Burns Flashcards
what are the three layers of skin?
epidermis
dermis
subcutaneous layer
what is the most abundant fiber in skin?
collagen
what kind of fibers regenerate poorly after a burn?
elastin
what are eight ways to burn yourself?
thermal chemical allergic reaction (poison ivy etc) electrical skin infection radiation friction immune system reaction
how many degrees of burns are there? How deep does each one go?
first degree - superficial
second degree - partial thickness
third degree - full thickness
fourth degree - into muscle/tendon/bone/adipose (subcutaneous)
what does TBSA stand for?
total body surface area
a burn greater than %__ threatens survival
20
how fast do donor sites usually heal?
about 21 days
name the four types of skin grafts possible
- autogenic (donor site)
- cultured (grow your skin)
- allogenic (somoene else’s temporary)
- synthetic (intergra - do not confuse with that biosimilar drug’s name)
what is the disadvantage of a split thickness graft?
higher risk of contraction compared to full thickness graft
what characteristics of a burn make a mesh graft a good idea? what is one big disadvantage of a mesh graft?
burn with irregular contours
burn with a large surface area
burns with a contaminated bed
mesh grafts have the highest risk of scar contraction
what is the disadvantage of using a full thickness graft?
leaves deficit at the donor site (used mostly for reconstructive surgeries)
what type of graft can transfer muscle, fat and skin?
free skin flaps (used mostly for reconstructive surgeries)
z flaps do what?
lengthen linear scar
used mostly for reconstructive surgeries
what three things need to be monitored with a burn victim’s skin in rehab?
wounds (slower healing)
altered perspiration and dryness
hypertrophic scar (4X extra disorganized hypervascularized collagen - can contract and persist for up to 2 years)
what has the largest risk of hypertrophic scar retraction?
scar formation from wound closure that took longer than 3 weeks
when is a hypertrophic scar mature?
when it is paler, smoother, and more flexible
what are some common MSK problems that occur with burns?
impingement, bad posture, capsulitis
name some MSK complications of burns
osteoporosis osteomyelitis septic arthritis fractures dislocations amputations hetertopic bone formation abnormal growth in children
nerves can be compressed or losses of sensation can occur (%50) but what kind of burn in particular may cause nerve compression?
circumferential burns
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)
PTSD
what do %18 of major adult burn victims report 5 years after injury?
chronic pain
name four types of pain seen with burns
neuropathic
musculoskeletal
emotional/psychological
persistent
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?
superficial - right when it happens
partial to full thickness - grafts pain+++
deep - pain for longer
what is the #1 research priority with burns in europe? what are three sources?
itch - very prevalent and debilitating
pruritogenic
neuropathic
psychogenic
three side problems related to burns?
sleep disorders
hypermetabolism
cardiovascular issues
what are some essential components to assess during the joint PT/OT interview?
sleeping position/quality
itching
morale
would slight frowning or grimacing count as a 0,1, or 2 on the observational pain assessment scale?
1
what five pieces of information are useful when asking about pruritis (or pain for that matter) - 5 D’s!
- location
- intensity
- what worsens/improves
- frequency
- duration
5 D’s : duration, direction, disability, degree, distribution
other than the typical ROM, Strength, and functional movements assessment, what else can be assessed with burn patients?
swelling posture ADLS Endurance** Modified Vancouver Scar scale for scar vascularity, flexibility, pigmentation, height or thickness
what is an advantage to using POSAS to evaluate scar tissue?
it also shows how the patient perceives their scars
name some scar management techniques
- heat (wax, hot packs, maybe ultrasound)
- massage and stretching
- positioning and spints
- low-load long time stretches
