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Integ > Burns > Flashcards

Burns Flashcards

1
Q

thermal burns are defined as

A

direct/indirect contact with flame hot liquid or steam

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2
Q

what does the severity of a thermal burn depend upon

A

contact time
temperature of object
type of insult

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3
Q

what causes chemical burns

A

acids
bases
industrial accidents
assaults

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4
Q

what are chemical burns more likely to cause

A

full-thickness damage

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5
Q

what influences the severity of a chemical burn

A

alkaline worse than acidic
contact time
chemical concentration
amount of chemical

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6
Q

considering contact time of chemical burns, what is something to keep in mind

A

burning can continue until removed/diluted
– need to thoroughly irrigate for 20-30 min

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7
Q

electrical burns are caused by

A

low and high voltage currents

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8
Q

explain the entrance vs exit wound in an electrical burn

A

entrance = depressed and charred
exit = larger and explosive

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9
Q

what are electrical burns associated with

A

MSK dysfunction
- fx and muscle necrosis

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10
Q

compare low and high voltage burns

A

high = more damaging
low = relatively less damage

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11
Q

compare AC and DC burns

A

AC more severe

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12
Q

factors influencing electrical burns

A

AC > DC
contact time
voltage

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13
Q

why is classification of burns different? what do you do instead?

A

not uniform in depth
– describe level of tissue involvement

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14
Q

how long will chemical burns take to develop

A

24-72 hrs

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15
Q

what are islands of a burn and what is their significance

A

areas not as deep as the deepest portion
– infection in this area can convert the depth of tissue involvement

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15
Q

superficial burn depth includes

A

epidermis

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16
Q

standard for determining burn depth

A

laser doppler imaging

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17
Q

superficial partial thickness burn depth includes

A

epidermis and papillary dermis

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18
Q

deep partial burn depth includes

A

epidermis and dermis

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19
Q

full thickness burn depth includes

A

through hypodermal region

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20
Q

subdermal thickness burn depth includes

A

all the way to bone, capsule or ligament

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21
Q

examples of superficial burns

A

first degree burns
- sunburn

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22
Q

how will superficial burns present

A

dry
bright red/pink
blanches upon pressure

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23
Q

what will superficial burns not have

A

dermal vessel damage
blistering

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24
Q

timeline of superficial burns

A

resolution within 3-7 days w/o scarring

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25
Q

superficial partial-thickness burns are also called

A

superficial second degree burns

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26
Q

how will superficial partial thickness burns present

A

moist
weeping
blistered skin
local erythema
edema
blanch with pressure and immediate capillary refill

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27
Q

pain level of superficial partial-thickness burns? why?

A

very painful
nerve endings are exposed

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28
Q

healing time with superficial partial-thickness burns

A

within 10-14 days
none or minimal scarring

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29
Q

deep partial thickness burns are also known as

A

deep second degree burns

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30
Q

what causes deep partial thickness burns

A

contact with hot liquids/objects
flash burns
chemical burns

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31
Q

what will deep partial thickness burns present as

A

mottled areas of red / white eschar
blistering
areas of insensitivity
moderate edema
scarring / pigment changes

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32
Q

time associated with deep partial thickness burn healing

A

3 or more weeks

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33
Q

what may occur as a result of deep-partial thickness burns

A

contractures

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34
Q

full thickness burns are known as

A

third degree

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35
Q

what may be exposed in a full thickness burn

A

adipose tissue

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36
Q

what may cause third degree burns

A

immersion scald injury
prolonged contact with flame/steam
electrical currents
exposure to chemicals

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37
Q

how will full thickness burns present

A

red with mottled white/black
dry
leather eschar

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38
Q

pain level of full thickness burns

A

very painful

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39
Q

what is likely with full thickness burns

A

scarring and contractures

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40
Q

what are patients with full thickness burns more at risk for

A

hypertrophic scarring
contractures

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41
Q

what does not regenerate in a full thickness burn

A

hair follicles
sebaceous glands

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42
Q

subdermal burns are also known as

A

4th degree

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43
Q

how will subdermal burns present

A

charred, mummified appearance
dry with minimal edema
lack of sensation on surface

44
Q

what to assess for in a subdermal burn

A

exposed tendon
muscle
fascia
cartilate
capsule
bone

45
Q

what will need to be done to heal subdermal burns

A

fasciotomy
escharotomy
grafting
- amputation may be necessary

46
Q

what is often seen in subdermal burns

A

nerve damage leading to muscle paralysis

47
Q

how are burns described?

A

$ of total body surface area
(TBSA)

48
Q

what size burns are likely to negatively influence health-related quality of life

A

> 25% TBSA
full thickness

49
Q

what is the rule of 9s

A

integument divided into areas that are roughly 9% of TBSA

50
Q

what population is the lund-browder classification better for

A

children under 16
pediatrics

51
Q

what does the lund-browder classification account for

A

variation of body proportion from child to adult

52
Q

what is the palmar method?

A

area of palmar surface of hand to determine burn size
- unreliable and inaccurate

53
Q

how do burn size and pain relate

A

not very well
size of burn is not correlated with pain

54
Q

what to consider in the integumentary system when treating burn injuries

A

bandages that are too tight
undue pressure from splints
improper patient positioning
patients w/o sensation

55
Q

what to consider in the cardiovascular system when treating burn injuries

A

burn shock
hemodynamic instability
cardiac output decreases
tissue necrosis / organ failure

56
Q

what is burn shock

A

massive fluid shift from vasculature to interstitum

57
Q

who may be at risk of burn shock

A

patients with >15% TBSA burns

58
Q

how may cardiac output be affected acutely

A

may decrease by as much as 85% for the first hours after

59
Q

what would hemodynamic instability cause

A

hypovolemia
edema

60
Q

what would a therapist want to be aware of when treating deep burns

A

blood pressure changes due to hypovolemia
HR
peripheral pulses
edema

61
Q

compartment syndrome pressure ranges

A

< 9 mmHg = normal

62
Q

when to suspect pulmonary involvement

A

singed facial hair
carbonaceous sputum
closed space injury
burns to face/neck/torso
hoarseness
cough / dyspnea

63
Q

what % of burn unit patients require intubation

A

around 50%

64
Q

how do burns affect metabolism

A

metabolic rate 2-3x
raised skin temperatures
sustained hyperglycemia
increased fat catabolism
decreased body mass

65
Q

what causes skin temperature to be raised after a burn

A

release of cortisol and catecholamines

66
Q

% of burn patients that die due to infection

A

61

67
Q

what causes infection in burn patients

A

endogenous/exogenous bacteria
decreased tissue perfusion
less effective neutrophils

68
Q

what can promote bacterial growth in a wound

A

eschar
blister fluid
residual topical agents

69
Q

malnutrition can lead to

A

impaired healing
infection occurance

70
Q

what is necessary to reduce infection risk

A

aggressive debridement
rapid skin coverage
prophylactic topical antimicrobials

71
Q

what may cause multisystem organ dysfunction

A

hypovolemia
tissue hypoxia
sepsis

72
Q

what systems are typically affected outside of integument in severe burns

A

CNS
Kidney
GI

73
Q

what psychological issues can burn victims face

A

PTSD
Anxiety/Depression

74
Q

topical antimicrobials typically used

A

silver sulfadiazine
mafenide acetate
bacitracin

75
Q

dressings typically used in burns

A

topical antimicrobial agent with non-adherent impregnated gauze covered by a bulky gauze

76
Q

what can be used for heavy draining wounds

A

alginate dressings

77
Q

abnormalities in what phase of healing causes are hypertrophic scars

A

remodeling phase

78
Q

when does compression become mandatory

A

for wounds requiring >3 weeks to heal

79
Q

which type of burns typically need compression garments

A

deep partial thickness (DPT) and Full Thickness (FT)

80
Q

what can be put on the skin to reduce scarring

A

silicone gel sheets/pads

81
Q

what does the Vancouver scar scale measure by

A

vascularity
pliability
pigmentation
height

82
Q

essential components of ther ex in wound victims

A

positioning
range of motion
mobility training
breathing exercise
strengthening
aerobic exercise

83
Q

what is something to consider when positioning patients after burns

A

soft tissue in an elongated state to avoid contractures

84
Q

anterior neck burn has a predicted contracture of ___. how do you prevent that

A

cervical flexion
- towel under neck to support cervical lordosis

85
Q

shoulders/axilla burn has a predicted contracture of ___. how do you prevent that

A

adducted, restricted elevation
- abducted at least 90°
- ER

86
Q

cubital fossa burn has a predicted contracture of ___. how do you prevent that

A

elbow flexion
- elbow extension

87
Q

palmar/volar wrist hand burn has a predicted contracture of ___. how do you prevent that

A

wrist flexion/digit flexion
- wrist extension, digit extension

88
Q

dorsal wrist/hand burn has a predicted contracture of ___. how do you prevent that

A

wrist extension / MCP extension
- neutral wrist, flexed MCP jts, extended IP jts

89
Q

anterior thigh burn has a predicted contracture of ___. how do you prevent that

A

hip flexion
- supine legs straight neutral rotation

90
Q

posterior knee burn has a predicted contracture of ___. how do you prevent that

A

knee flexion
- knee extension

91
Q

ankle burn has a predicted contracture of ___. how do you prevent that

A

plantar flexion
- neutral w/ slight dorsiflexion

92
Q

ROM exercises contraindications

A

unstable fx
CV instability
extubation <8 hrs prior
exposed tendons (no shit)

93
Q

frequency of ROM exercises

A

2x daily

94
Q

management of compression wrap and physical therapy

A

must be on prior to getting out of bed

95
Q

timeline of strengthening exercises if indicated

A

from discharge of acute care –> 6 to 12 weeks for both adults/children

96
Q

in acute care settings, what needs to be considered about the CVD system in aerobic exercises

A

tachycardia, limited reserves
– BPM to not go >20 above resting HR
– strive for 50-70% predicted max HR

97
Q

splints are used to

A

maintain / increase motion
- immobilize structures

98
Q

biophysical agents used in small burns

A

simple irrigation
pulsating lavage w/ suction

99
Q

biophysical agents used in larger surface area burns

A

immersion / showering method

100
Q

biophysical agents used in facial burns

A

irrigation

101
Q

biophysical agents used in the remodeling phase

A

ultrasound
paraffin baths
silicone gel sheeting
compression
low-level laser therapy

102
Q

biophysical agents used in contracture prevention

A

ultrasound
20 min cold therapy w/ static stretching

103
Q

escharotomy is defined as

A

incision through eschar and subcutaneous tissue
release constriction of circulation

104
Q

fasciotomy is defined as

A

an incision through fascia to release pressure and improve distal circulation

105
Q

surgical interventions for grafts include

A

skin graft
split thickness graft
full thickness graft

106
Q

failure of a skin graft can be caused by

A

infection
eschar
insufficient mobilization
fluid collection

107
Q

contracture surgery focuses on ___
- what is its importance?

A

z-plasty tendon lengthening
- important because we improve ROM at jts involved

Integ (12 decks)

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