Complex Care Session 9: Burns

Session 9: Burn

 

Prevention of burn injuries is the top priority

Most common is to get burned by a flame, and next highest is scalding

 

  • Burns are often measured by percentage of total body size
  • Most common complications associated with burns are: in adults, Cellulitis uti and pneumonia, and in older patients tend to get wound infection and pneumonia.
  • Only give antibiotics if there is a high risk of infection, or signs of infection.
  • Depths of burns
    • Superficial, partial thickness, 1st degree: still have hair that is anchored,
      • Caused by, sun, and minor heats
      • Treat with: aloe vera, NSAIDS, no alcohol, benadryl.
    • Deep partial thickness, second degree: loose sweat glands, and hair follicles, has blisters
      • Takes 10-21 days to heal
      • May need skin grafts
      • Need to wait 24 hours to see how deep the burn really is
      • Deroof blisters that are greater than 2 cm
    • Full thickness 3rd and 4th degree: down to the fat layer.
  • Inhalation injury – priority is maintaining the airway.
  • Steven johnson’s – less than 10% of of total body
    • Not very bloody, sloughing off of skin
  • Tens – Affects greater than 30% of total body surface area.
    • Very bloody, Sloughing off of skin.
  • Amniotic graft tissue can be used for grafting over the eyes. This tissue is taken from donated placenta.
  • Electrical injuries – internal burning,visible burns on an entry point and exit point.
    • Deep muscle and nerve injury
    • Difficult to assess the extent of the injury
    • Patient can have rhabdomyolysis and compartment syndrome (five P’s are the s/s for compartment syndrome.)

 

  • Chemical burns
    • Irrigate the burn to get the chemical out
  • Tar burns
    • Cool the tar then we use oil to get the hard tar off.
  • Frostbite
    • Can regain vasculature to fingers and toes with tPA if treated under 24 hours from injury.
  • Phases of burns
    • Emergent first 48 hours
    • Acute – weeks to months
    • Rehabilitation phase – over two years
  • Fluid resuscitation in burns
    • 2ml of LR*TBSA*KG
    • Need 30-50ml/hr of urine output
  • Greater than 20% burn we will gown and glove to prevent infection of the patient.
  • Compartment syndrome – swelling of a compartment and the pressure will need a escharotomy or fasciotomy to relieve pressure.
    • 5 p’s for compartment syndrome: Pulseless, paresthesias, pallor, PAIN, paralysis.
  • Graft types
    • Autograft – patient own skin
    • Allograft – cadaver skin
    • Xenograft – pigskin
    • CEA – cultured epithelial cells
  • Sheet graft – one continuous piece of skin
  • Mesh graft – take the sheet and poke holes in the skin then stretch it out.
  • Meds used:
    • Increased need for pain meds due to the hypermetabolic state.
    • Antianxiety: benzodiazepines,
    • Beta blocker
    • Anabolic steroid – oxandrolone, growth hormone
      • Used for months to promote tissue growth.
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