Page 248 - Critical Care Notes

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MULTISYS

Type of Burn Extent of Burn Injury Description of Burn Injury
Third-degree or full- • Epidermis and • Pale white, red, mottled
thickness burn dermis destroyed • Broken skin with fat
• May involve exposed
connective tissue, • Edema or dry
muscle, and bone • No to slow blanching
• Underlying tissue with pressure
may be destroyed • Painless
• Hair follicles and sweat
glands destroyed
Fourth-degree or • Skin, fascia, muscle, • Hard, dry, black, charred,
full-thickness burn and bone irreversibly cracked leather-like eschar
destroyed • No pain or sensation
• No blanching
• Charred bones
A cold burn may occur when the skin is in contact with cold bodies (e.g.,
snow or cold air, as in cases of frostbite) or is exposed to dry ice or canned air.
The treatment is the same for this type of burn.
Pathophysiology
Burns of <25% total body surface area (TBSA) → local response to injury.
Burns of >25% TBSA → local and systemic response to injury. Hypovolemia can
develop if the burns involve >15%–20% of TBSA.
There are three zones of thermal injury:
■ Zone of coagulation (inner zone), where tissue necrosis is irreversible
■ Zone of stasis (middle zone) surrounding the zone of coagulation
■ There is ↓ blood flow to the area and vascular damage.
■ Tissue damage may potentially be reversed with adequate care and
treatment.
■ Zone of hyperemia (outer zone) surrounding the zone of stasis
■ There is minimal injury to the area and evidence of early recovery.
Burn Stages
The two burn stages are the resuscitative phase and the acute phase.

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