Burns Flashcards
1
Q
Most common burn for children aged 1-5
A
- scalding (hot liquid)
2
Q
Most common burn for children aged 14 and younger
A
- accidental/unintentinal
3
Q
Most common burn for men between 16-40
A
- flammable liquids
4
Q
Most common place for burn injury in the home
A
- in the kitchen for those >75 years old
5
Q
Most common place for burn for people between 5-74 years old
A
- outdoors
6
Q
Criteria for transfer
A
- partial thickness burns >10% of the total body
- burns that involve the face, hands, feet, genitalia, perineum, or major joints
- 3rd degree burns in any age group
- electrical burns, including lightning injury
- chemical burns
- inhalation injury
- burn patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality
- burns with multiple traumas
- facilities without proper protocols or equipment
7
Q
Describe thermal burns
A
- caused by contact from a heat source such as flame, hot substance, or steam
8
Q
Describe scalds
A
- can be caused by hot water, hot oil, or hot grease
- hot oils have greater thermal energy thus cause increased damage
9
Q
Describe radiation burns
A
- radiation does not have a direct contact
- examples are sunburn, radiation treatments, or atomic bomb
10
Q
Describe electrical burns
A
- often deepest damage to skin layers
- vary in damage based on current, intensity, & area of contact
- electricity follows the path of least resistance meaning nerves –> blood vessels –> bone
- usually a small entrance wound and a large exit wound
11
Q
Describe chemical burns
A
- results from acids (cleaning products/drain cleaners), alkaline (rust remover/swimming pool cleaner), or organic compounds (gasoline)
12
Q
Describe inhalation burns
A
- damage to the respiratory tract or lung tissue
- due to heat, smoke, or chemical irritants
- results in upper airway, tracheobronchial, &/or parenchymal injury
13
Q
Classification of burns
A
- depth and size of burn
- location
- age of patient
- health of patient
- cause of burn
14
Q
Describe superficial/epidermal burns
A
- only cell damage to epidermis
- skin appears erythematous, dry, free of blisters, & tender to touch
- mild edema & delayed onset of pain
- skin will heal on its own without scarring
- injured skin will “peel” in 3-4 days
15
Q
Describe superficial partial thickness
A
- epidermis & upper dermis are damaged
- presence of intact blisters
- blisters may impede healing
- evacuation to reveal moist bright red wound base
- blanching is present
- extremely painful
- scarring is minimal
- heals well
16
Q
Define blanching
A
- release = quick capillary refill
17
Q
Describe deep partial thickness
A
- epidermis is destroyed
- dermis is severely damaged
- hair follicles are present
- wound base is red & waxy white
- very painful
- marked edema
- light touch is diminished but deep pressure is intact
- sluggish capillary refill
- broken blisters
18
Q
Describe full thickness
A
- all epidermal & dermal layers destroyed
- eschar will be present
- destruction of blood vessels lead to massive edema & & thrombosis
- no blanching
- hair follicles, nerve endings destroyed
- surrounding wound may be painful
- distal pulses can be absent
- pressure & eschar = occlusion, no elasticity, & necrosis
19
Q
Define escharotomy
A
- incision length of extremity/chest to allow blood flow
20
Q
Subnormal burns
A
- complete destruction of epidermis, dermis, & subcutaneous tissue
- muscle & bone may be damaged
- patient will require extensive surgical & therapeutic management
21
Q
Depth and characteristics of superficial burns
A
- epidermis
- pain, redness, mild swelling
22
Q
Depth and characteristics of superficial partial burns
A
- dermis: papillary region
- pain, blisters, severe swelling
23
Q
Depth and characteristics of deep partial burns
A
- dermis: reticular region
- white, leathery
24
Q
Depth and characteristics of full thickness/subdermal
A
- hypodermis
- charred, insensate, eschar formation
25
Define zone of coagulation
- cells are irreversibly destroyed
- full thickness = skin grafting
- eschar is present & increased risk of infection
26
Define zone of stasis
- cells may die within 1-2 days without treatment
- infection, drying or ischemia may lead to necrosis
27
Define zone of hyperemia
- minimal cell damage
- may recover in a few days without long lasting damage
28
Describe the rule of 9's
Front of face = 4.5
Back of face = 4.5
Front of chest = 9
Back of chest = 9
Abdomen = 9
Buttocks = 9
Front of arm = 4.5
Back of arm = 4.5
Front of leg = 9
Back of leg = 9
Genitals = 1
29
Describe Lund and Browder
- decrease percentage body surface area for the head & increase percentage body surface area for the legs as the child ages, making it more useful in pediatric burns
30
Indirect complications for burns
- infection
- pulmonary complication
- metabolic complication
- cardiac complication
- heterotypic ossification
- neuropathy
- pathological scars
- amputations
31
Describe infection
- can cause a wound to deepen
- treated with topical/systemic antibiotics
32
Primary pulmonary complications
- pulmonary edema
- carbon monoxide poisoning
- tracheal damage
- upper airway obstruction
- pneumonia
33
Describe metabolic complications
- increased metabolic activity leads to decreased body weight, energy stores, & increased core body temp.
- increased heat loss at wound site requiring hospital rooms at 86 degrees
34
Describe cardiac complications
- patient may develop decreases in hemoglobin and hematocrit
- decrease plasma, intravascular fluid, & cardiac output
35
Define heterotopic ossification
- bone begins to lay down in soft tissues
36
Signs & symptoms of heterotopic ossification
- pain
- tenderness
- decreased ROM
- pathologic hard end feel
- surgery may be done to excise after 2 years of maturation
37
Causes of neuropathies in burn patients
- compression bandages that are too tight
- poor positioning
- poorly fitting splints
- trauma
- swelling
38
Describe hypertrophic scarring
- mismatch in collagen formation & lysis
- abnormal response to trauma or injury
- common in deep partial thickness burns
- pressure decreases the formation
- will not affect the uninjured skin
39
Describe keloids
- a proliferation of collagen tissue
- will travel beyond to unaffected skin
40
Common affected areas for amputation in burn patients
- ears
- nose
- fingers
- toes
41
Initial medical management for burns
- establish & maintain airway
- prevent cyanosis, shock, & hemorrhage
- establish baseline data
- prevent/reduce fluid loss
- clean patient & wounds
- examine injuries
- prevent pulmonary & cardiac complications
42
Surgical management for burns
- Escharatomy: used for full thickness burns/ means to cut into eschar
- Primary excision: used to remove eschar, grafting can be done right after
43
Describe skin grafting
- graft is taken from donor site (thigh, buttocks, or back)
- split thickness = epidermis & varying amount of dermis
- full thickness = full dermal thickness
- thinner grafts = greater adherence
- thicker grafts = cosmetics
44
Define autograft
- the skin is donated by the patient
45
Define sheet graft
- an autograft technique
- the harvested skin is applied to a site without alteration & stapled in place
- common on the face, neck, & hands for cosmetic appeal
46
Define mesh graft
- an autograft technique when limited skin is available
- the harvested skin is run thru a machine that makes tiny slits to stretch for coverage
47
Define allograft
- graft skin is taken from individual of the same species
48
Define xenografts
- graft skin is taken from another species
- pig grafts are most common
49
Describe graft care
- usually held in place with sutures, staples, or steri-strips
- requires pressure dressings to remove build between graft & recipient site
- requires adequate vascularity
- we don't exercise until graft has adhered
- avoid separation of graft from site
50
Purpose of z-plasty
- the purpose is to lengthen the scar & increase ROM
51
Physical therapy inventions for burn patients
- positioning
- splinting
- therapeutic exercise
- ambulation
- scar management
52
Physical therapy goals for burn patients
- increase wound/soft tissue healing
- decrease risk of infection/secondary complications
- max ROM achieved
- restore pre-morbid cardiovascular endurance
- increase strength
- maximize independence in ambulation & ADL's
- minimize scar formation
- patient, family, & caregiver education
- independent self management
53
Goals for positioning
- minimize edema
- prevent tissue destruction
- maintain soft tissues
- prevent contractures
- preserve function
54
Goals of splinting
- prevent contractures
- maintain ROM achieved during treatment
- protect joint or tendons
- improve pain
55
Define orthostatic hypotension
- when you feel light headed after standing up too quickly due to low blood pressure caused by slow blood return to the heart
56
How often should compression garments be worn
- should be worn 23 hours a day for 12-18 months until scar is flat & pale
