BURNS
Burns
Burns
Burns are injuries to either skin (caused by heat, electricity, or chemicals), or respiratory tract (caused by inhalation of smoke or hot particles). According to the CDC someone in the United States sustained burn injuries every 30 minutes (CDC, 2013).
Pathophysiology
The cell and tissue damage noted in burns is a result of exposure to temperatures above 44⁰C, which cause proteins to denature (Hettiaratchy & Dziewulski, 2004). This breakdown causes tissue necrosis; the necrotic area is known as the zone of coagulation. This zone has irreversible tissue damage. Around the primarily affected tissue, platelets aggregate, vessels constrict, and marginally perfused tissue (known as the zone of stasis) can extend around the injury. In the zone of stasis tissue is hyperemic and inflamed, but is potentially salvageable. The outer most portion of affected skin is considered the zone of hyperaemia; tissue perfusion is increased, and unless infection or sepsis occur the damage can be reversed. (Hettiaratchy & Dziewulski, 2004)
Damage to the epidermal barrier allows bacterial invasion and external fluid loss; damaged tissues often become edematous, further enhancing volume loss. Heat loss can be significant because thermoregulation of the damaged dermis is absent, particularly in wounds that are exposed. Cytokine and other inflammatory mediators release at the site of injury has a systemic effect once the burn reaches 30% of total body surface area.
Classifications
The signs and symptoms of burns reflect the depth, affected area amount, and severity. Classifying burns into these three categories allows ease of treatment for medical personnel.
Depth
Burns are classified by the depth into the skin and underlying tissues they reach. The levels include: superficial, superficial-partial thickness, deep-partial thickness, full thickness, and deep-full thickness (refer to Table 1). The degree of severity increases the deeper into the skin the burn
Burns
Burns are injuries to either skin (caused by heat, electricity, or chemicals), or respiratory tract (caused by inhalation of smoke or hot particles). According to the CDC someone in the United States sustained burn injuries every 30 minutes (CDC, 2013).
Pathophysiology
The cell and tissue damage noted in burns is a result of exposure to temperatures above 44⁰C, which cause proteins to denature (Hettiaratchy & Dziewulski, 2004). This breakdown causes tissue necrosis; the necrotic area is known as the zone of coagulation. This zone has irreversible tissue damage. Around the primarily affected tissue, platelets aggregate, vessels constrict, and marginally perfused tissue (known as the zone of stasis) can extend around the injury. In the zone of stasis tissue is hyperemic and inflamed, but is potentially salvageable. The outer most portion of affected skin is considered the zone of hyperaemia; tissue perfusion is increased, and unless infection or sepsis occur the damage can be reversed. (Hettiaratchy & Dziewulski, 2004)
Damage to the epidermal barrier allows bacterial invasion and external fluid loss; damaged tissues often become edematous, further enhancing volume loss. Heat loss can be significant because thermoregulation of the damaged dermis is absent, particularly in wounds that are exposed. Cytokine and other inflammatory mediators release at the site of injury has a systemic effect once the burn reaches 30% of total body surface area.
Classifications
The signs and symptoms of burns reflect the depth, affected area amount, and severity. Classifying burns into these three categories allows ease of treatment for medical personnel.
Depth
Burns are classified by the depth into the skin and underlying tissues they reach. The levels include: superficial, superficial-partial thickness, deep-partial thickness, full thickness, and deep-full thickness (refer to Table 1). The degree of severity increases the deeper into the skin the burn
References: American Burn Association. (2006). Burn center referral criteria. Retrieved from http://www.ameriburn.org/BurnCenterReferralCriteria.pdf CDC Garmel, edited by S.V. Mahadevan, Gus M. (2012). An introduction to clinical emergency medicine (2nd ed.). Cambridge: Cambridge University Press. pp. 216–219. ISBN 978-0-521-74776-9. Hettiaratchy, S., & Dziewulski, P. (2004). ABC of burns: pathophysiology and types of burns. BMJ (Clinical Research Ed.), 328(7453), 1427-1429. Ignatavicius, D. (2013). Medical-surgical nursing: Critical thinking for collaborative care (Revised/Expanded ed.). St. Louis, Mo.: Elsevier Saunders. Mitra, B., Fitzgerald, M., Cameron, P., & Cleland, H. (2006). FLUID RESUSCITATION IN MAJOR BURNS. ANZ Journal Of Surgery, 76(1/2), 35-38. doi:10.1111/j.1445-2197.2006.03641.x U.S