Burns Flashcards
What is a thermal burn and what factors influence severity?
Contact through a flame, hot liquid, or steam (Scald = wet heat from steam; transfers more heat to the body then a flame)
Contact time, temperature, and type of insult influence the severity
What are chemical burns and what factors influences severity?
Exposure to acids, bases, and industrial accidents/assualts
Factors that influence severity are contact time, chemical concentration, and type of chemical
What does radiation damage do and what are the symptoms?
Due to direct damage to the DNA
Recurrent exposure to low doses of radiation produce erythema, edema, and severe induration
Is an electrical injury a thermal injury?
yes
Does dry skin increase the risk of internal injury?
No, it does increase the risk of skin injury
What increases the risk of frostbite?
What areas are damaged?
Risk is increased by peripheral artery disease, Raynaud’s disease, DM, smoking, beta blockers, ETOH
Nose, ears, fingers, toes
What are the different zones of burns?
Zone of coagulation: most severe injury; irreversible cell injury (may expand 48 hrs after burn)
Zone of stasis: less severe; reversible cells injury
Zone of hyperemia: inflammed area; expected to recover fully within 7-10 days
What is a superficial burn?
Damage to the epidermis with erythema, pain, edema (sunburn)
should heal spontaneously, may exfoliate
What is a superficial partial thickness burn?
damage to the epidermis and PAPILLARY layer of the dermis
caused by scalds (brief contact and brief flame)
What are the characteristics of a superficial partial thickness burn (SPTB)?
erythema, extreme pain, moderate edema, BLISTERING (up to 5 days)
Intact sensory receptors
blanches to pressure with quickly capillary refill
large amounts of drainage
should heal in 10-14 days with minimal scarring
What is a deep partial thickness burn?
damage to epidermis and deep into dermis with less pain, edema and eschar
extends into reticular layer of dermis
mottled red and white areas
DECREASED pinprick but intact pressure sensation
blanches to pressure with slow capillary refill
heals in 3 weeks with scarring and pigment changes
What is a full thickness burn?
damage to epidermis, dermis, and subcutaneous tissue with LITTLE TO NO PAIN
risk of infection increases
will not heal on own or would take three to four months
grafting is NECESSARY
may have contractures
lacks pain, pressure and temperature sensation
dry, rigid, leathery eschar
What is a subdermal burn?
Destruction beyond the subcutaneous tissues charred, mummified, dry appearance exposed deep tissues amputation and paralysis possible leads to scarring
What are the methods to measure burns?
The rule of nines and the Lund and Browder Method (used for infants and young children)
What are reasons to be admitted to burn centers?
hand, foot, or groin burn pain 10-15% total body surface area burn infection inhalation injury
Who is at risk for a burn?
Kids: abuse, accident, neglect
Elderly
Young males: electricians, plumbers, tree trimmers
What are the effects of a burn on the cardiac system?
burn shock - perfusion is unable to meet demands of body tissues; leads to hypovolemia and edema
Decreases cardiac output by 50% for first 2-4 days after severe burn
15% total body surface area at high risk for burn shock
What are the effects of a burn on the pulmonary system?
Pulmonary edema, respiratory distress, pneumonia, inflammation
inhalation injuries account for 20% of deaths
What are the effects of a burn on metabolism?
Skin temperatures increases to account for a heat loss
increase in resting oxygen consumption
nutrition consult
What are the effects of a burn on the immune system?
Sepsis (75% of deaths may be due to infection)
aggressive debridement and wound closure very important
(staph/pseudomonas)
If you are preparing a dressing change what must you do to treat a patient?
Must gown, glove, mask, and hat
What are the phases of burn care?
Emergent (onset - 48 hrs post)
Sub-acute (48 hours post burn to wound closure)
Rehabilitative (period of scarring and societal reintegration
What are some problems and treatments during the emergent phase?
Problems: wounds, edema, pain, associated trauma
Tx: positioning, ROM, splinting
What are the goals of the sub-acute phase of burns?
prevent contracture formation (aggressive), functional positioning
prevent neuropathies
maintain function of muscles and joints
mobilize and encourage ambulation
What are characteristics of sub-acute patients?
Small burns - less than 20% who are able to ambulate and perform gym activities Patient admitted for IV antibiotics inhalation patients - bag and drag large burns in ICU large burns further along in course
What are the main functions of PT & OT in the burn center?
wound care passive stretching positioning splinting/casting progressive mobility conditioning/strengthening scar management
How do you manage superficial burns?
Do not require topical antimicrobials
How do you treat superficial partial thickness burns?
Can use topical antimicrobial ointment such as bacitracin
How do you treat deep partial thickness burns?
Silver sulfadiazine (inhibits wound epitheliazation)
What are some of the dressings used in burn centers?
Antibacterial creams (silvadene, silver sulfadiazine, sulfamylon) Silver impregnated products (acticoat, aquacel Ag) Enzymatic debriders (santyl)
What donor sites are usually used with grafting?
Upper thigh; somewhere not seen
What are rehabilitative phase goals?
family/patient education scar control ROM - WNL Independent mobility Str - WNL Increase endurance Complete discharge planning
What are some interventions for scarring?
Ace wraps tubigrip isotoner/edema gloves coban pressure garments silon/elastomer
What are some plastic interventions for scarring?
flaps tissue expanders serial excision full thickness skin grafts lasers
What can improper scar management lead to?
Immobility can lead to adhesive subcutaneous tissue; leads to pain, decrease in ROM and mobility
How much pressure to topical garments exert on the tissue?
18-30 mmHg
How are silicone sheets utilized after burns?
adhere to clean, dry skin
must be removed for bathing and sleep
expensive but can be reusable
Scars become flatter and less discolored
What are the rules for scar mobilization?
Wound must be sufficiently healed Mobility should be assessed in every direction should mobilize on scabs (2.5-5 cm away) May need to be desensitized Pushed and pulled for 15-30 seconds
What are two aggressive scar mobilization techniques?
Plucking (stabilize two areas along a scar while pulling perpendicular)
Rolling (grasping a segment of the scar and pulling the incision parallel to the incision)
What should you educate the patient on about burns and subsequent scar?
Lack of melanocytes make scar more susceptible to sun damage
Increased risk of skin cancer
tissue needs to be moisturized
What are two overrepair mechanisms?
Hypertrophic scars (rise above level of skin but DO NOT extend beyond the area of injury) Keloid scar (extends beyond injured area)
