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