Airway, Breathing, Circulation, Disability, and Exposure.

• Assessment Methods of Thermal Burns: Focused and rapid assessment of trauma, determine approximate burn extent using rule of nines or Lund-Browder charts, depth of burn, area of body affected. Special consideration for burns involving face, hands, feet, joints, or genitalia. Age matters.

• Management of Thermal Burns (Minor): Local cooling (20 minutes of cool water immersion), analgesic administration, wound cleaning, and removal of foreign/non-viable tissues.

• Management of Thermal Burns (Moderate-Severe): Dry sterile dressings, maintaining warmth to prevent hypothermia, aggressive fluid therapy (Parkland formula), IV placement in partial thickness areas, and preventative measures against infection.

• Management of Thermal Burns (Inhalation): High-flow oxygen (non-rebreather mask), intubation if swelling is present, and hyperbaric oxygen therapy when appropriate.

• Management of Electrical, Chemical, & Radiation Burns:

  • Electrical: Safety first (turn off power), safety zone established, treatment of entrance and exit wounds, ECG monitoring, advanced cardiac life support protocols.
  • Chemical: Thorough removal of chemical agents and skin, then flushing with water.
    • Radiation: Similar to the other burn types, focusing on the skin and associated effects, monitoring, and other complications.

• Nursing Care - Evaluation (all types): ABC assessment, airway (stridor, accessory muscles), breath sounds, circulation (CVP, BP, pulse oximetry), fluids and electrolytes (renal function, urinary output), pain levels, presence of infections, nutritional needs (weight and ulcer management), multi-disciplinary care.