Burn Flashcards
Burn causes
Heat, cold =, chemicals, electricity, friction, or radiation
Skin fxns
Protection against: infections, UV Yas, fluid loss
Temp regulation
Sensation
Secretion of oils to lubricate skin
Vit D synthesis
Cosmetic appearance
Two layers of the skin
Epidermis (outermost and a vascular)
Dermis (deepest layer
Classification of burn injury
Depth
Total body surface
Superficial (1st degree)
Sun burn (2-3 days)
Damage to epidermis only
Superficial partial thickness (2nd degree)
Scald burn (like boiling water to skin)- looks like a marble. Intact blister. very painful
Damage to epidermis and into papillary dermis
7-10 days to heal. Minimal scarring
Deep partial thickness burn
immersion scald- Marked edema
Broken blisters. Wet surface
Insensitive
Damage to epidermis and into reticular dermis
3-5 weeks to heel with scar formation (may require skin grafting)
Full thickness; 3rd degree
Flame burn.
No hair follicles
Escher formation
Painless
Damage to epidermis, dermis, and partially into subcutaneous tissue
3-5 weeks with scarring formation
Subdermal; 4tdegree
High voltage electrical burn (large exit burn and smaller entry wound- follows path of nerve)
Charred
Subcutaneous tissue visible
Damage to epidermis, dermis, into subcutaneous tissue, muscle, bone, and large nerves
Extensive healing time. Requires surgery, debridement and grafting.
Total body surface area
Rules of Nines
Modified Lund-Browder chart
Rules of 9:
Head and neck-
Anterior trunk-
Posterior trunk-
Right arm-
Left arm-
Pubic area-
Right leg-
Left leg-
Head and neck- 9%
Anterior trunk- 18%
Posterior trunk- 18%
Right arm- 9%
Left arm- 9%
Pubic area- 1%
Right leg- 18%
Left leg- 18%
Children rules of 9
Head and neck-
Anterior trunk-
Posterior trunk-
Right arm-
Left arm-
Pubic area-
Right leg-
Left leg-
Head and neck- 18%
Anterior trunk- 18%
Posterior trunk- 18%
Right arm- 9%
Left arm- 9%
Pubic area- 0%
Right leg- 14%
Left leg- 14%
Complications of burn injury
Infection
Pulmonary
Metabolic (increase metabolic activity due to negative nitrogen balance)
Cardiovascular
Heterotrophic ossification
Neuropathy
Amputation
Pathological scars
Metabolic Complications
Increased metabolic rate
-Decreased energy stores
-Weight loss
-Muscle atrophy
-Increased evaporative heat loss
Pulmonary complications
Inhalation injury due to smoke inhalation
Common cause of mortality in burn injury
Cardiovascular complications
Increased capillary permeability leading to:
- fluid loss
- decreased cardiac output
Capillary permeability returns to normal after 24 hours
Fluid replacement therapy helps manage intravascular fluid loss
Heterotopic ossification
Etiology unknown
Most common in elbow, hips no shoulders
Symptoms; decrease ROM and increase point pain tenderness
Neuropathy complications
Usually due to poor management (tightness of bandages and splinting)
Why would amputation occur
Subdermal burns. Usually electrical burns
Hypertrophic scar
Raised, red , rigid
Keloid scar
Type of hypertrophic scar that extends beyond the boundary of original wound
Types of pathological scars
Hypertrophic scar
Keloid scar
Scar contracture (scar bands)
Initial management
Establish and maintain an airway
Prevent cyanosis, shock, and hemorrhage
Establish baseline data
Fluid replacement
Clean the patient and wounds
Examine injury
Prevent and manage any pulmonary complications
Wound care
Inspect wound
Clean wound
Debridement of wound
Prevent injection
Permanent skin graft
Autografts- from patients own skin (commonly from thighs and back)
- sheet graft
-mesh great
Temporary graft
Allograft (from the same species)
Xenograft (from another species)
Escharmatomies
Performed when Escher is restricting circulation
Physical therapy management
Prevent scar formation contractures
bring them back to normal
Healing
Maximal ROM
PT Goals
Maximal function and minimal complications
Positioning and splinting
Minimize edema
Prevent contracture
Preserve function
AROM
Begin day of admission on all extremities and trunk
Coordinate with pain medication and dressing changes
Discontinue joints above and below skin graft for roughly 3-5 days
PROM
Perform when patient is not alert or able to follow commands
Perform on children
If patient cannot fully achieve active ROM
Stress should be applied in a gentle, gradual and sustained fashion
Resistive
Monitor vital signs initially
Proper hydration is vital
Room temp may need to be adjusted
Conditioning
Same as resistive
All exercises should be done
Ambulation
Begin as soon as possible
Discontinue after LE skin grafting until safe to resume
Use elastic wraps or TED stockings to minimize edema and stasis when upright, and to protect new graft
Scar management
Pressure Dressings
Massage
Superficial burn
Erythema (just redness)
Partial thickness burn (epidermis and upper part of dermis)
Blistering (may heal without a scar)
Full thickness burn (epidermis and entire dermis)
Necrosis (will heal with scar)
Subdermal burn (epidermis, dermis and subcutaneous tissue)
Extensive surgical and therapeutic management necessary to return patient to some degree of function.
