estra
onin
Function
↳
malhtalt:
-
body temp
fluids
↳
protect from infect - injury
-
sensory contact w/
touch
pressure
enviorn:
-
-
-
pain
↳Vitamin
D. prod.
manetoregeneraterson
body
RMIS
-
↳
the
↳ 2 layers:
in
·
·
thick
layer
connective tissue, collagenous fibers,
blood vessels, sweat, hair follicles,
nerves, sensory fibers
-ERMIS
·
·
dead cornified cells,tough barrier
regenerates (2-3 weeks)
-
-
most severe damage
I heat transfer
irreversible skin death
-
-
protein
↳
Stasis
coagulation
urnst
dation
-
impaired
that leads
to the cessation of blood
flow
circ.
can
have full-
thickness loss
-
↳
-
-
chest/back
extremities
emergency risk for
vasodilation
I blood flow
↳
↳
full thick
common
acidswalls, organic compound,
concentration, exposure duration,
severity
↳
ELECTRICAL-children
-
-
inserting
objects
in
outlets
occupational hazard
RADIATION
compli
chic an
Cardiovasc., resp, renal, DM, peripheral
↳ alcohol/drug-catecholamine
or
-up to 48hrs for full damage
compartment syndrome
s/young
deep thermal burns
more severe
-
eyes, hands, feet, perineum
-
flame, flash, scald, hot-objects
CHEMICALhands
↳
Hyperemia
↳
-
-
-
↳circumferential
potentially salvageable,
but still
THERMAL- most common
↳D Serious:
-
-
↳
Types
↳
vascu
↳ malnutrition
additional injuries
↳
↳D child abuse
-
BURN SHOCK TBSA1. 420
Chypovolemic shock)
↳
Hemodynamic Values?
↳
edema:locally systemically
W/ Thermal Injury
AR1, I collapse, death
-
Degree
DegreeDen
al
Epidermis -- Dermis
↳
red, swollent, blisters, some
here
↳Outermostlayerlederm
↳
in
women
destroyed
Healing:2-7days
NT in
the rule of 9
Degree
⑭
↳
Full Thickness
↳ No pain,
only when pressure
applied
↳
↳
-able
to
grow new
↳eschar
dead tissue
-
-
bacterial grow
no mediators
skin
-
↳
Healing:7-21 days
-
partial
4 6 weeks deep
-
-
9's
of
LD for adults
is
tough, leathery,lots of color variation,
dry in appearance
-
edema, shiny, PAINFUL
[graft
↳ 1s
Degree NT
↳A head:9%
↳D each
arm:9%
front forso:18%
↳b back torso:18%.
↳
leg:18%
perineal:1%
↳each
↳)
included
dermal
To
begins immediatly after burn
↳
1tour crucial, 24-36hr impacts
survival & rehabilitation
↳Hx? mechanism
respiratory
circulatory
hypovolemic shock:
-
-
↳
Fluid Resuscitation
↳D
monitorpt response to 4 fluid vol.
↳
Lactated
#x
isotonic crystalloids
=
↳2
large bore IVs
-
not
delay perfusion distally
=
in
burn areas
FORMULA-First24HRS
↳LAND
4mL kg T BSA.
+
50%
50%
x
over
the first 8 hrs
over
the next 16hrs
c-collar
-
↳
Inhation injury?
BLACK SOOT?:INTUBATION
carbon monoxide, I death
-
common cause
↳ evaluate BP, p's, skin color,
↳ circumferential limbs
↳
death
wound,
pain
prevent inf,
-
eulatory
Ringers
↳ secure/protect airway
cervical precautions
11.
III.
of
injury?
↳ Chemical?What
is the agent?
↳ remove:
jewelery due to swelling
Resp
Arway:
-0
e
esuscitation
-
↳D admin
100%02
↳circumferential
-
-
chest burn?
I chest compliance
I chest
wall expansion
S
-
analgesics/sedatives
↳ Tetanus Shot
-
↳D antimicrobials
·
↳
only med IM
-
topical
silver sulfadazine
prophalaxls -PUTE, ulcers
riedment
nd
Manage
↳
room
↳ Remove the
temp:85 degrees
↳ wound care
↳antimicrobial
-
↳
agent
YPES
Hibiclens
-wash/pat dry
1) Mechanical
↳debriedment
↳D
topical
necessary
ESCHAR]dead tissue!
to control infection
-
axb
gauze dressing outer layer
↳
Grafts
TX for 32 Degree Burns
Acute Phase:
wound closure by excision
↳
scissors/forceps to
cut tissue
2) Enzymatic:
#x
-
agents soften/ dissolve eschar
Surgical
3)
-
Debriedment
remove non-viable tissue in OR
bleeding tissue
down to viable
↳
-
-
e
done
↳
in
OR
on
day I or 2
Complications:
bleeding/infections
-
-
-
donated skin:
open
grafts:fragile
harotomy
↳o TX:circumferential
↳A relieves:
chest
-
-
full-thickness eschar
expansion/restrict.
A compliance
↳D Improves:
-
-
-
compliance
ventilation
compartment syndrome
Grafts
TX for 32 Degree Burns
Acute Phase:
wound closure by excision
↳
↳
plastic surgery/grafts
secretes peptides proteins anticoag
↳
-
-
e
done
↳
in
OR
on
↳
day I or 2
↳A promotes
#x
-
-
donated skin:
open
grafts:fragile
Types?
↳
graft
-
-
from
healthy site, placed
-MANENT
sheets/mesh
-
-
If donor
is
on
burn
wound coverage
available
Homograft (allograft)
↳
-
-
-
-
ORARY Wound coverage
allows for revascularization
better control
Xenograft
-
over
bacterial
-
-
↳ Increases
circulation
Complications:
bleeding/infections
-
Leches
Sterile lab leeches
↳
growth
expensive, last only 2 weeks
than
healing