Burn Rehabilitation

Dermis is the
highly vascularized layer or skin

epidermis is the
non-vascular layer of skin

burns are classified based on

1. causes
2. depth
3. extent or location

Four main causes (types) of burn

Thermal
Chemical
Electrical
Radiation

causes of burn: THERMAL

results from flame, steam, hot liquids or metals, extremes in temperatures
most common type of burn

causes of burn: ELECTRICAL

results from any type of voltage (pruning a tree, electrical plugs)
can cause renal failure, cardiac arrest, pulmonary arrest... depends on duration of
contact, voltage, and current

cause of burn: CHEMICAL

from cleaning agents, acids or from a combo of agents (tylex, fantastic)
chemical burns-->
- smaller as far as amount of skin that is covered
- most likely to cause full thickness burn which is the most severe
- inhalation --> burn
- it takes 24-72 hours for a chemical burn to fully develop

Cause of burn: radiation

nuclear exposure, chemotherapy can also cause a radiation burn

superficial burns
involve the upper layers of the epidermis (not vascularized layer that is about to shed)
- first degree burn

sunburn, hot fluids, minor flash injuries are considered

superficial burns

superficial burns also includes:

dry/bright red/ or pink skin that blanches under pressure
- generally do not cause edema
- no blisters are formed
- skin may exfoliate
- resolve spontaneously in 3-5 days without scarring

partial thickness burns

2nd degree burns- superficial partial thickness, deep partial thickness
superficial partial thickness burns are
-2nd degree burns
-involve the epidermis and papillary dermis
-moist, weepy, blistered skin

superficial partial thickness burns

-local erythema and edema
- blanch under pressure
-extremely painful

superficial part. thickness burns

-heal within 10-14 days with minimal to no scarring
-pigment changes are possible (hyperpigmented, freckles in that area)
- immediate capillary refill

superficial partial thickness burns can heal

without surgical intervention or hospitalization. to protect against infection, you want
to keep it dry

- deep 2nd degree

- involves the epidermis and dermis
- mottled areas of red and white eschar (dead tissue)
deep partial thickness burn

- may be painful
-capillary refill is sluggish
- prone to hypertrophic scarring (forms in knots) and contracture
deep partial thickness

deep partial thickness

may need some skin grafting
and boutonniere-dorsal fingers

full thickness burn

* third degree
- adipose tissue may be exposed
- initially may be red, quickly become mottled white, grey, or black, non blanching

full thickness burns

- appear dry, leathery
- no pain
-requires skin grafting and debridement of tissues
full thickness
- high risk for hypertrophic scarring
- more than three weeks to close
- destruction of dermis, epidermis, and subcutaneous tissues

subdermal burns
- fourth degree
- destruct fat, muscle, tendon, bone
- charred or mummified appearance

subdermal burns-
- skin is dry with minimal edema (No vascularization)
- extensive surgical intervention

subdermal burns -
amputation is often necessary
- paralysis is possible

5 functions of the skin

-protection
-conservation of fluids
-temperature regulation
-sensation
-identity

Superficial burn
Involves epidermis

Superficial partial-thickness burn

Involves epidermis, and papillary dermis

Deep partial-thickness burn

Complete destruction of epidermis and most of dermis

Full-thickness burn
Destruction of epidermis, dermis and partial damage of subcutaneous layer

Sub dermal burn

Complete destrcution of epidermis, dermis, subdermal tissue n may involve muscle
tissue, tendon or bone

A superficial burn involves what layer of skin

epidermis

What are the 2 s/s of superficial burns

-local pain
-erythema
Do superficial burns have blisters
no

Do superficial burns have scarring

no
How many days does a superficial burn normally take to heal
3-5 days

What layers of skin does a superficial partial thickness affect

-epidermis
-superficial layer of dermis

Superficial partial thickness.... color? blisters or no blisters? wet or dry?

-pink or red
-blisters
-pain
-wet

Is a persons sensation intact or absent with a superficial partial thickness burn

intact

Does a pt have hair with a superficial partial thickness burn

yes

How many days will a superficial partial thickness burn to heal

14-21

Will a superficial partial thickness burn scar

there is a possibility

What layers of skin are affected with a deep partial thickness burn
-epidermis
-most of the demris

3 s/s of deep partial thickness burn...color? skin condition? dry or wet?

-mottled
-cherry red or white
-dry

What is sensation like in a deep partial thickness burn

-can feel pressure but not pin prick because the pressure sensors are deeper so you
dont lose those

Will hair be present in a deep partial thickness burn

yes

How long will it take to heal a deep partial thickness burn

3-6 weeks
Will there be scarring in a deep partial thickness burn
yes

Layers of skin affected by a full thickness burn

-epidermis
-dermis
-subcutaneous

Full thickness burn

-What color? texture? sensation? is it dry or wet? hair or no hair? what happens
to the vessels? and what does it require
-red, black, or white
-leathery
-insensate
-dry
-no hair
-coagulated vessels because the blood is all dried up
-requires skin graft unless it is a small area