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Selected Topics > Burn Management > Flashcards

Burn Management Flashcards

1
Q

(true/false) Burns are a systemic problem

A

true

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2
Q

How are burns assessed?

A

By their thickness (not by staging or wagner scale)

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3
Q

What is the most common treatment technique to manage large body surface area burns?

A

hydrotherapy

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4
Q

Any burn > __% TSA requires specialized care

A

9

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5
Q

What are burn wounds at high risk for if they travel over a joint?

A

contracture

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6
Q

(gentile/aggressive) ROM/Positioning/splinting interventions are required for optimal management of burns

A

aggressive

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7
Q

What is considered as part of standard care for burns?

A

compression garments

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8
Q

What is the role of the epidermis?

A

protection
waterproofing
regeneration

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9
Q

What is the primary cell type found in the epidermis?

A

keratinocyte

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10
Q

definition: layer of integumentary system
- thin
- superficial
- avascular

A

epidermis

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11
Q

What are the 5 layers of the epidermis from superficial to deep?

A
  1. stratum corneum
  2. stratum lucidum
  3. stratum granulosum
  4. stratum spinosum
  5. stratum basale
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12
Q

What is the role of the basement membrane zone?

A

prevent shearing (Rete Pegs)

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13
Q

What is the primary cell of the dermis?

A

fibroblast

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14
Q

What is the role of the dermis?

A

tensile strength
nutrition to epidermis
encloses the epidermal appendages

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15
Q

What structures does the dermis contain?

A
  • collagen
  • elastin
  • blood vessels
  • lymphatics
  • nerves
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16
Q

What are the two layers of the dermis?

A

papillary and reticular

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17
Q

definition: layer of integumentary system
- superficial
- loosely organized collagen
- vascular eminences

A

papillary dermis

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18
Q

definition: layer of integumentary system
- deep
- thick/dense
- organized collagen
- merge with hypodermis

A

reticular dermis

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19
Q

What layer of the skin contains sensory nerve receptors?

A

dermis

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20
Q

What nerve receptors are damaged if a burn goes to the epidermis? What is impacted?

A

free nerve endings - superficial pain and itch
merkel’s disks- touch

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21
Q

What nerve receptors are damaged if a burn goes to the papillary dermis? What is impacted?

A

meissner’s corpuscle- touch
ruffini’s corpuscles- heat
krause’s end bulb- cold

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22
Q

What nerve receptors are damaged if a burn goes to the reticular dermis? What is impacted?

A

pacinian corpuscles- pressure and vibration

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23
Q

What feature of a burn causes cell death?

A

heat absorption

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24
Q

who is at the highest risk for burns?

A

children <3 y/o
adults >70 y/o

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25
Q

What are the 4 main causes of burns? Rank them.

A
  1. thermal
  2. electricity
  3. chemicals
  4. hot gas, friction, radiation
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26
Q

Presence of deep electrical damage exceeds just surface damage due to ___.

A

resistance

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27
Q

What physiological change to cold injuries save the core body temperature and organs?

A

peripheral vasoconstriction

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28
Q

What burn approximation tool is commonly used for pediatric cases?

A

lund and brower approximation

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29
Q

> ___% TBSA partial thickness burn requires a specialized burn unit

A

25

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30
Q

“first degree burn”

A

superficial burns

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31
Q

s/s
- red/pink irritated epidermis
- painful
- tender
- no blisters
- minimal to no edema

A

superficial burns

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32
Q

How do superficial burns heal?

A

spontaneously with no scarring

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33
Q

“superficial second-degree burn”

A

superficial partial thickness burn

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34
Q

s/s
- bright pink/red inflamed dermis
- intact blisters
- moist surface
- weeping
- painful (due to exposed nerve endings)
- sensitive to temperature and touch
- moderate edema

A

superficial partial thickness burn

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35
Q

How does a superficial partial thickness burn heal?

A

spontaneous with minimal scarring and discoloration

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36
Q

What layers of the skin does a superficial partial thickness burn affect?

A

epidermis
papillary dermis

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37
Q

What layers of the skin does a deep partial thickness burn affect?

A

epidermis, papillary dermis, reticular dermis

38
Q

(true/false) hair follicles and sweat glands are damaged with deep partial thickness burns.

A

false

39
Q

“deep second degree burns”

A

deep partial thickness burn

40
Q

s/s
- broken blisters
- wet surface
- pressure sensitivity (but not to light touch)
- significant edema

A

deep partial thickness burns

41
Q

How do deep partial thickness burns heal?

A

slow healing with extensive scarring

42
Q

“third degree burns”

A

full thickness burn

43
Q

s/s
- white/charred/black/tan/red
- non-blanching
- poor circulation
- leathery
- rigid
- dry skin appearance
- depressed area

A

full thickness burn

44
Q

“fourth degree burn”

A

subdermal full thickness burn

45
Q

s/s
- charred appearance
- visible subcutaneous tissue
- muscle and neurologic damage
- tissue defects

A

subdermal full thickness burn

46
Q
  • the most significant and prolonged area in contact with offending agent
  • Greatest risk of full thickness injury and tissue necrosis
A

zone of coagulation

47
Q
  • Partial thickness injury with compromised blood flow
  • Can be preserved with correct management
  • Can be preserved if severity of the burn is not excessive
A

zone of stasis

48
Q
  • Vasodilated and increased cellular activity
  • Cells help support the zone of stasis
  • help prevent necrosis of the zone of stasis
A

zone of hyperemia

49
Q

superficial/ superficial partial thickness burns heal by re-epithelialization within ______ days.

A

5-10 days

50
Q

deep partial thickness burns heal by re-epithelialization within ______ weeks.

A

2-3 weeks

51
Q

What is harvested with a split-thickness skin graft (STSG)?

A

epidermis and a small portion of the dermis

52
Q

What is harvested with a full thickness skin graft (FTSG)?

A

epidermis and dermis

53
Q

types:
- STSG
- FTSG

A

autograft

54
Q

types:
- allograft
- xenograft
- dermal substitute

A

temporary graft

55
Q

definition: skin graft from another person

A

allograft (homograft)

56
Q

definition: skin graft from another species.

A

xenograft (heterograft)

57
Q

definition: skin graft created in a lab

A

dermal substitutes

58
Q

How long does it take most skin grafts to adhere?

A

5 days

59
Q

Vascularity is restored to a skin graft in about ___ hours.

A

48 hours

60
Q

What has to happen to the graft for vascularity to be maintained?

A

It must remain immobile

61
Q

What are the common causes of graft failure?

A
  • excessive edema and/or bacteria
  • mobility of the graft
  • inadequate excision to healthy tissue prior to application
62
Q

What do escharotomies and fasciotomies do?

A
  • decompress underlying tissue
  • improve circulation
  • prevent/treat compartment syndome
63
Q

Edema resolves within __-__ days if caused by burn shock.

A

7-21 days

64
Q

What MSK condition is associated with burns > 20% TBSA?

A

heterotpic ossification

65
Q

What are the highest risk locations for heterotopic ossification due to the risk of contracture?

A

elbow, shoulder, hip

66
Q

Renal impairment can occur with burns due to excessive _____.

A

myoglobin from muscle destruction

67
Q

Polyneuropathy is associated with > ___% TBSA burns.

A

20%

68
Q

What are the common locations of local neuropathies caused by burns?

A

brachial plexus, ulnar nerve, peroneal nerve, median nerve

69
Q

PTSD is seen in ___% of burn survivors after 1 year.

A

45%

70
Q

A position of ___ is the position of contracture.

A

comfort

71
Q

What are the temperature parameters of a hubbard tank/whirlpool for an adult?

A

95-100 degrees

72
Q

What are the temperature parameters of a hubbard tank/whirlpool for a child?

A

90 degrees

73
Q

What is the maximum amount of time a burn victim should be in a hubbard tank/whirlpool

A

30 minutes

74
Q

Scar tissue has more ___ and less ____ than normal skin.

A

More chondroitin-4-sulfate
Less hyaluronic acid

75
Q

Scar tissue has (more/less) collagen organization and elasticity.

A

less

76
Q

definition: progressive elongation of skin/scar over time in response to prolonged force

A

tissue creep

77
Q

What are the parameters for PROM/AROM in burn victims?

A

10-30 reps for 2-3x/day

78
Q

When splinting/positioning, you should maintain tissue at the end range of elongation in the (same/opposite) position of the burn wound location.

A

opposite

79
Q

What are the parameters for manual stretching?

A

low load, 3x5 sets for 30-60 second hold for each motion

80
Q

splinting type: airplane
splinting position:

A

90-120 degrees shoulder ABD

81
Q

splinting type: elbow conformer
splinting position:

A

elbow EXT

82
Q

splinting type: wrist cock up splint
splinting position:

A

wrist EXT

83
Q

splinting type: hand splint
splinting position:

A

MP FLX
IP EXT
phalanx ABD

84
Q

splinting type: hip splint
splinting position:

A

hip ABD and EXT

85
Q

splinting type: knee conformer
splinting position:

A

knee EXT

86
Q

Pressure application should be provided during the ___ process of burns/scar management.

A

remodeling process

87
Q

Wounds requiring __-__ days for closure should receive a pressure garment.

A

14-21 days

88
Q

Ace wraps provide __-__ mmHg of pressure.

A

10-15 mmHg

89
Q

Tubular support bandages provide __-__ mmHg of pressure.

A

10-20 mmHg

90
Q

Custom pressure garments can provide up to ___ mmHg of pressure.

A

25 mmHg

91
Q

How long should a patient use a scar-mgmt pressure garment?

A

12-24 months or more

92
Q

Remodeling of scar tissue can take up to __ months.

A

24 months

Selected Topics (8 decks)

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