stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum (layer of spinous cells), stratum basale stratum spinosum basal layer = germinal layer

Cell types: fibroblasts, endothelial cells, tissue cells, mast cells, lymphocytes

Contains: hair follicles, sweat glands, sebaceous glands

Composition: fibrous connective tissue

Nipple layer (superficial layer)

Network layer (deep layer)

fat loose connective tissue

It contains a small number of hair follicles and sweat glands. Due to the existence of epidermal cells in the hair root sheath, it can continue to proliferate and expand. This is the main reason why some third-degree burns can develop skin islands and eventually heal under conservative treatment.

hair follicle

sweat glands

sebaceous glands

Loss of body temperature regulation function due to destruction of superficial blood vessels after deep burns

After burns, the skin's touch and pain response can be used as an indicator to judge the depth of the wound.

Rule of nines

palm technique

Rule of thirds and fourths

Rule of 4ths and 5ths

Mild

Moderate

Severe

Extra heavy

Heat, local chemical stimulation, poisoning by absorption of harmful substances

clinical diagnosis and assessment

Prevention and treatment of hypovolemic shock (hydration)

Burn → Release of vasoactive substances → Increased capillary permeability

seepage speed

Small superficial burns: local tissue edema

Larger area (II and III adults >15%, children >5%): shock

Systemic infection causes

Strengthen nutrition, motivation support, eliminate wounds, and prevent infection

Shallow II, partial deep II: self-healing

III. Deep infection II: covered by epithelial extension of the wound edge

Large wounds: difficult to heal without skin grafting/scar hyperplasia and prone to contracture

Rehabilitation training, physical therapy, industrial therapy, plastic surgery

Deep II, III: residual wounds

Severe and extensive burns: sweat glands are destroyed, the ability to regulate body temperature is reduced, and it takes 2-3 years to adapt.

Fire extinguishing Cold therapy→burned limbs

Just want no more infection/injury Simply bandage and avoid applying colored topical medications

Move to a ventilated place

Thirst, irritability → shock → infusion/oral saline solution

comfort/encourage patient

Severe pain: diazepam, meperidine

Wound surface: clean and remove foreign matter

Light grade II: retain the blister skin and remove the blister fluid

Deep burns: remove blister skin

bandaging therapy

Exposure therapy: face, neck, perineum

Significant pain: analgesics

Antibiotics Tetanus Antitoxin

Understand the injury history and pay attention to whether there are inhalation injuries (in serious cases, cut the trachea as soon as possible), combined injuries

Establish intravenous infusion channel to replenish fluid and prevent shock

Leave a urinary catheter in place and pay attention to whether there is hemoglobinuria

Debridement, estimate burn area and depth

Develop the first 24-hour infusion plan based on burn area, depth, and fluid rehydration response

Extensive burns: exposure therapy

Injection of tetanus antitoxin and treatment with antibiotics

1. Increased heart rate, weak pulse, and low heart sounds

2. The pulse pressure becomes smaller in the early stage, and then the blood pressure drops.

3. Breathe shallowly and quickly

4. Oligouria (<20ml/h): an important sign of hypovolemic shock

5. Unbearable thirst, especially in children

6. Irritability: brain tissue ischemia and hypoxia

7. Poor peripheral vein filling, cold extremities and cold stomach

8. Blood tests: hemoconcentration (increased hematocrit), hyponatremia, hypoprotein, acidosis

Shock prevention and treatment

shock detection

Wound necrosis and exudation→medium

Severe burns→Intestinal stress→Microorganisms and endotoxin translocation→Endogenous infection

Inhalation injury → lung infection

Infusion→Intravenous catheter infection (the most common hospital-acquired infection)

Personality changes: excitement → hallucinations, delirium/apathy

Sudden rise in body temperature → accompanied by chills Body temperature does not rise: G-infection

HR>140 times/min

Shortness of breath

Sudden change of wound surface

Sudden change in WBC count

Actively correct shock

Treat wounds correctly

Rational use of antibiotics

Other comprehensive measures

Pulmonary infection, pulmonary edema > atelectasis

shock heart

It mostly occurs in severe shock/infection, mainly due to myocardial damage caused by ischemia, hypoxia and uncontrolled inflammation.

Oliguria type (caused by shock)

Non-oliguric type (caused by infection)

After bleeding/major perforation: abdominal pain, melena

Avoid severe shock and sepsis Antacids, anticholinergics, and H2 receptor antagonists protect the gastric mucosa

It is more common in children in the shock stage. It occurs when the infusion has reached a certain amount and the shock gradually stabilizes.

Early stage: nausea, vomiting, drowsiness, tongue sticking, snoring

Children: high fever, convulsions, arrhythmia, coma, cerebral herniation

If the blister skin is not broken: extract the blister fluid and wrap it with 75% alcohol gauze

The blister skin has broken

Topical application of 1% silver sulfadiazine cream and iodophor - only antibacterial Active surgical treatment: early scabectomy, scab removal and skin grafting

A large piece of allogeneic skin is opened and a small piece of autologous skin is embedded

blade thickness skin graft

Medium thickness skin graft

full thickness skin graft

Survival depends on establishing blood circulation between the skin graft and the wound, so it adheres closely to the wound.

It is suitable for repairing deep wounds with severe soft tissue defects, exposed tendons, blood vessels, nerves, and bones, and poor blood circulation at the wound bottom, especially in functional parts.

pedicled flap

free flap transplantation

Allogeneic skin

Autologous particle skin grafting

A large hole in the allograft skin is inserted into the autologous skin

Pediatric burns

Combined burn and impact injuries, which may be combined with blast injuries to the brain, limbs, inhalation injuries or poisoning

High disability rate Generally occurs in workshops that require the use of high-temperature shaping machines

Skin and tissue damage caused by long-term exposure to medium-temperature heat sources (≥45°C) Hot water bottles, baby warmers and close fire burns are the most common forms of low-temperature burns Infants, young children, the elderly, paralyzed patients or drunk people

It is not advisable to use neutralizers in the early stage (heat will aggravate the damage)

Dissolve fat and decalcify, eroding surrounding and deep tissues, and can damage bones

Saturated calcium chloride/25% magnesium sulfate soak/10% ammonia gauze wet compress/local injection of 5% calcium gluconate

Control copper sulfate concentration to prevent copper poisoning

Mild cases: nausea, palpitations, dizziness, disturbance of consciousness

Severe cases: coma, respiratory arrest, cardiac arrest

The entrance is heavier than the exit Entrance: crack, cave; small mouth, large bottom, shallow outside, deep inside Local exudation is more severe than ordinary burns, including intrafascial edema Progressive necrosis often occurs due to damage to adjacent blood vessels

Off the power supply - cardiopulmonary resuscitation - ECG monitoring

The amount of early fluid rehydration is greater than that of normal burns

Rehydration, alkalinization of urine, diuresis

Incision, decompression, thorough debridement, and skin flap repair; pay attention to secondary bleeding