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INTRODUCTION

Test Taking Tips

  • Count on using the Parkland formula to calculate the volume of fluids that you need to give to your burn patient. Don’t forget that the start time of volume resuscitation is at the time of the burn, not at the time of arrival to the hospital.

  • Review topical antimicrobials such as silver nitrate or Sulfamylon and their side effects and what they have the best coverage for.

CLASSIFICATION

What are the 5 mechanisms for burn injury?

  1. Heat: damage from thermal injury; related to contact temperature, duration of contact with heat source, and skin thickness

  2. Electrical: damage from conduction of electrical current through body tissues; severity of injury depends on pathway of the current, resistance of current through tissues, and strength and duration of current

  3. Friction: damage due to mechanical disruption of tissues, as well as the generated heat

  4. Chemical: damage due to contact with caustic chemicals; severity of injury depends on duration of contact, as well as the type of agent

  5. Radiation: damage caused by ionizing radiation interaction with DNA; severity depends on dose, duration of exposure, and type of particle

What is a superficial burn?

  • Injury localized to the epidermis

What is a superficial partial-thickness burn?

  • Injury to the epidermis and superficial dermis

What is a deep partial-thickness burn?

  • Injury through the epidermis and into the deep dermis

What is a full-thickness burn?

  • Full-thickness injury through the epidermis and dermis into the subcutaneous fat

What is a deeper injury (fourth-degree) burn?

  • Injury through the skin and subcutaneous fat into underlying muscle or bone

Identify the depth of the burn:

  • A painful, erythematous burn with an intact epidermal barrier that blanches to the touch

  • Superficial

  • Painful burn with blebs and blisters; hair follicles intact; blanches to the touch

  • Superficial partial thickness

  • Sensation decreased; loss of hair follicles

  • Deep partial thickness

  • Leathery feeling, no sensation

  • Full thickness

FIGURE 23-1

Illustration of the zones of injury after a burn. Factors likely to affect the zone of stasis determine the extension of injury from the original zone of coagulation. (Reproduced with permission from Moore EE, Feliciano DV, Mattox KL. Trauma, 8th ed. New York, NY: McGraw Hill; 2017.)

PATHOPHYSIOLOGY

What are the 3 zones of injury from a burn?

  • Zone of coagulation, zone of stasis, zone of hyperemia

Define the zone of coagulation:

  • Irreversibly damaged necrotic area of a burn where cells have been disrupted

Define the zone of stasis:

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