Burns Flashcards
Burn injury results from
thermal, chemical, electrical, or radioactive agents
Burn wound - zones
Zone of coagulation
Zone of stasis
Zone of hyperemia
Burn wound - zone of coagulation
cells are irreversibly injured, cell death occurs
Burn wound - zone of stasis
cells are injured, may die without specialized tx, usually within 24-48 hours
Burn wounds - zone of hyperemia
minimal cell injury, cells should recover
Degree of burn - first degree
epidermal burn
damage is to epidermis only
no blistering, minimal edema
Degree of burn - second degree - superficial partial thickness burn
Epidermis and upper layer of dermis are damaged
Blanching with brisk capillary refill
Blisters, moist surface, weeping
Moderate edema, painful, sensitive to touch and temp changes
Degree of burn - second degree - deep partial thickness burn
Severe damage to epidermis and dermis with injury to nerve endings, hair follicles and sweat glands
mixed red or waxy white appearance
Blanching with slow capillary refill
Broken blisters, wet surface
Marked edema
Sensitive to pressure but insensitive to light touch or soft pin prick
Degree of burn - third degree
Full thickness burn
Complete destruction of epidermis, dermis, and subcutenous tissues - might extend into muscle
White, charred, tan, or black appearance
No blanching - poor circulation
Dry leathery surface, depressed area
Little pain - nerve endings destroyed
Degree of burn - fourth degree
Subdermal burn
Complete destruction of epidermis, dermis, with involvement of subcutaneous tissues and mm
Charred appearance
Destruction of vascular system
Additional complications if electrical burn
Extent of burned area - rule of
Nines for estimating burn area Head and neck 9% Anterior trunk 18% Posterior trunk 18% Arms 9% each Legs 18% each Perineum 1%
Classification by % of body area burned - Critical
10% of body with 3rd degree burns and 30% or more with 2nd degree
Complications are common
Classification by % of body area burned - moderate
less than 10% with 3rd degree and 15-30% with 2nd degree
Classification by % of body area burned - minor
less than 2% with 3rd degree and 15% with 2nd degree
Complications of burn injury
Infection Shock Pulmonary complications Metabolic complications Cardiac and circulatory complications Integumentary scars
Complications of burn injury - Pulmonary complications
Smoke inhalation - pulmonary edema, airway obstruction
Restrictive lung disease if burns to trunk
Pneumonia
Complications of burn injury - Metabolic
Inc metabolic and catabolic activity results in weight loss, negative nitrogen balance and dec energy
Complications of burn injury - Cardiac and circulatory
fluid and plasma loss results in dec CO
Burn healing - Epidermal healing
Retention of viable cells allows for epithelialization to occur
Protection of epithelial cells is critical
Loss of sebaceous glands can result in drying and cracking of wound
Burn healing - dermal healing
results in scar formation
scars are initially red or purple, later become white
Burn healing - phases
Inflammatory phase
Proliferative phase
Maturation phase
Burn healing - Inflammatory phase
characterized by redness, edema, warmth, pain, decreased ROM, lasts 3 to 5 days
Burn healing - Proliferative phase
Granulation or fibroblastic phase
Four primary events - Angiogenesis, granulation formation, wound contraction, epithelialization
Burn healing - proliferative phase - fibroblasts…
synthesize collagen, glycoaminoglycans, and elastin
Type III collagen is initially deposited and replaced later with Type I collagen
Myofibroblasts are responsible for wound contraction in dermal wounds
Burn healing - maturation phase
Tissue remodeling - lasts up to 2 years
Normal mature scar is soft, white, and flat (takes about 1 yr to occur)
At 6 to 12 wks scar is immature and bright pink
Burn healing - maturation phase - hypertrophic scar
a raised scar that stays within the boundaries of the burn wound and is characteristically red, raised, firm
Burn healing - maturation phase - keloid scar
a raised scar that extends beyond the boudnaries of the original burn wound and is red, raised, and firm
more common in young women and those with darker skin
Burn healing - maturation phase - hypotrophic scar
flat and depressed below the surrounding skin
Burn management - Emergency care
Immersion in cold water
if less than half body and injury is immediate - cold compresses can be used
Cover burn with sterile bandage or clean cloth - NO ointments of creams
Burn management - Medical management - topical meds
applied 1 to 3 x day
Ointments
Silver sulfadiazine
Sulfamylon
Burn management - surgery - Primary excision
Escharotomies and fasciotomies
Might be required to prevent tourniquet effects
Burn management - surgery - grafts
Closure of the wound
Burn management - surgery - grafts - allograft
Use of other human skin (cadaver)
Temporary grafts for large burns, used until autograft is available
Burn management - surgery - grafts - Xenograft
use of skin from another species
Temporary graft
Burn management - surgery - grafts - Biosynthetic graft
combination of collagen and synthetics
Burn management - surgery - grafts - Cultured skin
lab grown from pt own skin
Burn management - surgery - grafts - Autograft
use of pt own skin
Burn management - surgery - grafts - Split thickness graft
contains epidermis and upper layers of dermis from donor site
Burn management - surgery - grafts - full thickness graft
contains epidermis and dermis from donor site
Burn wound healing - factors that impact it
nutrition, infection, associated illnesses, cytotoxic tx
PT - wound debridement - autolytic dressings
use of moist dressings such as hydrogels or hydrocolloids to help remove eschar
PT - wound debridement - Surgical or sharp debridement
excision of eschar using sterilized surgical instruments
PT - Rehab - overall goals
limit loss in ROM, reduce edema, prevent predictable contractures through positioning and splinting
PT - rehab typically includes what freq
2x daily with planned pain meds
PT - rehab - anti contracture positioning and splinting starts day one and continues for months - anterior neck common deformity is
flexion
So stress hyperextension
position with firm (plastic) cervical orthosis
PT - rehab - anti contracture positioning and splinting - Shoulder common deformity is
adduction and IR
So stress abduction and ER
position with axillary splint (airplane splint)
PT - rehab - anti contracture positioning and splinting - Elbow common deformity is
flexion and pronation
So stress extension and supination
Position in extension with post arm splint
PT - rehab - anti contracture positioning and splinting - Hand common deformity is
claw hand
Stress wrist ext (15) and MP flex (70) with PIP and DIP ext, thumb abd
Position in intrinsic plus position with resting hand splint
PT - rehab - anti contracture positioning and splinting - Hip common deformity is
flexion and adduction
Stress ext and abduction
Position in ext, abd, and neutral rotation
PT - rehab - anti contracture positioning and splinting - knee common deformity is
flexion
stress ext
position in ext with posterior knee splint
PT - rehab - anti contracture positioning and splinting - ankle common deformity is
PF
stress DF
position in foot ankle neutral with splint or plastic AFO
PT - postgrafting
postpone/discontinue exercise for 3 to 5 days to let graft to heal
