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Clinical Medicine I > Burns > Flashcards

Burns Flashcards

1
Q

Most common burn for children aged 1-5

A
  • scalding (hot liquid)
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2
Q

Most common burn for children aged 14 and younger

A
  • accidental/unintentinal
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3
Q

Most common burn for men between 16-40

A
  • flammable liquids
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4
Q

Most common place for burn injury in the home

A
  • in the kitchen for those >75 years old
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5
Q

Most common place for burn for people between 5-74 years old

A
  • outdoors
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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
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7
Q

Describe thermal burns

A
  • caused by contact from a heat source such as flame, hot substance, or steam
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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
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9
Q

Describe radiation burns

A
  • radiation does not have a direct contact
  • examples are sunburn, radiation treatments, or atomic bomb
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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
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11
Q

Describe chemical burns

A
  • results from acids (cleaning products/drain cleaners), alkaline (rust remover/swimming pool cleaner), or organic compounds (gasoline)
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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
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13
Q

Classification of burns

A
  • depth and size of burn
  • location
  • age of patient
  • health of patient
  • cause of burn
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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
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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
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16
Q

Define blanching

A
  • release = quick capillary refill
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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
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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
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19
Q

Define escharotomy

A
  • incision length of extremity/chest to allow blood flow
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20
Q

Subnormal burns

A
  • complete destruction of epidermis, dermis, & subcutaneous tissue
  • muscle & bone may be damaged
  • patient will require extensive surgical & therapeutic management
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21
Q

Depth and characteristics of superficial burns

A
  • epidermis
  • pain, redness, mild swelling
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22
Q

Depth and characteristics of superficial partial burns

A
  • dermis: papillary region
  • pain, blisters, severe swelling
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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
Q

Define zone of coagulation

A
  • cells are irreversibly destroyed
  • full thickness = skin grafting
  • eschar is present & increased risk of infection
26
Q

Define zone of stasis

A
  • cells may die within 1-2 days without treatment
  • infection, drying or ischemia may lead to necrosis
27
Q

Define zone of hyperemia

A
  • minimal cell damage
  • may recover in a few days without long lasting damage
28
Q

Describe the rule of 9’s

A

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
Q

Describe Lund and Browder

A
  • 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
Q

Indirect complications for burns

A
  • infection
  • pulmonary complication
  • metabolic complication
  • cardiac complication
  • heterotypic ossification
  • neuropathy
  • pathological scars
  • amputations
31
Q

Describe infection

A
  • can cause a wound to deepen
  • treated with topical/systemic antibiotics
32
Q

Primary pulmonary complications

A
  • pulmonary edema
  • carbon monoxide poisoning
  • tracheal damage
  • upper airway obstruction
  • pneumonia
33
Q

Describe metabolic complications

A
  • 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
Q

Describe cardiac complications

A
  • patient may develop decreases in hemoglobin and hematocrit
  • decrease plasma, intravascular fluid, & cardiac output
35
Q

Define heterotopic ossification

A
  • bone begins to lay down in soft tissues
36
Q

Signs & symptoms of heterotopic ossification

A
  • pain
  • tenderness
  • decreased ROM
  • pathologic hard end feel
  • surgery may be done to excise after 2 years of maturation
37
Q

Causes of neuropathies in burn patients

A
  • compression bandages that are too tight
  • poor positioning
  • poorly fitting splints
  • trauma
  • swelling
38
Q

Describe hypertrophic scarring

A
  • 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
Q

Describe keloids

A
  • a proliferation of collagen tissue
  • will travel beyond to unaffected skin
40
Q

Common affected areas for amputation in burn patients

A
  • ears
  • nose
  • fingers
  • toes
41
Q

Initial medical management for burns

A
  • establish & maintain airway
  • prevent cyanosis, shock, & hemorrhage
  • establish baseline data
  • prevent/reduce fluid loss
  • clean patient & wounds
  • examine injuries
  • prevent pulmonary & cardiac complications
42
Q

Surgical management for burns

A
  • Escharatomy: used for full thickness burns/ means to cut into eschar
  • Primary excision: used to remove eschar, grafting can be done right after
43
Q

Describe skin grafting

A
  • 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
Q

Define autograft

A
  • the skin is donated by the patient
45
Q

Define sheet graft

A
  • 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
Q

Define mesh graft

A
  • 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
Q

Define allograft

A
  • graft skin is taken from individual of the same species
48
Q

Define xenografts

A
  • graft skin is taken from another species
  • pig grafts are most common
49
Q

Describe graft care

A
  • 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
Q

Purpose of z-plasty

A
  • the purpose is to lengthen the scar & increase ROM
51
Q

Physical therapy inventions for burn patients

A
  • positioning
  • splinting
  • therapeutic exercise
  • ambulation
  • scar management
52
Q

Physical therapy goals for burn patients

A
  • 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
Q

Goals for positioning

A
  • minimize edema
  • prevent tissue destruction
  • maintain soft tissues
  • prevent contractures
  • preserve function
54
Q

Goals of splinting

A
  • prevent contractures
  • maintain ROM achieved during treatment
  • protect joint or tendons
  • improve pain
55
Q

Define orthostatic hypotension

A
  • when you feel light headed after standing up too quickly due to low blood pressure caused by slow blood return to the heart
56
Q

How often should compression garments be worn

A
  • should be worn 23 hours a day for 12-18 months until scar is flat & pale

Clinical Medicine I (26 decks)

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