BURNS 6

BURNS CLINICAL

A partial thickness burn involves the outer layer of the skin and

may extend into the dermis.

This wound, commonly termed a second degree burn, is

characterized by blistering of the skin and is red, moist and

painful; sensation is intact.

The clinical importance of differentiating between these depths

of injury lies on the understanding that a superficial wound

heals with minimal cosmetic or functional defect in two weeks.

The healing occurs from the peripheral migration of cells, and out pouring

of cells from sweat glands and hair follicals.

The deep partial thickness wound, although it will heal given 3

week or more and there will be a defect in function and cosmetic

defect. In these cases skin grafting will improve results.

With burn of full thickness the wounds are leathery, white or

charred dry with loss of sensation.

Because all the epidermis is destroyed, these wounds can only

heal by migration of epidermis from the margins of the wound.

During the process of healing, contraction occurs; this decreases

the area that must be epithelialized but leads to a poor cosmetic

result and the healed wound is less resistant to trauma.

If the wound is adjacent to or involves a joint, the function of

the joint will be impaired.

Large full thickness wounds should be either excised and closed

primarily or grafted with the patient's skin to prevent

deformity.

Wounds however are often of mixed depth in such cases evaluation

of discrete areas may not define the depth of the overall wound.

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BURNS 5

RADIATION BURNS

Injury caused by exposure to ionizing radiation may be limited to

the  skin  but often is deep.

Because these wounds  do  not  heal well,  care  must  be taken to avoid  additional  damage  of  the tissue.

The vasculitis that is associated with these injuries  is usually a lifelong problem.

2.1 PATHOLOGY

The   area   subjected   to   heat   shows   cellular   swelling,

disintegrative  necrosis or coagulative necrosis  depending  upon

the degree of heat it has been subjected to.

- The  application  of  heat  to  the  body  tissues  results  in

  denaturing of proteins.

- It also results in inactivation of enzyme systems.

- It has been shown that oxygen consumption of skin is decreased. 

- There is also decrease in glucose utilization.

- These  process  are  depressed  in  direct  proportion  to  the

  increase in heat.

The  maximum  injury would be inflicted at the point  of  contact

(Fig.Above) and varying grades of injury would be inflicted towards

the periphery of this point of contact.

This  gradation effect would also be observable from the  surface

of  the skin to its depth.

The depth of burns is also related  to the temperature of the heated object and the period for which  it remains  in  contact  with the skin(deeper burns  will  occur  in unconcious  patients

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BURNS 4

INHALATION INJURY

Diagnosis of inhalation injury is difficult to make, a

presumptive diagnosis is made based on a history that is

consistent and signs and symptoms that are associated with injury

to the airway.

Any patient who sustains injury in a closed space and has burns

above the clavicle, singeing of nasal hair, hoarseness, or

carbonaceous sputum should be assumed to have sustained an

inhalation injury.

Elevated carboxy-hemoglobin levels will confirm exposure to carbon

monoxide, but are not diagnostic for injury to the lung.

Because the primary concern early after inhalation injury is

obstruction of the airway, the upper airway should be evaluated

immediately, usually in the emergency department.

Flexible bronchos-copy provides the opportunity to confirm the

diagnosis and initiate therapy.

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BURNS 3

 
SPECIAL BURNS

Chemical  burns cause denaturing of protein, and  disruption  of

cellular integrity.

The  degree of injury is dependent on the time of  exposure,  the

strength of the agent, and the solubility of the agent is tissue.

Alkali tends to penetrate deeper into tissues than does an acid.

One  exception  to this is hydrofluoric  acid,  which  penetrates

lipid  membranes  very readily. 

The  major concern is evaluting patients who  sustain  electrical

injuries is that the surface injury, which may appear similar  to

other  burn  injuries, is often not indicative of the  extent  of

injury.

In the local area of injury subcutaneous tissue, muscle and  bone

may be injured.

Electrical  current flows along the path of least resistance  and

therefore   will   pass   through   nerve   and   blood   vessels

preferentially and cause injury to these tissues.

 If the current passes through the torso of the patient, organ injury may result.

Injury of the heart is primarily associated with arrhythmia.

Injury of  the other viscera  including  the   pancreas   and

gastrointestinal tract have been reported.

Late sequelae have been reported to occur months or  even  years

after electrical injury.

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