Burns Flashcards
1
Q
What are the types of burns?
A
Thermal
Chemical
Radiation
Electrical
2
Q
Describe thermal burns
A
- Caused by convection (touching) or conductione (via liquid such as air or steam)
- Examples: contact with hot liquid, fire, or steam
3
Q
Describe chemical burns
A
- 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
4
Q
Describe radiation burns
A
- 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
5
Q
Describe electrical burns
A
- 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
6
Q
What is the zone of coagulation?
A
The area of the burn that received the most severe injury with irreversible cell damage
7
Q
What is the zone of stasis?
A
The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation
8
Q
What is the zone of hyperemia?
A
The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage
9
Q
What is the severity and extent of burn dependent on?
A
- gender
- age
- duration of burn
- type of burn
- affected area
10
Q
How are burns classified?
A
Depth of tissue damage
- superficial burns
- superficial partial thickness burn
- deep partial thickness burn
- full thickness burn
- subdermal burn
11
Q
What are superficial burns?
A
- only involves epidermis
- area may be red with slight edema
- no peeling or evidence of scarring
- healing in 2-5 days
12
Q
What are superficial partial-thickness burns?
A
- involves epidermis and upper portion of dermis
- may have pain and exhibit blister
- minimal to no scarring
- healing in 5-21 days
13
Q
What are deep partial-thickness burns?
A
- 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)
14
Q
What are full-thickness burns?
A
- 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
15
Q
What are subdermal burns?
A
- complete destruction of epidermis, dermis, and subcutaneous tissue
- may involve muscle and bone
- often require multiple surgeries
- healing time is extensive
16
Q
How much is the head and neck according to the rule of nines for an adult?
A
9%
17
Q
How much is the anterior trunk according to the rule of nines for an adult?
A
18%
18
Q
How much is the posterior trunk according to the rule of nines for an adult?
A
18%
19
Q
How much is the bilateral anterior arm, forearm, and hand according to the rule of nines for an adult?
A
9%
-Each anterior surface of entire arm is therefore 4.5%
20
Q
How much is the bilateral posterior arm, forearm, and hand according to the rule of nines for an adult?
A
9%
-Each posterior surface of entire arm is therefore 4.5%
21
Q
How much is the genital region according to the rule of nines for an adult?
A
1%
22
Q
How much is the bilateral anterior leg and foot according to the rule of nines for an adult?
A
18%
-Each anterior surface of leg and foot is 9%
23
Q
How much is the bilateral posterior leg and foot according to the rule of nines for an adult?
A
18%
-Each posterior surface of a leg and foot is 9%
24
Q
How much is the head according to the rule of nines for an 5 y.o.?
A
14%
25
How much is the upper limb according to the rule of nines for an 5 y.o.?
9% each arm
26
How much is the torso according to the rule of nines for an 5 y.o.?
36%
27
How much is the low limbs according to the rule of nines for an 5 y.o.?
16% each leg (Posterior: 8%, Anterior: 8%)
28
How much is the head according to the rule of nines for an 1 y.o.?
18%
29
How much is the upper extremity according to the rule of nines for an 1 y.o.?
9% (each arm)
30
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)
31
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
```
32
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
33
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
```
34
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
```
35
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
36
What are complications from hypertrophic scarring?
- Contracture
- adhesions
- hypersensitivity
- functional limitation
- poor cosmesis
37
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
38
What general characteristics should be documented with scar assessment?
- location
- sensation
- texture
- pigmentation
- vascularity
- pliability
- height
39
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
40
Describe the benefits of scar massage
-Decreased sensitivity and improved pliability
41
How is scar massage performed?
- slow and firm
| - utilizes perpendicular, parallel, circular, and or rolling strokes to mobilize tissue layers
42
When are compression garments recommended for burns?
- burns requiring 14+ days to heal
| - reduces chance of hypertrophic scarring
43
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
44
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
45
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
46
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
```
47
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
```
48
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
```
49
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
```
50
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
```
51
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
```
52
What is an allograft?
temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area
53
What is an autograft?
a permanent skin graft taken from a donor site on the patient's own body
54
What is a donor site?
a site where healthy skin is taken and used as a graft
55
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
56
What is full-thickness graft?
a skin graft that contains the dermis and epidermis
57
What is a heterograft (xenograft)?
a temporary skin graft taken from another species
58
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
59
What is a recipient site?
a site that has been burned and requires a graft
60
What is a sheet graft?
a skin graft that is transferred directly from the unburned donor site to the prepared recipient site
61
What is a split-thickness graft?
A skin graft that contains only a superficial layer of the dermis and addition to the epidermis
62
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
