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Integumentary > Burn Care > Flashcards

Burn Care Flashcards

1
Q

Epidermis

A
  • Stratum corneum
  • Stratum lucidum
  • Stratum granulosum
  • Stratum spinosum
  • Stratum basale
  • All layers are avascular
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2
Q

Dermal papillae

A

Found in the junction between epidermis and dermis and allows them to move together and overcome frictional forces (can be damaged with wounds)

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3
Q

Dermis

A
  • Contains blood vessels, lymphatics, nerves, sweat glands & hair follicles
  • Constructed of collagen & elastic fibers primarily in parallel orientation (in the direction that the body needs to move)
  • Papillary dermis
  • Reticular dermis
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4
Q

Papillary dermis

A

Responsible for touch, warm/cold sense

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5
Q

Reticular dermis

A

Responsible for deep pressure and vibration

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6
Q

Free nerve endings

A

Location: epidermis
Function: pain, itch

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7
Q

Merkel’s disk’s

A

Location: epidermis
Function: light touch

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8
Q

Free nerve endings

A

Location: dermis
Function: pain

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9
Q

Meissner’s corpuscle

A

Location: papillary dermis
Function: light touch

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10
Q

Ruffini’s corpuscle

A

Location: papillary dermis
Function: detect warmth

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11
Q

Krause’s end bulb

A

Location: papillary dermis
Function: detect cold

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12
Q

Pacinian corpuscle

A

Location: reticular dermis
Function: pressure & vibration

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13
Q

Burn classifications

A
  1. Superficial
  2. Superficial partial-thickness
  3. Deep partial-thickness
  4. Full thickness
  5. Subdermal
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14
Q

Superficial burn

A
  • Damage to epidermis (free nerve endings and Merkel’s disk’s affected)
  • Wound appear erythematous, pink to red
  • No blisters present, dry, delayed pain and tenderness, sensitive to light touch
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15
Q

Healing and scarring of superficial burn

A
  • Minimal edema
  • Spontaneous healing after desquamation (2-3 days)
  • No scarring
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16
Q

Superficial partial-thickness burn

A
  • Damage to epidermis and papillary dermis (free nerve endings epidermis and dermis, and Merkel’s disks affected)
  • Wound appears bright pink to red, blanching with capillary refill
  • Intact blisters, moist weeping surface, extremely painful, sensitive to light touch & change in temp
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17
Q

Healing and scarring in superficial partial-thickness burn

A
  • Moderate edema
  • Spontaneous healing after desquamation & debridement
  • Minimal scaring (discoloration)
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18
Q
A
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19
Q

Deep partial-thickness burn

A
  • Damage to epidermis, papillary and reticular dermis (free nerve endings epidermis/dermis, Merkel’s disks, meissner’s corpuscle, ruffini’s corpuscle, krause’s end bulbs affected)
  • Wound appears mixed red and waxy white color, blanching with very slow capillary refill
  • Broken blisters, moist weeping surface sensitive to pressure but not light touch or pin prick, pain is less than superficial-partial thickness burns, hair follicles remain intact
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20
Q

Healing and scarring in deep partial-thickness burns

A
  • Marked edema
  • Some spontaneous healing but grafting is best
  • Hypertrophic and keloid scars
  • Skin is very dry due to loss of sebaceous glands
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21
Q

Full-thickness burn

A
  • Damage to epidermis, dermis, and subcutaneous tissue all cells may be affected
  • Wound appears white (ischemic), charred, no blanching with poor distal circulation
  • Skin is leathery and rigid (forms eschar from desiccated plasma & necrotic cells)
  • No pain (anesthetic)
  • Body hairs pull out easily
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22
Q

Healing and scarring in full thickness burns

A
  • Area is depressed compared to rest of skin
  • Heals only with grafting
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23
Q

Subdermal burn

A
  • Wound appears charred
  • Surface significant for subcutaneous tissue muscle or tendon damage, neuro-involvement
  • Area of damage is depressed and heals only with grafting
  • Electrical burns
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24
Q

Zones of burn injury

A
  • Zone of coagulation
  • Zone of stasis
  • Zone of hyperemia
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25
Zone of coagulation
- The inner zone - Where cellular death occurs and sustains the most damage
26
Zone of stasis
- The middle zone - Compromised supply of blood, inflammation, and tissue injury (may have ability to recover depending on severity)
27
Zone of hyperemia
- The outer zone - Sustains the least damage - Area of increased blood flow
28
Rule of nines
Quick way to estimates the extent of burn in adults through dividing the body into multiples of nine and the sum total of these parts is equal to the total body surface area injured
29
Head represents
9% TBSA
30
Arms represent
9% TBSA EACH
31
Trunk represents
18% TBSA front & back
32
Genitals represent
1% TBSA
33
Legs represent
18% TBSA EACH
34
Acute medical treatment for burns
Involves vigorous fluid resuscitation, early wound excision, nutrition, topical and systemic antibiotics, multidisciplinary burn centers
35
Risk of death following burns
- Age greater than 60 - Greater than 40% TBSA - Inhalation wound with soot below vocal cords - Risk of dying is 90% with all 3 factors
36
Infection following burns
Leading cause of death since body is in vulnerable state to pathogens
37
Pulmonary complications following burns
Inhalation injury; burns to inside of lungs -> increased risk of obstruction
38
Metabolic complications following burns
- Large increase in load - Decrease in core temp -> heat loss via evaporation (rooms kept at 86 degrees) - Huge fluid losses - Huge nutritional needs protein** via NG tube
39
Cardiac complications following burn
- Shift of fluids into interstitium leads to loss of plasma volume and decreased cardiac output - Loss of distal circulation (pulse & temp) secondary to compression of tissue from fluid, inflammation and tightness of skin
40
Escharotomy
- Surgical intervention performed in efforts to maintain distal circulation and chest wall expansion (dependent on location) - It is done always from major vessels and nerves
41
Silver sulfadiazine
Topical medication used in burns - White cream used for pseudomonas infection
42
Sulfamylon
Topical medication used in burns - Gram negative and positive bacteria - Penetrates eschar deeply, may be painful - White cream
43
Silver nitrate
Topical medication used in burns - General germicide - Penetrates eschar superficially - Stains black
44
Furacin
Topical medication used in burns - Antibacterial cream in less severe burns (superficial)
45
Gentamycin
Topical medication used in burns - Staphylococcal and streptococcal antibacterial cream - More used for superficial burns
46
Collagenase
Topical medication used in burns - Enzymatic debriding agent - only for when necrotic tissue is present
47
Primary excision
Removal of eschar done in preparation for a graft
48
Graft types
- Autograft: from self - Allograft: from another person (cadaver) - Xenograft: from another species (generally pig) - Skin substitutes: created tissue (lab)
49
Used to harvest tissue (treated as a partial thickness burn; generally from thighs, buttock, back
Dermatomes
50
Sheet grafts
- Graft may be adhered with stables and/or fibrin glue - Graft expanded 2:1 or 4:1
51
Mesh grafts
Split-thickness Appears as mesh
52
Donor sites
- Covered with xeroform - 3% bismuth tribomophenate in a special petrolatum blend on fine mesh gauze OR semi-occlusive transparent film dressing
53
For grafts to take they need…
- Proper vascularity (dependent upon primary excision) - Light pressure (ace warps, encourage direct connection between graft and host vessels) - Proper positioning for contracture prevention - No dressing change for 5 days - No movement (generally 5 days) - Start with very gentle ROM
54
Physical therapy intervention for burns
- Positioning and splinting - Strengthening (role of isometrics) - ROM once graft takes - Ambulation with arms and legs wrapped to promote blood flow proximally, they have decrease CO
55
The three R’s
- Red - Raised - Rigid Indicative of hypertrophic scarring
56
The three P’s
- Pale - Planar - Pliable
57
Anterior neck burn
Deformity: flexion Motion: hyperextension via double mattress, rigid cervical orthosis
58
Axilla burn
Deformity: adduction & IR Motion: abduction, flexion, ER via airplane splint
59
Elbow burns
Deformity: flexion and pronation Motion: extension and supination via extension splint
60
Hand burns
Deformity: claw hand (intrinsic minus position) Motion: wrist extension, MCP flexion, PIP and DIP extension, thumb abduction via intrinsic plus position with hand elevation to reduce edema
61
Hip and groin burns
Deformity: flexion and adduction Motion: extension and abduction via his in neutral with slight abduction
62
Knee burns
Deformity: flexion Motion: extension via posterior knee splint, prone
63
Ankle burns
Deformity: plantarflexion Motion: dorsiflexion via AFO, ankle in neutral watch for pressure sore development
64
Scar management
- Wounds that take longer than 14 days (deep partial to grafted, pressure is indicated) - Silicone sheeting first line for hypertrophic scars prohylactically - Start with ace wraps -> tubigrip -> premade -> custom pressure garments - Want around 15-25 mmHg - Start wreaking at wound closure and continue for 12 months - Wear 23 hours a day (remove for breathing or eating) - 2 sets one for wearing, one for washing

Integumentary (15 decks)

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