Burns Flashcards
What are the three types of burns, their mechanisms, and factors influencing severity?
Thermal Burns:
- Caused by direct or indirect contact with flame, hot liquids, or steam.
- Severity depends on contact time, temperature, and type of insult.
Chemical Burns:
- Result from acids, bases, or industrial chemicals.
- Alkaline burns are more severe than acidic burns.
- Severity depends on chemical concentration, contact time, and thoroughness of irrigation.
Electrical Burns:
- Caused by low- or high-voltage currents.
- Characterized by entrance and exit wounds, with deeper tissue damage due to varying tissue resistance.
- Severity depends on voltage, contact time, and whether the current is alternating (more damaging).
How do thermal, chemical, and electrical burns differ in presentation and long-term implications?
Thermal Burns:
- Present with localized tissue damage, varying in depth depending on contact time.
- Long-term complications include scarring and potential contractures.
Chemical Burns:
- Can worsen over time (24–72 hours) if not thoroughly irrigated.
- Long-term risks include full-thickness damage and systemic absorption of chemicals.
Electrical Burns:
- May have minimal visible skin damage despite severe internal injuries like muscle necrosis and cardiac arrhythmias.
- Long-term risks include nerve damage and organ failure.
Differentiate between superficial, partial-thickness, full-thickness, and subdermal burns.
Superficial Burns (1st degree):
- Affect the epidermis only.
- Skin is dry, red/pink, blanches under pressure, no blisters.
- Heals in 3–5 days without scarring (e.g., sunburn).
Partial-Thickness Burns (2nd degree):
- 1. Superficial:
- Involves the papillary dermis.
- Skin is moist, blistered, painful, and erythematous.
- Heals in 10–14 days with minimal scarring.
- 2. Deep:
- Extends to the reticular dermis.
- Skin is mottled red/white with eschar, slow capillary refill, and reduced sensation.
- Healing >3 weeks with risk of scarring and contractures.
Full-Thickness Burns (3rd degree):
- Destruction of epidermis and dermis to subcutaneous fat.
- Skin appears leathery, dry, insensate. Requires grafting.
Subdermal Burns (4th degree):
- Extends to muscle/bone.
- Charred appearance, insensate, often requires amputation.
What are common causes for each burn depth?
Superficial Burns:
- Sunburn, minor flash burns.
Partial-Thickness Burns:
- Superficial
- brief contact with hot objects or dilute chemicals;
- Deep
- prolonged contact with scalds or flames. Full-
Thickness Burns:
- Prolonged exposure to flame, immersion scalds.
Subdermal Burns:
- High-voltage electrical burns, strong chemical burns.
How do partial-thickness burns differ from full-thickness burns in healing and outcomes?
Partial-Thickness Burns:
- Heal through re-epithelialization.
- Superficial types heal within 10–14 days.
- Deep burns may take >3 weeks and carry risks of pigment changes and contractures.
Full-Thickness Burns:
- Require surgical intervention (debridement and grafting) as they lack viable epithelial structures for natural healing.
- Scarring and functional impairments are common without treatment.
What is the Rule of Nines, and how is it used in burn size estimation?
The Rule of Nines divides the body into regions representing 9% (or multiples) of the total body surface area (TBSA):
- Head (9%)
- Front and back of each arm (4.5%),
- Front of each leg (9%)
- Back of each leg (9%)
- Anterior trunk (18%)
- Posterior trunk (18%)
- Perineum (1%)
It provides a quick method for estimating burn size in adults but often overestimates injuries.
How does the Lund-Browder classification improve burn size estimation in children?
The Lund-Browder Classification adjusts for age-related differences in body proportions.
- For example, the head represents a larger percentage of TBSA in children.
- This method is more accurate for pediatric burn patients and is preferred in pediatric burn units.
What is the Palmar Method, and when is it used for burn size estimation?
- The Palmar Method uses the patient’s palm and fingers as a reference for estimating burn size, with the area representing approximately 1% of TBSA.
- It is particularly useful for assessing small, irregularly shaped burns when other methods are impractical.
How is burn severity classified, and what determines treatment location?
Burn severity depends on burn size, depth, and patient age:
- Minor Burns:
- Small partial-thickness burns (< 10% TBSA in adults, < 5% TBSA in children).
- Treated outpatient.
- Moderate Burns:
- Larger partial-thickness burns (10–20% TBSA in adults).
- Require inpatient care.
- Major Burns:
- > 20% TBSA in adults, full-thickness burns >10%, or burns involving critical areas (face, hands, feet, perineum).
- Treated in specialized burn centers.
What are the zones of burn injury, and how do they differ?
Burns involve three zones:
- Zone of Coagulation:
- Central area with irreparable damage and necrosis.
- Zone of Stasis:
- Surrounding area with impaired perfusion.
- Conversion can extend necrosis.
- Zone of Hyperemia:
- Peripheral area with minimal cellular damage, recoverable with proper treatment.
These zones guide therapeutic focus to prevent progression and promote healing.
What is burn shock, and why is fluid resuscitation critical in burn management?
- Burn shock is a condition of hypovolemia and edema caused by massive fluid shifts after burns >15% TBSA.
- It leads to reduced tissue perfusion, organ failure, and death if untreated.
- Fluid resuscitation using formulas like Parkland (e.g., 4 mL/kg/%TBSA) restores circulatory volume, prevents ischemia, and reduces complications.
- Blood pressure and heart rate (elevated to 100–120 bpm) must be monitored.
How do burns affect the pulmonary system, and what are key considerations for management?
- Burns may cause pulmonary damage, especially if inhalation injury is suspected (e.g., singed nasal hairs, carbonaceous sputum).
- Complications include airway obstruction, carbon monoxide poisoning, and ARDS.
- Management involves monitoring oxygen saturation, encouraging pulmonary hygiene (deep breathing, coughing), and possibly ventilatory support.
What metabolic changes occur after a major burn injury?
- Burns increase basal metabolic rate (BMR) up to 2–3 times normal levels, leading to hypercatabolism, muscle wasting, and stress hyperglycemia.
- Nutritional needs increase significantly, and core body temperature rises.
- These changes peak 7–17 days post-injury, requiring aggressive nutritional support to prevent loss of lean body mass and promote healing.
Why are burn patients at high risk for infection, and what are common signs?
- Burn patients are at high risk due to prolonged open wounds, decreased tissue perfusion, and ineffective neutrophils.
- Eschar and residual fluids provide an ideal environment for bacteria.
- Common signs of infection include increased erythema, pain, foul odor, purulence, necrosis, fever, and tachycardia.
What are the primary goals of debridement in burn wound management?
- Debridement removes necrotic tissue, exudate, and foreign debris to reduce infection risk, promote healing, and prepare for grafting.
- It may involve sharp, enzymatic, or mechanical techniques.
- Removal of blisters (open and closed) prevents bacterial colonization.
- Aggressive debridement is essential for large burns to ensure rapid coverage and minimize complications.
What are the key principles of infection control for burn patients?
- Infection control includes:
- 1. Sterile technique for dressing changes in burns with large TBSA.
- 2. Topical antimicrobials like silver sulfadiazine, mafenide acetate, or bacitracin to prevent bacterial colonization.
- 3. Frequent monitoring for infection signs (erythema, purulence, fever).
- 4. Avoidance of dressings with strikethrough to minimize bioburden.
- Effective infection control reduces sepsis risk, which accounts for 75% of burn-related deaths.
What types of dressings are used for burn wounds, and how are they selected?
- Dressings are chosen based on wound characteristics:
- 1. Nonadherent impregnated gauze (e.g., with antimicrobials) for large burns.
- 2. Hydrogel sheets for partial-thickness localized burns to retain moisture.
- 3. Semipermeable foam for wounds with moderate drainage.
- 4. Compression dressings to reduce edema and support mobility.
- Dressings should be adjusted as the wound progresses, ensuring minimal bulk for ROM and splint use.
What are the procedural interventions for managing burn injuries?
- Key interventions include:
(1) Range of Motion (ROM):
- Prevents contractures and maintains joint mobility.
(2) Mobility Training:
- Encourages early ambulation with assistive devices.
(3) Breathing Exercises:
- Promotes pulmonary hygiene in patients with inhalation injuries.
- Aerobic Exercise:
- Targets 50–70% of maximum heart rate to counteract deconditioning.
- These interventions enhance overall recovery and minimize complications.
How is scar management conducted in burn patients?
Scar management involves:
- Moisturization and Protection: Prevent friction and shear.
- Scar Mobilization: Manual techniques to increase pliability.
- Compression Therapy: Mandatory for wounds taking >3 weeks to close.
- Silicone Gel Sheets/Pads: Reduce hypertrophic scarring.
- Ultrasound Therapy: Improves scar pliability.
- Patients with darker skin tones are at higher risk for hypertrophic scars and keloids, requiring aggressive management.
What is the Vancouver Scar Scale, and how is it used?
The Vancouver Scar Scale (VSS) rates four scar qualities:
- vascularity
- pliability
- pigmentation
- height
- Scores range from 0–14, with lower scores indicating less severe scarring.
- The VSS is used to assess treatment efficacy and guide interventions like compression therapy and silicone gel application.
Why are compression garments essential in scar management, and when are they indicated?
- Compression garments are essential for scars from burns that take >3 weeks to heal.
- They reduce edema, flatten hypertrophic scars, and improve tissue alignment.
- Continuous use (23 hours/day) for 12–18 months is typically required.
- Compression also facilitates ROM and prevents banding of scar tissue, especially in joints.
How are contractures prevented in burn patients, and why is positioning important?
Contractures are prevented through:
- Proper Positioning: Avoid shortening of tissues (e.g., neck in extension for anterior neck burns, arms abducted for axillary burns).
- Stretching and Splinting: Maintain length in healing tissues.
- ROM Exercises: Frequent passive and active stretching.
Improper positioning can lead to permanent deformities, especially in high-risk areas like the hands, neck, and knees.
What is the purpose of escharotomy and fasciotomy in burn management?
Escharotomy:
- Incision through eschar to relieve constriction and restore circulation in full-thickness burns.
- Prevents ischemia and compartment syndrome.
Fasciotomy:
- Deeper incision through fascia to improve perfusion in cases of severe pressure or deep tissue injury (e.g., electrical burns).
- Both procedures are life-saving in cases of circulatory compromise.
What are the types of skin grafts used for burn patients, and how do they differ?
- Split-Thickness Grafts:
- Include epidermis and part of the dermis.
- Preferred for larger wounds; less durable and cosmetic.
- Full-Thickness Grafts:
- Include epidermis and full dermis. Used for areas requiring durability (e.g., palms, soles).
- Xenografts/Allografts:
- Temporary coverage from animal or cadaver tissue.
- Skin Substitutes:
- Bilayered dressings (e.g., Integra) mimic skin layers for temporary coverage.
- Autografts are the gold standard for long-term wound healing.
What are the benefits of skin substitutes in burn treatment?
- Skin substitutes (e.g., AlloDerm, Integra) provide temporary coverage for large wounds, reducing infection risk and promoting granulation.
- They mimic epidermal and dermal layers, aiding in donor site healing and reducing fluid loss.
- Substitutes like cultured epithelial autografts (CEAs) use the patient’s own cells, allowing for personalized long-term grafting solutions.
How is patient education integrated into burn rehabilitation?
Patient education includes:
- Wound Care: Dressing changes, positioning techniques, and reducing shear forces.
- Pain Management: Setting expectations for procedures.
- Scar Care: Importance of moisturization, compression, and sun protection.
- Psychological Support: Referral for PTSD or anxiety as needed.
- Comprehensive education empowers patients and reduces complications during recovery.
What psychological challenges are common in burn patients, and how are they addressed?
- Burn patients often experience PTSD, anxiety, depression, and sleep disturbances due to trauma and long recovery periods.
- Addressing these involves regular psychological assessments, referrals to mental health professionals, and creating a supportive environment for patients and families.
What is the role of whirlpool therapy in burn rehabilitation?
- Whirlpool therapy removes necrotic tissue, softens eschar, and facilitates ROM exercises by improving tissue pliability.
- However, it may increase infection risks due to potential cross-contamination, so sterile techniques and alternatives like enzymatic debridement are often preferred.
How does ultrasound therapy assist in burn recovery?
- Ultrasound therapy improves scar pliability, reduces adhesion formation, and enhances collagen remodeling.
- It is particularly effective for hypertrophic scars and keloids, used alongside other interventions like compression garments and silicone pads.
What is the metabolic peak in burn recovery, and how is it managed?
- The metabolic peak occurs 7–17 days post-injury, characterized by elevated energy expenditure, hypercatabolism, and muscle wasting.
- Management involves high-calorie, high-protein nutritional support to counteract tissue loss and support healing.
- Early mobilization and exercise also help preserve lean body mass.
What are the complications of subdermal burns, and why do they often require amputation?
- Subdermal burns (4th degree) extend to underlying structures like muscle, bone, and tendons, resulting in a charred, mummified appearance.
- These burns are insensate due to complete nerve destruction and may cause permanent damage to deep tissues.
- Severe cases often require fasciotomy, escharotomy, or amputation to remove necrotic tissue and restore circulation.
How does the immune system respond to burn injuries, and what challenges arise?
- Burn injuries impair immune function by reducing tissue perfusion and neutrophil effectiveness, increasing susceptibility to infections.
- Eschar, blister fluid, and residual topical agents create an ideal environment for bacterial growth.
- This contributes to the high incidence of sepsis, responsible for 75% of burn-related deaths.
- Management involves sterile dressing changes, early debridement, and antimicrobial application to prevent systemic infections.
What factors increase the likelihood of hypertrophic scars and keloids in burn patients?
- Darker skin tones and wounds taking longer than 3 weeks to heal are associated with a higher risk of hypertrophic scarring and keloids.
- These scars are characterized by raised, thickened tissue that can restrict mobility.
- Aggressive management with compression garments, silicone gel pads, and scar mobilization is critical to minimize these outcomes.
What are the key differences between full-thickness and subdermal burns in terms of appearance and treatment?
Full-Thickness Burns (3rd degree):
- Skin appears dry, leathery, and may be white or black.
- Requires surgical intervention (debridement and skin grafting).
Subdermal Burns (4th degree):
- Involve deep tissues with a charred, mummified appearance.
- Often necessitate fasciotomy, escharotomy, or amputation for management.
- Both burn types result in significant scarring and functional impairments without early and aggressive treatment.
Why is early mobilization crucial in burn rehabilitation, and what does it include?
- Early mobilization prevents complications like contractures, deconditioning, and respiratory issues.
- It includes:
- ROM Exercises: Maintain joint mobility.
- Weight-Bearing Activities: Improve strength and circulation.
- Pulmonary Hygiene: Breathing exercises to prevent atelectasis and pneumonia.
- Aerobic Exercise: Maintains cardiovascular health and counters metabolic effects.
- Mobilization also supports mental health and faster functional recovery.
