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What is a burn injury?
- Usually results from energy transfer from a heat source to the body that results in both local and systemic responses
- Can result from thermal, electrical, or radioactive agents
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Major goals for burns
- Prevention
- Life-saving measures for severely burned pt
- Prevention of disability/disfigurement through early, individualized treatment
- Rehabilitation through reconstructive surgery and rehabilitative programs
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Classification of burns
- Amount and depth of tissue damage
- Superficial-thickness burns
- Partial thickness burns
- Superficial partial-thickness
- Deep partial-thickness
- Full-thickness
- Deep full-thickness burns
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Superficial-thickness burn
- Least damage-only epidermis is injured
- Prolonged exposure to low intensity heat (sun) or short exposure to high-intensity heat
- Redness with mild edema
- Pain and increased sensitivity to heat
- Desquamation (peeling of dead skin) occurs in 2-3 days
- Heals rapidly in 3-5 days
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Partial thickness burns
- Superficial partial-thickness:
- Damage to upper third of dermis
- Red, moist, and blanchable when pressure is applied
- May blister (large blisters are usually opened to promote healing)
- Nerve endings exposed, cause intense pain
- Burns heal in 10-21 days, without scar, may have pigment changes
- Deep partial-thickness:
- Extend deeper into the skin dermis
- Red and dry with white areas in deeper parts
- Moderate edema
- Nerve endings have been destroyed, pain may be less
- Generally heal in 3-6 wks, scarring results and surgical intervention with skin graft may reduce healing time
- Full-thickness burns:
- Destruction of entire epidermis and dermis, leaving no residual epidermal cells to repopulate
- Hard, dry, leathery eschar (needs to be removed before healing can occur)
- Waxy white, deep red, yellow, brown, or black
- Sensation reduced or absent due to nerve ending destruction
- Healing time depends on establishing a good blood supply, could take weeks or months
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Deep full-thickness burns
- Extend into fascia and tissues
- Damaged muscle, bone, and tendons are left exposed
- Black, depressed, and sensation is completely absent
- Require early excision and grafting (decreases pain and length of recovery)
- Amputation may be necessary
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Patho of burn injury
- Tissue destruction can lead to:
- Fluid/protein losses
- Sepsis
- Multiple system disturbances
- Metabolic
- Endocrine
- Respiratory
- Cardiac
- Hematologic
- Immune
- Extent of local and systemic disruption depends on:
- Age
- General health status
- Extent of injury
- Depth of injury
- Area of body injured
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