Burns are injuries to either skin (caused by heat, electricity, or chemicals), or respiratory tract (caused by inhalation of smoke or hot particles). According to the CDC someone in the United States sustained burn injuries every 30 minutes (CDC, 2013). Pathophysiology
The cell and tissue damage noted in burns is a result of exposure to temperatures above 44⁰C, which cause proteins to denature (Hettiaratchy & Dziewulski, 2004). This breakdown causes tissue necrosis; the necrotic area is known as the zone of coagulation. This zone has irreversible tissue damage. Around the primarily affected tissue, platelets aggregate, vessels constrict, and marginally perfused tissue (known as the zone of stasis) can extend around the injury. In the zone of stasis tissue is hyperemic and inflamed, but is potentially salvageable. The outer most portion of affected skin is considered the zone of hyperaemia; tissue perfusion is increased, and unless infection or sepsis occur the damage can be reversed. (Hettiaratchy & Dziewulski, 2004) Damage to the epidermal barrier allows bacterial invasion and external fluid loss; damaged tissues often become edematous, further enhancing volume loss. Heat loss can be significant because thermoregulation of the damaged dermis is absent, particularly in wounds that are exposed. Cytokine and other inflammatory mediators release at the site of injury has a systemic effect once the burn reaches 30% of total body surface area. Classifications
The signs and symptoms of burns reflect the depth, affected area amount, and severity. Classifying burns into these three categories allows ease of treatment for medical personnel. Depth
Burns are classified by the depth into the skin and underlying tissues they reach. The levels include: superficial, superficial-partial thickness, deep-partial thickness, full thickness, and deep-full thickness (refer to Table 1). The degree of severity increases the deeper into the skin the burn penetrates. (Ignatavicius, 2013) Superficial burns, once considered first degree burns, are injuries of the epidermis. These can occur from sunburns and flash burns. These burns are normally managed at home without medical assistance, and heal without scarring within 3-5 days. These burns are painful, red, and dry. Superficial-partial thickness burns, second degree burns, are injuries to the upper third of the dermis layer that heal within 10-21 days without scarring. These burns cause intense pain and are red, moist, and blanching. Superficial-partial thickness burns are marked by the formation of blisters. Deep-partial thickness burns extend further into the dermis than superficial-partial thickness burns. Deep-partial burns produce blisters, are red and dry. They heal with 3-6 weeks with scarring. (Ignatavicius, 2013) Full thickness, third degree, burns damage the entire dermis layer. This provides no opportunity for regrowth of dermal layers, and as such these injuries require skin grafting fir optimal healing. Full thickness burns can either be waxy white, red, yellow, brown, or black in color. Unlike the previous burn depths, full thickness burns are painless, as they have burned away all nerve endings. Deep-full thickness burns extend into the underlying fascia and tissues, including muscle, bone, and connective tissue. These wounds are black and have a depressed elevation, and are without sensation. (Ignatavicius, 2013) Amount of Affected Area
The amount of total body surface area (TBSA) affected by burns reflects both severity and the manner in which the injury is managed. There are multiple ways to estimate TBSA, one of them is called the ‘rule of nines.’ The rule of nines is a standardized method of estimation, it involves dividing body areas into sections representing 9% of TBSA. The sections are as follows: the head, chest, abdomen, right arm, left arm, anterior right leg, posterior right leg, anterior left leg, and posterior left leg...
References: American Burn Association. (2006). Burn center referral criteria. Retrieved from http://www.ameriburn.org/BurnCenterReferralCriteria.pdf
Garmel, edited by S.V. Mahadevan, Gus M. (2012). An introduction to clinical emergency medicine (2nd ed.). Cambridge: Cambridge University Press. pp. 216–219. ISBN 978-0-521-74776-9.
Hettiaratchy, S., & Dziewulski, P. (2004). ABC of burns: pathophysiology and types of burns. BMJ (Clinical Research Ed.), 328(7453), 1427-1429.
Ignatavicius, D. (2013). Medical-surgical nursing: Critical thinking for collaborative care (Revised/Expanded ed.). St. Louis, Mo.: Elsevier Saunders.
Mitra, B., Fitzgerald, M., Cameron, P., & Cleland, H. (2006). FLUID RESUSCITATION IN MAJOR BURNS. ANZ Journal Of Surgery, 76(1/2), 35-38. doi:10.1111/j.1445-2197.2006.03641.x
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