Burns Flashcards
how does smoke inhalation injure?
Heat
Systemic Toxins
Smoke
what are primary burn diagnoses?
Flame Scald Contact Inhalation Radiation Chemical Electrical Frostbite
what are the levels of frozen soft tissue effects?
–10 erythema, edema, numbness
–20 same plus blisters
–30 same bloody blisters
–40 full thickness injury to muscles, tendons, bone
how do you tx someone with frostbite that isnt totally frozen?
immersion in warm water. Do not allow refreezing
how do you tx totally frozen dead tissue?
CONSERVATIVE debridement
taking off dead skin
how do you recognize frostbite?
White or grayish- yellow skin area
Skin feels firm, waxy Numbness
Victim usually unaware
what is frost nip?
White insensate areas, usually on fingertips. Respond to warming, no permanent damage
what is chilblains?
Red swollen patches of skin exposed to cold with burning and/or itching sensation
what is trench foot?
Prolonged exposure to moisture and cold (non-freezing)
Foot: red, swollen, numb, bleeds easily, blisters
what are common causes of thermal injuries?
Residential fires MVA Playing with matches Improperly stored gasoline Space heater malfunction Arson
what are high risk groups for burns?
children: scalds
teens: flames, hot liquids
elderly
what are the 3 cell types in the epidermis?
Melanocytes = Base of epidermis, synthesize and secrete pigment
Langerhans cells = Migrate from bone marrow, initiate immune response, provide defense against antigens
Merkel cell = Slow adapting mechanoreceptors respond to touch
if layer of skin is destroys what happens to the cells in that layer?
they lose function
what are the 3 types of connective tissue in the dermis?
Collagen can regenerate the epidermis
Elastin and reticulin
Gel-like ground substance
what structures does the dermis contain?
Hair follicles, sebaceous glands, sweat glands, blood & lymphatic
vessels, and nerves
what types of cells are in the dermis?
Fibroblasts: secrete connective tissue matrix
Mast cells: release histamines
Macrophages: participate in immune response
what are the functions of the skin?
Protects against infection Prevents loss of body fluid Controls body temp excretory organ sensory organ Produces vitamin D Determines identity, self-worth
what are the causes, involved skin, presentation & healing time of a 1st degree burn?
Causes = Sunburn, ultraviolet, short flash fire
Involved skin = Superficial epidermis
Clinical presentation = Red, edema, painful
Healing = 3-5 days, no pigment change
what are the causes, involved skin, presentation & healing time of a 2nd degree superficial burn?
Causes = Scalds, spills, flashes of flame
Involved skin = Epidermis, most of basal layer remains
Clinical presentation = pink or mottled red, blisters, weeping, painful
Healing = < 3 weeks, min scar or pigment change
what are the causes, involved skin, presentation & healing time of a 2nd degree deep burn?
Causes = Immersions, scalds, flame
Involved skin = Epidermis and dermis
Clinical presentation = Cherry red, pale, pain (+,-), skin pliable
Healing = > 3 weeks, severe scar may occur, may need grafting
what are the causes, involved skin, presentation & healing time of a 3rd degree burn?
Causes = Flame, chemical, electrical
Involved skin = Total skin destruction, may involve deeper structures (fat, muscles, bone)
Clinical presentation = Tan or pearly white, leathery, odor of burned skin, non- pliable parchment-like, anesthetic
Healing = Skin grafts required
what are the causes, involved skin, presentation & healing time of a 4th degree burn?
Causes = Prolonged exposure to source of heat or Electrical
Involved skin = Total destruction, burned to bone
Clinical presentation = May see burned bone or deeper structures (Mummified)
Healing = grafting or amputation
what are the factors that determine severity of burns?
age, medical history, extent & depth of injury, body area involved
what % burned is considered a minor burn for adults, children?
Adult = 15% TBSA (1st and 2nd) Child = 10% TBSA (1st and 2nd) Both = 2% (3rd) as long as does not involve eyes, ears, face, genitalia
what % burned is considered a moderate burn for adults, children?
Adult = 15-20% TBSA (2nd) Child = 10-21% TBSA (2nd) Both = 2-10% (3rd) not involving eyes, ears, face, genitalia
what % burned is considered a severe burn for adults, children?
Adult = 25% TBSA (2nd) Child = 20% TBSA All 3rd degree greater than 10% All burn of face, eyes, ears, feet, genitalia All electrical All inhalation Complications Pts in high risk groups
what is the hypovolemic component of burn shock?
Massive fluid loss from circulating blood volume
Caused by increased capillary permeability for 24 hrs
what are the organs affected by burn shock?
Cardiac contractility diminished
Shunts blood away from kidneys, liver, gut
what is disrupted during burn shock?
Cellular metabolism
which effects pose greater threat to mortality?
systemic rather than local
what are symptoms of burn shock?
dull eyes, pupils dilated
shallow, rapid breathing
nausea, vomit, thirst
weak, rapid pulse
how does invasion of bacteria occur?
Occurs when epidermis is broken
Dead tissue, warmth and moisture are ideal for bacterial growth
what are the priorities of a burn care pt?
Airway
Breathing
Circulation
Disability (Mini-Neurologic Exam) Exposure/Temperature Control
what occurs during emergent phase recovery?
At site: est. airway, provide fluids
ER: use burn sheet to est. fluid needs
what are the steps for wound care?
Resuscitate pt for 48-72 hours
Excise burn beginning post burn day 2 or 3 limited debriding
Debride burn for no longer than 30-45 minutes
Cover wound with cadaver skin
Attempt to remove entire burn within 7-10 days
Remove heterograft and cover wound with autograft
what are the topical antibiotics used and their implications?
Sulfamyalon: bacteriocidal, causes metabolic
acidosis, painful
Silver sulfadiazine: bacteriostatic, causes leukopenia, painless
General approach: Sulfamyalon during day, Silver sulfadiazine at night
what are the acute care goals?
Scar Management Control edema Prevent loss of mobility Promote self-care Orientation activities/simulation Pt + family education
what is neutral positioning of burn body?
head: neutral
shoulder: 60 degree abduction
elbow: 30 degree abduction
wrist: 30 degree extension
metacarp: 60 degree flex
digits: full extension
leg: 15 degree abduction
ankle: 90 degree flex
what are factors affecting positioning?
Associated injuries Tracheotomy Ventilator dependency Intravenous/arterial lines Pre-existing conditions Skin grafts and other surgeries
what is skin escahrotomy?
cutting of skin to allow expansion
what is an Allograft (Homograft, Cadaver)?
taken from a donor who is a member of the same species but in NOT genetically identical to recipient
what is an autograft?
taken from the recipients body
what is a full thickness graft?
graft that contains all the layers of skin but not contain subcutaneous fat
what is a Heterograft (Xenograft)?
graft taken from another species
what is a mesh graft?
the donor skin is cut to form a mesh so that it can be expanded to cover a larger area
what is a sheet graft?
the donor skin is applied without alteration to the site
what is a Split-thickness skin graft?
graft that contains only superficial dermal layers
what are possible complications after skin graft surgery?
Bleeding Graft failure Infection at donor or recipient site Poor healing Increased/decreased sensation No hair growth Contracture of graft
what are risk factors for complications?
Age (Newborn, 60 years & older)
Smoking
Diabetes
Poor overall health
How do Skin graft procedures and other surgeries influence therapeutic goals?
Splints & positioning
Adaptive devices for ADL
Exercise (Continue with goals of earlier phase)
what are exercise goals for burn pts?
Reduce edema
Maintain ROM
Prevent skin contracture
what are exercise goals for burn pts that are sick?
Positioning, splinting, PROM, AAROM. AROM Stretch
when should pt start ROM after grafting? Ambulation & ADLs?
7-10 days
Ambulation & ADLs immediately
what are goals in rehab for burn pts?
Joint mobility & flexibility (via exercise)
ADLs: increase participation as patientis able Strength & endurance
Re-acquisition of social/vocational skills
what should be a primary goal in wound healing?
scar control
what are methods for scar management?
Positioning: Acute phase and continue
Stretch: PROM and passive stretch, Splinting, casting
Pressure:Early contact dressing, Splinting, Pressure garments
what is heterotopic ossification?
Bone formation in tissues that normally do not ossify
what is Calcific tendonitis?
due to scarring that shifts to other joints
Usually shoulder, pain with limited ROM
how does Joint dislocation or ankylosis occur?
result of faulty positioning or scar contracture
who is most likely to get Scoliosis or Kyphosis?
Usually in children with neck, trunk burns
what influences adjustment after burn injuries?
Pre-morbid personality Family stability Extent of burn Location of burn Hospital and outpatient environment Attitudes of burn team members & family Community support systems
what are the psychological effects during the acute phase?
Patient may be disoriented, fearful, in pain Survival issues dominate
how do OT’s tx survival issues?
Repeat information, involve family/friends early in patient support
Provide consistent/accurate information
what are the psychological effects during the sub-acute phase?
Pt is anxious about future-appearance, work, family, social, acceptance
May see depression, withdrawal, emotional lability
what are the psychological effects during the rehab phase?
Long term adjustment issues continue especially if hands or face are involved
what does the burn care outcome depends on?
combined efforts of the pt and a well-organized multidisciplinary burn team
what are the burn care outcomes if left to spontaneous recovery?
severe scarring and contractures
