外科急诊创伤(英文)-烧伤.ppt

1、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 howe

2、ver 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,A- B- C- Transport decision? % BSA burned? Tx?,Objectives,Describe the structure and function of skin Discuss the types of

3、 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.,Burns, thermal. Escharotomy to release chest wall and allow for ventilation of the patien

4、t.,Skin,Largest organ of the body,Anatomy,Epidermis Dermis Subcutaneous tissue,Layers Epidermis Dermis Subcutaneos Underlying Structures Fascia Nerves Tendons Ligaments Muscles Organs,Anatomy & Physiology of the Skin,Function,Protection Regulation Prevention Sensory,Epidermis,Outer, thinner layer Co

5、nsists of dead keratinized cells Protects dehydration trauma light infection,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 Ele

6、ctrical Chemical Radiation,Thermal,Majority flame scald contact with hot objects,Child with burns from a scald,Determining Severity,1st degree 2nd degree 3rd degree (4th degree),Depth of Burn,Superficial Burn Partial Thickness Burn Full Thickness Burn,First Degree,Superficial involve only epidermis

7、Local pain and redness No blistering present Heal spontaneously 2-5 days without scarring Not included when calculating % TBSA,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 thick

8、ness 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 Signs & Symptoms Intense pain White to red skin Blisters Involves epidermis & dermis,Third Degree,Invol

9、ve epidermis, dermis, subcutaneous tissue White, waxy, red, brown, leathery Dry and painless (muscle and bone),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,

10、Fourth Degree,Include involvement of muscle and bone Charred in appearance Painless,Pathophysiology,Local changes- 111F produce injury,Area of Damage,Zone of coagulation Zone of stasis Zone of hyperemia,Jacksons Theory of Thermal Wounds Zone of Coagulation Area in a burn nearest the heat source that

11、 suffers the most damage as evidenced by clotted blood and thrombosed blood vessels 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.,Jacksons Theory of Thermal Wounds,Zone of Hyp

12、eremia,Zone of Stasis,Zone of Coagulation,Zone of Coagulation,Central area of burn Necrotic from time of exposure,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 tissu

13、e,Bodys Response to Burns,Emergent Phase (Stage 1) Pain response Catecholamine release Tachycardia, Tachypnea, Mild Hypertension, Mild Anxiety Fluid Shift Phase (Stage 2) Length 18-24 hours Begins after Emergent Phase Reaches peak in 6-8 hours Damaged cells initiate inflammatory response Increased b

14、lood flow to cells Shift of fluid from intravascular to extravascular space MASSIVE EDEMA “Leaky Capillaries,Systemic Changes,Massive release of inflammatory mediators Produce vasoconstriction/ dilation Increased capillary permeability Edema,Fluid Shifts,Initial decrease blood flow to burned area Fo

15、llowed by increased arterial vasodilation Release of vasoactive substance resulting in increased capillary permeability and edema,Cardiovascular,Loss of plasma volume Increased peripheral vascular resistance Decreased cardiac output decreased blood volume decreased venous return increased blood visc

16、osity decreased contractility,Renal,Decrease circulating plasma Increase hematocrit Decreased CO decreased renal blood flow oliguria acute renal failure,Gastrointestinal,Decreased gastrointestinal blood flow Increased mucosal hemorrhage 20% ileus,Immune System,Depressed immune function 20% directly

17、proportional to burn size,sepsis,Bodys Response to Burns,Hypermetabolic Phase (Stage 3) Last for days to weeks Large increase in the bodys need for nutrients as it repairs itself Resolution Phase (Stage 4) Scar formation General rehabilitation and progression to normal function,Hypermetabolism,Follo

18、wing severe burn and resuscitation tachycardia increased CO increased O2 demand massive proteolysis & lipolysis severe nitrogen loss,Systemic Complications,Hypothermia Disruption of skin and its ability to thermoregulate Hypovolemia Shift in proteins, fluids, and electrolytes to the burned tissue General electrolyte imbalance Eschar Hard, leathery product of a deep full thickness burn Dead and denatured skin,Systemic Complications,Infection Greatest risk of burn is infection Organ Failure Release of myoglobin Special Factors Age & Health Physical Abuse Elderly, Infirm or Young,Crit