Burns Flashcards
Deep partial thickness s Sx
Thick, rubbery scar
Poor hand/arm function
Poor skin integrity
Grafting better cosmetically and funtionally
Surgical burn management
Autograft: deep partial/full thickness-permanent
Allograft: temporary
Xenograft: pig skin-temporary
Skin substitute: temporary, special protocols
Split thickness skin graft (STG)
Advantages: durable, limits contraction, cosmetic
Disadvantages: difficult adherence
STSG mesh
Advantage: donor skin covers more of burn, better for irregularities or if wound bed contaminated
Disadvantages: less durable, contracts more
STSG donor site
Thigh, leg, back, buttock
Heals by re-epitheliazation.(7-14 days)
Can be harvested 3-4 times
treat as partial thickness wound
Graft recipient area requirements
Adequate vascularity
Complete contact
Adequate immobilization
Few bacteria
ACE wrap for burns
Supports graft/burn, promotes circulation, prevents hemorrhage
Figure 8 or spiral
No sleeping in ACE wrap
LE burn and ambulation
Apply compression: progressively dangle legs, walk immediately on stance
If grafted, progressively dangle: start at 1 min and observe for color change, bleeding, etc.
Contraindications to ex for burns
Exposed joints, tendons of PIP
DVT
Compartment syndrome
Position of contracture
Usually position of comfort
Facial complications of burns
Ectropion of eye: excessive tear production, conjunctivitis, keratitis
Ectropion of mouth: difficulty managing secretions, liquids
Shoulder complications of burns
Flexion or add contracture
Limited chest wall expansion
Burn numbers
500k a year
Males 16-40 most common
Children 1-5: 2* to scalds
Adolescents: 2* to accidents with flammable liquids
Superficial (First degree)
Sunburn No blisters, bright red or pink. Epidermis only, blanches under pressure. Tender to touch Spontaneous healing in 2-3 with no scar No edema
Superficial Partial Thickness
Epidermis and papillary dermis. Intact blisters c inflammation Blanches under pressure. Painful/sensitive. Heals s surgical intervention in 7-10 days c minimal scarring Immediate capillary refill
Deep partial thickness
Epidermis and dermis down to reticular layer. Mixed red/waxy apperance. Significant edema. Heals in 3-5 wks, STSG usually required Hypertrophic scarring common Sluggish capillary refill
Full thickness burn
Epidermis and dermis, possibly subQ
Covered c eschar
STSG necessary
Edema
Beyond PT scope
Escharotomy
Swelling c circumferential burn
Decreases pressure, restore blood flow, save limb
Subdermal burn
Destruction from dermis through subQ tissue, muscle, bone
Prolonged contact
Charred or mummified appearance
Extensive sx/therapy
Rule of 9’s
Head: 9% Anterior trunk: 18% Posterior trunk: 18% Leg: 18% each Arm: 9% each Balls: 1% Palm: 1% each
Types of burns
Thermal: direct contact: contact time, temperature, type of insult
Chemical: acids/bases: alkali>acid, contact time, concentration, amount
Electrical:AC>DC, contact time, voltage
Electrical burn
Destructive
Entrance and exit wounds
Cardiac arrhythmia, respiratory arrest
Inhalation injury
Increases morbidity/mortality: 60% of fire related death
Prolonged ventilation and bed rest
No smoke detector increases risk of death by 60%
Stevens Johnson Syndrome/TENS
Immune complex hypersensitivity
Skin and mucous membranes
Drugs, viral, infection.
Tens=greater than 30% of body
Complications of burns
Shock: hypovolemia, TBSA >30% Pulmonary: inhilation injury Hypermetabolism Thermoregulation Infection
Resuscitive phase
Nothing by mouth first 24 hrs
IV for fluid loss
Cardiopulm complications
Wound coverage phase
Excision/debridement
Dressings
Grafting
Dressings for burns
Siladene: non-graft or donor site Acitcoat: impregnated c silver Collagenase: deeper burns c slough/eschar Bacitracin: grafts/donor sites Sulamylon: grafts with poor adherence
