Burns Flashcards
Most common burn for children aged 1-5
- scalding (hot liquid)
Most common burn for children aged 14 and younger
- accidental/unintentinal
Most common burn for men between 16-40
- flammable liquids
Most common place for burn injury in the home
- in the kitchen for those >75 years old
Most common place for burn for people between 5-74 years old
- outdoors
Criteria for transfer
- 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
Describe thermal burns
- caused by contact from a heat source such as flame, hot substance, or steam
Describe scalds
- can be caused by hot water, hot oil, or hot grease
- hot oils have greater thermal energy thus cause increased damage
Describe radiation burns
- radiation does not have a direct contact
- examples are sunburn, radiation treatments, or atomic bomb
Describe electrical burns
- 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
Describe chemical burns
- results from acids (cleaning products/drain cleaners), alkaline (rust remover/swimming pool cleaner), or organic compounds (gasoline)
Describe inhalation burns
- damage to the respiratory tract or lung tissue
- due to heat, smoke, or chemical irritants
- results in upper airway, tracheobronchial, &/or parenchymal injury
Classification of burns
- depth and size of burn
- location
- age of patient
- health of patient
- cause of burn
Describe superficial/epidermal burns
- 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
Describe superficial partial thickness
- 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
Define blanching
- release = quick capillary refill
Describe deep partial thickness
- 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
Describe full thickness
- 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
Define escharotomy
- incision length of extremity/chest to allow blood flow
Subnormal burns
- complete destruction of epidermis, dermis, & subcutaneous tissue
- muscle & bone may be damaged
- patient will require extensive surgical & therapeutic management
Depth and characteristics of superficial burns
- epidermis
- pain, redness, mild swelling
Depth and characteristics of superficial partial burns
- dermis: papillary region
- pain, blisters, severe swelling
Depth and characteristics of deep partial burns
- dermis: reticular region
- white, leathery
Depth and characteristics of full thickness/subdermal
- hypodermis
- charred, insensate, eschar formation
Define zone of coagulation
- cells are irreversibly destroyed
- full thickness = skin grafting
- eschar is present & increased risk of infection
Define zone of stasis
- cells may die within 1-2 days without treatment
- infection, drying or ischemia may lead to necrosis
Define zone of hyperemia
- minimal cell damage
- may recover in a few days without long lasting damage
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
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
Indirect complications for burns
- infection
- pulmonary complication
- metabolic complication
- cardiac complication
- heterotypic ossification
- neuropathy
- pathological scars
- amputations
Describe infection
- can cause a wound to deepen
- treated with topical/systemic antibiotics
Primary pulmonary complications
- pulmonary edema
- carbon monoxide poisoning
- tracheal damage
- upper airway obstruction
- pneumonia
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
Describe cardiac complications
- patient may develop decreases in hemoglobin and hematocrit
- decrease plasma, intravascular fluid, & cardiac output
Define heterotopic ossification
- bone begins to lay down in soft tissues
Signs & symptoms of heterotopic ossification
- pain
- tenderness
- decreased ROM
- pathologic hard end feel
- surgery may be done to excise after 2 years of maturation
Causes of neuropathies in burn patients
- compression bandages that are too tight
- poor positioning
- poorly fitting splints
- trauma
- swelling
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
Describe keloids
- a proliferation of collagen tissue
- will travel beyond to unaffected skin
Common affected areas for amputation in burn patients
- ears
- nose
- fingers
- toes
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
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
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
Define autograft
- the skin is donated by the patient
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
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
Define allograft
- graft skin is taken from individual of the same species
Define xenografts
- graft skin is taken from another species
- pig grafts are most common
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
Purpose of z-plasty
- the purpose is to lengthen the scar & increase ROM
Physical therapy inventions for burn patients
- positioning
- splinting
- therapeutic exercise
- ambulation
- scar management
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
Goals for positioning
- minimize edema
- prevent tissue destruction
- maintain soft tissues
- prevent contractures
- preserve function
Goals of splinting
- prevent contractures
- maintain ROM achieved during treatment
- protect joint or tendons
- improve pain
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
How often should compression garments be worn
- should be worn 23 hours a day for 12-18 months until scar is flat & pale
