burns Flashcards
transparent film dressing
- semi-occlusive
- primary or secondary dressing
- reduces infection risk
- creates moist healing environment
hydrogel sheet dressing
- hydrates wound
- keeps bacteria out
- promotes autolytic debridement
alginate dressing
- primary wound care dressing
- can absorb large quantities of exudate
autolytic debridement
- body’s own enzymes break down nonviable tissue
- hydrogel sheet dressing to promote
mechanical debridement
- hydrotherapy
- wet-to-dry dressings
- wound irrigation followed by suction
autograft
transplanting someone’s own skin from unburned area to burned area
split-thickness graft
full epidermal & partial dermal layers & a % of fat layers from donor site
- graft survival is high
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
meshed graft
stretched to cover greater surface area
sheet graft
donor graft laid down as is
how is edema measured with a burn?
circumferential measurements (no volumeter)
when is scar management completed after a burn?
6-12 weeks after wound closure
when is the emergent phase of a burn?
0-72 hours after
xenografts
biologic dressing
- bovine skin, processed pig skin to protect skin from infection, debride, comfort during emergent phase
allograft
human cadaver skin
-protect skin from infection, debride, comfort during emergent phase
superficial/epidermal burn
1st degree
- superficial epidermis
- PAIN: min to mod
- BLISTERING: none
- min erytheme (redness)
- HEALING TIME: 3-7 days
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
- immediately immerse in cool water/cool compress
- 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
- splint hand in safe position for 5-7 days to allow graft to take & wounds to heal (prevent deformity)
- 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
