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Physiotherapy in Specific Groups > Burns > Flashcards

Burns Flashcards

1
Q

At what temperature does cell damage start to occur?

A

41 degrees

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2
Q

At what temperature does coagulation of protein occur?

A

> 50 degrees

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3
Q

What are the components of a burn wound?

A
  • Total body surface area %

- Depth (superficial [epidermal], partial [dermal], deep partial and full thickness)

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4
Q

What kinds of burns can occur?

A
  • Thermal
  • Chemical
  • Electrical
  • Radiation
  • Inhalation
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5
Q

What are the functions of the skin?

A
  • Protection
  • Prevention
  • Preservation
  • Sensory
  • Thermoregulatory
  • Communication
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6
Q

What can occur between the epidermis and dermis when burnt?

A
  • Irregular formation (rete ridges) results in mixed depths
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7
Q

Where are the three most likely places that a burn injury will occur?

A
  • Home
  • Work
  • Roadways
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8
Q

What are the two top reasons for a burn injury occurring?

A
  • Carelessness (42%)

- Accident (36%)

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9
Q

What are the three top sources of burns that occur in children?

A
  • Scald (60%)
  • Flame (25%)
  • Contact (10%)
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10
Q

What are the three top sources of burns that occur in adults?

A
  • Explosion/flame (48%)
  • Scald: oil/water (33%)
  • Contact (8%)
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11
Q

What populations is scald injury most likely to occur?

A

Predominantly evidence in the very young, the elderly, D&A, epilepsy

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12
Q

What is the peak age for likelihood of burns?

A

Around 20 years old

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13
Q

What is the percentage of burns injury in male and female adults?

A

Males: 62%
Females: 38%

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14
Q

What are the common surfaces that cause contact burns?

A
  • Irons
  • Oven doors
  • Heaters
  • Exhaust pipes
  • Industrial presses
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15
Q

When does a flash burn occur?

A

Ignition in the vicinity of inflammable material, resulting in a sudden release of energy in the form of heat.

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16
Q

Voltage and temperature of electrical conduction injury

A

1000-33000V

1000 to 3000 degrees

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17
Q

Is electrical conduction injury always physically visible?

A

No

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18
Q

What occurs with an acid chemical burn?

A

Acid coagulates protein and desiccates, so it cannot keep burning

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19
Q

What occurs with an alkali chemical burn?

A

Alkali produces vesicles and liquefication which allows the chemical to continue to penetrate the tissue.

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20
Q

What are the five classifications of burn depth?

A
  • Epidermal
  • Superficial dermal
  • Mid-dermal
  • Deep dermal
  • Full thickness
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21
Q

Which acid is most dangerous and why?

A

Hydrochloric acid

Penetrates the skin

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22
Q

What is the colour, blister presence, capillary refill, sensation and healing characteristics of a epidermal burn?

A 
Red
No blisters
Capillary refill present
Sensation present
Healing capacity
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23
Q

What is the colour, blister presence, capillary refill, sensation and healing characteristics of a superficial dermal burn?

A 
Pale pink
Small blisters
Capillary refill present
Sensation painful
Healing capacity
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24
Q

What is the colour, blister presence, capillary refill, sensation and healing characteristics of a mid-dermal burn?

A 
Dark pink
Blisters present
Slugglish capillary refill
Variable sensation
Usual healing capacity
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25
Q

What is the colour, blister presence, capillary refill, sensation and healing characteristics of a deep dermal burn?

A 
Blotchy red
Variable presence of blisters
Capillary return absent
Sensation absent
No healing capacity
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26
Q

What is the colour, blister presence, capillary refill, sensation and healing characteristics of a full thickness burn?

A 
White
No blisters
Capillary refill absent
Sensation absent
No healing capacity
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27
Q

What can determine if surgery is completed on a burn?

A

Location of the burn

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28
Q

What are the three different zones of burns?

A
  • Zone of coagulation
  • Zone of stasis
  • Zone of hyperaemia
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29
Q

What are the skins characteristics of a superficial dermal burn?

A
  • Necrosis confined to upper third of dermis
  • Zone of necrosis lifted off viable wound by edema
  • Small zone of injury
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30
Q

What is the approximate healing time of a superficial dermal burn?

A

7-14 days

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31
Q

What is the approximate healing time of a mixed dermal burn?

A

14-21 days

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32
Q

What are the skins characteristics of a deep dermal burn?

A
  • Necrosis involving majority of skin layers
  • Zone of necrosis adherent to zone of injury
  • Smaller edema layer
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33
Q

What is an indeterminate dermal burn?

A

A deep burn that cannot be clinically distinguished as a deep dermal or full thickness.

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34
Q

What is the state of the dermis after a full thickness burn?

A

No remaining viable dermis

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35
Q

What is the most important acute treatment for burns?

A

Fluid resuscitation

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36
Q

What joint will always be operated on if burnt and why?

A

Ankle

Capacity to wear shoes and tolerate friction

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37
Q

How is inhalation injury classified?

A

Extent and location of damage

  • Based on anatomical structure: upper or lower respiratory tract
  • Based on irritants
38
Q

What are the three main types of inhalant injury, classified by irritants?

A
  • Inhale of chemicals: associated with industrial accidents or home drug laboratory
  • Inhale of poison gases: associated with industrial accidents and house fire
  • Inhale of hot gases: steam, flame
39
Q

What is inhalation injury?

A

An acute respiratory tract insult caused by steam or toxic inhalants

40
Q

How is inhalation injury best assessed?

A
  • Fibre-optic bronchoscopy
  • X-ray
  • Intravenous xenon-133 ventilation perfusion scanning
41
Q

What can a fibre-optic bronchoscopy detect?

A

Detects airway oedema, mucosal sloughing, charring or soot in the upper airways

42
Q

How much does inhalation injury increase the rate of mortality?

A

Increases mortality rate by 40%.

43
Q

What does the severity of inhalation injury depend on?

A

Size of the particles and the concentration

44
Q

How do inhalation injuries mimic COPD symptoms?

A

Restriction of the airway caused by epithelial lining thickening due to fibrosis, decreases saturation - just as the smooth muscle restricts in COPD

45
Q

What occurs to the brain after the inhalation of poison gas?

A

Hypoxic brain damage

46
Q

What chemical does plastic release when burnt?

A

Hydrogen cyanide

47
Q

When is carbon monoxide is produced?

A

Incomplete combustion

48
Q

What are the signs and symptoms of CO toxicity?

A
  • Tightness of forehead
  • Dilation of blood vessels
  • Headache
  • Vomiting
  • Dimness of vision
  • Increased HR and RR
49
Q

How quickly can CO toxicity be reversed?

A

Depends on the availability of oxygen and the half life of CO.

  • 250 mins in room air
  • 40-60 mins if given 100% oxygen
  • 30 mins if 3 atm pressure and 100% oxygen given
50
Q

When is hydrogen cyanide produced?

A

Produced in fires involving nitrogen i.e. containing polymers

51
Q

At what point does hydrogen toxicity occur?

A

Starts at level of 0.1 micrograms/ml (concentration of >20ppm)

52
Q

What other injuries are gas inhalation injuries associated with?

A
  • Head and neck burns

- Thoracic/abdominal burns

53
Q

What areas are generally affected by gas inhalation?

A

Damage to the upper airways and highly ventilated areas

54
Q

What are common signs of hot gas inhalation?

A
  • Singed hair

- Soot in sputum

55
Q

Of the three classifications of injury (irritants), which respond to chest physiotherapy?

A

Hot gas inhalation requires intubation and aggressive chest physiotherapy.
Chemical and poison gas inhalation does not respond.

56
Q

What location of burn is associated with self-harm?

A

Axilla burns, but no hand burns

57
Q

What is the aim of echarotomy?

A

To release compartment pressure so as to allow blood flow to distal part of the limbs with circumferential burns.

58
Q

Where are echarotomies of the chest and abdomen made?

A

Along the edge of the rib cage, laterally and sidways, to allow pressure changes and natural ‘bucket-handle’ action - sometimes under breast line

59
Q

What does chest physiotherapy for intubated severe burns patients involve?

A
  • Check cervical spine and ribs fracture
  • Manual hyper-inflation (check respiratory support parameters) and suctioning
  • Postural drainage
  • Percussion and vibration techniques (no manual technique after skin grafting until Day 5)
  • Early mobilisation
60
Q

What does chest physiotherapy for extubated severe burns patients involve?

A
  • ACBT and lots of deep breathing exercises
  • Continue with manual techniques
  • Coughing
  • Active exercise and sits out of bed
  • Suctioning
  • Gradual increase of ambulation (to improve lung function as well as sense of self control)
61
Q

When are echarotomies done in the neck?

A

If the carotid or vertebral arteries are compromised.

62
Q

What are burns patients most at risk of in hospital?

A
  • Infection
  • Hospital acquired diseases e.g. pneumonia
  • Aspiration
63
Q

What is the process leading to a echarotomy being performed?

A

Acute swelling induced by inflammatory responses, resulting in soft tissues being compressed. Blood flow is restricted to distal areas causing avascular nqecrosis.

64
Q

What other respiratory insults need to be considered when treating an inhalation injury?

A
  • TENS
  • Other respiratory problems: asthma, CAL, heavy smoker
  • Related cardiac issues leading to pulmonary oedema, pulmonary effusion or insufficiency together with excessive fluid resuscitation
65
Q

What are the goals of physiotherapy when treating a burns patient?

A
  • Primary: save life
  • Preserve potentials
  • Prevent contracture development
  • Minimise deformities
  • Assist in regaining motor functions
  • Restore cardio-pulmonary fitness
  • Ultimate goal: return to work/ community
66
Q

What factors affect scarring?

A
  • Children: the younger the patient the more scar activity, elderly less likely.
  • Skin type: dark pigmented, Asian.
  • Genetic predetermination.
  • Length of time to heal: the longer to heal, the more active the scarring process.
  • Infection
67
Q

What kind of burns will scar?

A
  • Partial thickness: if >21 days

- Full thickness

68
Q

What occurs during the scarring process?

A
  • Increasing vascularity over 2-4 weeks

- Delivery of new skin tissue (fibrocytes, collagen) in a disorganised manner

69
Q

Why is management of hypertrophic scarring important?

A
  • Prevent contracture
  • Increase independence
  • Maximise function
  • Decrease the need for reconstructive surgery
  • Attain the best cosmetic results possible
70
Q

What does pressure therapy do to help scarring?

A

Works by blanching or dampening blood flow and limited the deposition of scar tissue, to assist with collagen remodelling

71
Q

What pressure is ideal for effective pressure therapy? How long should it be continued?

A

Above capillary pressure (~25mmHg), no more than 40mmHg.

Continuous until scar maturation, except removal for bathing

72
Q

Clinically, what has pressure therapy shown to help?

A
  • Flatten and soften hypertrophic scarring
  • Reduce itching
  • Normalise skin colour
  • Help maintain joint range of motion and prevent contractures
  • Provide a protective shield to new scar tissue
  • Relieve “pain” over scar area
73
Q

What can be used to apply pressure therapy?

A
  • Garments
  • Bandages
  • Tubigrip
74
Q

What are the key tips for fitting a pressure therapy garment?

A
  • Cover all graft areas at risk of, or have hypertrophy development
  • Extend the garment 10cm beyond scar boundaries
  • Do not end garments on muscle bellies
75
Q

What are the indications for the use of silicone gel?

A
  • Discreet scar areas
  • Dense scar over joint surfaces
  • Scar band contractures
  • Dry and flaky skin with hypertrophy
76
Q

What are the precautions for the use of silicone gel?

A
  • Excessive moisturiser under silicone
  • Unhealed wounds
  • Skin reactions
77
Q

What are the use of inserts beneficial?

A

Beneficial for thick, rigid scars that are not located over joints and particularly in concave areas.

78
Q

What effect does sun have on new skin?

A
  • Hyper pigmentation
  • Re-burning by damaging new skin cells
  • Increased chance of malignant melanoma
79
Q

What precautions must be taken when around chemicals after a burn?

A
  • Avoid chlorinated swimming pools for six months post-burn

- Wear appropraite grade of disposable gloves or protective clothing

80
Q

What characterises scar maturation clinically?

A
  • Progressive remodeling of the scar
  • Softening
  • Flattening
  • Decrease in wound tension
  • Progressive devascularisation from red to white in colour
81
Q

What considerations need to be made when fitting a garment for pressure therapy?

A
  • Patient lifestyle and job: leather on gloves, reinforcement
  • Fragility of the skin: lining the garment
  • Distal oedema: reinforce is present
  • Facilitate comfort and self-application
82
Q

Who might not have a pressure garment placed on the lower limb?

A

Diabetic patient

83
Q

What are the common features of a burns patient that may require physio?

A
  • Inhalation injury
  • Facial burns
  • High % cutaneous burns
  • Associated with other medical problems
  • Associated trauma
  • Fractures/shrapnel wounds
84
Q

What are the goals of physiotherapy for burns patients?

A
  • Primary: save life
  • Preserve potentials
  • Prevent contracture development
  • Minimise deformities
  • Assist in regaining motor functions
  • Restore cardiopulmonary fitness
  • Return to work/community
85
Q

What aspects of physiotherapy are likely to be used with a burns patient?

A
  • Aggressive chest physiotherapy
  • Splinting and positioning
  • Early mobilisation
  • Passive and active exercises
  • Passive stretches
86
Q

What considerations need to be made when exercising with burns patients?

A
  • Age
  • Previous medical conditions
  • Other conditions, such as limb amputation or spinal injury
  • Wound healing vs mobility
  • Emotional/mental
87
Q

What aspects of chest physiotherapy may be used with a burns patient?

A
  • DB + C
  • Manual techniques
  • Suctioning
  • Manual hyperinflation
  • Early mobilisation
  • Facilitate oxygenation and healing
  • Regain exercise tolerance and cardiovascular fitness
88
Q

What aspects of musculoskeletal physio may be important with a burns patient?

A
  • Joint stiffness
  • Development of contracture
  • Muscle wasting
  • Joint pain
  • Ossification
  • Amputation
89
Q

What musculoskeletal interventions may be important with a burns patient?

A
  • Splinting and braces
  • Passive movement exercise and CPM
  • Active strengthening exercise
  • Aware of development of ossification and skin tears
  • Avoid damage to skin grafting
90
Q

What aspects of neurological physiotherapy intervention may be necessary with a burns patient?

A
  • Motor re-learning program
  • Muscle stimulation
  • Tilt table
  • Early mobilisation and early weight bearing
91
Q

What ageing factors may need to be considered when treating a burns patient?

A
  • Dementia
  • Associated musculoskeletal problems i.e. arthritis, back pain
  • Difficulty walking
  • Falling
  • Acopia
  • Living arrangements

Physiotherapy in Specific Groups (5 decks)

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