Burns Flashcards
Burn size on Adults
Rule of nines
head/neck - 9% arm - 9% (you have two so 18%) trunk - 18% leg - 18% (you have two so 36%) groin - 1%
Superficial (1st degree) burn
involves superficial epidermis
pain is min to mod
healing time is 3-7 days
Superficial partial-thickness (2nd degree) burn
upper epidermis and upper dermis layers
Pain is significant, wet blistering w/erythema
healing time is 1-3 weeks
erythema
redness of the skin or mucous membranes
Deep partial-thickness (deep 2nd-degree) burn
Involves the epidermis/deep dermis layers, hair follicles and sweat glands
- Pain is severe - even to light touch
- can turn into a full-thickness burn due to infection
- Grafting may be considered to prevent infection
- Impairment of sensation
- Potential for hypertrophic scar
- Healing time is 3-5 weeks
hypertrophic scar
excessive amounts of collagen which gives rise to a raised scar (over cut or burn)
Full-thickness (3rd-degree) burn
Involves epidermis/dermis, hair follicles, sweat glands, and nerve endings
-Pain free! -No sensation to touch!
Burn is pale w/no blanching
Requires skin graft!
Hypertrophic scarring is high!
Blanching
when you touch your skin near a burn a white spot means you have good circulation
Subdermal Burn
Full-thickness burn to tissue, fat, muscles and bone
-charring is present, destruction of nerve
Peripheral nerve damage
Needs surgical intervention for wound closure/amputation
escharotomy
surgical incision into the burn tissue to relieve pressure on extremities
homograft
human cadaver graft (temporarily)
heterograft
pig skin graft (temporarily)
Autograft
Own skin (permanent)
Cultured epithelial autografts (CEA)
own skin is grown and then grafted (permanent)
OT Intervention: Splinting in antideformity positions
- Intrinsic plus for hands
- Opposite client’s posture
- Generally in extension for neck, elbows and knees
- Shoulder in abduction
- Hip in extension
- Anti-frog leg and anti-foot drop for lower extremity
OT Interventions - Acute Phase
ROM, muscle strength and pain
-Splinting, positioning in antideformity positions, edema management
Anticontracture Positioning: Neck
Netural to slight extension
Anticontracture Positioning: Chest and Abdomen
Trunk extension, shoulder retraction
Anticontracture Positioning: Axilla (armpit)
Shoulder abduction to 90 degree, external rotation
Anticontracture Positioning: Elbow
Extension
Anticontracture Positioning: Forearm
Neutral to supination
Anticontracture Positioning: Dorsal Wrist
Wrist in neutral to 30 degree extension
Anticontracture Positioning: Volar Wrist
Wrist in 30-45 degrees extension
Anticontracture Positioning: Hand
Metacarpal extension, 70 degrees flexion, interphalangeal extension, thumb abducted and extended
Anticontracture Positioning: Hip
10-15 abduction, neutral extension
Anticontracture Positioning: Knee
Extension; w/anterior burn, slight flexion
Anticontracture Positioning: Ankle
Neutral to 5 degrees dorsiflexion
Anticontracture Positioning
Is critical because the position of greatest comfort is usually the position of contracture
How long do you wait until you can do passive/active ROM w/exposed tendons or recent grafts
5-7 days
How long should you wait after pain meds have been given?
30 minutes
Heterotopic Ossification
Formation of bones in abnormal areas.
- Loss of ROM is rapid
- Use AROM exercise within the pain-free range to preserve as much joint movement as possible
For edema measurement in the hand using a volumeter should be avoided because?
All wounds in the hand should be closed first
Are silastic gel sheeting used on open wounds?
NO
What are silastic gel sheeting used for?
Temporary use in the management of both old and new hypertrophic scars or keloid scars
Pressure garment purpose
To provide pressure at the burn sight to decrease scarring and help circulation so less swelling is observed and to decrease a risk of infection
How often a day should you wear your pressure garment
24 hours a day and remove for washing
What is the initial skin treatment?
moist gauze wraps
How long do patients wear gauze wraps?
Depends on skin healing. Some pts may need to wear the gauze for 2-3 weeks…
What do you place on the skin that has adequately healed?
Xeroform
What is xeroform?
Is placed on any small burn that has the potential for cracking or bleeding. This is placed on the area under the pts tubigrip
What is tubigrip?
Helps to decrease swelling, prevent keloid scarring, decrease pain to sensitivity to the air, and to prepare the skin for a custom-made Jobst compression garment
keloid scarring
firm, rubbery lesions or shiny, fibrous nodules
What does a Jobst compression garment do?
Provide additional pressure and therefore serve to further decrease swelling, pain, scarring, skin sensitivity and remodeling of skin.
Order of garments for burn pts
wet gauze wraps
tubigrip
Jobst compression garment
