外科急诊创伤(英文)-烧伤148页PPT

Zone of Stasis
Moderate degree of insult Decreased tissue perfusion Vascular damage/ leakage May progress to necrosis 24-48 hours
Zone of Hyperemia
Vasodilation Inflammation Viable tissue
Burn Depth
Full-Thickness Burn: 3rd Degree Burn
Signs & Symptoms
Dry, leathery skin (white, dark brown, or charred)
Loss of sensation (little pain)
All dermal layers/tissue may be involved
Fourth Degree
Include involvement of muscle and bone Charred in appearance Painless
Pathophysiology
Local changes- > 111F produce injury
MASSIVE EDEMA “Leaky Capillaries
Systemic Changes
Massive release of inflammatory mediators Produce vasoconstriction/ dilation Increased capillary permeability Edema
superficial partial thickness red, painful, blistered
deep partial thickness pale, mottled
Very painful Infection may evolve into 3rd degree
Burn Depth
Partial-Thickness Burn: 2nd Degree Burn
Burn Depth
Superficial Burn: 1st Degree Burn
Signs & Symptoms
Reddened skin Pain at burn site Involves only
epidermis
Second Degree
Involve epidermis and dermis Partial thickness
BURNS
Leaugeay Webre BS, CCEMT-P, NREMT-P
Scenario
Paramedic is called to the scene of a structure fire. FD has removed a victim from the house. BSI Scene safe 1 patient A/C standby FD/ PD on scene Now what?
General Impression
33 yo male pt writhing in pain. Screams and begs for pain medication however poor historian. S- blistering to back and chest, R upper ventral area leg exposed muscle; eyebrows singed A- PCN, codeine M- none P- none L- earlier today E- woke up on fire
Dermis
Gel like matrix Consists of collagen and elastin Contains blood vessels, lymphatics, sweat glands, hair follicles, sensory fibers
Subcutaneous
Connective tissue Adipose tissue
cushioning insulation
Causes
Thermal Electrical Chemical Radiation
Thermal
Majority flame scald contact with hot objects
Child with burns from a scald
Determining Severity
Anatomy & Physiology of the Skin
Layers
cutaneos Underlying
Structures
Fascia Nerves Tendons Ligaments Muscles Organs
Cardiovascular
Loss of plasma volume Increased peripheral vascular resistance Decreased cardiac output
decreased blood volume decreased venous return increased blood viscosity decreased contractility
Zone of Stasis
Area surrounding zone of coagulation characterized by decreased blood flow.
Zone of Hyperemia
Peripheral area around burn that has an increased blood flow.
Body’s Response to Burns
Emergent Phase (Stage 1)
Pain response Catecholamine release Tachycardia, Tachypnea, Mild Hypertension, Mild
Anxiety
Fluid Shift Phase (Stage 2)
ABCTransport decision? % BSA burned? Tx?
Objectives
Describe the structure and function of skin Discuss the types of burns. Explain the degrees of thermal burns. Discuss causes and treatments of inhalation injuries. Identify methods of approximating burn injuries. Describe and apply treatment modalities for the burn patient.
Area of Damage
Zone of coagulation Zone of stasis Zone of hyperemia
Jackson’s Theory of Thermal Wounds
Zone of Coagulation
Area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
Immune System
Depressed immune function > 20% directly proportional to burn size
sepsis
Body’s Response to Burns
Hypermetabolic Phase (Stage 3)
Last for days to weeks Large increase in the body’s need for
Jackson’s Theory of Thermal Wounds
Zone of Hyperemia Zone of Stasis
Zone of Coagulation
Zone of Coagulation
Central area of burn Necrotic from time of exposure
Length 18-24 hours Begins after Emergent Phase
Reaches peak in 6-8 hours
Damaged cells initiate inflammatory response
Increased blood flow to cells Shift of fluid from intravascular to extravascular space
nutrients as it repairs itself
Resolution Phase (Stage 4)
Function
Protection Regulation Prevention Sensory
Epidermis
Outer, thinner layer Consists of dead keratinized cells Protects
dehydration trauma light infection
Burns, thermal. Escharotomy to release chest wall and allow for ventilation of the patient.
Skin
Largest organ of the body