Burns Flashcards
What are the 3 types of burn injuries?
- Thermal
- Chemical
- Electrical
What do thermal burn injuries result from?
direct/indirect contact with flame, hot liquid, or steam
Thermal burn injury severity is influenced by what 3 things?
- Contact time
- Temperature
- Type of insult
Only 1 second of exposure to temperatures above ___ degrees can cause a full-thickness burn
158
What 4 things can cause a chemical burn injury?
- acids
- bases
- industrial accidents
- assaults
Chemical burns are ____ likely to cause full-thickness damage
more
What is the severity of a chemical burn injury related to?
the contact time with the skin, as well as the type, concentration, and amount of chemical
Are acidic or alkali burns more severe?
alkali
Because chemical burns continue to burn until the substance is removed or diluted, what is suggested?
thoroughly irrigate for 20-30 minutes
What are the 2 types of electrical burns?
low and high voltage
How do electrical burns typically present?
a depressed or charred entrance wound and a larger, explosive-appearing exit wound
Describe what happens to deeper tissues affected by an electrical burn
They are often times damaged even if the skin does not appear to be due to differences in resistance
The severity of an electrical injury depends on what 3 things?
- type of current
- duration of contact
- voltage
Does an alternating or direct current penetrate the skin more readily and produce 3 times the amount of tissue damage?
alternating
High voltage injuries result from currents greater than ____ volts
1000
What are the 2 ways in which burn injuries are classified?
- depth of injury
- burn size
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
24-72
What are the 5 burn classifications according to depth? (from most superficial to deepest)
- superficial
- superficial partial-thickness
- deep partial thickness
- full-thickness
- subdermal
What layers of the skin are involved in a superficial burn?
the epidermis only
Superficial burns fit into what Integumentary practice pattern?
B
Describe the characteristics of a superficial burn
Dry, bright red, or pink skin that blanches under pressure
Superficial burns resolve within - days without scarring
3-5
What are 2 examples of superficial burns?
- sunburn
- minor flash burn
What layers of the skin are involved in a superficial partial-thickness burn?
epidermis and part of the dermis
Superficial partial-thickness burns fit into what Integumentary practice pattern?
C
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
Superficial partial-thickness burns resolve within __-__ days with minimal or no scarring
10-14
What are 4 examples of superficial partial-thickness burns?
- severe sunburns
- brief contact burns
- flash burns
- brief contact with dilute chemicals
What layers of the skin are involved in a deep partial-thickness burn?
epidermis and part of the dermis
Deep partial-thickness burns fit into what Integumentary practice pattern?
C
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
Deep partial-thickness burns may take _ or more weeks to heal and are often characterized by scarring, pigment changes, and contractures
3
What are 3 examples of deep partial-thickness burns?
- severe sunburns
- scald
- flash burns
- brief contact with dilute chemicals
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
What layers of the skin are involved in a full-thickness burn?
epidermis and the entire dermis
Full-thickness burns fit into what Integumentary practice pattern?
D
Describe the physical characteristics of a full-thickness burn
Initially look red then become mottled white/black, dry, leathery eschar, very painful
What is typically required of full-thickness wounds?
surgical debridement and grafting
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
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
What layers of the skin are involved in a subdermal burn?
Epidermis, dermis, and beyond into fat, muscle, tendon and/or bone
Subdermal burns fit into what Integumentary practice pattern?
E
Describe the physical characteristics of a subdermal burn
Charred, mummified appearance in which deep tissues are exposed
What is required of subdermal wounds?
surgery (fasciotomy, escharotomy, grafting) and possible amputation
What are 4 ways in which subdermal burns may result?
- electrical injury
- prolonged thermal contact
- exposure to strong chemicals
What are the 3 methods in which burn size is estimated?
- Rule of Nines
- Lund-Browder Classification
- Palmar Method
What is the problem with the rule of nines?
It consistently overestimates the size of the burn injury
What does the Lund-Browder Classification take into account?
The variation of body proportion from child to adult
Burn Severity Treatment Guidelines:
Minor Burn: _____
Moderate Burn: _____
Major Burn: _____
treat as out-patient
treat as in-patient
treat in specialized burn unit
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
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
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
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
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
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
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
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
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
Within the zone of stasis RBCs and platelets aggregate and may form microemboli which results in what?
further impeding of local circulation
What is the process of widening and deepening of the original area of necrosis called?
Conversion
What is the zone of hyperemia?
The outer edges of tissue that are affected by the burn and sustain only minimal cellular damage
What is the zone of hyperemia characterized by?
erythema due to vasodilation
The zone of hyperemia typically recovers within _-__ days of injury
7-10
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
What is burn shock?
a complex clinical syndrome in which there is a massive fluid shift from the vasculature to the interstitium
What does this massive fluid shift result in?
- hypovolemia (a decreased volume of circulating blood in the body)
- edema
What does burn shock result in?
- tissue necrosis
- organ failure
- possible death
Patients with greater than __% TBSA burns at high risk for burn shock
15
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
What 2 things account for half of all deaths that occur after the first 12 hours of a burn injury?
- CO poisoning
- smoke inhalation
Inhalation injuries cause up to __% of burn deaths
20
What are 3 pulmonary symptoms that PTs should be cautious of?
- breathing difficulties
- oxygen saturation
- encourage aggressive pulmonary hygiene
A patients BMR may increase by how much with severe burn injuries?
2-3 times
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
The hypermetabolic response peaks _-__ days following a major burn injury
7-17
It is estimated that up to __% of burn deaths may be due to infection
75
What is the number one recommendation for patients with severe burns that have resulted in complications?
early, controlled mobility
What are 3 precautions for patients with burn injuries?
- screen for domestic violence
- anticipate/prevent complications when possible
- ensure adequate pain control
What are the 4 keys to local burn wound care?
- Debridement
- Infection Control
- Dressings
- Scar Management
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
If a burn wound is going to take longer than 2-3 weeks to heal what is required?
Compression
Do lighter or darker skinned individuals have a greater incidence of hypertrophic or keloid scars?
darker
The Vancouver scar scale rates 4 scar waulities, what are they?
- Vascularity
- Pliability
- Pigmentation
- Height
The Vancouver scar scale scores range from _-__ with lower scores indicating ____ severe scar tissue
less
What are the 5 areas in which contracture risk is highest?
- Anterior neck
- Axilla/shoulders
- Cubital fossa
- Ankle
- Posterior knee
When performing aerobic exercise with a burn patient it is suggested that target HR should be between __-__% of max predicted HR
50-70
Define Escharotomy
Incision through eschar and subcutaneous tissue to release tissue constricting circulation
Define Fasciotomy
Incision through fascia to release pressure/improve distal circulation