Burns Flashcards
thermal burns are defined as
direct/indirect contact with flame hot liquid or steam
what does the severity of a thermal burn depend upon
contact time
temperature of object
type of insult
what causes chemical burns
acids
bases
industrial accidents
assaults
what are chemical burns more likely to cause
full-thickness damage
what influences the severity of a chemical burn
alkaline worse than acidic
contact time
chemical concentration
amount of chemical
considering contact time of chemical burns, what is something to keep in mind
burning can continue until removed/diluted
– need to thoroughly irrigate for 20-30 min
electrical burns are caused by
low and high voltage currents
explain the entrance vs exit wound in an electrical burn
entrance = depressed and charred
exit = larger and explosive
what are electrical burns associated with
MSK dysfunction
- fx and muscle necrosis
compare low and high voltage burns
high = more damaging
low = relatively less damage
compare AC and DC burns
AC more severe
factors influencing electrical burns
AC > DC
contact time
voltage
why is classification of burns different? what do you do instead?
not uniform in depth
– describe level of tissue involvement
how long will chemical burns take to develop
24-72 hrs
what are islands of a burn and what is their significance
areas not as deep as the deepest portion
– infection in this area can convert the depth of tissue involvement
superficial burn depth includes
epidermis
standard for determining burn depth
laser doppler imaging
superficial partial thickness burn depth includes
epidermis and papillary dermis
deep partial burn depth includes
epidermis and dermis
full thickness burn depth includes
through hypodermal region
subdermal thickness burn depth includes
all the way to bone, capsule or ligament
examples of superficial burns
first degree burns
- sunburn
how will superficial burns present
dry
bright red/pink
blanches upon pressure
what will superficial burns not have
dermal vessel damage
blistering
timeline of superficial burns
resolution within 3-7 days w/o scarring
superficial partial-thickness burns are also called
superficial second degree burns
how will superficial partial thickness burns present
moist
weeping
blistered skin
local erythema
edema
blanch with pressure and immediate capillary refill
pain level of superficial partial-thickness burns? why?
very painful
nerve endings are exposed
healing time with superficial partial-thickness burns
within 10-14 days
none or minimal scarring
deep partial thickness burns are also known as
deep second degree burns
what causes deep partial thickness burns
contact with hot liquids/objects
flash burns
chemical burns
what will deep partial thickness burns present as
mottled areas of red / white eschar
blistering
areas of insensitivity
moderate edema
scarring / pigment changes
time associated with deep partial thickness burn healing
3 or more weeks
what may occur as a result of deep-partial thickness burns
contractures
full thickness burns are known as
third degree
what may be exposed in a full thickness burn
adipose tissue
what may cause third degree burns
immersion scald injury
prolonged contact with flame/steam
electrical currents
exposure to chemicals
how will full thickness burns present
red with mottled white/black
dry
leather eschar
pain level of full thickness burns
very painful
what is likely with full thickness burns
scarring and contractures
what are patients with full thickness burns more at risk for
hypertrophic scarring
contractures
what does not regenerate in a full thickness burn
hair follicles
sebaceous glands
subdermal burns are also known as
4th degree
how will subdermal burns present
charred, mummified appearance
dry with minimal edema
lack of sensation on surface
what to assess for in a subdermal burn
exposed tendon
muscle
fascia
cartilate
capsule
bone
what will need to be done to heal subdermal burns
fasciotomy
escharotomy
grafting
- amputation may be necessary
what is often seen in subdermal burns
nerve damage leading to muscle paralysis
how are burns described?
% of total body surface area
(TBSA)
what size burns are likely to negatively influence health-related quality of life
> 25% TBSA
full thickness
what is the rule of 9s
integument divided into areas that are roughly 9% of TBSA
what population is the lund-browder classification better for
children under 16
pediatrics
what does the lund-browder classification account for
variation of body proportion from child to adult
what is the palmar method?
area of palmar surface of hand to determine burn size
- unreliable and inaccurate
how do burn size and pain relate
not very well
size of burn is not correlated with pain
what to consider in the integumentary system when treating burn injuries
bandages that are too tight
undue pressure from splints
improper patient positioning
patients w/o sensation
what to consider in the cardiovascular system when treating burn injuries
burn shock
hemodynamic instability
cardiac output decreases
tissue necrosis / organ failure
what is burn shock
massive fluid shift from vasculature to interstitum
who may be at risk of burn shock
patients with >15% TBSA burns
how may cardiac output be affected acutely
may decrease by as much as 85% for the first hours after
what would hemodynamic instability cause
hypovolemia
edema
what would a therapist want to be aware of when treating deep burns
blood pressure changes due to hypovolemia
HR
peripheral pulses
edema
compartment syndrome pressure ranges
< 9 mmHg = normal
when to suspect pulmonary involvement
singed facial hair
carbonaceous sputum
closed space injury
burns to face/neck/torso
hoarseness
cough / dyspnea
what % of burn unit patients require intubation
around 50%
how do burns affect metabolism
metabolic rate 2-3x
raised skin temperatures
sustained hyperglycemia
increased fat catabolism
decreased body mass
what causes skin temperature to be raised after a burn
release of cortisol and catecholamines
% of burn patients that die due to infection
61
what causes infection in burn patients
endogenous/exogenous bacteria
decreased tissue perfusion
less effective neutrophils
what can promote bacterial growth in a wound
eschar
blister fluid
residual topical agents
malnutrition can lead to
impaired healing
infection occurance
what is necessary to reduce infection risk
aggressive debridement
rapid skin coverage
prophylactic topical antimicrobials
what may cause multisystem organ dysfunction
hypovolemia
tissue hypoxia
sepsis
what systems are typically affected outside of integument in severe burns
CNS
Kidney
GI
what psychological issues can burn victims face
PTSD
Anxiety/Depression
topical antimicrobials typically used
silver sulfadiazine
mafenide acetate
bacitracin
dressings typically used in burns
topical antimicrobial agent with non-adherent impregnated gauze covered by a bulky gauze
what can be used for heavy draining wounds
alginate dressings
abnormalities in what phase of healing causes are hypertrophic scars
remodeling phase
when does compression become mandatory
for wounds requiring >3 weeks to heal
which type of burns typically need compression garments
deep partial thickness (DPT) and Full Thickness (FT)
what can be put on the skin to reduce scarring
silicone gel sheets/pads
what does the Vancouver scar scale measure by
vascularity
pliability
pigmentation
height
essential components of ther ex in wound victims
positioning
range of motion
mobility training
breathing exercise
strengthening
aerobic exercise
what is something to consider when positioning patients after burns
soft tissue in an elongated state to avoid contractures
anterior neck burn has a predicted contracture of ___. how do you prevent that
cervical flexion
- towel under neck to support cervical lordosis
shoulders/axilla burn has a predicted contracture of ___. how do you prevent that
adducted, restricted elevation
- abducted at least 90°
- ER
cubital fossa burn has a predicted contracture of ___. how do you prevent that
elbow flexion
- elbow extension
palmar/volar wrist hand burn has a predicted contracture of ___. how do you prevent that
wrist flexion/digit flexion
- wrist extension, digit extension
dorsal wrist/hand burn has a predicted contracture of ___. how do you prevent that
wrist extension / MCP extension
- neutral wrist, flexed MCP jts, extended IP jts
anterior thigh burn has a predicted contracture of ___. how do you prevent that
hip flexion
- supine legs straight neutral rotation
posterior knee burn has a predicted contracture of ___. how do you prevent that
knee flexion
- knee extension
ankle burn has a predicted contracture of ___. how do you prevent that
plantar flexion
- neutral w/ slight dorsiflexion
ROM exercises contraindications
unstable fx
CV instability
extubation <8 hrs prior
exposed tendons (no shit)
frequency of ROM exercises
2x daily
management of compression wrap and physical therapy
must be on prior to getting out of bed
timeline of strengthening exercises if indicated
from discharge of acute care –> 6 to 12 weeks for both adults/children
in acute care settings, what needs to be considered about the CVD system in aerobic exercises
tachycardia, limited reserves
– BPM to not go >20 above resting HR
– strive for 50-70% predicted max HR
splints are used to
maintain / increase motion
- immobilize structures
biophysical agents used in small burns
simple irrigation
pulsating lavage w/ suction
biophysical agents used in larger surface area burns
immersion / showering method
biophysical agents used in facial burns
irrigation
biophysical agents used in the remodeling phase
ultrasound
paraffin baths
silicone gel sheeting
compression
low-level laser therapy
biophysical agents used in contracture prevention
ultrasound
20 min cold therapy w/ static stretching
escharotomy is defined as
incision through eschar and subcutaneous tissue
release constriction of circulation
fasciotomy is defined as
an incision through fascia to release pressure and improve distal circulation
surgical interventions for grafts include
skin graft
split thickness graft
full thickness graft
failure of a skin graft can be caused by
infection
eschar
insufficient mobilization
fluid collection
contracture surgery focuses on ___
- what is its importance?
z-plasty tendon lengthening
- important because we improve ROM at jts involved
