Burns Flashcards
What are the types of burns?
Thermal
Chemical
Radiation
Electrical
Describe thermal burns
- Caused by convection (touching) or conductione (via liquid such as air or steam)
- Examples: contact with hot liquid, fire, or steam
Describe chemical burns
- Occurs when chemical compounds come in contact with the body
- Reaction continues until chemical compound is diluted at site of contact
- Examples: sulfuric acid, Lye (sodium hydroxide), hydrochloric acid, and gasoline
Describe radiation burns
- Occurs commonly with exposure to external beam radiation therapy
- DNA is altered in exposed tissues and ischemic injury may be irreversible
- Complications: severe blistering and desquemation, non-healing wounds, tissue fibrosis, permanent discoloration, and new malignancies
Describe electrical burns
- Caused by electrical current through the body
- Typically there is an entrance and exit wound
- Complications: cardiac arrhythmias, respiratory arrest, renal failure, neurological damage, and fractures
- Ex: lightening strikes
What is the zone of coagulation?
The area of the burn that received the most severe injury with irreversible cell damage
What is the zone of stasis?
The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation
What is the zone of hyperemia?
The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage
What is the severity and extent of burn dependent on?
- gender
- age
- duration of burn
- type of burn
- affected area
How are burns classified?
Depth of tissue damage
- superficial burns
- superficial partial thickness burn
- deep partial thickness burn
- full thickness burn
- subdermal burn
What are superficial burns?
- only involves epidermis
- area may be red with slight edema
- no peeling or evidence of scarring
- healing in 2-5 days
What are superficial partial-thickness burns?
- involves epidermis and upper portion of dermis
- may have pain and exhibit blister
- minimal to no scarring
- healing in 5-21 days
What are deep partial-thickness burns?
- complete destruction of the epidermis and majority of dermis
- discolored with broken blisters and edema
- damage to nerve endings may result in moderate levels of pain
- hypertrophic or keloid scarring may occur
- healing in 21-35 days (if no infection present)
What are full-thickness burns?
- complete destruction of epidermis and dermis along with partial damage to subcutaneous fat layer
- eschar formation and minimal pain
- require grafts
- susceptible to infection
- healing time varies significantly
- smaller areas may or may not need grafts, take weeks to heal
- larger areas need grafts, take months to heel
What are subdermal burns?
- complete destruction of epidermis, dermis, and subcutaneous tissue
- may involve muscle and bone
- often require multiple surgeries
- healing time is extensive
How much is the head and neck according to the rule of nines for an adult?
9%
How much is the anterior trunk according to the rule of nines for an adult?
18%
How much is the posterior trunk according to the rule of nines for an adult?
18%
How much is the bilateral anterior arm, forearm, and hand according to the rule of nines for an adult?
9%
-Each anterior surface of entire arm is therefore 4.5%
How much is the bilateral posterior arm, forearm, and hand according to the rule of nines for an adult?
9%
-Each posterior surface of entire arm is therefore 4.5%
How much is the genital region according to the rule of nines for an adult?
1%
How much is the bilateral anterior leg and foot according to the rule of nines for an adult?
18%
-Each anterior surface of leg and foot is 9%
How much is the bilateral posterior leg and foot according to the rule of nines for an adult?
18%
-Each posterior surface of a leg and foot is 9%
How much is the head according to the rule of nines for an 5 y.o.?
14%
How much is the upper limb according to the rule of nines for an 5 y.o.?
9% each arm
How much is the torso according to the rule of nines for an 5 y.o.?
36%
How much is the low limbs according to the rule of nines for an 5 y.o.?
16% each leg (Posterior: 8%, Anterior: 8%)
How much is the head according to the rule of nines for an 1 y.o.?
18%
How much is the upper extremity according to the rule of nines for an 1 y.o.?
9% (each arm)
How much is the lower extremity according to the rule of nines for an 1 y.o.?
14% for each leg (7% anterior, 7% posterior)
What is the anticipated deformity for the anterior neck and what type of splinting should be used?
Deformity: flexion with possible lateral flexion Splint: -soft collar -molded collar -Philadelphia collar
What is the anticipated deformity for the anterior chest and axilla and what type of splinting should be used?
Deformity: shoulder adduction, extension, and medial rotation
Splint:
-axillary or airplane splint
-shoulder abduction brace
What is the anticipated deformity for the elbow and what type of splinting should be used?
Deformity: flexion and pronation Splint: -Gutter splint -conforming splint -three-point splint -air splint
What is the anticipated deformity for the hand and wrist and what type of splinting should be used?
Deformity: -extension or hyperextension of MCPs -flexion of the IP joints -adduction and flexion of thumb -flexion of the wrist Splint: -wrist splint -thumb spica splint -palmar or dorsal extension splint
What is hypertrophic scarring?
- result of an imbalance between collagen synthesis and lysis during healing and can occur with any integumentary condition
- common in relation to severe burn
What are complications from hypertrophic scarring?
- Contracture
- adhesions
- hypersensitivity
- functional limitation
- poor cosmesis
What is involved in scar assessment?
- using assessment devices such as a tonometer (measures pliability) and rating scales aid in quantifying scar characteristics
- purpose is to objectively document observed characteristics
- helpful in assessment and re-assessment of individual
- not helpful in comparative assessment of a group
What general characteristics should be documented with scar assessment?
- location
- sensation
- texture
- pigmentation
- vascularity
- pliability
- height
What is scar massage?
used to manage scar healing
- losen adhesions between cutaneous scar tissue and underlying structures
- do not begin scar massage too soon or too aggressively: may cause re-injury or re-initiating the inflammatory process
Describe the benefits of scar massage
-Decreased sensitivity and improved pliability
How is scar massage performed?
- slow and firm
- utilizes perpendicular, parallel, circular, and or rolling strokes to mobilize tissue layers
When are compression garments recommended for burns?
- burns requiring 14+ days to heal
- reduces chance of hypertrophic scarring
How much pressure is applied with compression garments?
15-35 mmHg
-creates environment that facilitates balance of collagen synthesis and lysis and improves scar structure
How long are compression garments to be worn?
22-23 hours a day until scar has matured
- garments are custom fit
- begin wearing garments between 2 weeks and 2 months after wound closure or grafting
- wear up to 2 yrs
How do you use the rule of 9s for a child?
- A child under 1: take 9% from lower extremities combined and add to head and neck reagion
- each year of life 1% distributed back to BLE
- at 9 y.o. head is considered to be the same proportion as an adult
What are the advantages and disadvantages to sliver sulfadiazine in burn care?
Advantages: -can be used with or without dressings -painless -can be applied to wound directly -broad-spectrum -effective agains yeast Disadvantages: -does not penetrate into eschar
What are the advantages and disadvantages to sliver nitrate in burn care?
Advantages: -broad-spectrum -non-allergenic -dressing application is painless Disadvantages: -poor penetration -discolors, making assessment difficult -can cause severe electrolyte imbalances -removal of dressings is painful
What are the advantages and disadvantages to povidone-iodine in burn care?
Advantages: -broad spectrum -antifungal -easily removed with water Disadvantages: -not effective against pseudomonas -may impair thyroid function -painful application
What are the advantages and disadvantages to mafenide acetate in burn care?
Advantages: -broad spectrum -penetratres burn eschar -May be used with or without occlusive dressings Disadvantage: -May cause metabolic acidosis -May compromise respiratory function -May inhibit epithelialization -painful application
What are the advantages and disadvantages to gentamicin in burn care?
Advantages: -broad spectrum -may be covered or left open to air Disadvantages: -has caused resistant strains -ototoxic -nephrotoxic
What are the advantages and disadvantages to nitrofurazone in burn care?
Advantages: -bacteriocidal -broad-spectrum Disadvantages: -May lead to overgrowth of fungus and pseudomonas -painful application
What is an allograft?
temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area
What is an autograft?
a permanent skin graft taken from a donor site on the patient’s own body
What is a donor site?
a site where healthy skin is taken and used as a graft
What is escharotomy?
a surgical procedure that opens or removes eschar from a burn site to reduce tension on surrounding structure
-relieves pressure from interstitial edema and subsequently enhance circulation
What is full-thickness graft?
a skin graft that contains the dermis and epidermis
What is a heterograft (xenograft)?
a temporary skin graft taken from another species
What is a mesh graft?
a skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area
What is a recipient site?
a site that has been burned and requires a graft
What is a sheet graft?
a skin graft that is transferred directly from the unburned donor site to the prepared recipient site
What is a split-thickness graft?
A skin graft that contains only a superficial layer of the dermis and addition to the epidermis
What is a Z-plasty?
A surgical procedure to eliminate a scar contracture. An incision in the shape of a “Z” allows the contracture to change configuration and lengthen the scar
