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Chapter 14: Integ Final Burns > Burns > Flashcards

Burns Flashcards

1
Q

What are the 3 general causes of burns?

A
  1. Chemical
  2. Thermal
  3. Electrical
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2
Q

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:

A
  1. Contact time
  2. Temperature
  3. Type of insult
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3
Q

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?

A

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

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4
Q

For a chemical burn irrigation should be done for how long?

A

20-30 min

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5
Q

Electrical burns can occur with low and high voltage currents. Severity is influenced by

A
  1. High volt currents cause more damage and AC burns injuries are more severe
  2. Also dependent on contact time
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6
Q

T/F with electrical burns skin may not be severely damaged despite deep tissue injury due to the differences in resistance.

A

T

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7
Q

If a partial thickness burn becomes infected what can happen?

A

it can convert from partial -thickness to full thickness

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8
Q

Chemical burns can take ____hours to develop

A

24-72 hours

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9
Q

Describe 5 key characterisitics of Superficial Burns aka first degree

A
  1. Involves ONLY the epidermis
  2. Dry, bright red/pink skin that blanches upon pressure
  3. Resolves within 3-5 days without scarring
  4. Skin may peel
  5. Skin barrier function is maintained
  6. Blistering is not present
    ex: sunburns, minor flash burns
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10
Q

Describe key 5 characteristics of Superficial part-thickness burns aka superficial 2nd degree

A
  1. Involves the epidermis and papillary dermis
  2. Blistering
  3. local erythema and edema
  4. Blanchable, refill is immediate
  5. heal within 10-14 days, common after closure to have itching and hypersentivitiy
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11
Q

Brief Contact burns
Flash burns
brief contact burns with dilute chemicals
are examples of what type of burn

A

superficial 2nd degree

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12
Q

Describe 5 key characteristics of deep partial thickness burns aka deep 2nd degree

A
  1. Involves dermis and epidermis
  2. Mottled areas of red with white eschar, blistering possible
  3. Decreased pinprick
  4. Intact pressure sensation
  5. Blanchable but slow capillary refill, takes greater than/= 3 weeks to heal
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13
Q

Severe sunburns, scald, flash burn brief contact with dilute chemical are all examples of

A

deep 2nd degree burn

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14
Q

Describe 5 key characterisitics for full-thickness burns aka 3rd degree

A
  1. Involves destruction of the epidermis, dermis to subcutaneous
  2. Mottled white/black, dry leathery eschar, very painful
  3. can’t feel light touch
  4. most require surgical debridement and grafting
  5. Scarring and contracture likley
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15
Q

Prolonged contact with flame, immersion scald injury are examples of what type of burn

A

3rd degree

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16
Q

Describe key characteristics of subdermal burns aka 4 degree burns

A
  1. Destruction beyond dermis into fat, muscle, tendon and bone
  2. Charred and mummified
  3. permanent nerve damage
  4. Areas with no viable tissue
  5. Require sx and possible amp
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17
Q

Electical burns, strong chemical burns are examples of what type of burn

A

subdermal or 4 dgree

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18
Q

Lund-Browder classfication is appropiate in determining total body surface area to classify burns in what population

A

children under 16, subdivides body segments into percentages based on age.

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19
Q

Rule of 9
Head, front and back of each UE
the front of each LE
the back of each LE =______%

Anterior and posterior trunk_____%

A

9%

18%

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20
Q

T/F the palmar method is highly unreliable and inaccurate

A

T

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21
Q

Classification of Burns
Minor Burn for a Child
%FT
%PT

A 
%FT= < 1%
%PT= <5%
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22
Q

Classification of Burns
Moderate Burn for an Adult
%FT
%PT

A 
%FT= 2-5%
%PT= 10-20%

Treat Inpatient

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23
Q

Classification of Burns
Moderate Burn for a Child
%FT
%PT

A

%FT=1-5%

%PT=5-10%

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24
Q

Classification of Burns
Major Burn for an Adult
%FT
%PT

A

%FT= >5%
%PT=>20%

treat in specialized burn unit

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25
Q

Classification of Burns
Major Burn for a Child
%FT
%PT

A

%FT= >5%

%PT=>10%

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26
Q

Name the Zone
Central portion of the burn that has suffered irreparable damage and is characterized by coagulation, ischemia, necrosis.

A

Zone of Coagulation

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27
Q

The zone of coagulation may expand up to

A

48 hours after initial burn injury

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28
Q

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.

A

Zone of stasis

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29
Q

In which zone can conversion occur, the process of widening orginial area of necrosis

A

Zone of stasis

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30
Q

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

A

Zone of Hyperemia

31
Q

What happens if you place a bandage on a burn and it is too tight?

A

create a volume change in the area of the burn

32
Q

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 _____.

A

greater than 15%, burn shock

33
Q

A massive shift causing decreased blood volume (hypovolemia and edema) is known as

A

Burn shock, tissue necrosis, organ failure and death are possible

34
Q

Inhalation injuries/damage to the pulmonary system cause up to ___% of burn deaths.

A

20%

35
Q

What does inhalation do to lung compliance?

A

it decreases it leading to hypoxemia

36
Q

When should a practioner suspect lung involvement?

A
  1. Carbonaceous sputum is present
  2. closed space injury
  3. burns to neck/face/torso
37
Q

Need to monitor what vital signs and promote what in patients that have inhalation injuries?

A
  1. Monitor breathing
  2. Monitor O2 sta
  3. encourage aggressive pulmonary hygeine
    may need to look inside nose and mouth
38
Q

What happens to the basal metabolic rate in burn patients?

A

the rate doubles or triples.
Increase in core temp
Sustained hyperglycemia
Increased fat catabolism

39
Q

When does the metabolic rate peak after initial burn injury?

A

7-17 days post major burn injuries

40
Q

T/F patients who have suffered a major burn with have a decrease in body mass

A

T

41
Q

____% of burn patient deaths are due to infection

A

75, sepsis and infection very common

42
Q

What is necessary to reduce risk of infection?

A
  1. rapid skin coverage
  2. Aggressive debridement
  3. Prophylactic topical antimicrobials
43
Q

What is the most commonly psychological disorder seen in burn patients?

A

PTSD, anxiety, depression, distrubed sleep common

44
Q

What is the key motto for PT interventions with burn rehab?

A

Give patient control over their reahb

45
Q

T/F you should always tell a patient what to expect before a procedure

A

T

46
Q

For burn patients how will the cardiovascular system present?

A
  1. Patient will be Hypotensive
  2. Patient will have resting tachycardia
  3. Burn shock
  4. Hypvolemia
  5. Edema
47
Q

For burn patients how ill the pulmonary system present?

A
  1. Patient can be hypoxic
  2. Patient can present with SOB
  3. Patients are prone to pneumona and ARDS
  4. Will have increased pulmonary vasicular resistance
48
Q

Name 4 common organ system dysfunction that burns can affect?

A
  1. kidneys
  2. GI
  3. Ulcers
  4. Ileus
49
Q

What are 3 precautions a PT should be aware of when treating a burn patient?

A
  1. Domestic Violence
  2. Need to prevent and anticipate compliations
  3. Ensure Adequate pain control
50
Q

What are 5 complications to burns?

A
  1. Contractures
  2. Infections
  3. Deconditioning
  4. Pulmonary dysfunciton
  5. Pressure ulcers
51
Q

Burns require repeated bouts of what types of debridement?

A

mechanical, sharp or enzymatic. Always remove blisters

52
Q

What type of technique should be used for large TBSA burns to prevent infection

A

sterile

53
Q

Topical antimicrobials are the standard for preventing infection. List 3

A
  1. sliver sulfadiazine
  2. mafeninde acetate
  3. bacitarcin
54
Q

What is the most common type of dressing for burns?

A

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

55
Q

Name 4 types of scar management interventions

A
  1. silicone gel sheets
  2. ultrasound
  3. paraffin
  4. MOISTURIZE, apply several times a day
56
Q

T/F darker skinned individuals have higher incidence of hypertrophic scarring and keloids

A

true

57
Q

List the 4 items in the vancouver scale and what is the scale used for?

A 
used to describe quality of the scare tissue after a burn
includes
1. Vascularity
2. Pliability
3. Pigmentation
4. Height
58
Q

Lower scores on the vancouver scale indicate what?

A

less severe scar tissue (range 0-14)

59
Q

When is ROM contraindicated for a burn patient?

A

for non-stabilized fx, cardiovascular instaiblity, extubation within 8 hours of tx, exposed tendon

60
Q

When moving a patient with a lower leg graft with compression wrap what is important to note before gettting this patient out of bed

A

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

61
Q

Burn patients and aerobic exercise what would target HR be

A

50-70% of predicted max

62
Q

Patient with an anterior neck burn what is the predicted position of contracture and how can we prevent the contracture

A

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

63
Q

Patient with axilla/shoulder burn what is the predicted position of contracture and how can we prevent the contracture?

A

adducted, restricted elevation

prevent by abducting at least 90 deg and ER

64
Q

Patient with anterior hip/thigh burn what is the predicted position of contracture and how can we prevent the contracture?

A

Hip flexion

lay patient flat supine with hip extended.

65
Q

Dynamic splints assist with

A

contracture management

66
Q

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?

A
  • ROM
  • small wounds
  • open wounds
67
Q

T/F PT should time interventions with medications

A

T

68
Q

Surgical Interventions

  1. Performed on patients with medium and large full thickness burns
  2. Incision through eschar and subcutaneous tissue to release tissue contristing ciruclation
  3. Incision through fascia to release pressure improve distal circulation, due to volume changes.
A
  1. Debridement
  2. Escharotomy
  3. Fasciotomy
69
Q

What type of graft is prefferred with skin grafting?

A

autografts from univolved areas. Xenografts or allografts are for temporary converage

70
Q

What type of graft is the epidermis and parts of the dermis removed and replaced with a mesh or sheet

A

Split-thickness graft

71
Q

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.

A

Full-thickness skin grafts

72
Q

Name 4 reasons for graft failure

A
  1. Infection
  2. eschar
  3. Insufficienct immobilization
  4. Fluid collection under graft
73
Q

Classification of Burns
Minor Burn for an Adult
%FT
%PT

A

<10

Chapter 14: Integ Final Burns (1 decks)

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