Understanding Burns and Skin Function

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Questions and Answers

What primarily causes a burn?

Injury from sharp objects

Deficiency of skin nutrients

Contact with heat or chemicals (correct)

Exposure to sunlight

Which type of burn affects only the epidermis?

Deep dermal burn

Superficial dermal burn

Superficial epidermal burn (correct)

Full thickness burn

What is the main role of dermal tissue in the skin's regeneration?

It protects against chemicals

It provides elasticity

It stores fat

It supports epidermal regeneration (correct)

What happens during a superficial dermal burn?

Blisters are present and the dermis is intact Signup and view all the answers

In which layer of the skin does regeneration occur every 2-3 weeks?

Deepest layers of the epidermis Signup and view all the answers

What indicates a superficial epidermal burn during examination?

Skin is red and painful but not blistered Signup and view all the answers

What type of burn is caused by contact with hot solids?

Contact burn Signup and view all the answers

What physiological changes occur due to burns?

Loss of skin function and integrity Signup and view all the answers

What is one consequence of hypermetabolism in burn patients?

Muscle wastage Signup and view all the answers

What is the purpose of early enteral feeding in burn patients?

To maintain gut integrity Signup and view all the answers

Why does hyperglycaemia occur in burn patients?

Due to insulin resistance and increased glucose production Signup and view all the answers

What is a potential risk of insulin treatment in burn patients?

Hypoglycaemia Signup and view all the answers

What is included in the A – E survey for clinical assessment of burn patients?

Airway, breathing, circulation, disability, exposure Signup and view all the answers

Which formula is commonly used for calculating fluid resuscitation in burn patients?

Parkland Formula Signup and view all the answers

Which factor is NOT part of the Burn Unit Criteria?

Body mass index Signup and view all the answers

What is a critical temperature to maintain in burn patients to prevent hypothermia?

34°C Signup and view all the answers

What characterizes superficial partial-thickness burns?

Involves the epidermis and upper dermis Signup and view all the answers

How do deep dermal burns present?

Dry, blotchy, and typically painful Signup and view all the answers

What happens to capillary refill in superficial partial-thickness burns?

Capillary refill blanches and regains color quickly Signup and view all the answers

What is a feature of full thickness burns?

Involves underlying tissues Signup and view all the answers

What distinguishes deep dermal burns from superficial partial-thickness burns?

Depth of tissue damage Signup and view all the answers

In deep dermal burns, what typically occurs with capillary refill?

Capillary refill regains color slowly Signup and view all the answers

What skin color is associated with superficial partial-thickness burns?

Pale pink and painful Signup and view all the answers

How do full thickness burns typically feel?

Painless because of nerve damage Signup and view all the answers

What respiratory issues are displayed in this patient based on the A-E assessment?

Increased respiratory rate and audible wheeze Signup and view all the answers

What does a heart rate of 150 indicate in this patient situation?

Tachycardia potentially indicating stress or pain Signup and view all the answers

What does cyanosis, along with swollen lips and tongue, primarily suggest?

Hypoxia leading to inadequate oxygenation Signup and view all the answers

What could the inability to measure capillary refill time (CRT) due to burns imply?

Severe local tissue damage potentially impacting circulation Signup and view all the answers

What does the presence of full thickness burns indicate regarding the depth and severity of the injuries?

Severe injuries that damage deeper structures, likely requiring surgical intervention Signup and view all the answers

What three components make up the lethal triad?

Hypothermia, coagulopathy, metabolic acidosis Signup and view all the answers

Which type of skin graft lasts between 2–4 weeks?

Allograft Signup and view all the answers

What is a primary concern when a patient has decreased O2 reaching the brain?

Altered consciousness Signup and view all the answers

Which procedure is important for improving survival rates after burns?

Immediate grafting and early excision Signup and view all the answers

Which type of dressing is specifically indicated for managing burns?

Paraffin gauze dressing Signup and view all the answers

What complication can arise from burns leading to metabolic changes?

Hyperglycemia Signup and view all the answers

What should be the recommended theatre temperature for burn treatments?

29°C Signup and view all the answers

What is an important airway consideration for a patient with burns?

Early intubation for controlled ventilation Signup and view all the answers

What is the primary outcome of inflammation in tissues?

Coagulation of protein constituents leading to irreversible tissue loss Signup and view all the answers

What occurs when burns reach 30% of the total body surface area?

Release of inflammatory mediators causing systemic changes Signup and view all the answers

Which of the following best describes the impact of cytokines released at the site of injury?

They cause fluid leakage from blood vessels leading to systemic hypotension Signup and view all the answers

What effect does bronchoconstriction have on the respiratory system after severe burns?

Results in reduced diffusion of O2 and potential ARDS Signup and view all the answers

What is one significant cardiovascular effect of severe burns?

Vasoconstriction in peripheral and splanchnic circulation Signup and view all the answers

Which condition can develop due to severe burns and associated inflammatory responses?

Systemic hypotension and end organ hypoperfusion Signup and view all the answers

What role do catecholamines play in the systemic response to injury?

They cause peripheral vasoconstriction and decreased blood flow Signup and view all the answers

What is a potential effect of hypotension caused by burns?

Impaired organ perfusion leading to dysfunction Signup and view all the answers

Study Notes

Burns

Burns are injuries to skin or other organic tissue, primarily caused by heat, radiation, electricity, chemicals, friction, or contact with chemicals
Thermal burns occur when cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns)
Burns are classified into two groups based on tissue damage: superficial partial-thickness burns and full-thickness burns

Learning Objectives

Discuss different types of burns
Link skin function to maintaining homeostasis during burns
Apply pathophysiology during burns
Discuss clinical assessments of burns
Discuss clinical management to correct pathophysiology

Skin and Homeostasis

Skin is the largest organ system in the body
Epidermis has five layers
Dermis has two layers
Deepest layers of epidermis regenerate every 2-3 weeks
Epidermis requires dermal tissue to regenerate

Classification of Burns

Burns are classified by depth of burn and layers of skin affected
Superficial epidermal burns: affects epidermis only, skin is red and painful, no blisters, capillary refill quickly
Superficial dermal (partial thickness) burns: involves epidermis and upper layers of dermis, skin is often reddish-pink, painful, blistering; capillary refill slow to return to normal
Deep dermal (partial thickness) burns: epidermis and upper/deeper layers of dermis are involved, skin typically appears dry, blotchy, or mottled; capillary refill is slow or doesn't return
Full thickness burns: extends through all layers of skin, possibly into muscle or bone; skin color is white or black, waxy or leathery, and painless with loss of sensation

Pathophysiology: Local Response

Burns involve three zones: coagulation, stasis, and hyperemia
Zone of coagulation: maximal damage; cell death, protein denaturation, and damaged circulation; irreversible tissue loss
Zone of stasis: potentially salvageable tissue; aiming to increase tissue perfusion; can become irreversible with infection and hypotension
Zone of hyperemia: increased blood flow due to inflammation; will recover unless it becomes systemic infections like sepsis

Pathophysiology: Systemic Response

Release of cytokines and inflammatory mediators at the burn site creates systemic effects once the burn area reaches 30% of total body surface area.
Cardiovascular changes: fluid leaks from vessels, leading to loss of intravascular proteins and fluid; peripheral and splanchnic vasoconstriction; reduced cardiac contractility, hence increased heart rate and oxygen consumption; this results in systemic hypotension and end-organ hypoperfusion.
Respiratory changes: inflammatory mediators cause bronchoconstriction and decreased perfusion; severe burns can lead to adult respiratory distress syndrome (ARDS), decreased oxygen into blood and carbon dioxide out of blood thus affecting oxygen carrying capacity
Metabolic changes: threefold increase in metabolic demands causing muscle, bone, and adipose catabolism; insulin resistance; increase in glucose production; decrease in glucose uptake and clearance causing hyperglycemia

Clinical Management - Airway

Assess patient consciousness; assess for stridor, hoarseness, or wheezing
Determine if intubation is necessary (assess ventilator, airway equipment, oxygen availability, monitoring, CO2 line, and capnography)
Smaller tubes may be needed due to swelling/edema

Clinical Management - Breathing

Assess resistance to breathing: inflammatory mediators cause bronchoconstriction and difficulty breathing
Assess compliance in lungs and posture: how much the lungs expand and if the burns affect the chest and back; posture may affect short breaths,
Anaerobic respiration (low oxygen): can lead to lactic acid release, becoming acidotic.

Clinical Management - Surgical Instruments

Zimmer dermatome
Watson knife

Clinical Management - Fasciotomy & Escharotomy

Fasciotomy: incision through fascia to relieve compartment syndrome
Escharotomy: incision through eschar to restore blood flow

Clinical Management - Circulation

Fluid loss from vascular permeability: fluid extra uptake on local sites
Calculate crystalloid (lactated ringers/Hartmans/saline) resuscitation using Parkland formula
Increase stroke volume to maintain blood pressure (BP)
Increase oxygen-carrying capacity

Clinical Management - Disability/Conscious Level

Decreased/altered level of consciousness and brain oxygenation: due to reduced oxygen reaching the brain due to increased body demands and may require intubation for controlled ventilation
Evaluate and correct hypoxia and hypercapnia

Clinical Management - Exposure

Document full extent of injuries, calculations for different burn types are often done in burn units

Skin Grafts

Allograft: from cadaver or living donor; lasts 2-4 weeks, can be xenograft (different species)
Autograft: from patient's own skin (split skin or full thickness); meshed grafts are possible using paraffin oil or saline

Application to Practice

Theatre temperature >29°C
Warm IV fluids
Correct airway and positioning
Consider pressure area management
Manage drugs and infusions
Control movement to reduce infection
Early excision and immediate grafting improve survival rates
Development of grafts, working with grafts, and infection control improve survival rates

Case Study

20-year-old female with 3rd-degree burns to face, chest, and arms.
Presented with respiratory issues (cyanosis, swollen lips and tongue, RR 30, SpO2 decreased, wheeze, crackles)
Unstable vital signs (HR 150, BP 103/62, unrecordable temperature) and unable to measure central BP
Glucose levels of 7.5 mmol/l, full thickness burns, and other considerations (AVPU, abnormal posture)

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Description

This quiz explores the different types of burns and their classifications, focusing on thermal burns and tissue damage. Learners will also link skin function to homeostasis, apply pathophysiology related to burns, and discuss clinical assessments and management strategies. Enhance your understanding of burns and their impact on the body.