Burns Flashcards
What are the 3 general causes of burns?
- Chemical
- Thermal
- Electrical
A thermal burn is classified as direct or indirect contact with flame, hot liquid or steam the severity of the burn is influenced by 3 factors which are:
- Contact time
- Temperature
- Type of insult
A chemical burn can be due to acids, bases, industrial accidents or assaults. These types of burns are more likely to cause what type of damage and how is severity of the burn influenced?
More likely to cause full thickness damage (alkali more severe)
Severity dependent on
1. Contact time: burning continues until substance is diluted or removed. Need to thoroughly irrigate for 20-30 min
2. Chemical concentration
3. Amount of chemical
For a chemical burn irrigation should be done for how long?
20-30 min
Electrical burns can occur with low and high voltage currents. Severity is influenced by
- High volt currents cause more damage and AC burns injuries are more severe
- Also dependent on contact time
T/F with electrical burns skin may not be severely damaged despite deep tissue injury due to the differences in resistance.
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If a partial thickness burn becomes infected what can happen?
it can convert from partial -thickness to full thickness
Chemical burns can take ____hours to develop
24-72 hours
Describe 5 key characterisitics of Superficial Burns aka first degree
- Involves ONLY the epidermis
- Dry, bright red/pink skin that blanches upon pressure
- Resolves within 3-5 days without scarring
- Skin may peel
- Skin barrier function is maintained
- Blistering is not present
ex: sunburns, minor flash burns
Describe key 5 characteristics of Superficial part-thickness burns aka superficial 2nd degree
- Involves the epidermis and papillary dermis
- Blistering
- local erythema and edema
- Blanchable, refill is immediate
- heal within 10-14 days, common after closure to have itching and hypersentivitiy
Brief Contact burns
Flash burns
brief contact burns with dilute chemicals
are examples of what type of burn
superficial 2nd degree
Describe 5 key characteristics of deep partial thickness burns aka deep 2nd degree
- Involves dermis and epidermis
- Mottled areas of red with white eschar, blistering possible
- Decreased pinprick
- Intact pressure sensation
- Blanchable but slow capillary refill, takes greater than/= 3 weeks to heal
Severe sunburns, scald, flash burn brief contact with dilute chemical are all examples of
deep 2nd degree burn
Describe 5 key characterisitics for full-thickness burns aka 3rd degree
- Involves destruction of the epidermis, dermis to subcutaneous
- Mottled white/black, dry leathery eschar, very painful
- can’t feel light touch
- most require surgical debridement and grafting
- Scarring and contracture likley
Prolonged contact with flame, immersion scald injury are examples of what type of burn
3rd degree
Describe key characteristics of subdermal burns aka 4 degree burns
- Destruction beyond dermis into fat, muscle, tendon and bone
- Charred and mummified
- permanent nerve damage
- Areas with no viable tissue
- Require sx and possible amp
Electical burns, strong chemical burns are examples of what type of burn
subdermal or 4 dgree
Lund-Browder classfication is appropiate in determining total body surface area to classify burns in what population
children under 16, subdivides body segments into percentages based on age.
Rule of 9
Head, front and back of each UE
the front of each LE
the back of each LE =______%
Anterior and posterior trunk_____%
9%
18%
T/F the palmar method is highly unreliable and inaccurate
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Classification of Burns
Minor Burn for a Child
%FT
%PT
%FT= < 1% %PT= <5%
Classification of Burns
Moderate Burn for an Adult
%FT
%PT
%FT= 2-5% %PT= 10-20%
Treat Inpatient
Classification of Burns
Moderate Burn for a Child
%FT
%PT
%FT=1-5%
%PT=5-10%
Classification of Burns
Major Burn for an Adult
%FT
%PT
%FT= >5%
%PT=>20%
treat in specialized burn unit
Classification of Burns
Major Burn for a Child
%FT
%PT
%FT= >5%
%PT=>10%
Name the Zone
Central portion of the burn that has suffered irreparable damage and is characterized by coagulation, ischemia, necrosis.
Zone of Coagulation
The zone of coagulation may expand up to
48 hours after initial burn injury
Name the Zone
Surrounds central necrotic region, and represents an area of cellular injury and compromised tissue perfusion. RBCs and platelets form microemoboli, further impeding circulation. If perfusion is not restored in 1-2 days cells will NOT survive.
Zone of stasis
In which zone can conversion occur, the process of widening orginial area of necrosis
Zone of stasis
Name the zone
outer edges of tissues affected by burn injury. tissues here receive least thermal energy and sustain only minimal cellular injury. Erythema is key characteristic. Recovers in 7-10 days after injury
Zone of Hyperemia
What happens if you place a bandage on a burn and it is too tight?
create a volume change in the area of the burn
Burn Patients have multisystem damage. The cardiovascular system is most like to affect a patient that has ____% TBSA and places that patient at high risk for _____.
greater than 15%, burn shock
A massive shift causing decreased blood volume (hypovolemia and edema) is known as
Burn shock, tissue necrosis, organ failure and death are possible
Inhalation injuries/damage to the pulmonary system cause up to ___% of burn deaths.
20%
What does inhalation do to lung compliance?
it decreases it leading to hypoxemia
When should a practioner suspect lung involvement?
- Carbonaceous sputum is present
- closed space injury
- burns to neck/face/torso
Need to monitor what vital signs and promote what in patients that have inhalation injuries?
- Monitor breathing
- Monitor O2 sta
- encourage aggressive pulmonary hygeine
may need to look inside nose and mouth
What happens to the basal metabolic rate in burn patients?
the rate doubles or triples.
Increase in core temp
Sustained hyperglycemia
Increased fat catabolism
When does the metabolic rate peak after initial burn injury?
7-17 days post major burn injuries
T/F patients who have suffered a major burn with have a decrease in body mass
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____% of burn patient deaths are due to infection
75, sepsis and infection very common
What is necessary to reduce risk of infection?
- rapid skin coverage
- Aggressive debridement
- Prophylactic topical antimicrobials
What is the most commonly psychological disorder seen in burn patients?
PTSD, anxiety, depression, distrubed sleep common
What is the key motto for PT interventions with burn rehab?
Give patient control over their reahb
T/F you should always tell a patient what to expect before a procedure
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For burn patients how will the cardiovascular system present?
- Patient will be Hypotensive
- Patient will have resting tachycardia
- Burn shock
- Hypvolemia
- Edema
For burn patients how ill the pulmonary system present?
- Patient can be hypoxic
- Patient can present with SOB
- Patients are prone to pneumona and ARDS
- Will have increased pulmonary vasicular resistance
Name 4 common organ system dysfunction that burns can affect?
- kidneys
- GI
- Ulcers
- Ileus
What are 3 precautions a PT should be aware of when treating a burn patient?
- Domestic Violence
- Need to prevent and anticipate compliations
- Ensure Adequate pain control
What are 5 complications to burns?
- Contractures
- Infections
- Deconditioning
- Pulmonary dysfunciton
- Pressure ulcers
Burns require repeated bouts of what types of debridement?
mechanical, sharp or enzymatic. Always remove blisters
What type of technique should be used for large TBSA burns to prevent infection
sterile
Topical antimicrobials are the standard for preventing infection. List 3
- sliver sulfadiazine
- mafeninde acetate
- bacitarcin
What is the most common type of dressing for burns?
Topical antimicrobial covered with nonadherent impregnated gauze, bulky guaze dressing. (limit bulk so that movement is encouraged)
Use short-stretch compression wrap to decrease edema and scarring
Name 4 types of scar management interventions
- silicone gel sheets
- ultrasound
- paraffin
- MOISTURIZE, apply several times a day
T/F darker skinned individuals have higher incidence of hypertrophic scarring and keloids
true
List the 4 items in the vancouver scale and what is the scale used for?
used to describe quality of the scare tissue after a burn includes 1. Vascularity 2. Pliability 3. Pigmentation 4. Height
Lower scores on the vancouver scale indicate what?
less severe scar tissue (range 0-14)
When is ROM contraindicated for a burn patient?
for non-stabilized fx, cardiovascular instaiblity, extubation within 8 hours of tx, exposed tendon
When moving a patient with a lower leg graft with compression wrap what is important to note before gettting this patient out of bed
make sure they have compression wrap on before getting out of bed. Limits edema, prevents venous pooling, increased venous return and reduces risk of DVT
Burn patients and aerobic exercise what would target HR be
50-70% of predicted max
Patient with an anterior neck burn what is the predicted position of contracture and how can we prevent the contracture
predicted position would be into cervical flexion
Prevent by having the patient be supine without a pillow, use a small towel roll to support cervical lordosis
Patient with axilla/shoulder burn what is the predicted position of contracture and how can we prevent the contracture?
adducted, restricted elevation
prevent by abducting at least 90 deg and ER
Patient with anterior hip/thigh burn what is the predicted position of contracture and how can we prevent the contracture?
Hip flexion
lay patient flat supine with hip extended.
Dynamic splints assist with
contracture management
Whirlpool is easier for what?
Pulsed lavage with suction you tend to use on what type of wound?
Paraffin is not indicated for what type of wound?
- ROM
- small wounds
- open wounds
T/F PT should time interventions with medications
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Surgical Interventions
- Performed on patients with medium and large full thickness burns
- Incision through eschar and subcutaneous tissue to release tissue contristing ciruclation
- Incision through fascia to release pressure improve distal circulation, due to volume changes.
- Debridement
- Escharotomy
- Fasciotomy
What type of graft is prefferred with skin grafting?
autografts from univolved areas. Xenografts or allografts are for temporary converage
What type of graft is the epidermis and parts of the dermis removed and replaced with a mesh or sheet
Split-thickness graft
What type of graft requires removal of epidermis and entire dermis layer. Required greater vascular support from recipient area and is typically used on face feet and hands for cosmesis.
Full-thickness skin grafts
Name 4 reasons for graft failure
- Infection
- eschar
- Insufficienct immobilization
- Fluid collection under graft
Classification of Burns
Minor Burn for an Adult
%FT
%PT
<10