Functions Of The Skin

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Functions Of The Skin

• Protects vital organs
• Provides a barrier to the intrusion of dirt,
  chemicals and microorganisms
• Permits for safe free movement within our
  environment
• Maintains fluid electrolyte balance

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Carbon Monoxide Poisoning

• A common colorless, odorless byproduct of
  combustion of organic material. Carbon monoxide
  binds with the HEME molecule of circulating
  erythrocytes _at_ a rate 200 times that of o2 -the
  CARBOXYHEMOGLOBIN formed blocks o2 transport
  results in hypoxia, loc, and cardiac arrest.
  Rx100 o2

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Carbon Monoxide Poisoning

• A common colorless, odorless byproduct of
  combustion of organic material. Carbon monoxide
  binds with the HEME molecule of circulating
  erythrocytes _at_ a rate 200 times that of o2 -the
  CARBOXYHEMOGLOBIN formed blocks o2 transport
  results in hypoxia, loc, and cardiac arrest.
  Rx100 o2

4
Carbon Monoxide Poisoning

• A common colorless, odorless byproduct of
  combustion of organic material. Carbon monoxide
  binds with the HEME molecule of circulating
  erythrocytes _at_ a rate 200 times that of o2 -the
  CARBOXYHEMOGLOBIN formed blocks o2 transport
  results in hypoxia, loc, and cardiac arrest.
  Rx100 o2

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Risks For Various Patient Populations

• Children lt 5 years old
• Adults gt65 years old suffer burn injury _at_ twice
  the national average
• Children
• Adolescents
• Elderly and disabled

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Mechanisms Of Injury

• Thermal burns
• Convection
• 2 factors will determine burn depth
• 1. Temperature _at_ which tissue is heated
• 2. Duration of exposure

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Chemical Burns

• Caused by tissue reactions to noxious substances
• Early copious LAVAGE with water or saline
• ALKAI cause more damage than acids

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Electrical Burns

• Pathway of least resistance-along blood vessels
  nerves
• Duration of contact
• Thermal injury appearance is very deceptive
  compared to damage done to muscle, bone, and fat
• Cardiac dysfunction seen in 2/3

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Inhalation Injury Classic Clinical Features

• HX of sustaining burn injury in an enclosed space
• Singed nasal hair
• Facial burns
• Brassy cough
• Hoarseness stridor

• Sob
• Anxiety
• Wheezing
• Disorientation
• Soot in the sputum

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Carbon Monoxide Poisoning

• A common colorless, odorless byproduct of
  combustion of organic material. Carbon monoxide
  binds with the HEME molecule of circulating
  erythrocytes _at_ a rate 200 times that of o2 -the
  CARBOXYHEMOGLOBIN formed blocks o2 transport
  results in hypoxia, loc, and cardiac arrest.
  Rx100 o2

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Emergency Room Care

• Stop the burning process
• Airway-NASOPHARYNX OROPHARYNX
• Breathing-look, listen feel
• Circulation-ESCHAROTOMY if indicated

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Pre Hospital Care

• Rescuer safety
• Stop the burning process
• Primary survey
• Ample
• Allergies
• Medications
• Preexisting illness
• Last meal
• Events leading up to the injury

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Emergency Room Care

• Remove jewelry, rings, watches belts
• Cover burn wounds with clean dry sheets
• Photos may be taken for legal insurance
  purposes
• Electrical injury-cardiac monitoring

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Determining Severity Of Burn Injury

• 1.) Extent of BSA involved
• 2.)Depth of burn
• 3.)Location of burn
• Face
• Hands
• Feet
• Genitalia
• Major joints

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Burn Depth

• Third degree-full thickness
• Fourth degree

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Goals Of Fluid Resuscitation

• 1.) UO 30-50 MLS/hr( kids 1ml/kg/hr)
• 2.) Normal SENSORIUM
• 3.) Hrlt110/minute
• 4.) Normal capillary refill(lt3 seconds)
• Majority of formulas use
• Wgt in kilograms x TBSA burned

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Formulas For Fluid Replacement

• Parkland formula
• LR 4ml x kg x TBSA
• Modified brook formula
• LR 2ml x kg x TBSA
• For example 2ml x 70kg x 50 TBSA7,000mls/ 24
  hours
• First 8 hours administer 3,500 ml (437 ml/hr
  from 4am to 12 noon)
• Next 8 hours administer 1,750 ml (219./Hr from
  12 noon-8pm)
• Next 8 hours administer 1,720 ml (219/hr from
  8pm-4 am)

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Acute Phase

• Mechanical- wet to dry dressing.
• Chemical.
• Surgical.
• Tangential.
• Vs.
• SCALPAL excision.

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Dressing The Wound

• SULFAMYLON (MAFENIDE acetate cream)
• SILVADENE (silver SULFADIAZINE cream)
• Open method
• Closed method

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Temporary Wound Coverings

• Biologic dressings
• XENOGRAFT or HETEROGRAFT (pig)
• ALLOGRAFT or HOMOGRAFT (same species)

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Purposes For Biologic Dressings

• 1.) IMMEDIATE COVERAGE
• 2.) PROTECTION OF GRANULATING TISSUE
• 3.) TEST RECEPTIVITY BEFORE GRAFTING

• 4.) MINIMIZE PROTEIN FLUID LOSSES
• 5.) DECREASE THE PAIN FROM EXPOSED NERVE ENDINGS
• 6.) MAINTAIN MOIST WOUND ENVIRONMENT

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Biosynthetic Dressings

• BIOBRANE
• Thin film polyurethane- op- site, TEGADERM-
  occlusive waterproof yet permeable to vapor
  air

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Burn Wound Closure Grafting

• Full thickness
• Split thickness--
• Sheet vs. Meshed

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Graft Failure

• HEMATOMA
• Recipient site COLONOIZED with bacteria
• Persistent motion of the graft

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Tenets Of Pain Management

• 1.)If the patient says he has pain, he has pain.
• 2.) Analgesics are most effective when given on a
  routine as opposed to PRN basis.
• 3.) Bowel management begins with narcotic pain
  management.
• 4.)Doses of the medication are modified as the
  clinical situation dictates.

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Pediatric Considerations

• Play therapy
• Picture books
• Puppets
• Tapes
• Distraction (TV, video, games)
• Relaxation
• Imagery
• Humor

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Twelve Criteria To Confirm Non-accidental Burn
Injury

• 1.)Multiple HEMATOMAS in various stages of
  healing.
• 2.)Concurrent evidence of neglect.
• 3.)HX of prior accidental trauma.
• 4.)Unexplained delay seeking treatment.

• 5.)BURNS APPEARING OLDER
• 6.)ACCOUNT NOT COMPATIBLE WITH THE CHILDS AGE
• 7.)NO WITNESSES TO THE ACCIDENT
• 8.)RELATIVES OTHER THAN PARENTS BRINGING CHILD IN

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Criteria Continued

• 11.)Scalds on hands feet symmetric-suggest
  immersion
• 12.)Isolated burns of the buttocks that in
  children can hardly be produced any other way

• 9.)The burn blamed on the action of another child
• 10.)The injured child excessively withdrawn,
  submissive or not crying during painful
  PRODECURES