Burns

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

Rule Out

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

• • 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

Acute Care

• • 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 ...