Burns Flashcards
1
Q
What are the 3 types of burn injuries?
A
- Thermal
- Chemical
- Electrical
2
Q
What do thermal burn injuries result from?
A
direct/indirect contact with flame, hot liquid, or steam
3
Q
Thermal burn injury severity is influenced by what 3 things?
A
- Contact time
- Temperature
- Type of insult
4
Q
Only 1 second of exposure to temperatures above ___ degrees can cause a full-thickness burn
A
158
5
Q
What 4 things can cause a chemical burn injury?
A
- acids
- bases
- industrial accidents
- assaults
6
Q
Chemical burns are ____ likely to cause full-thickness damage
A
more
7
Q
What is the severity of a chemical burn injury related to?
A
the contact time with the skin, as well as the type, concentration, and amount of chemical
8
Q
Are acidic or alkali burns more severe?
A
alkali
9
Q
Because chemical burns continue to burn until the substance is removed or diluted, what is suggested?
A
thoroughly irrigate for 20-30 minutes
10
Q
What are the 2 types of electrical burns?
A
low and high voltage
11
Q
How do electrical burns typically present?
A
a depressed or charred entrance wound and a larger, explosive-appearing exit wound
12
Q
Describe what happens to deeper tissues affected by an electrical burn
A
They are often times damaged even if the skin does not appear to be due to differences in resistance
13
Q
The severity of an electrical injury depends on what 3 things?
A
- type of current
- duration of contact
- voltage
14
Q
Does an alternating or direct current penetrate the skin more readily and produce 3 times the amount of tissue damage?
A
alternating
15
Q
High voltage injuries result from currents greater than ____ volts
A
1000
16
Q
What are the 2 ways in which burn injuries are classified?
A
- depth of injury
- burn size
17
Q
Clinicians should be cautious with their assessment of burn depth immediately after chemical exposure because it takes up to __-__ hours for a chemical burn to fully develop
A
24-72
18
Q
What are the 5 burn classifications according to depth? (from most superficial to deepest)
A
- superficial
- superficial partial-thickness
- deep partial thickness
- full-thickness
- subdermal
19
Q
What layers of the skin are involved in a superficial burn?
A
the epidermis only
20
Q
Superficial burns fit into what Integumentary practice pattern?
A
B
21
Q
Describe the characteristics of a superficial burn
A
Dry, bright red, or pink skin that blanches under pressure
22
Q
Superficial burns resolve within - days without scarring
A
3-5
23
Q
What are 2 examples of superficial burns?
A
- sunburn
- minor flash burn
24
Q
What layers of the skin are involved in a superficial partial-thickness burn?
A
epidermis and part of the dermis
25
Superficial partial-thickness burns fit into what Integumentary practice pattern?
C
26
Describe the characteristics of a superficial partial-thickness burn
Painful, moist, weeping, blistered skin with local erythema and edema that blanches to pressure with immediate capillary refill
27
Superficial partial-thickness burns resolve within __-__ days with minimal or no scarring
10-14
28
What are 4 examples of superficial partial-thickness burns?
- severe sunburns
- brief contact burns
- flash burns
- brief contact with dilute chemicals
29
What layers of the skin are involved in a deep partial-thickness burn?
epidermis and part of the dermis
30
Deep partial-thickness burns fit into what Integumentary practice pattern?
C
31
Describe the physical characteristics of a deep partial-thickness burn
Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity or be painful that blanches to pressure with immediate capillary refill
32
Deep partial-thickness burns may take _ or more weeks to heal and are often characterized by scarring, pigment changes, and contractures
3
33
What are 3 examples of deep partial-thickness burns?
- severe sunburns
- scald
- flash burns
- brief contact with dilute chemicals
34
Other than the physical appearance how can the clinician determine whether or not a burn is superficial or deep partial-thickness?
Both blanch to pressure, however superficial burns demonstrate immediate capillary refill, whereas deep demonstrates slow capillary refill
35
What layers of the skin are involved in a full-thickness burn?
epidermis and the entire dermis
36
Full-thickness burns fit into what Integumentary practice pattern?
D
37
Describe the physical characteristics of a full-thickness burn
Initially look red then become mottled white/black, dry, leathery eschar, very painful
38
What is typically required of full-thickness wounds?
surgical debridement and grafting
39
What are 4 ways in which full-thickness burns may result?
- immersion scald injury
- prolonged contact with a flame or steam
- contact with electrical currents
- exposure to chemicals
40
Describe why a patient with a full-thickness burn feels pain even if though this type of burn is insensate to light touch
Less severely damaged areas surrounding the FT burn are likely to be excruciatingly painful
41
What layers of the skin are involved in a subdermal burn?
Epidermis, dermis, and beyond into fat, muscle, tendon and/or bone
42
Subdermal burns fit into what Integumentary practice pattern?
E
43
Describe the physical characteristics of a subdermal burn
Charred, mummified appearance in which deep tissues are exposed
44
What is required of subdermal wounds?
surgery (fasciotomy, escharotomy, grafting) and possible amputation
45
What are 4 ways in which subdermal burns may result?
- electrical injury
- prolonged thermal contact
- exposure to strong chemicals
46
What are the 3 methods in which burn size is estimated?
- Rule of Nines
- Lund-Browder Classification
- Palmar Method
47
What is the problem with the rule of nines?
It consistently overestimates the size of the burn injury
48
What does the Lund-Browder Classification take into account?
The variation of body proportion from child to adult
49
Burn Severity Treatment Guidelines:
Minor Burn: _____
Moderate Burn: _____
Major Burn: _____
treat as out-patient
treat as in-patient
treat in specialized burn unit
50
For an adult a burn is classified as minor if the percentage of TBSA that is a FT burn injury is less than _% or if the percentage of TBSA that is a PT burn injury is less than __%
2
10
51
For a child a burn is classified as minor if the percentage of TBSA that is a FT burn injury is less than _% or if the percentage of TBSA that is a PT burn injury is less than _%
1
5
52
For an adult a burn is classified as moderate if the percentage of TBSA that is a FT burn injury is somewhere between _-_% or if the percentage of TBSA that is a PT burn injury is between __-__%
2-5
10-20
53
For a child a burn is classified as moderate if the percentage of TBSA that is a FT burn injury is somewhere between _-_% or if the percentage of TBSA that is a PT burn injury is between __-__%
1-5
5-10
54
For an adult a burn is classified as major if the percentage of TBSA that is a FT burn injury is greater than _% or if the percentage of TBSA that is a PT burn injury is greater than __%
5
20
55
For a child a burn is classified as major if the percentage of TBSA that is a FT burn injury is greater than _% or if the percentage of TBSA that is a PT burn injury is greater than __%
5
10
56
Integumentary damage due to burn injuries is divided into 3 concentric circles known as the zones of what?
- Zone of coagulation
- Zone of stasis
- Zone of hyperemia
57
What is the zone of coagulation?
The central portion of the burn that has suffered irreparable damage and is characterized by coagulation, ischemia, and necrosis
58
What is the zone of stasis?
The area the surrounds the central necrotic region and represents an area of cellular injury and compromised tissue perfusion
59
Within the zone of stasis RBCs and platelets aggregate and may form microemboli which results in what?
further impeding of local circulation
60
What is the process of widening and deepening of the original area of necrosis called?
Conversion
61
What is the zone of hyperemia?
The outer edges of tissue that are affected by the burn and sustain only minimal cellular damage
62
What is the zone of hyperemia characterized by?
erythema due to vasodilation
63
The zone of hyperemia typically recovers within _-__ days of injury
7-10
64
What are 3 things PTs should be cautious to further impede the already precarious circulation in the zone of stasis?
- Bandages that are too tight
- Undue pressure from splints
- Improper patient positioning
65
What is burn shock?
a complex clinical syndrome in which there is a massive fluid shift from the vasculature to the interstitium
66
What does this massive fluid shift result in?
- hypovolemia (a decreased volume of circulating blood in the body)
- edema
67
What does burn shock result in?
- tissue necrosis
- organ failure
- possible death
68
Patients with greater than __% TBSA burns at high risk for burn shock
15
69
Although PTs do not manage burn shock directly, what are 4 things they should be cautious of?
- Fluid resuscitation
- Decreases in BP
- Increased resting HR (100-120 in adults; 120-170 in children)
- Edema management
70
What 2 things account for half of all deaths that occur after the first 12 hours of a burn injury?
- CO poisoning
| - smoke inhalation
71
Inhalation injuries cause up to __% of burn deaths
20
72
What are 3 pulmonary symptoms that PTs should be cautious of?
- breathing difficulties
- oxygen saturation
- encourage aggressive pulmonary hygiene
73
A patients BMR may increase by how much with severe burn injuries?
2-3 times
74
What 3 things cause an increase in resting BMR?
- increased body temperature
- increase in resting O2 consumption due to increased fat catabolism
- decrease in body mass due to hyperglycemia
75
The hypermetabolic response peaks _-__ days following a major burn injury
7-17
76
It is estimated that up to __% of burn deaths may be due to infection
75
77
What is the number one recommendation for patients with severe burns that have resulted in complications?
early, controlled mobility
78
What are 3 precautions for patients with burn injuries?
- screen for domestic violence
- anticipate/prevent complications when possible
- ensure adequate pain control
79
What are the 4 keys to local burn wound care?
- Debridement
- Infection Control
- Dressings
- Scar Management
80
What is the most common dressing type for burns?
Topical antimicrobial covered with nonadherent impregnated gauze and a short-stretch compression wrap to decrease edema and scarring
81
If a burn wound is going to take longer than 2-3 weeks to heal what is required?
Compression
82
Do lighter or darker skinned individuals have a greater incidence of hypertrophic or keloid scars?
darker
83
The Vancouver scar scale rates 4 scar waulities, what are they?
- Vascularity
- Pliability
- Pigmentation
- Height
84
The Vancouver scar scale scores range from _-__ with lower scores indicating ____ severe scar tissue
less
85
What are the 5 areas in which contracture risk is highest?
- Anterior neck
- Axilla/shoulders
- Cubital fossa
- Ankle
- Posterior knee
86
When performing aerobic exercise with a burn patient it is suggested that target HR should be between __-__% of max predicted HR
50-70
87
Define Escharotomy
Incision through eschar and subcutaneous tissue to release tissue constricting circulation
88
Define Fasciotomy
Incision through fascia to release pressure/improve distal circulation
