Burn injury and rehab

Question 1

What are the burn depth classifications?

Answer 1

superficial = epidermis
partial thickness
full thickness

Question 2

For a partial thickness burn what are the two subcategories?

Answer 2

superficial partial (papillary)
deep partial (reticular)

epidermis. dermis.

Question 3

What layers are involved in a full thickness burn?

Answer 3

epidermis
dermis
subcutaneous layer

Question 4

What is the healing time for a superficial thickness?

Answer 4

healing = 3-7 days, may peel

Question 5

What is the healing time for a superficial partial thickness?

Answer 5

7-21 days, by re-epithelialization
minimal to no scarring
pigment change unlikely

Question 6

What is the healing time for a deep partial thickness burn?

Answer 6

healing time 21-35 days
may develop severe hypertrophic scarring

can either heal on its own OR
develop into full thickness (shows in first few days)

Question 7

What are types of burns?

Answer 7

thermal= scald, flame, friction
electrical
chemical
radiation

Question 8

What is a scald burn?

Answer 8

most common from hot liquids and grease
grease (holds the heat longer)

common in children and elderly

patterns= downward with splash marks= accident
circumferential= abuse

Question 9

What is flame burn?

Answer 9

may involve inhalation injury in closed doors
patterns vary

Question 10

What is a friction burn?

Answer 10

road rash usually from motocycle, MVA, or bikes

Question 11

What is an electrical burn?

Answer 11

contact points may be small, internal damage may be more severe
follows a pattern of least resistance
(bone> fat> tendon> skin> muscle> BV> nerves)

job related/power lines- high voltage

flash/flame/contact

Question 12

What and how is a chemical burn treated?

Answer 12

treat by massive dilution – continous showering for a prolonged period after the injury
attempts to chemically neutralize the burn can have an adverse affect

household cleaning agents

industrial – sodium hydroxide

Question 13

What are radiation burns?

Answer 13

sunburn

radiation therapy

Question 14

What is necrotizing fasciitis

Answer 14

caused by bacterial infection– usually Strep A

progresses quickly (red, warm, swollen area, severe pain, fever)

antibiotics and daily surgical debridement necessary

complications= sepsis, shock, organ failure
life or limb
severe scarring

Question 15

How do burns affect the renal system?

Question 16

How do burns affect the integumnetary system?

Question 17

What is a escharotomy?

Answer 17

fluid accumulates in extracellular space
circumfirential burn//eschar acts as tourniquet
ischemic extremities, compartment syndrome

not as extensive as a faschiotomy

Question 18

What is the rule of 9’s?

Answer 18

body surface of an adult, divided into 11 segments

Question 19

What is frostbite?

Answer 19

Hennepin Score– quantifies injury and tissue loff of FB injury
largely affects homeless population
t-PA protocol to help profuse blood clots

Question 20

What is hypovolumeic shock?

Answer 20

most immediate life threating response to injury
marked fluid loss
fluid shift from intravascualr space to extravascular space
most worried about acute renal failure

Question 21

What did you need to be mindful of in the respiratory system?

Answer 21

airway managment
inhalation injru
pre-exsiting conditions
ventilaotr associate pneumonia (VAP)

Question 22

What about the CV system do you need to be aware of after a burn?

Answer 22

tachycardia d/t hypovolemia, pain
bedrest/deconditioning

Question 23

What do opiates due to the GI system?

Answer 23

bowel management
slows GI motility
orevent bowel obstruction
rectal tube, stool softn

Question 24

What is a nasogastric tube placement?

Answer 24

NG tibe feeds
pt with only 20% burn will automatically get NG tube

Question 25

What is burn excision?

Answer 25

done by surgeon
burn eschar causes systemic inflammation
healthy, bleeding wound base

Question 26

What is a temporary coverage for a burn?

Answer 26

allograft (cadaver skin) and Xenograft (usually pig)
skin substitutes (synthetic or biologics)
used over joints, bones, tendons, and cartilage

Question 27

What is definitive coverage?

Answer 27

autograft

Question 28

What are the two teype of autograft?

Answer 28

split thickness skin graft
full thickness skin graft

Question 29

What is a split thickness ksin graft?

Answer 29

dermatome, .007-.16 inches thick
heal in 10-14 days
sheet graft, mesh graft

Question 30

What is ful thickness skin graft?

Answer 30

entire thickness of skin down to subcutaneous tissue
problem areas
eyelids, palmar aspect hand/fingers
reconstruction

Question 31

What is a mesh graft?

Answer 31

graft runs through a mesher
interstices allow for wound drainage
expanded over large area of slin
less durable than sheet grafts
waffle like appearance

Question 32

What is a sheet graft

Answer 32

graft unalerted
cosmetically appealing
requires large donor site

Question 33

What is a cultured epidermal autograpft (CEA)?

Answer 33

pts with large TBSA%
surgeon places casssettes over a larger meshed
skin cells fill in the gaps of the mesh
period of immobilization

Question 34

What is recell ASCS (autologous skin cell suspension)?

Answer 34

small donor site
donor skin placed into an enzymatic solution
after 15-20 minutes, scrapes the epidermic
draws up solution and sprays onto mesh

Question 35

What are the advantages of recell ASCS?

Answer 35

small donor site
used in combo with STSG for faster healing
used on deep partial thickness burns
used on donor sites to promote faster healing
less expensive and more avaioable
quicker time and less bedrest