Burns

Question 1

What is the rule of 9’s for identifying amount of body covered with a burn?

Answer 1

head/neck = 9%
arms = 9% each
legs = 18% each
anterior trunk = 18%
posterior trunk = 18%
perineum = 1%

Question 2

What % of the body covered with burns identifies them as critical?

Answer 2

critical = 10% of body with 3rd degree burns and 30% or more with 2nd degree burns
- complications common

Question 3

What is a partial thickness burn?

Answer 3

partial thickness can be either superficial or deep, but this means that epidermis AND dermis are both affected

Question 4

If only epidermis is damaged, what kind of burn is that?

Answer 4

first degree burn; no blistering

Question 5

What is affected in a second-degree burn?

Answer 5

2nd degree burn = partial thickness burn (either superficial or deep)

Question 6

What is a full-thickness burn?

Answer 6

3rd degree burn: complete destruction of epidermis, dermis, and subcutaneous tissues
- may extend into muscle

Question 7

What is the leading cause of death in a burn injury?

Answer 7

infection -> gangrene may develop

Question 8

Loss of sebaceous glands in skin d/t a burn can result in what issues?

Answer 8

drying, cracking of a wound

- thus need to protect with moisturizing cream for epidermal burns

Question 9

Discuss the transformation of scar color as it heals.

Answer 9

initially is purple or red, then eventually becomes white

Question 10

What are the three phases of wound healing?

Answer 10

1) inflammatory phase (redness, edema 3-5 days)
2) granulation phase (collagen laid down)
3) maturation phase (scar reforms)

6-12 wks = immature, pink scar
- reformation can take up to 2 years

Question 11

What does emergency care for a burn look like?

Answer 11

immersion in cold water - if less than half of the body is burned and injury is immediate, cold compress may be used

cover burn with sterile bandage/clean cloth, NO ointments

Question 12

T/F: shock often occurs as a result of a burn.

Answer 12

true - often need fluid replacement therapy to prevent and control shock

Question 13

What is an allograft?

Answer 13

use of cadaver skin for a graft

Question 14

T/F: Excessive immersion is the first line of burn wound debridement.

Answer 14

false, it’s contraindicated

Question 15

What are the overall goals of rehab for burn victims?

Answer 15

• limit loss of ROM
• reduce edema
• prevent predictable contractures through positioning/splinting
• prevent or reduce complications of immobilization

Question 16

When does anti-contracture positioning and splinting begin?

Answer 16

day one, continues for many months

Question 17

How should you position the neck?

Answer 17

common for it to be in flexion

- get it in hyperextension and position with a firm plastic cervical orthosis

Question 18

How should you position the shoulder of a burn victim?

Answer 18

abduction, external rotation, flexion (position with axillary “airplane” splint)

Question 19

How should you position the elbow after a burn?

Answer 19

in extension and supination (posterior arm splint)

Question 20

What position should you have the hand in after a burn?

Answer 20

intrinsic plus position (lumbrical action position)

• wrist ext, MP flexion, PIP/DIP extension, thumb abduction
• use resting hand splint

Question 21

How should you position the hip and knee after a burn?

Answer 21

hip = extension and abduction, neutral rotation

knee = extension with posterior knee splint

Question 22

How should you position the ankle after a burn?

Answer 22

dorsiflexion with foot-ankle in neutral via plastic AFO

Question 23

How should you attempt to control edema after a burn?

Answer 23

elevate extremities, ACTIVE ROM

- need to take all joints through PROM prior to achieving AROM

Question 24

How long should you wait after postgrafting to allow grafts to heal before you begin exercise again?

Answer 24

3-5 days

Question 25

What does scar management involve?

Answer 25

• massage/application of moisturizer
• regular massage/touching of scars to dec. sensitivity
• pressure garments to reduce keloids