- primary wound care dressing - can absorb large quantities of exudate

- full thickness of epidermal & dermal layers & % of fat layers from donor site - graft survival is less - outcome better if graft adherence occurs

burns Flashcards by Samantha Elia

transparent film dressing

semi-occlusive
primary or secondary dressing
reduces infection risk
creates moist healing environment

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hydrogel sheet dressing

hydrates wound
keeps bacteria out
promotes autolytic debridement

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alginate dressing

primary wound care dressing
can absorb large quantities of exudate

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autolytic debridement

body’s own enzymes break down nonviable tissue
hydrogel sheet dressing to promote

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mechanical debridement

hydrotherapy
wet-to-dry dressings
wound irrigation followed by suction

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autograft

transplanting someone’s own skin from unburned area to burned area

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split-thickness graft

full epidermal & partial dermal layers & a % of fat layers from donor site
- graft survival is high

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full thickness graft

full thickness of epidermal & dermal layers & % of fat layers from donor site
graft survival is less
outcome better if graft adherence occurs

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meshed graft

stretched to cover greater surface area

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sheet graft

donor graft laid down as is

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how is edema measured with a burn?

circumferential measurements (no volumeter)

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when is scar management completed after a burn?

6-12 weeks after wound closure

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when is the emergent phase of a burn?

0-72 hours after

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xenografts

biologic dressing
- bovine skin, processed pig skin to protect skin from infection, debride, comfort during emergent phase

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allograft

human cadaver skin
-protect skin from infection, debride, comfort during emergent phase

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superficial/epidermal burn

1st degree
- superficial epidermis
- PAIN: min to mod
- BLISTERING: none
- min erytheme (redness)
- HEALING TIME: 3-7 days

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superficial partial thickness burn

superficial 2nd degree
- epidermis & dermis
- PAIN: significant
- BLISTERING: wet
- erytheme
- HEALING TIME: 1-3 weeks

deep partial thickness burn

deep 2nd degree
- epidermis, deep dermis, hair follicles, sweat glands
- PAIN: severe, even to light touch
- erythema, with or without blisters
- high risk of turning into full thickness burn due to infection
- consider grafting to prevent infection
- SENSATION: highly impaired
- high potential for hypertropic scar
- HEALING TIME: 3-5 weeks (varies)

full thickness burn

3rd degree
- epidermis, dermis, hair follicles, sweat glands, nerve endings
- PAIN: none
- SENSATION: none, even to light touch
- burn is pale, non blanching
- requires skin graft
- very high potential for hypertrophic scar

subdermal burn

full thickness burn with damage to underlying tissue (fat, muscle, bone)
charring, exposed fat, tendons, muscles
electrical burn = nerve pathway destruction
significant peripheral nerve damage
surgical intervention for wound closure or amputation
extremely high potential for hypertrophic scar

which burn phase includes charring?

subdermal burn

what burn phase has no pain?

full thickness/3rd degree

during what burn phase are skin grafts required?

full thickness/3rd degree

what types of precautions are necessary during the emergent phase of burn?

0-72 hrs after burn
- universal precautions for staff/family

what pharmacological treatment is used during the emergent phase to manage pain?

narcotic analgesics

escharotomy & debridement

removing burnt/dead skin, allowing new vascularized skin to close up wound

how long does the acute phase of burn last?

72 hrs after injury to wound closure (days or months later)

basic first aid for a 1st degree burn

1. immediately immerse in cool water/cool compress 2. apply sterile dressing to cover area

protocol for dorsal hand burns

- Boutonniere precaution - avoid active or passive composite flexion (ROM to MP with IP straight, ROM to IP with MP & DIP straight, confirm extensor hood integrity before composite flexion allowed)

ROM protocol for burn areas

gentle AROM/PROM early as possible except for post graft (wait until graft has adhered before AROM initated)

what should be done for LEs before standing, walking, prolonged sitting are attempted after a burn?

compression wrapping for vascular support beforehand to avoid pooling of fluid/blood in LEs

protocol following skin graft

1. splint hand in safe position for 5-7 days to allow graft to take & wounds to heal (prevent deformity) 2. AROM/PROM when graft has fully adhered

how long is hand in safe position after skin graft?

5-7 days

during which type of burn protocol is gross sensory screening completed?

electrical burns due to peripheral nerve involvement

scar management protocol after a burn

- mobilization orthosis (sub max stretch) - massage (manual, graded vibration) - compression (gloves, tubular gloves) - desensitization (graded touching, textures) - ROM (active, passive) - thermal modalities (ultrasound, moist heat)

which modalities should be applied in scar management protocol after a burn?

ultrasound, moist heat

pruritus

persistent itching, can lead to reopening of wound & skin maceration - tx: compression garments, skin lubrication, cold packs, antihistamines

edema management during acute phase of burn

elevate, AROM (if movement allowed), wrap with elastic bandage unless bulky wound dressing is used

Splinting with hand burns

- Splint opposite if burn is on volar side of hand (will develop contracture if not) - if burn is on dorsal side of hand, put it into extension as well (splint on same side)- makes client more functional - want position of discomfort

Intrinsic plus

Safe position/antideformity/clam digger position - MCPs in 70-90 degrees flexion - IPs in 0 degrees extension