Burns

Question 1

what are the three layers of skin?

Answer 1

epidermis
dermis
subcutaneous layer

Question 2

what is the most abundant fiber in skin?

Answer 2

collagen

Question 3

what kind of fibers regenerate poorly after a burn?

Answer 3

elastin

Question 4

what are eight ways to burn yourself?

Answer 4

thermal
chemical
allergic reaction (poison ivy etc)
electrical
skin infection
radiation
friction
immune system reaction

Question 5

how many degrees of burns are there? How deep does each one go?

Answer 5

first degree - superficial
second degree - partial thickness
third degree - full thickness
fourth degree - into muscle/tendon/bone/adipose (subcutaneous)

Question 6

what does TBSA stand for?

Answer 6

total body surface area

Question 7

a burn greater than %__ threatens survival

Answer 7

20

Question 8

how fast do donor sites usually heal?

Answer 8

about 21 days

Question 9

name the four types of skin grafts possible

Answer 9

• autogenic (donor site)
• cultured (grow your skin)
• allogenic (somoene else’s temporary)
• synthetic (intergra - do not confuse with that biosimilar drug’s name)

Question 10

what is the disadvantage of a split thickness graft?

Answer 10

higher risk of contraction compared to full thickness graft

Question 11

what characteristics of a burn make a mesh graft a good idea? what is one big disadvantage of a mesh graft?

Answer 11

burn with irregular contours
burn with a large surface area
burns with a contaminated bed

mesh grafts have the highest risk of scar contraction

Question 12

what is the disadvantage of using a full thickness graft?

Answer 12

leaves deficit at the donor site (used mostly for reconstructive surgeries)

Question 13

what type of graft can transfer muscle, fat and skin?

Answer 13

free skin flaps (used mostly for reconstructive surgeries)

Question 14

z flaps do what?

Answer 14

lengthen linear scar

used mostly for reconstructive surgeries

Question 15

what three things need to be monitored with a burn victim’s skin in rehab?

Answer 15

wounds (slower healing)
altered perspiration and dryness
hypertrophic scar (4X extra disorganized hypervascularized collagen - can contract and persist for up to 2 years)

Question 16

what has the largest risk of hypertrophic scar retraction?

Answer 16

scar formation from wound closure that took longer than 3 weeks

Question 17

when is a hypertrophic scar mature?

Answer 17

when it is paler, smoother, and more flexible

Question 18

what are some common MSK problems that occur with burns?

Answer 18

impingement, bad posture, capsulitis

Question 19

name some MSK complications of burns

Answer 19

osteoporosis
osteomyelitis
septic arthritis
fractures
dislocations
amputations
hetertopic bone formation
abnormal growth in children

Question 20

nerves can be compressed or losses of sensation can occur (%50) but what kind of burn in particular may cause nerve compression?

Answer 20

circumferential burns

Question 21

social and psychological problems are prevalent with burn survivors, what psychological problem is more correlated with burn pain ( considered very severe) more than injury severity, TBSA, heart rate or blood pressure)

Answer 21

PTSD

Question 22

what do %18 of major adult burn victims report 5 years after injury?

Answer 22

chronic pain

Question 23

name four types of pain seen with burns

Answer 23

neuropathic
musculoskeletal
emotional/psychological
persistent

Question 24

which type of burn is most painful right when it happens? which one is most painful in the acute stage? many years after the burn?

Answer 24

superficial - right when it happens
partial to full thickness - grafts pain+++
deep - pain for longer

Question 25

what is the #1 research priority with burns in europe? what are three sources?

Answer 25

itch - very prevalent and debilitating
pruritogenic
neuropathic
psychogenic

Question 26

three side problems related to burns?

Answer 26

sleep disorders
hypermetabolism
cardiovascular issues

Question 27

what are some essential components to assess during the joint PT/OT interview?

Answer 27

sleeping position/quality
itching
morale

Question 28

would slight frowning or grimacing count as a 0,1, or 2 on the observational pain assessment scale?

Answer 28

1

Question 29

what five pieces of information are useful when asking about pruritis (or pain for that matter) - 5 D’s!

Answer 29

• location
• intensity
• what worsens/improves
• frequency
• duration

5 D’s : duration, direction, disability, degree, distribution

Question 30

other than the typical ROM, Strength, and functional movements assessment, what else can be assessed with burn patients?

Answer 30

swelling
posture
ADLS
Endurance**
Modified Vancouver Scar scale for scar vascularity, flexibility, pigmentation, height or thickness

Question 31

what is an advantage to using POSAS to evaluate scar tissue?

Answer 31

it also shows how the patient perceives their scars

Question 32

name some scar management techniques

Answer 32

• heat (wax, hot packs, maybe ultrasound)
• massage and stretching
• positioning and spints
• low-load long time stretches