Burns.dq.notes - Daniela Quinn Burns...

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Daniela Quinn Burns. Etiology/Pathophysiology Normal skin physiology as it relates to burns. Layers of skin: Epidermis, non-vascular protective outer layer; dermis, below the epidermis, contains connective tissue with blood vessels, hair follicles, nerve endings, sweat glands, and sebaceous glands; subcutaneous tissue, contains major vascular networks, fat, nerves, and lymphatics, it acts as heat insulator for underlying structures: muscles, tendons, bones and internal organs; muscle; bone Common places/causes of burn injury a. Occupational hazards: tar, chemicals, hot metals, steam pipes, fuels, fertilizers, electricity from power lines. b. Home and recreational hazards: kitchen and bathroom, general household, including: fireplaces, heaters, radiators, outdoor grills c. 73% of all fire related death in home. d. Age, smoking, alcohol/drugs, physical/mental impairment, occupation Risk reduction strategies for different types of burns: flame contact: never leave candles unattended, never use gas or other flammable liquids to start a fire. Scald: lower the water tem <120 F. Inhalation: install smoke and carbon monoxide detectors. Chemical: store them in safe place, use protective wear. Electrical: Avoid or repair frayed wiring. Types of burn a. Thermal: Caused by flame, flash, scald, or contact with hot objects. Most common cause of burns. Stop, drop and roll; stop the burning process; cool water, NOT ICE because it vasoconstricts; cover to prevent hypothermia. b. Chemical: Result from tissue injury and destruction from acids, alkalis, and organic compounds. Alkali burns are hard to manage because they cause protein hydrolysis and liquefaction- damage continues after alkali is neutralized. Severity dependent on type, concentration, mechanism, duration of contact, and amount of body surface exposed. Alkalis: drain cleaners, fertilizers, & heavy industrial cleaners. Organic compounds: Chemical disinfectant, petroleum products. c. Smoke and inhalation Injury : Result from inhalation of hot air or noxious chemicals. Cause damage to respiratory tract/ major predictor of mortality in burn victims. Treat quickly. Frequently trapped in an enclosed space.3 Types: Carbon monoxide poisoning/ metabolic asphyxiation : Carbon monoxide (CO) poisoning- CO is produced by incomplete combustion of burning materials; CO displaces oxygen on the hemoglobin molecule this interferes with O2 sat monitoring- need ABG’s (hypoxia, carboxy- hemoglobinemia> death); Treat with 100% humidified oxygen; CO poisoning may occur in the absence of burn injury to the skin; skin color is described as “cherry red”. Inhalation injury above glottis/ upper airway injury : Inhalation injury above glottis- thermally produced (hot air, steam, or smoke) (Example: the hot air that is produced from a fire in an enclosed room); mucosal burns of oropharynx & larynx; airway obstruction can occur quickly- true emergency! Symptoms: presence of facial burns, singed nasal hair, and hoarseness, painful swallowing, darkened oral, and nasal membranes Inhalation below glottis/ lower airway injury . Inhalation injury below glottis- Injury is related to the length of exposure to smoke or toxic fumes;
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