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Questions and Answers
What is a key component of nutritional support for burn patients?
Which phase of burn care focuses on wound healing and rehabilitation?
What is the primary purpose of the Lund and Browder chart in burn assessment?
What physiological change is commonly associated with smoke inhalation?
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Which factor does NOT classify a burn as critical?
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What is the primary function of burn centers?
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Which phase of burn care focuses on stabilization and prevention of complications?
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What is the primary dietary consideration for patients recovering from burns?
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How is the extent of burns typically assessed in adults?
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Which of the following is a common pathophysiological response to smoke inhalation burns?
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What complication is associated with sympathetic nervous system activation in burn patients?
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According to the Lund and Browder chart, what percentage of the total body surface area is assigned to the 'Right leg'?
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What is a potential consequence of metabolic acidosis in burn patients?
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Which factor is NOT considered when assessing the severity of burns?
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What distinguishes a third-degree burn from a second-degree burn?
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What physiological change is associated with burn injury?
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Which nutritional support is critical for burn patients?
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What is the main component of burn shock in major burns greater than 30% TBSA?
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Which condition can result from the pathophysiology of smoke inhalation?
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What does the zone of stasis in burn injuries represent?
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Which type of burn is characterized by blisters and severe pain?
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Study Notes
Sympathetic Nervous System Activation
- Release of adrenal corticoid hormones and catecholamines increases blood pressure
- Peripheral vasoconstriction occurs
- Tachycardia is present
- Hyperglycemia develops
- Increased catabolism increases the risk of Curling's ulcer
- Afterload increases
- Cardiac output increases
- Risk of acute renal failure and ileus increases
- Metabolism increases after burn shock resolves
Tissue Perfusion
- Reduced renal and Gl blood flow occurs
- Anaerobic metabolism leads to metabolic acidosis
- Tissue damage and potential necrosis can occur
- Cellular dysfunction leads to cell swelling
Pathophysiology of Smoke Inhalation Burns
- Activated pulmonary alveolar macrophages release chemotactic factors
- Chemotactic factors cause neutrophil aggregation and activation
- Neutrophils release oxygen radicals and proteases
- Thromboxane released from the lungs increases pulmonary artery pressure
- Tracheobronchial epithelial injury results in exudate case formation and small airway obstruction
- Atelectasis and air trapping can occur
- Increased pulmonary endothelial permeability causes pulmonary edema
- Pneumonia and pulmonary fibrosis can develop
Burn Extent
- The Rule of Nines is used to estimate burn size in adults
- Palm size can be used to estimate small, scattered burns
- The Rule of Five is used to estimate burn size in pediatric patients
- The Lund and Browder Rule is a more accurate method for estimating burn size, especially in children
The Rules of Nines
- Head: 9%
- Neck: 9%
- Anterior Trunk:18%
- Posterior Trunk: 18%
- Right Arm: 9%
- Left Arm: 9%
- Buttocks: 1%
- Genitalia: 1%
- Right Leg: 18%
- Left Leg: 18%
Lund and Browder Chart
| REGION | PT % | FT % |
|---|---|---|
| Head | 4.5% | 4.5% |
| Neck | 9% | 9% |
| Ant.trunk | 13 | 13 |
| Post.trunk | 13 | 13 |
| Right arm | 9 | 9 |
| Left arm | 9 | 9 |
| Buttocks | 1.5% | 1.5% |
| Genitalia | 1 | 1 |
| Right leg | 15 | 15 |
| Left leg | 15 | 15 |
Burn Centers
- Burn centers are specialized facilities with highly trained healthcare professionals dedicated to managing severe burn injuries
Burn Severity
- Burns can be classified as minor, moderate, or severe
- Severity depends on the temperature and duration of exposure, location, extent, and the patient's age and medical condition
Burn Depth
- Burns are also classified by depth of tissue damage
- Superficial (first degree): involves only the epidermis
- Partial thickness (second degree): involves the epidermis and dermis
- Full thickness (third degree): involves the epidermis, dermis, and subcutaneous layers
Burn Depth Classification
| Depth | Histology | Appearance | Sensation | Healing |
|---|---|---|---|---|
| First-degree: | Epidermis only | Erythema; blanches with pressure | Intact; mild to moderate pain | 3-6 days without scarring |
| Second degree: - Superficial | Epidermis and superficial dermis; skin appendages intact | Erythema, blisters, moist, elastic; blanches with pressure | Intact, severe pain | 1-3 weeks; scaring unusual |
| - Deep | Epidermis and most dermis; most skin appendages destroyed | White appearing with erythematous areas, dry, waxy, less elastic; reduced blanching to pressure | Decreased; may be less painful | >3 weeks; often with scarring and contractures |
| Third-degree: | Epidermis and all of dermis; destruction of all skin appendages | White, charred, tan, thrombosed vessels; dry and leathery, does not blanch | Anesthetic, not painful (although surrounding areas of second-degree burns are painful) | Does not heal; severe scarring and contractures |
The Body's Response To a Burn
- Burn injuries trigger both local and systemic responses
Clinical Image of Burn Zones
- Burn wounds have three zones:
- Central necrosis: area of irreversible damage
- Zone of stasis: area of potential damage
- Zone of hyperemia: area of inflammation and potential recovery
Physiology/Pathophysiology of Burns
- Cell lysis and hemolysis release hemoglobin and myoglobin into the urine, leading to hyperkalemia
- Increased red blood cell concentration and blood viscosity
- Increased capillary permeability causes a shift of sodium, water, and protein from the intravascular to interstitial spaces, leading to a decrease in circulating blood volume (up to 50%)
- Hyponatremia and thermo-regulation problems can occur
- Inflammation and impaired immune response
Major Burns (>30% TBSA)
- Burn shock can develop due to the release of a myocardial depressant factor
- Massive stress response is triggered
Inhalation Injury: Smoke Inhalation Suspected In:
- Hypoxemia
- Unconsciousness in enclosed spaces
- Exposure to toxic chemicals
- Tracheobronchitis and epithelial fibrin casts
- Airway obstruction
Classifications of Burns
- Causes of burns can be classified as:
- Thermal/scald: caused by hot liquids, solids, or flames
- Chemical: caused by contact with corrosive substances
- Electrical: caused by electric current
- Ionizing radiation: caused by exposure to radiation
- Inhalation injury: caused by breathing in smoke or hot gases
Critical Burns
- Potential life-threatening, disfiguring and disabling burns require qualified medical and nursing care
- Burns from chemicals, electrical sources, or inhalation injury
- Full-thickness burns in patients younger than 5 or older than 50
- Difficulty breathing, burns around the mouth, head, neck, hands, feet, or genitals
- Burns associated with other trauma or diseases
Burn Injury, Plastic & Reconstructive Surgery Management
- Burns are a special type of soft tissue injury
- They cause physical and psychological damage
- Account for about 25% of all soft tissue injuries
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Description
This quiz explores the complex pathophysiological changes that occur due to sympathetic nervous system activation following burns and smoke inhalation. It covers the release of hormones, blood flow alterations, and the impact on various organs and tissues. Understanding these mechanisms is crucial for managing burn injuries effectively.
