• outermost layer of skin
• provides a watertight and resilient barrier from external environment 

• Second layer of skin
• Contains small capillary beds as well as sensory structures 

• Innermost layer 
• Composed of fatty connective tissue and contains larger blood vessels

Functions of skin

-8 listed in study guide

• Provides a physical barrier against external environment
• Provides a barrier against infection
• Provides protection from bacteria or other harmful agents
• Insulates and protects underlying structures and body organs from injury
• Aids in the regulation of body temperature
• Provides for sensation transmission
• Aids in elimination of some of the body's wastes
• Contains fluids necessary to functioning of other organs and systems 

What do most patients in a prehospital setting die from?

-Hint: not from the soft tissue trauma of burn itself

• Occluded airway
• Toxic inhalation
• Other trauma

*Given this info first establish and maintain a patent airway, adequate ventilations, and adequate O2 

• Burns increase capillary permeability
• increases ability of fluid to leak from vessels
• decreases fluid volume inside the vessels
• creates edema
• compromise tissue perfusion

• Swelling of the face or throat may cause airway closure
• Inhalation of superheated air may cause the lining of the larynx to swell (laryngeal edema)
• Fluid to accumulate in the lungs

• A decrease in blood flow from fluid loss causes decreased blood flow to kidneys and decrease in urinary output
• Kidneys responsible for filtering contaminated blood
• Burns may cause all or parts of kidneys to stop functioning

• Injury involves only the epidermis
• Skin appears pink to red and is dry
• Slight swelling may occur
• Skin soft and tender to touch
• May be very painful because the pain receptors in the underylying dermis of skin are still intact

• Involves epidermis and portions of dermis
• Damage to small blood vessels causes plasma and tissue fluid to collect and form blisters
• Pain receptors are still intact 
• Further classified as superficial partial thickness and deep partial thickness burns

• Involves all layers of skin
• Skin becomes dry, hard, tough, and leathery
• May appear white and waxy to dark brown or black and charred
• Most are not very painful because nerve endings are destroyed 

• Involve bone and burning of the bone
• Very high temps or chemical involved

• Face, eyes, ears
• Because of potential for respiratory compromise
• Hands and feet
• Because of potential for loss of function
• Genital or groin region
• Because of potential for loss of genitourinary function and increased chances for infection
• Major joint function
• Because loss of joint function

• Encircle a body area such as arm, leg, or chest, ones that encircle joint areas
• Critical because circulatory compromise and nerve damage
• Burns that encircle the chest may impede respiratory function by limiting chest expansion

• Children under the age of 5
• Have greater skin surface in relation to body mass so potential for greater fluid loss
• Adults over the age of 55
• Prolonged healing processes and may have underlying medical conditions 

• Only applied to burns that are partial or full thickness in depth
• Guides in determining burn severity, catergorizing for triage, alerting receiving facility to the severity of pt

• Head and neck- 9%
• Posterior trunk-18%
• Anterior trunk-18%
• Each upper extremity-9%
• External genitalia-1%
• Each lower extremity-18%

• Head and neck-18%
• Arms-9%
• Anterior trunk-18%
• Posterior trunk-18%
• Each lower extremity-14%

• Pts palm equals approx 1% of BSA

1. Thermal burns
• heat applied to body
• flame, hot water, steam
2. Inhalation burns
• high temp air or steam that is inhaled and causes damage to mucosa of upper airway
3. Chemical burns
• acids, alkalis, other heat generating chemicals
4. Electrical burns
• resistance to electrical current flow in body, primarily internal
5. Radiation burns
• absorption of radiation into body

5 types of shock

*know the flow chart

1. Hypovolemic
2. Cardiogenic
3. Metabolic/Respiratory
4. Obstructive
5. Distributive