Burns

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Thermal Burn
caused by conduction or convection (e.g., hot liquid, fire, steam)
Electrical Burn
caused by the passage of electrical current through the body; typically there is an entrance & an exit wound; complications can include cardiac arrhythmias, respiratory arrest, renal failure, neurological damage, & fractures (ex: lightning)
Chemical Burn
occurs when certain chemical compounds come in contact w/the body; the reaction will continue until the chemical compound is diluted from the site; compounds include sulfuric acid, lye, hydrochloric acid, & gasoline
Burn Classification
the extent & severity of a burn is dependent on gender, age, duration of burn, type of burn, & affected area; burns are most appropriately classified according to the depth of tissue destruction
Superficial Burn
involves only the outer epidermis; the involved area may be red w/slight edema; healing occurs w/o evidence of scarring
Superfical Partial-Thickness Burn
involves the epidermis & the upper portion of the dermis; the involved area may be extremely painful & exhibit blisters; healing occurs w/minimal to no scarring
Deep Partial-Thickness Burn
involves complete destruction of the epidermis & the majority of the dermis; the involved area may appear to be discolored w/broken blisters & edema; damage to nerve endings may result in only moderate levels of pain; healing occurs w/hypertrophic scars & keloids
Full-Thickness Burn
involves complete destruction of the epidermis & dermis along w/partial damge of the subcutaneous fat layer; the involved area often presents w/eschar formation & minimal pain; pts. require grafts & may be susceptible to infection
Subdermal Burn
involves the complete destruction of the epidermis, dermis & subcutaneous tissue; may involve muscle & bone & as a result often require surgical intervention
Zone of Coagulation
the are of the burn that received the most severe injury along w/irreversible cell damage
Zone of Stasis
the area of less severe injury that possesses reversible damage & surrounds the zone of coagulation
Zone of Hyperemia
the area surrounding the zone of stasis that presents w/inflammation, but will fully recover w/o any intervention or permanent damage
Rule of Nines (Adult)
allows for a gross approximation of the % of the body affected by a burn
Head and Neck
9%
Anterior Trunk
18%
Posterior Trunk
18%
(B) Anterior Arm, Forearm, & Hand
9%
(B) Posterior Arm, Forearm, & Hand
9%
Genital Region
1%
(B) Anterior Leg & Foot
18%
(B) Posterior Leg & Foot
18%
Silver Sulfadiazine Advantages
can be used w/or w/o dressings; painless; can be applied to wound directly; broad-spectrum; effective against yeast
Silver Sulfadiazine Disadvantages
does not penetrate into eschar
Silver Nitrate Advantages
broad-spectrum; non-allergenic; dressing application is painless
Silver Nitrate Disadvantages
poor penetration; discolors, making assessment difficult; can cause severe electrolyte imbalances; removal of dressings is painful
Povidone-iodine Advantages
broad-spectrum; antifungal; easily removed w/water
Povidone-iodine Disadvantages
not effective against Pseudomonas; may impair thyroid function; painful application
Mafenide Acetate Advantages
broad-spectrum; penetrates burn eschar; may be used w/or w/o occlusive dressings
Mafenide Acetate Disadvantages
may cuase metabolic acidosis; may compromise respiratory function; may inhibit epithelialization; painful application
Gentamicin Advantages
broad-spectrum; may be covered or left open to air
Gentamicin Disadvantages
has caused resistant strains; ototoxic; nephrotoxic
Nitrofurazone Advantages
bacteriocidal; broad-spectrum
Nitrofurazone Disadvantages
may lead to overgrowth of fungus & Pseudomonas; painful application
Allograft (homograft)
a temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area
Autograft
a permanent skin graft taken from a donor site on the patient's own body
Heterograft (xenograft)
a termporary skin graft taken from another species
Mesh graft
a skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area
Sheet graft
a skin graft that is transferred directly from the donor site to the recipient site
Split-thickness skin graft
a skin graft that contains only a superficial layer of the dermis in addition to the epidermis
Full-thickness skin graft
a skin graft that contains the dermis & the epidermis
Dermis
the vascular layer of skin below the epidermis that contains hair follicles, sebaceous glands, & sweat glands
Donor site
a site where healthy skin is taken & used as a graft
Epidermis
the superficial avascular layer of skin that contains the hair follicles, sebaceous glands, & sweat glands
Eschar
the necrotic & nonviable tissue resulting from a deep burn; this skin is hard, dry, & doesn't possess qualities of normal skin
Escharotomy
a surgical procedure that removes eschar from a burn site & subsequently enhances circulation
Hypertrophic scarring
an abnormal & disorganized scar formation characterized by a raised, firm scar w/collagen fibers that don't follow any pattern
Normotrophic scarring
a scar w/organized formation of collagen fibers that align in a parallel fashion
Pressure garments
a custom-made garment that applies sustained pressure in order to improve the structure of a scar; they are worn 22-23 hrs/day & may be required for up to 2 yrs.
Recipient site
a site that has been burned & requires a graft
Z-plasty
a surgical procedure to eliminate a scar contracture; an incision in the shape of a "z" allows the contracture to change configuration & lengthen the scar