HDP401 Burn Lecture

Toronto Metropolitan University **We aren't endorsed by this school
NUR 301
Health Science
Sep 22, 2023
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BURNS - high temperatures - dry heat (fire) - wet heat (boiling water) - electromagnetic radiation - prolonged radiation from the sun (sunburn) - x-ray -UV Electrical Burns Chemical Burns - Chemicals that react and generate a lot of heat when they contact skin and damage tissue All burns have generalised effects Dept and extent are important factors to consider - high temperatures will cause coagulation of proteins and direct death of cells as a result of that - can lead to dehydration (d/t high temperatures, you lose water from the tissues which will kill the tissues) - involves damaging the outer layer, causing a loss of the protective layer/covering of the body which increases the risk of infections and further fluid loss - burns cause a lot of pain d/t the pain receptors being in the skin - severe pain - will often lead to an SNS response (stress ulcers, GI ulcers, further dehydration from the stress response) Depth of Burn First Degree: - Superficial burn - Only involves the epidermis - Eg. sunburn - Surface cells can die and cause you to dehydrate - Risk of cancer and melanomas - Can completely recovery - Can be painful Second Degree:
- a little deeper than first degree - deep superficial (epidermis and upper dermis) - self resolves without scars - dehydration - damage hair follicles - grow back normal skin and grow back what was lost - skin may have wet blisters - deep burn into the deeper parts of the dermis - all of the epidermis and most of the dermis - more significant - lots of pain - more likely to develop scar formation d/t more damage (i.e glands, hair follicles, small muscles) - may require skin grafts - takes longer to heal - greater chance of infection Third Degree: - involve the epidermis and dermis and the subcutaneous layer (where a lot of the lymphatics and blood supply are) - nervous supply - more significant burns - most likely always lead to some level of scarring - most likely always need a skin graft - special coverings can also prevent dehydration and act as a barrier to pathogens - involves intensive treatment - take a lot longer to heal - require a lot of fluid intake, proteins and other nutritional balances to grow back the tissue Fouth Degree: - much rare - deeper than subcutaneous layer and go to bones, muscles - do more damage - very severe explore to high temps or electrical burns (i.e high voltage) - can cause massive contracture of muscles and breaking of joints (d/t the contractures) - lots of tissue damage and coagulation of proteins Extent of the Burn (area) - greater the surface that is damaged, the greater the risk associated with it - assess using the rule of nines
- description of the portion of the body surface that has been burned or damage - head (4.5 front, 4.5 back = 9) - arm (4.5 each arm = 9) - torso (=18) - each leg (9 = 18) - and so forth Depth and Extent are looked at together - The greater the depth, the greater the extent, the greater the likelihood of severe outcomes - Some severe burns can kill you Problems? - almost all burns have intense pain - shock - fluid shifts - wide-spread vasoconstriction - local damage may cause local vasodilation - necrosis and it may be surrounded by tissue that may or may not die and around that there may be redness (erythema) (these are the local blood vessels being dilated) - during recovery, it is important to remember the massive fluid loss, BP drops significantly - require fluids through IV to raise back BP - immune compromised - d/t being in a state of shock - corticoid levels rising and d/t breaking a lot of the barriers to pathogens (increased risk of infections) Treatment? - takes intensive wound care, wound must always be kept cleaned and the coverings must be replenished and complete - fluid and electrolytes - good nutrition - these factors will help generate new tissue as fast as possible - (at the very least help close the breaks in the barrier) - when wounds heal, may be some level of scarring - can cause some level of contracting too much - new growth of tissue over an immobilised area can cause growth of small muscle? -important to have appropriate range of motion to optimise wound healing
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