Burns Flashcards
Zones of injury for burns
- Zone of coagulation - center of burn; eschar attracts micro-organisms and houses burn toxins
- Zone of stasis - surrounds zone of coagulation; partially viable, platelets aggregate in area and can cause microemboli
- Zone of hyperemia - outer edges of burn; least damage
Ways to determine extent of a burn on total body surface area
- Rule of nines- arms are 9%, legs and trunk each are 18%
- Lund and Browder formula - body divided into 19 sections
1st degree superficial burn
- Injured epidermis
- Pink to red without blisters
- normal healing by epitheliazation
2nd degree superficial burn
- Superficial dermis injury
- Pink to red with edema
- Blisters and blanches immediately
- Heals 10-14 days with epitheliazation
2nd degree deep burn
- Deep dermal injury
- Ivory to pink
- Dry with blisters
- Decreased sensation
- Several months to heal
- Granulation tissue and epitheliazation occurs
- Scar likely
3rd degree burn
- Entire dermis and subcutanous tissue
- White, red, brown, or black
- Dry without blanching
- Insensate
- Depressed wounds
- Not able to regenerate, requires surgery
- No burn pain
4th degree burn
- Sub dermal burn
- Damage into fat, muscle, or bone
- Body may appear charred
- Usually by electrical injury
- Burn is anesthetic
- Amputation is common
PT intervention in burn management
- Infection control - sterile technique
- Body temperature - room should be warm
- Pain - meds start early; caused by free nerve endings, edema, exudate accumulation, debridement, mobility, secondary injury
What is silver sulfadiazine?
Antimicrobial cream; does not penetrate eschar and may cause maceration
What is mafenide acetate?
Antimicrobial cream that penetrates eschar, kills pseudomonas, but is painful and cannot be used on large areas
What is acticoat silver dressing?
Silver impregnated mesh dressing that helps control infection
What is collagenase?
Enzymatic ointment that penetrates collagenous eschar, but is painful and not antimicrobial
T/F Scar tissue is not vascularized
False, scar tissue is highly vascular
What is a normotrophic scar?
Visible scar, not raised above surrounding skin
What is a hypertrophic scar?
A scar that is raised above the level of surrounding skin, but stays within borders of injury
What is a keloid scar?
Scar which is raised and extends outside borders of the injury
Scar intervention
- Pressure therapy - custom fit pressure garments, short stretch wraps, elastic tubular bandages
- Custom-fit rigid plastics - example: burn mask
- Silicone gel pad decreases hypertrophic scar
- Splint- static, dynamic, or serial
What is pyoderma gangrenosum?
- Chronic inflammatory disease
- Presents as a pustule progressing into tissue necrosis
- Sharp debridement contraindicated due to wound enlargement
What is vasculitis?
- Inflammation and necrosis of the blood vessels
- Caused by antibody-antigen complexes deposited in blood vessel walls
- Treat with wound care, elevation, and anti-inflammatory meds or immunosuppressants
What is necrotizing fasciitis?
- Bacterial infection progressing quickly to infolve fascia
- Will see development of gangrene
- High mortality rate
- Red, painful, swollen area of cellulitis progressing to increased swelling, dark red areas
- Antibiotics, corticosteroids, sharp debridement, hyperbaric oxygen can help
What is calciphylaxis?
- Seen in pts with ESRD
- Progressive skin necrosis due to calcification and occlusion of the small vessels
- Ischemic wounds lead to gangrene
- Wounds with eschar, central necrosis, and ulceration
- Bilateral and symmetric
- Treat with topical wound care, surgical debridement, and pain meds
What is symmetrical peripheral gangrene?
- Found in critically ill pts with acute hypotensive septic shock
- Associated with disseminated intravascular coagulation
- Pts have hx of PVD, diabetes, frostbite, or Raynaud’s
