Burns ( Deep Partial Thickness)

Injuries that result from direct contact with or exposure to any thermal,
chemical, or radiation source are termed burns. Burn injuries occur when
energy from heat source is transferred to the tissues of the body. The depth
of the injury is related to the temperature and the duration of exposure and
contact.

Characteristics of Burns of Different Depths

Color and Capillary Pinprick

Classification Depth of Burn Recovery
Appearance Refill* Sensibility**

First-degree Epidermic Red or Pink Yes Yes 5-7 days

Epidermis and
Second-degree Red, possibly
extends in the Yes Yes 7-15 days
Superficial Partial blistered
dermis

Epidermis and
Second-degree Red to marbley 15-30
deeper into the Possibly Possibly
Deep Partial white days
dermis

Extends into the Charred and

Third-degree Full
subcutaneous leathery and often
thickness
tissue depressed

Local Effects -
(1) Tissue damage - Heating a tissue results in cell necrosis. In the peripheral cells may be viable
but injured. There is damage to the peripheral microcirculation occurs. The capillaries are either
thrombosed where the damage is severe or in less damaged area there is increased capillary
permeability such that the tissue becomes edematous and there is external leakage of serous
fluid. The essential difference between a partial thickness and full thickness skin loss is the depth
of injury. But it is possible that a partial thickness may progress to full thickness skin loss.

(2) Inflammation - There is a marked and immediate inflammatory response. In the area least
damaged by burning is manifested by erythema . The precise cause of this vasodilatation is
neurovascular response to trauma. Mild area of erythema resolves within a few hours. Severely
damaged tissue develops a prolonged inflammatory response. Macrophages produce
inflammatory mediators and cytokines and phagocytose necrotic cells. Neutrophils protects
against infection. Damaged tissue separates by a process called dislodging which completes by 3
weeks.

(3) Infection - The damaged and dead tissue acts as a nidus for infection. Burn wounds will
almost always be infected by micro-organisms within 24 to 48 hours. There may in addition be a
bacteremia and septicemia. Bacteremia is a common cause of fatality in severe burns.

Systemic Effect From Burning –

(1) Fluid loss - Fluid loss from the damaged capillaries either by visible external loss or
internally into the tissue from edema in the region of burn. In addition there may be more
extensive edema of the region or even of the entire body which is mediated by the cytokines
acting on the microcirculation. Thus prevention of hypovolemia is the most important function in
early burn resuscitation. Effective fluid replacement will minimize the risk of other systemic
complications .

(2) Multiple organ failure - There may be progressive failure of renal or hepatic function or heart
failure. The precise cause of these complications is uncertain and has often been attributed to
fluid loss, toxemia from infection.

(3) Inhalation Injury - These occur in those trapped in enclosed space. They are particularly
common in association with burns of the head and neck. The inhalation of hot gases causes
thermal burn to the upper airway. This is manifested early by stridor, hoarseness, cough and
respiratory obstruction. Inhalation of product of combustion causes a chemical burn to the
bronchial tree and lungs. This is manifested by hypoxia , Acute Respiratory Distress Syndrome
(ARDS) and respiratory failure. Carbon monoxide displaces oxygen from hemoglobin to form
carboxyhemoglobin thus reducing oxygen carrying capacity of blood. Immunosuppressant
increases the risk of septic complication.
Effect of Burn in the Renal System

Renal failure is a feared complication of critical illness and is also often an early sign of
multiple organ dysfunction, which complicates the care of critically ill patients . In modern burn
care, in which most patients now survive early resuscitation, multiple organ failure is the most
common cause of death.

 In hypovolemic state, blood flow decreases, causing renal ischemia. If it continues, acute
renal failure may develop

 Hypovolemic Shock may occurs when there is a loss of intravascular fluid volume. The
volume is inadequate to fill vascular space and is unavailable for circulation.

 Also, burns have a direct loss of fluid due to evaporation.

Renal Needs

 Glomerular filtration may be decrease in extensive injury.

 Without resuscitation or with delay, decrease renal blood flow may lead to high output or
oliguric renal failure and decrease creatinine clearance.

 Hemoglobin and myoglobulin, present in the urine of the patients with deep muscle
damage commonly associated with electrical injury, may cause acute tubular necrosis and
call for a greater amount of initial fluid therapy and osmotic diuresis.
What is Deep Partial Thickness?
Deep partial-thickness burns extend downward into the reticular, or
deeper, layer of the dermis and present as mixed red or waxy white. Areas of
redness will continue to blanch when pressure is applied, but capillary refill
may be absent or may be sluggish when pressure is released. Blisters are
usually absent; however, the exposed surface of the wound is wet or moist,
similar to superficial partial-thickness burns. Edema is marked and sensation
is altered in areas of a deep partial-thickness burn. In deep partial-thickness
burns, tissue may undergo spontaneous epithelialization from the few viable
epithelial appendages at this deepest layer of dermis and heal within 3-6
weeks

What causes a partial thickness burn?

Direct exposure to heat or flame is the most common cause of partial thickness burn. This
includes contact with flames or hot objects such as an iron, a skillet, tar, cigarettes, or fireworks.
The following may also cause partial thickness burn:
• Chemicals: Harsh chemicals, such as cleaning products, car battery acid, gasoline, wet or
dry cement, lime, or chlorine.
• Electricity: Touching damaged electrical cords, outlets, or wires.
• Scalding: Burns from hot water, steam, or liquids, such as boiling water, coffee, or tea.
• Sun: Deep sunburns or too much use of tanning beds.

How is a partial thickness burn treated?

You may need one or more of the following:
• Medicines:
o Antibiotics: Antibiotics may be given to help treat or prevent an infection caused
by germs called bacteria.
 o Pain medicines: These are medicines to take away or decrease your pain.
o Tetanus shot: This is medicine to keep you from getting tetanus. It is given as a
shot. You should have a tetanus shot if you have not had one in the past 5 to 10
years. Your arm can get red, swollen, and sore after getting this shot.
• Surgery:
o Debridement: This is done to clean and remove objects, dirt, or dead tissues from
the burned area.
o Escharotomy: An incision (cut) along the eschar (dead tissue or scab) is made to
decrease swelling. This is usually done when the arms, legs, or chest are burned
all the way round.
o Skin grafting: A patch of skin is removed by surgery from one area of the body.
The skin is transferred to the burned or wounded areas to help heal your injury.
Artificial, or donor skin may also be used.

What is the first-aid for deep partial thickness burn?

• For burns with blister:

o Remove jewelry or tight clothing from the burned area before the skin begins to
swell. Do not remove clothing if it is stuck to the burn.
o Do not break closed blisters. This increases the risk of infection.
o Flush the burned area with large amounts of cool running water. Clean it with
mild soap and water to prevent infection.
o Use a simple skin lubricant, such as aloe vera cream, to soothe the skin.
o Take painkillers, such as acetaminophen, to relieve pain and swelling.
o Put clean non-stick bandage to protect the burned area from dirt and more injury.

• For burns caused by a chemical:

o Remove clothing or jewelry on which the chemical has spilled right away.
o Flush liquid chemicals from the skin completely with large amounts of cool
running water. Avoid splashing the chemical into your eyes.
o Brush dry chemicals off the skin if large amounts of water are not available.
Small amounts of water will activate some chemicals, such as lime, and cause
more damage. Be careful not to get any of the chemicals in your eyes.
o Do not put butter, petroleum jelly, or other home remedies on skin burned by a
chemical.
o Put a clean non-stick bandage to protect the burned area from dirt and more
injury.
Seek emergency medical help if a burn is on the face, feet, hands, groin, buttocks, or major
joints.

How can partial thickness burn be prevented?

• Do not leave cups, mugs, or bowls containing hot liquids at the edge of a table. Turn the
pot handles away from the stove front. Children can reach up and pull them down onto
themselves.

• Do not leave lit cigarettes unattended and discard them properly. Keep cigarette lighters
and matches in a safe place where children cannot reach them.

• Set your water heater to low or medium.

• Use smoke detectors in the house and check them regularly to make sure they are
working.

• Wear sunscreen that has a sun protectant factor (SPF) of 15 or higher. The sunscreen
should also have ultraviolet A (UVA) and ultraviolet B (UVB) protection. Follow the
directions on the label when using sunscreen. Put on more sunscreen if you are in the sun
for more than an hour. Reapply sunscreen often if you go swimming or are sweating a lot.

Sources:

http://www.indiasurgeons.com/burns.htm

http://findarticles.com/p/articles/mi_qa3977/is_200307/ai_n9270135/

http://ccforum.com/content/12/5/R124

http://www.scribd.com/doc/2591191/Burns-and-Patient-Management

http://emedicine.medscape.com/article/1278244-overview

Bare B., Cheever K., et al. (2008) “Brunner & Suddhart’s textbook of Medical-
Surgical Nursing”. Vol. 2 Lippincott Williams & Wilkins. Pages1995-
2003.

Black J., Hawks J.K., et al. (2001) “ Medical-Surgical Nursing”. Vol.2

Saunders Company, Philadelphia. Page 1331.

Mc. Cann J. (2006)” Lippincott Manual of Nursing Practice”. 8th edition.

Lippincott Company. Pages 1122-1123.

Deep
Partial
Thickness

Submitted to: Mrs. Mervic Alegado

Submitted by: Hencynt Soria

BSN III-D