Burn Management Flashcards
What are the three peak incidences for burns?
Children 1-5 2 to scalds
Adolescents 2 to accidents with flammable liquids
Men 16-40
Which demographic has the highest incidence of burns?
Men 16-40
What is the amount of time needed for follow-up post burn injury?
Minimum of 1 year
What are the four classifications of burns?
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
What are some characteristics of a superficial burn? (3)
Tender to touch
Dry, bright red, or pink skin that blanches under pressure
No edema or blisters
A superficial burn involves what layer(s) of the skin?
The epidermis only
What is the healing time for a superficial burn?
2-3 days with no scarring
A superficial partial thickness burn involves what layer(s) of the skin?
Epidermis and papillary layer of the dermis
What are some characteristics of a superficial partial thickness burn? (4)
Moist, weeping, (intact) blistered skin
Will blanch under pressure
Painful due to exposed nerve endings
Wound drainage
What is the healing time for a superficial partial thickness burn?
7-10 days with minimal scarring
A deep partial thickness burn involves what layer(s) of the skin?
Epidermis and dermis down to reticular layer - includes nerve endings, hair follicles, and sweat glands
What are some characteristics of a deep partial thickness burn? (5)
Mottled areas of red with white eschar May have large ruptured blisters Sluggish capillary refill Significant edema Decreased sensation
What is the healing time for a deep partial thickness burn?
3-5 weeks, split thickness skin graft is usually required
A full thickness burn involves what layer(s) of the skin?
Epidermis and dermis
Subcutaneous tissue may also be involved
What are some characteristics of a full thickness burn? (6)
Covered with eschar (black/deep red/white)
Necrotic, charred
Leathery, dry, rigid
Exposed deep tissues (tendon, muscle or bone)
Insensate
Peripheral vascular system damaged –> fluid leaks into interstitial spaces –> edema
Split thickness skin graft required
What is an escharotomy?
an incision through the eschar to expose the fatty tissue below
Why would a patient have an escharotomy?
To combat compartment syndrome
What is a subdermal burn?
A burn from the dermis down through the subcutaneous tissue, muscle, and bone
What would cause a subdermal burn?
Prolonged contact with flame, hot liquid, electricity, etc
What would a subdermal burn look like?
Charred or mummified
Will a subdermal burn need intervention?
Yes, it will not heal without intervention such as fasciotomy, escharotomy, grafting
Amputation is usually required however
What is the breakdown of percentages of the TBSA classification for burns? (Rule of 9’s)
Head - 9%
Arms - 9% each
Trunk - 18% each for ant/post
Legs - 18% each
What are three types of burns?
Thermal
Chemical
Electrical
Which type of burn is most common?
Thermal
What are some severity factors for thermal burns? (3)
Contact time
Temp
Type of insult
What are some severity factors for chemical burns? (4)
Alkali > acid
Contact time
Concentration
Amount of chemical
What are some severity factors for electrical burns? (3)
AC > DC
Contact time
Voltage
What are some things to watch for with an electrical burn? (3)
Entrance and exit wounds
Cardiac arrythmias
Respiratory arrest
What is an inhalation injury?
An injury from inhaling smoke/hot air
The absence of a smoke detector increases the risk of death in a fire by what %?
60%
What is Stevens Johnson Syndrome (SJS)?
An immune complex mediated hypersensitivity disorder involving the skin and mucous membranes
What is SJS caused by?
Drugs, viral infections
How do you classify the severity of a burn? (5)
TBSA burned Depth of wound Age of pt PMH Part of body burned
Why would you see shock in a burn pt?
Hypovolemia ( ↑HR, ↓ BP, ↓ urine)
Loss of plasma and extracellular fluid
TBSA > 30%
When would you see hypermetabolism in a burn pt?
> 50% TBSA (may be 2.5 BMR)
What is involved the medical management of a burn? (7)
Maintain airway Determine extent/depth of injury Prevent fluid loss Prevent pulmonary and CV issues Clean pt and wounds Place dressings Surgical management
What are the three phases of burn management?
Resuscitive phase
Wound coverage phase
Reconstructive phase
What is involved in the resuscitive phase? (4)
IV therapy to compensate for fluid loss
Escharotomy as needed
NPO first 24 hr
CV support as needed
What is involved in the wound coverage phase? (3)
Excision/debridement
Dressings
Grafting if needed
What are some common dressings used in burns? (5)
Silvadene - use on non-grafted burn or donor site
Acticoat/Mepilex - impregnated with Ag
Collagenase - for deeper burns or grafts with slough/eschar
Bacitracin - for grafts or donor sites
Sulfamylon - used on grafts with poor adherence (soupy or fragile)
What are four options for skin grafts?
Autograft (STSG)
Allograft (cadaver skin)
Xenograft (pig)
Skin substitute (Integra)
What is the only skin graft that is permanent?
Autograft
What are some advantages of using a sheet STSG? (3)
Durable
Limits contraction
Cosmetic
What are some disadvantages of using a sheet STSG?
Difficult adherence
What are some advantages of using a mesh STSG? (3)
Covers more area
Better if wound bed is irregular
Better if wound bed is contaminated
What are some disadvantages of using a mesh STSG?
Less durable
Contracts more
What are some common STSG donor sites?
Thigh
Leg
Back
Buttock
How many times can a donor site be harvested?
3-4
How would you treat a donor site?
As a partial thickness wound
What factors need to be present in the graft recipient area? (4)
Adequate vascularity
Complete contact between graft and wound
Adequate immobilization
Few bacteria
What are some physical therapy goals for burn pts? (7)
Decrease edema Prevent contracture Maintain/improve strength and activity tolerance 3 day hold after STSG to LE for gait Pt edu D/C planning Manage scarring
What are some benefits of ace wrapping a burn?
Supports graft or burn area
Promotes circulation
Preventing hemorrhaging
First phase of scar control
What shape will you use for ace wrapping a burn?
Spiral or figure 8
Can a pt sleep in an ace wrap?
No
When should ROM be performed?
Upon admission
What are some benefits of ROM? (5)
Reduce edema Promote circulation Prevent contractures Preserve jt mobility Promote max functional independence
What kind of burns have a greater chance of scar contracture?
Deeper burns
How pliable is burn scar tissue?
1/3 of normal skin
How should you keep burn scar tissue?
Elongated
How do you know if burn scar tissue is tight?
If it’s white, it’s tight
What are some contraindications to exercise in burn pts? (4)
Exposed joints
Exposed tendon over PIPs
DVT
Comparment syndrome
How much exercise is too much exercise for burn patients?
You cannot over-exercise
How long should a skin graft be immobilized?
5-14 days
Do we want burn patients to be comfortable?
NO. THEY WILL FORM CONTRACTURES AND DIE!!!
What are some complications of facial burns?
Ectropion of eye
Ectropion of mouth
What is an ectropion of the eye?
The lower lid pulls away from the eye
What are some complications an ectropion of the eye? (3)
Excessive tear production
Conjunctivitis
Keratitis
What are some complications an ectropion of the mouth?
Difficulty managing secretions, liquids
What are potential some complications of a shoulder burn? (3)
Flexion or adducation contracture
Scapular retraction of protraction contracture
Limited chest wall expansion
What are potential some complications of a wrist burn? (2)
Flexion or extension contracture
Inability to ulnar deviate
What are potential some complications of a hip burn? (2)
Flexion contracture
Inability to fully extend hips during gait
What are potential some complications of a knee burn? (2)
Flexion contracture
Inability to fully extend knees during gait
What are potential some complications of a ankle burn? (2)
PF contracture
For deep partial and full thickness, which cross posterior ankle, consider multipodus boot
What are potential some complications of a MTP/IP burn? (2)
Can affect wearing shoes or push-off during gait
Use aggressive ROM
What is the most important rule of positioning for burn patients?
POSITION OF COMFORT = POSITION OF CONTRACTURE
What percentage of burn patients will develop hypertrophic scarring?
80% - the use of compression therapy is indicated for most burns
What benefits from compression therapy confer?
Mechanical thinning effect
Decreases blood flow to area
Reorganizes collagen bundles
Decreases tissue water content
How long will patients need to wear compression garments after a burn?
1-2 years, 23 hours per day
