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  • • Skin is the largest organ of the body, ranging from 0.25 m2 in infants to 1.8 m2 in adults

    • Skin has 2 layers: epidermis and dermis

    • -The outermost cells of the epidermis are dead cornified cells that act as a tough protective barrier

      -The dermis is chiefly composed of fibrous connective tissue and contains the blood vessels and nerves to the skin and epithelial appendages of specialized function

      -The dermis prevents loss of body fluids and loss of excess body heat

    • Nerve endings that mediate pain are found only in the corium

    • -Partial-thickness injuries may be extremely painful

      -Full-thickness burns are usually painless

    Second-degree (or partial-thickness) burns are deeper, involving all of the epidermis and some of the dermis

    • -The systemic severity and quality of subsequent healing are related to the amount of undamaged dermis

    • Complications are rare from superficial partial-thickness burns and usually heal in 10-14 days

    Deep partial-thickness burns heal over 25-35 days with a fragile epithelial covering that arises from residual uninjured epithelium of the deep dermal sweat glands and hair follicles

    • -Severe hypertrophic scarring occurs when such an injury heals

      -Evaporative losses remain high

      -Conversion to full-thickness by bacteria is common

    • Skin grafting, when feasible, improves the physiologic quality and appearance of the skin cover

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Epidemiology

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  • • Over 2 million burn injuries require medical attention each year in United States

    • Over 14,000 deaths per year in United States

    • House fires responsible for 5% of fires but 50% of deaths, most from smoke inhalation

    • 75,000 patients require hospitalization and 25,000 for more than 2 months

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Symptoms and Signs

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  • First-degree burn:

    • -Involves only the epidermis

      -Characterized by erythema and minor microscopic changes

      -Tissue damage is minimal

      -Pain, the chief symptom, usually resolves in 48-72 hours and healing takes place uneventfully

    Superficial partial-thickness burns:

    • -Characterized by blistering while deeper partial-thickness burns have a reddish appearance or a layer of whitish nonviable dermis adherent to the remaining viable tissue

    Full-thickness (third-degree) burns:

    • -Have a characteristic white, waxy appearance

      -May appear to the untrained eye as unburned skin

      -The diagnostic findings are lack of sensation in the burned skin, lack of capillary refill, and a leathery texture that is unlike normal skin

    • All epithelial elements are destroyed, leaving no potential for reepithelialization

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Rule Out

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  • • Must evaluate for associated injuries, such as blunt trauma (falls)

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  • • Burn victim should be assessed and treated like any patient with major trauma

    • If smoke inhalation is possibility, ABG measurements, oxygen saturation, and carboxyhemoglobin levels should be obtained

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Acute Care

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  • • Oxygen administration

    • Endotracheal intubation is indicated if patient is semicomatose, has deep burns to the face and neck, or is otherwise critically injured

    • Intubation should be done early, as edema will make it more difficult later

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