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Practice topics Exam 2 > Burns > Flashcards

Burns Flashcards

1
Q

Criteria for admission to burn center

A

1) full thickness and partial thickness burn more than 10% BSA (less than 10 yrs, over 50 - others are 20% BSA)
2) Face, hands, feet or perineum involved
3) Full thickness over 5% any age
4) Electrical (lightening included) or chemical burn
5) Inhalation injury
6) Other injuries (fractures, head injury..)
7) Existing systemic diseases
8) Suspicion of abuse

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2
Q

Emergency care focus

A

1) stop any ongoing issues
2) Airway management
3) Fluid resuscitation - getting IV access
4) Circulation assessment
5) Life threatening injuries
6) Severity of burn

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3
Q

Superficial burn affects what

A

Epidermis

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4
Q

Superficial dermal includes what

A

Epidermis and superficial dermal layer

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5
Q

Deep dermal includes what

A

Epidermis and dermis

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6
Q

Full thickness includes what

A

Epidermis, dermis, and into the subcutaneous tissue

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7
Q

Epidermal (first degree) burn

A 
Correlates with superficial 
Encompasses the epidermis only
Dry, red skin
May have small blisters
Painful!
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8
Q

Epidermal (first degree) burn - healing

A

2 to 7 days to heal

No scars, but may have pigmentation changes (temp)

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9
Q

Superficial partial thickness (second degree) burn

A

Epidermis and papillary dermis
Moist, large blisters
May be mottled looking
Very painful! Tends to be sensitive to stimulation

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10
Q

Superficial partial thickness (second degree) burn - healing

A

10 to 14 days
Primarily through epithelialization
Change in skin pigmentation in the area, once healed (more permanent pigment changes)

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11
Q

Deep partial thickness (deep second degree) burn

A

Epidermis and papillary dermis layers are completely involved
Reticular dermis is damaged
Might have blisters that are leaky
More fluid loss than superficial
Significant edema
Mottled red and white skin color
Pain and sensitivity is less than a superficial

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12
Q

Deep partial thickness (deep second degree) burn - healing

A

More than 30 days

May need grafting depending on how large the area is

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13
Q

Full thickness (third degree) burn

A 
All layers of skin including subQ layers
Eschar forms
Might have marble appearance
Not as painful as other depths, but surrounding tissue can be pretty painful 
Will not heal without grafts!!!
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14
Q

Zones of a burn - A

A

Central zone of coagulation = This is the central part of burns with complete coagulative necrosis - it is dead

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15
Q

Zone of a burn - B

A

Zone of stasis = Located at the periphery of zone of coagulation - the circulation is sluggish in this zone but it can recover after early and adequate resuscitation, and proper wound care
Dec perfusion in this zone but the tissue can be saved

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16
Q

Zone of a burn - C

A

Outer most zone of hyperemia - peripheral to the zone of stasis - result of intense vasodilation as is seen in inflammatory process after trauma
Response from fluid/blood coming in - turns red and swells - this will heal

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17
Q

Determination of BSA

A

Lund and Browder chart - best
Rules of nines
Rule of one

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18
Q

Determination of BSA - Lund and Browder chart

A

Most common
Split body into percentages
Accounts for youth and uses more sections than others like Rules of nines

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19
Q

Determination of BSA - Wallace rules of nines

A

Used if lund-browder chart is not available
Does not account for all age groups
Does not ask that the severity of the burn be included

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20
Q

Determination of BS - rule of 1

A

Use the pt hand (including digits) as 1%

21
Q

Causes of burns

A 
Thermal, flame, contact
Hot liquid, scald, steam
Electrical
Chemical
Hypothermal (frostbite)
Inhalation
22
Q

Thermal

A

Depends on the agent, mechanism, time

Protein denatures at 160 degrees

23
Q

Hot liquid

A

Common with kids

Think abuse if all creases are saved

24
Q

Hot material

A

Tar = ex

Does not come off easily and it won’t cool fast - so it will keep burning the tissue

25
Q

Electrical

A

Direct electrical burns have an entrance and an exit
Cardiac arrhythmia needs to be looked out for - you don’t know the path of the electricity (usually takes path of least resistance - internal organs can be impacted)

26
Q

Chemical

A

Key to this is to take care of saving the tendons and muscles - do NOT let them dry out

27
Q

Hypothermal

A

LIke frostbite
Warm them up slowly and prevent cells from bursting (liquid in the cells freezes)
Degree of temp they are exposed to will impact how long the inflammatory response goes for
After re-warming then you determine what tissue is still viable

28
Q

Inhalation

A

Nasal hair burn = inhalation burn
coughing, hoarseness = inhalation burn
Thermal burns around the head, neck, trunk = inhalation burn
Trachea becomes burned and gets inflammation within the airway and it can become obstructed

29
Q

Escharotomy

A

Scalpel to open them up and remove the eschar
Some tissue does better than others
Need to remove the thick, bad tissue to prevent infection

30
Q

Escharotomy is defintiely needed when

A

Eschar on trunk - will limit breathing!

31
Q

Pain

A

Medications will generally be given IV (not IM or orally - too hard to find a good site, and you do not know how it will metabolize)
IM and oral will likely not be absorbed as expected

32
Q

Positioning

A

Position of comfort = position of dysfunction! They will go to a comfort position and then lose function
Need to position them in the way that they do not want to be positioned to help maintain motion

33
Q

Splinting - why

A

Need to prevent contractures!

34
Q

Burn care - treatments

A 
Hydrotherapy (special for burns)
Debridement
Dressing changes
Monitor fluids
Prevent infection
35
Q

Exercise

A

ROM is critical
Ambulation - do this asap
Resp. system - esp. with upper body burn
Strengthening

36
Q

Functional activities

A

Home care issues
Occupational considerations
Adaptive equipment

37
Q

Psychological considerations

A 
Threat to life
Disfiguration (self-image)
Fear of loss of affection
Inability to perform life roles 
Also the reason for the burn (their fault, someone else?)
38
Q

Grafts - Homograft (allo) =

A

Cadavers are the usual source

this is usually a temporary graft

39
Q

Grafts - Xenograft =

A

Pig skin is the usual source

Usually a temporary graft

40
Q

Grafts - Autograft

A

Pt own skin

Can be meshed or sheet

41
Q

Grafts - Autograft - Meshed

A

take 1 in piece and put it through something to cut holes in it and stretch it out
Makes it grow 3x bigger!

42
Q

Grafts - autograft - sheet

A

Usually from the epidermis

sometimes some of dermis too

43
Q

Skin substitutions in burn care -

A

CEA
Synthetic substitutes
Cultrued dermis
Alloderm

44
Q

Skin substitutions in burn care - CEA

A

Cultured epithelial autografts - keratinocytes are obtained, cultered, and used to grown into skin sheets!

45
Q

Skin substitutions in burn care - synthetic substitutes

A

Temporary

Biobrane, apligraft, dermagraft…

46
Q

Skin substitutions in burn care - Cultured dermis

A

integra

47
Q

Skin substitutions in burn care - alloderm

A

treated cadaver skin

48
Q

Complication (just one of them) and what helps

A

Keloid formation

compression garment can help

Practice topics Exam 2 (15 decks)

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