of the Week: December
are burns classified?
are Burns Classified?
burns are limited in depth to the first 2 or 3 of the 5 layers of the epidermis
by erythema, hyperemia, tenderness and pain
vesicles or blisters
to the shallow depth, regeneration of skin will occur within several days
involve entire epidermis (blue zone) and upper third of dermis (mauve zone)
will usually appear red
to microvessels that perfuse the skin results in wet wounds with bullae
painful; pain increases when exposed to air currents
heal within 1 - 6 weeks with minimal scarring
includes the entire epidermus and deep into the dermis
of blood supply often limits fluid leakage; blisters are not usually present
and only a modest amount of plasma leakage appears on the wound
usually red with white appearance in center; blanches following assessment
for capillary refill
necrosis and surface protein turns gives burn surface a yellow appearance
heal spontaneously by slow granulation, often leaving unstable epithelium,
scarring and contractures
is the desired treatment as it improves the quality of the healing (better
cosmetic and functional healing) and reduces the opportunity for infection
progress to full thickness injuries if infection develops
in destruction of skin through all layers of epidermis and dermis, extending
into subcutaneous fat and underlying tissue
layer contains hair follicles and sweat glands and is poorly vascularized;
this is below the stratum germinativum layer (dark blue area) which is
responsible for the generation of new skin cells
appears white, red or brown and is often charred and leathery in appearance
is usually dry and insensitive to pin or palpation
skin is broken, subcutaneous fat may be visible
with extensive fluid and electrolyte imbalances, altered thermoregulation,
metabolic disturbances and infection
small wounds will contract and eventually heal, larger wounds require grafting
partial thickness (2)
partial thickness (3)
is the "Percentage of Burned Area" Calculated?
of the size of the burn is done using the "rule of nines" shown in Diagram
2. The corresponding area of burn is identified on the diagram, and
the total percentage is calculated as the sum of the burned areas.
type or thickness of the burn can also be recorded on the diagram.
Many burns are mixed in nature, for example, the outer edges may be partial
thickness, while areas of deep partial and full thickness burns may extend
toward the center. The appearance of the burn, along with the presence
of blanching, blisters and pain helps to determine the extent of the injury.
percentage of burns may change as the tissue injury evolves and more extensive
tissue damage becomes evident. Infection can increase the severity
of the burn over the course of the injury.
Brenda Morgan. (December
L., Urden, L., Lough, M., & Stacy, K. Critical Care Nursing: Diagnosis
and Management. Mosby: Toronto. pp. 1141-1170.