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PT in Specific Groups > Burns > Flashcards

Burns Flashcards

1
Q

Why are burns often deeper in children?

A

Skin is not so thick

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2
Q

What is the most common burn in children?

A

Thermal (upper body in infant, hot noodles/soup common in older children)

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3
Q

How should chemical burns be treated?

A

Neutralise then dressings

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4
Q

What additional risks are involved with electrical burns?

A

Cardiac arrhythmias in first 24hrs (especially if existing cardiac issues)

Compartment syndrome (check circulation in few days)

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5
Q

What should be involved in electrical burn Ax?

A

Look for entry/exit points (deep burns in bone etc)

Cardiac monitoring for first 24/24

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6
Q

After a fire in an enclosed area, what level of O2 should a patient be on?

A

Up to 8L/min

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7
Q

Why are petroleum burns more complex? (3)

A

Mixed depth
Chemical and thermal
Increased risk of infection

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8
Q

What indicates an oil burn?

A

Splatter pattern

Often deep as oil clings to skin

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9
Q

Why are burns from man-made fibres, such as clothing or furniture, more complex?

A
  • Melts onto patient
  • Items may fall on patient
  • Toxic fumes
  • Risk of inhalation burns
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10
Q

What are combination above/below larynx burns more common in?

A

House fires

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11
Q

How are inhalation burns classified and when will signs present?

A

By irritants

4-24 hrs

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12
Q

When is the risk of respiratory obstruction greatest after a house fire?

A

12-36hrs post burn (time of greatest swelling)

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13
Q

S/S of inhalation burn above larynx

A 
Stridor
Hoarseness/weak voice
Brassy cough
Restlessness
Respiratory difficulty/obstruction
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14
Q

How should inhalation burns above the larynx be managed?

A
  • Early intubation if concerned
  • Respiratory techniques to aid sputum clearance (mucosa comes off)
  • huff/bubble PEP for difficulty coughing
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15
Q

S/S of below larynx inhalation burn (immediate -2; gradual - 4)

A

Immediate

  • Restlessness
  • Severe anoxia

Gradual

  • Hypoxia
  • Pul oedema
  • ARDS
  • Resp failure
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16
Q

Rx for below larynx inhalation burn

A
  • Supportive ventilation, esp kids, until lung damage repairs
  • Humidified 8L O2/min
  • Chest PT not that helpful usually… maybe sputum clearance
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17
Q

Results of systemic intoxication of inhaled chemicals (CO, hydrogen cyanide)

A

Hypoxic brain damage (CO)

Inhibition of cellular oxygenation + Lactic acidosis (cyanide)

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18
Q

S/S of high CO (7)

A 
Forehead tightness
Dilation of cutaneous blood vessels
Headache
Vomiting
Dim vision
Convulsions
Coma
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19
Q

What levels of CO are problematic?

A

60% is toxic

30% is fatal (will already have been 60% initially)

20
Q

Rx for CO toxicity

A

100% O2 ASAP

dependent on O2 availability/CO half-life

21
Q

S/S of HC toxicity (4)

A

Lethargy
Nausea
Weakness
Coma (mimic acute MI)

22
Q

HC toxicity levels

A

Begins at 0.1

Death likely at 1 microgram/mL

23
Q

Superficial (epidermal) burn description

A

Red, painful, no blisters
Sensation present
Good capillary refill

24
Q

Superficial (epidermal) burn Rx

A

Full ROM as pain allows

Usually no hospitalisation

25
Q

Superficial dermal burn description

A

Pale pink, small blisters
VERY painful
Sensation/cap-ref good

7-10 day heal

26
Q

Superficial dermal burn Rx

A

ROM as pain allows

Positioning for oedema

27
Q

Mid-dermal description (4) and Rx (1)

A

Dark pink, blisters
Slower cap-ref, sensation +/-
14 day healing
>21 days usually scar

ROM during dressings with pain relief

28
Q

Deep dermal description

A

Blotchy red/white, +/- blisters

No cap-ref/sensation

29
Q

Deep dermal Rx

A

Needs graft if no healing within 21/7
ROM during dressings
Resting splints

30
Q

Full thickness description

A

White/black
Leathery
NO cap-ref, sensation, blisters, healing

31
Q

Full thickness Rx (4)

A
  • Needs grafting
  • Escharotomy if oedema develops?
  • ROM during dressings
  • Care with extensors (tendons at risk of rupture)
32
Q

Larger the burn… (Rx) (5)

A
  • Quick fluid resuscitation
  • More oedema
  • More calories needed
  • Increased infection risk
  • Increased risk of ARDS (even with no inhalation burn
33
Q

Positioning for burns (i.e. axilla, elbows)

A

Extended (don’t lose ROM)

Axilla = 90 abd, 10-15 horiz flex
Elbows = full ext
34
Q

Oedema - what does 25% TBSA give, and when is oedema worst/peak?

A

Generalised oedema

Peak = 12-36/24
Worst = first 72hrs
35
Q

Pain relief - kids vs adults

A

Kids

  • Nitric oxide
  • Ketamine for larger burns

Adult

  • PCA +/- nitric oxide
  • Ketamine
36
Q

Main PT Rx for burns

A

Maintain ROM

  • splint
  • exercise
  • positioning

Respiratory
CV fitness
Early mobilisation where possible

37
Q

Grafts Mx

A

Same day/next day

  • Gentle stretches
  • Dangle legs

Dressing (day 5-7)

  • Fixamull over graft
  • 1 layer of tubigrip over all burns

Following
- increase walking, watch for oozing

38
Q

Metabolic changes

A

Abnormal up-take of Ca
Prtn breakdown
High prtn demand
Fluid and electrolyte imbalance

39
Q

Systemic changes

A 
Increased periph resistance
Kidney failure
Sepsis
Nerve damage
Sweat gland loss (thermoreg)
40
Q

Scar Mx - healing of graft

A

Fixamull + tubigrip (immediate)

Silicone gel/garments (later) and avoid chlorine

6-12 months

  • Pressure garments 23/24
  • Replace 1-3/12
41
Q

Hypertrophic scarring Mx

A

Not keliod scars (restrict ROM but no pain)

Rx

  • Prevent contracture
  • Max fn
  • Decrease need for reconstruction
42
Q

New skin protection (6)

A
  • hygiene
  • dressings
  • moisturise
  • massage
  • protect from sun
  • move
43
Q

What pressure should tubigrip NOT exceed?

A

40mmHg

44
Q

When is PT/OT needed for scar Mx?

A

Needs ROM/strength

encourage continual as graft tighten up, esp 2-3/12

45
Q

When to splint (4)

A

Oedema
Contracture/deformity
Immobilisation/protection
Improve ROM

PT in Specific Groups (5 decks)

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