Burn Management Flashcards
(true/false) Burns are a systemic problem
true
How are burns assessed?
By their thickness (not by staging or wagner scale)
What is the most common treatment technique to manage large body surface area burns?
hydrotherapy
Any burn > __% TSA requires specialized care
9
What are burn wounds at high risk for if they travel over a joint?
contracture
(gentile/aggressive) ROM/Positioning/splinting interventions are required for optimal management of burns
aggressive
What is considered as part of standard care for burns?
compression garments
What is the role of the epidermis?
protection
waterproofing
regeneration
What is the primary cell type found in the epidermis?
keratinocyte
definition: layer of integumentary system
- thin
- superficial
- avascular
epidermis
What are the 5 layers of the epidermis from superficial to deep?
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinosum
- stratum basale
What is the role of the basement membrane zone?
prevent shearing (Rete Pegs)
What is the primary cell of the dermis?
fibroblast
What is the role of the dermis?
tensile strength
nutrition to epidermis
encloses the epidermal appendages
What structures does the dermis contain?
- collagen
- elastin
- blood vessels
- lymphatics
- nerves
What are the two layers of the dermis?
papillary and reticular
definition: layer of integumentary system
- superficial
- loosely organized collagen
- vascular eminences
papillary dermis
definition: layer of integumentary system
- deep
- thick/dense
- organized collagen
- merge with hypodermis
reticular dermis
What layer of the skin contains sensory nerve receptors?
dermis
What nerve receptors are damaged if a burn goes to the epidermis? What is impacted?
free nerve endings - superficial pain and itch
merkel’s disks- touch
What nerve receptors are damaged if a burn goes to the papillary dermis? What is impacted?
meissner’s corpuscle- touch
ruffini’s corpuscles- heat
krause’s end bulb- cold
What nerve receptors are damaged if a burn goes to the reticular dermis? What is impacted?
pacinian corpuscles- pressure and vibration
What feature of a burn causes cell death?
heat absorption
who is at the highest risk for burns?
children <3 y/o
adults >70 y/o
What are the 4 main causes of burns? Rank them.
- thermal
- electricity
- chemicals
- hot gas, friction, radiation
Presence of deep electrical damage exceeds just surface damage due to ___.
resistance
What physiological change to cold injuries save the core body temperature and organs?
peripheral vasoconstriction
What burn approximation tool is commonly used for pediatric cases?
lund and brower approximation
> ___% TBSA partial thickness burn requires a specialized burn unit
25
“first degree burn”
superficial burns
s/s
- red/pink irritated epidermis
- painful
- tender
- no blisters
- minimal to no edema
superficial burns
How do superficial burns heal?
spontaneously with no scarring
“superficial second-degree burn”
superficial partial thickness burn
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
superficial partial thickness burn
How does a superficial partial thickness burn heal?
spontaneous with minimal scarring and discoloration
What layers of the skin does a superficial partial thickness burn affect?
epidermis
papillary dermis
What layers of the skin does a deep partial thickness burn affect?
epidermis, papillary dermis, reticular dermis
(true/false) hair follicles and sweat glands are damaged with deep partial thickness burns.
false
“deep second degree burns”
deep partial thickness burn
s/s
- broken blisters
- wet surface
- pressure sensitivity (but not to light touch)
- significant edema
deep partial thickness burns
How do deep partial thickness burns heal?
slow healing with extensive scarring
“third degree burns”
full thickness burn
s/s
- white/charred/black/tan/red
- non-blanching
- poor circulation
- leathery
- rigid
- dry skin appearance
- depressed area
full thickness burn
“fourth degree burn”
subdermal full thickness burn
s/s
- charred appearance
- visible subcutaneous tissue
- muscle and neurologic damage
- tissue defects
subdermal full thickness burn
- the most significant and prolonged area in contact with offending agent
- Greatest risk of full thickness injury and tissue necrosis
zone of coagulation
- Partial thickness injury with compromised blood flow
- Can be preserved with correct management
- Can be preserved if severity of the burn is not excessive
zone of stasis
- Vasodilated and increased cellular activity
- Cells help support the zone of stasis
- help prevent necrosis of the zone of stasis
zone of hyperemia
superficial/ superficial partial thickness burns heal by re-epithelialization within ______ days.
5-10 days
deep partial thickness burns heal by re-epithelialization within ______ weeks.
2-3 weeks
What is harvested with a split-thickness skin graft (STSG)?
epidermis and a small portion of the dermis
What is harvested with a full thickness skin graft (FTSG)?
epidermis and dermis
types:
- STSG
- FTSG
autograft
types:
- allograft
- xenograft
- dermal substitute
temporary graft
definition: skin graft from another person
allograft (homograft)
definition: skin graft from another species.
xenograft (heterograft)
definition: skin graft created in a lab
dermal substitutes
How long does it take most skin grafts to adhere?
5 days
Vascularity is restored to a skin graft in about ___ hours.
48 hours
What has to happen to the graft for vascularity to be maintained?
It must remain immobile
What are the common causes of graft failure?
- excessive edema and/or bacteria
- mobility of the graft
- inadequate excision to healthy tissue prior to application
What do escharotomies and fasciotomies do?
- decompress underlying tissue
- improve circulation
- prevent/treat compartment syndome
Edema resolves within __-__ days if caused by burn shock.
7-21 days
What MSK condition is associated with burns > 20% TBSA?
heterotpic ossification
What are the highest risk locations for heterotopic ossification due to the risk of contracture?
elbow, shoulder, hip
Renal impairment can occur with burns due to excessive _____.
myoglobin from muscle destruction
Polyneuropathy is associated with > ___% TBSA burns.
20%
What are the common locations of local neuropathies caused by burns?
brachial plexus, ulnar nerve, peroneal nerve, median nerve
PTSD is seen in ___% of burn survivors after 1 year.
45%
A position of ___ is the position of contracture.
comfort
What are the temperature parameters of a hubbard tank/whirlpool for an adult?
95-100 degrees
What are the temperature parameters of a hubbard tank/whirlpool for a child?
90 degrees
What is the maximum amount of time a burn victim should be in a hubbard tank/whirlpool
30 minutes
Scar tissue has more ___ and less ____ than normal skin.
More chondroitin-4-sulfate
Less hyaluronic acid
Scar tissue has (more/less) collagen organization and elasticity.
less
definition: progressive elongation of skin/scar over time in response to prolonged force
tissue creep
What are the parameters for PROM/AROM in burn victims?
10-30 reps for 2-3x/day
When splinting/positioning, you should maintain tissue at the end range of elongation in the (same/opposite) position of the burn wound location.
opposite
What are the parameters for manual stretching?
low load, 3x5 sets for 30-60 second hold for each motion
splinting type: airplane
splinting position:
90-120 degrees shoulder ABD
splinting type: elbow conformer
splinting position:
elbow EXT
splinting type: wrist cock up splint
splinting position:
wrist EXT
splinting type: hand splint
splinting position:
MP FLX
IP EXT
phalanx ABD
splinting type: hip splint
splinting position:
hip ABD and EXT
splinting type: knee conformer
splinting position:
knee EXT
Pressure application should be provided during the ___ process of burns/scar management.
remodeling process
Wounds requiring __-__ days for closure should receive a pressure garment.
14-21 days
Ace wraps provide __-__ mmHg of pressure.
10-15 mmHg
Tubular support bandages provide __-__ mmHg of pressure.
10-20 mmHg
Custom pressure garments can provide up to ___ mmHg of pressure.
25 mmHg
How long should a patient use a scar-mgmt pressure garment?
12-24 months or more
Remodeling of scar tissue can take up to __ months.
24 months
