Burns Flashcards
Superficial partial thickness
Blanches with pressure
Wet/Blistered
Increased sensitivity
Deep Partial Thickness
White, waxy and dry
Non blanching
Pressure sensitivity only
Full Thickness
Requires graft to heal
White/Charred
Decreased sensation
Zones of Cellular Injury
Outside ring - zone of hyperemia (increased perfusion)
Middle ring - zone of stasis (decreased sensation
Inside ring - zone of coagulation (maximal damage)
Cardiovascular response
Hypovolemic shock
Cardiac output changes
Electrolyte Imbalances
Edema
Respiratory
Inhalation injuries
Sedation requiring mechanical ventilation
Respiratory failure
Musculoskeletal
Loss of lean muscle mass and decreased bone density
Associated trauma/fractures
Amputation
Heterotopic Ossification
Exposed Tendons
Integumentary
Loss of thermoregulation
Changes in sensation
Cosmesis
Neurologic
Pain
Anxiety and PTSD
ICU Delirium
Peripheral Nerve Damage
Metabolic
Hypermetabolic state
Nutrition is critically important
X2 increase in metabolic need
Immunologic
Wound Infection
Sepsis
Burn Assessment Lund and Browder Chart
% by region
Head, thigh and leg changes % with age
Rule of Nines
% with head, torso, ab, legs and arm
Child and adult model
Indications for Referral to Burn Center
Partial-thickness burns greater than 10% TBSA
Full-thickness burns in any age group
Burns involving the face, hands, genitalia, perineum
Circumferential burns
Chemical or high voltage electric burns
Inhalation injury
Patients with significant co-morbidities
Burn injury with additional trauma injuries
Patient will require special social/emotional or long-term care and rehabilitation
Surgical Interventions
Autograph: Own body
Allograft: Cadaver/donor
Xenograft: Pig skin
Skin substitutes: man made matrix
Cultured epithelial cells: own grown cells
Priorities for grafting
Survival
Function
Cosmetic Appearance
Sheet Graft vs Meshed Graft
Sheet:
Improved cosmetic appearance
Graft of choice when there is more donor site available
Used on face, hands, feet
Meshed:
Slits are mechanically cut into graft to allow for stretch
Covers a larger surface area
Poorer cosmetic appearance
Often leads to hypertrophy and or contraction or shrinking of graft
PT Treatment Focused
Splinting/Positioning
ADL’s
ROM
Balance Training
Gait training/Prosthetic Training
Endurance Training
Functional Mobility
Posture
Scar Management
Edema Management
Discharge Planning
Return to School/Work
Caregiver/Patient Education
Splinting Goals
Support: Elongated position or position of greatest function
Minimize: Contractures
Protect: Tendons and joints
Prevent: Movement/disruption of new grafts
Guidelines for Splinting
Splint over uniform dressings: Modify dressings if necessary, prior to splinting
Allow time out of splints for participation in active movement exercises/activities
Avoid bony prominences to prevent creation of pressure injury
ROUTINE SPLINT CHECKS!
Risk factors for Scarring
Healing time > 14 days
Grafted wounds
Very young children
Re-harvested donor sites
Darker pigmented skin tones
Genetics
Immature/Active Scars
the 3 R’s
- Red
- Raised
- Ridged
Mature Scars
the 3 P’s
- Pale
- Planar
- Pliable
Scar Assessments
Vascularity
Pigmentation
Pliability
Height
