Burns PDF - Lecture Notes

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 3: Inflammation and Tissue Repair Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lec...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 3: Inflammation and Tissue Repair Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Burns Clinical Pathophysiology Diagnosis Treatment manifestations  Burn Injuries Burn injuries cause an inflammatory response In the skin In other integumentary structures  Burn Pathophysiology Cause: Direct contact with excessive heat or radiation, caustic chemicals, or electricity Heat: Denatures proteins Irreversible cellular damage All burns Result: acute inflammatory response Burn severity is correlated with exposure type and time of the affected surface area  Burn Pathophysiology: Classification Superficial partial-thickness (first degree) Epidermal damage only Vasodilation of dermal blood vessels Increased capillary permeability Localized redness, warmth, edema (swelling), pain Do not result in cell necrosis or scarring Extracellular matrix remains intact Uneventful healing Epithelial cells rapidly regenerate http://hospitals.unm.edu/burn/classification.shtml  Burn Pathophysiology: Classification Deep partial-thickness (second degree) Epidermal and upper dermal damage Epidermal and dermal layers separate Fluid accumulates, blisters appear Loss of function: 1st line of defense Tissue necrosis are common, tissue fibrosis, scarring Healing occurs within 2-4 weeks Marieb EN, Hoehn KN. Human Anatomy & Physiology. 9th ed. Boston, Pearson Education; 2013 http://hospitals.unm.edu/burn/classification.shtml  Burn Pathophysiology: Classification Full thickness (third degree) Entire thickness of skin involved Epidermis, dermis, subcutaneous Skin gray-white, cherry red, or blackened Not painful (nerve endings destroyed) Healing is difficult due to extensive tissue loss Skin grafting usually necessary Regeneration of epithelial cells impaired Scarring is extensive Dead tissue and exudate convert into eschar Loss of elasticity leads to contractures https://www.nlm.nih.gov/medlineplus/ency/imagepages/9218.htm http://hospitals.unm.edu/burn/classification.shtml  Burn Pathophysiology Loss of skin function: multiple complications (in severe burns) Body fluid shifts Impaired blood circulation, edema Dehydration and electrolyte imbalance Leads to renal shutdown and circulatory shock Microorganism invasion Infection Overwhelming metabolic demand Increased risk of malnutrition Temperature regulation problems  Burn Pathophysiology Significant Hemodynamic changes Poor perfusion Problematic for vital organs Constant flow of oxygen required Inadequate blood in circulation: shock - hypovolemic shock Fluid volume replacement!  Burn Clinical Manifestations Depend on depth of burn injury Superficial-partial thickness burns: Erythema, warmth, pain, swelling, loss of function Deep-partial thickness burns: Blistering occurs, erythema, pain, edema, serous exudate Full thickness burns Erythema, eschar, edema, exudate Destroyed nerve endings, sweat glands and hair follicles  Burn Diagnosis Wound depths are classified according to the affected tissue layers  Estimating the extent and severity of burns using the rule of 9s. Totals 41/ 2% Anterior and posterior Surface area: rule of nines head and neck, 9% Anterior and posterior upper limbs, 18% 41/2% Anterior 41/2% Anterior and posterior trunk, trunk, 36% 18% 5-year old 9% 9% (Perineum, 1%) Anterior and posterior lower limbs, 36% 100% Marieb EN, Hoehn KN. Human Anatomy & Physiology. 9th ed. Boston, Pearson Education;2013 © 2013 Pearson Education, Inc.  Burn Diagnosis American Burn Association has designated criteria Wound depth Surface area Required level of treatment Critical if >25% of body has second-degree burns or >10% of body has third-degree or Face, hands, or feet bear third-degree burns Respiratory passageways, suffocation, joint mobility  Burn Treatment Minor and moderate burns: Remove source of injury Stop burning process Chemical burns flushed with plenty of water Minor burns: wound cleansed with tepid water Antimicrobial ointment applied Dressing Changing dressing frequently helps debridement: mechanical removal of debris, necrotic tissue  Burn Treatment Moderate and major burns: Emergency medical admission Face, hands, or feet Genital areas, respiratory passageways, joints Specialized intervention Initial focus: Stabilize airways, breathing and circulation Fluids: replace water and sodium, restore circulation Nutrition: increased metabolic demand Antibiotics: infection Analgesics: pain management Burn treatment Wound management for major burns include Cleansing with sterile saline Removing necrotic tissue Closing wound Preventing infection Hydrotherapy to cleanse the wound, remove dead tissue and exudate Skin grafting for full-thickness burns http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038392/ ü Unable to undergo re-epithelialization ü Transplanted tissue supports cellular regeneration ü Decrease infection ü Minimize scarring Long term rehabilitation (tertiary prevention): Severe scarring Contractures Deformity Chronic pain Depression, psychological issues