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Boards Review > Burns > Flashcards

Burns Flashcards

1
Q

What are the types of burns?

A

Thermal
Chemical
Radiation
Electrical

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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
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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
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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
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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
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6
Q

What is the zone of coagulation?

A

The area of the burn that received the most severe injury with irreversible cell damage

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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

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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

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9
Q

What is the severity and extent of burn dependent on?

A
  • gender
  • age
  • duration of burn
  • type of burn
  • affected area
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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
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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
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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
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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)
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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
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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
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16
Q

How much is the head and neck according to the rule of nines for an adult?

A

9%

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17
Q

How much is the anterior trunk according to the rule of nines for an adult?

A

18%

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18
Q

How much is the posterior trunk according to the rule of nines for an adult?

A

18%

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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%

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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%

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21
Q

How much is the genital region according to the rule of nines for an adult?

A

1%

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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%

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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%

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24
Q

How much is the head according to the rule of nines for an 5 y.o.?

A

14%

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25
Q

How much is the upper limb according to the rule of nines for an 5 y.o.?

A

9% each arm

26
Q

How much is the torso according to the rule of nines for an 5 y.o.?

A

36%

27
Q

How much is the low limbs according to the rule of nines for an 5 y.o.?

A

16% each leg (Posterior: 8%, Anterior: 8%)

28
Q

How much is the head according to the rule of nines for an 1 y.o.?

A

18%

29
Q

How much is the upper extremity according to the rule of nines for an 1 y.o.?

A

9% (each arm)

30
Q

How much is the lower extremity according to the rule of nines for an 1 y.o.?

A

14% for each leg (7% anterior, 7% posterior)

31
Q

What is the anticipated deformity for the anterior neck and what type of splinting should be used?

A 
Deformity: flexion with possible lateral flexion
Splint: 
-soft collar
-molded collar
-Philadelphia collar
32
Q

What is the anticipated deformity for the anterior chest and axilla and what type of splinting should be used?

A

Deformity: shoulder adduction, extension, and medial rotation
Splint:
-axillary or airplane splint
-shoulder abduction brace

33
Q

What is the anticipated deformity for the elbow and what type of splinting should be used?

A 
Deformity: flexion and pronation
Splint:
-Gutter splint
-conforming splint
-three-point splint
-air splint
34
Q

What is the anticipated deformity for the hand and wrist and what type of splinting should be used?

A 
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
Q

What is hypertrophic scarring?

A
  • 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
Q

What are complications from hypertrophic scarring?

A
  • Contracture
  • adhesions
  • hypersensitivity
  • functional limitation
  • poor cosmesis
37
Q

What is involved in scar assessment?

A
  • 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
Q

What general characteristics should be documented with scar assessment?

A
  • location
  • sensation
  • texture
  • pigmentation
  • vascularity
  • pliability
  • height
39
Q

What is scar massage?

A

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
Q

Describe the benefits of scar massage

A

-Decreased sensitivity and improved pliability

41
Q

How is scar massage performed?

A
  • slow and firm

- utilizes perpendicular, parallel, circular, and or rolling strokes to mobilize tissue layers

42
Q

When are compression garments recommended for burns?

A
  • burns requiring 14+ days to heal

- reduces chance of hypertrophic scarring

43
Q

How much pressure is applied with compression garments?

A

15-35 mmHg

-creates environment that facilitates balance of collagen synthesis and lysis and improves scar structure

44
Q

How long are compression garments to be worn?

A

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
Q

How do you use the rule of 9s for a child?

A
  • 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
Q

What are the advantages and disadvantages to sliver sulfadiazine in burn care?

A 
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
Q

What are the advantages and disadvantages to sliver nitrate in burn care?

A 
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
Q

What are the advantages and disadvantages to povidone-iodine in burn care?

A 
Advantages:
-broad spectrum
-antifungal
-easily removed with water
Disadvantages:
-not effective against pseudomonas
-may impair thyroid function
-painful application
49
Q

What are the advantages and disadvantages to mafenide acetate in burn care?

A 
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
Q

What are the advantages and disadvantages to gentamicin in burn care?

A 
Advantages:
-broad spectrum
-may be covered or left open to air
Disadvantages:
-has caused resistant strains
-ototoxic
-nephrotoxic
51
Q

What are the advantages and disadvantages to nitrofurazone in burn care?

A 
Advantages:
-bacteriocidal
-broad-spectrum
Disadvantages:
-May lead to overgrowth of fungus and pseudomonas
-painful application
52
Q

What is an allograft?

A

temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area

53
Q

What is an autograft?

A

a permanent skin graft taken from a donor site on the patient’s own body

54
Q

What is a donor site?

A

a site where healthy skin is taken and used as a graft

55
Q

What is escharotomy?

A

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
Q

What is full-thickness graft?

A

a skin graft that contains the dermis and epidermis

57
Q

What is a heterograft (xenograft)?

A

a temporary skin graft taken from another species

58
Q

What is a mesh graft?

A

a skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area

59
Q

What is a recipient site?

A

a site that has been burned and requires a graft

60
Q

What is a sheet graft?

A

a skin graft that is transferred directly from the unburned donor site to the prepared recipient site

61
Q

What is a split-thickness graft?

A

A skin graft that contains only a superficial layer of the dermis and addition to the epidermis

62
Q

What is a Z-plasty?

A

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

Boards Review (12 decks)

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