Burns Flashcards
Dry, bring red, or pink skin that balances upon pressure; No dermal vessel damage; Resolves within 3–5 days without scarring
Superficial burn
- AKA 1st degree
- sunburn, minor flash burn
Painful, moist, weeping, blistered skin with local erythema and edema; Blanches to pressure with immediate capillary refill; Heal within 10–14 days with minimal or no scarring
Superficial partial-thickness burn
- AKA 2nd degree burn
- Brief contact burns, flash burns, brief contact with dilute chemicals
Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity, can be very painful; Blanches to pressure with slow capillary refill; May take 3 or more weeks to heal; Scarring, pigment changes, contractures possible
Deep partial-thickness burns
- deep 2nd degree burn
- Severe sunburn, scald, flash burn, brief contact with dilute chemicals
Initially look red then become mottled white/black, dry, leathery eschar; Burned areas insensate to light touch, minimal pain; Scarring and contractures likely; Most require surgical debridement and grafting
Full thickness burns
- AKA 3rd degree burns
- Prolonged contact with flame, immersion scald injury
how long do chemical burns take to fully develop?
24-72 hours
Charred, mummified appearance; Exposed deep tissues; Burned areas insensate to light touch, no pain; May have permanent nerve damage; Require surgery (fasciotomy, escharotomy, grafting) and amputation
Subdermal burns
- AKA 4th degree burns
- Electrical burn, strong chemical burn
What burns start to require skin grafts?
deep partial thickness to full thickness
What happens to the CV system after a burn?
- Fluid resuscitation is of primary importance
- Blood pressure generally decreases as a result of hypovolemia
- Resting heart rate 100–120 bpm for adults
- Must monitor and manage edema
What happens to metabolism after a burn?
- Basal metabolic rate doubles or triples
- Increase in core temperature
- Sustained hyperglycemia
- Increased fat catabolism
- Decrease in body mass
- Peaks 7–17 days post major burn injury
* * Patient will have greater nutritional needs!
What happens to the immune system after a burn?
75% of burn patient deaths are due to infection; Sepsis and infection common
- Endogenous and exogenous bacteria
- Decreased tissue perfusion reduces immune system effectiveness
- Neutrophils less effective
- Eschar, blister fluid, residual topical agents excellent medium for bacterial growth
- Open wound for extensive periods of time
What are the keys to local wound care?
- Debride - Foreign debris, residual topical agents, exudate, hair, necrotic tissue
- Remove blisters (open and closed)
- Consider enzymatic debridement if appropriate
- Use sterile technique for large TBSA burns
- Topical antimicrobials are standard - Silver sulfadiazine, Bacitracin
- dressings
- Scar management
What are keys for dressings?
Most common: Topical antimicrobial covered with nonadherent impregnated gauze, roll gauze secondary dressing
- Limit bulk to allow/encourage movement, splint use
- Short-stretch compression wrap to decrease edema and scarring
What are keys for scar management?
- Moisturizer
- Protect from friction and shear
- Scar mobilization
- Compression – mandatory if wound takes 3+ weeks to close
- Darker-skinned individuals > incidence of hypertrophic scarring and keloids
Where are common areas for contractors to occur?
- Anterior neck
- Axilla/shoulders
- Cubital fossa
- Ankle
- Posterior knee
What parameters are important for ROM exercises?
- 2x/day
- Every joint through full range
- AROM or AAROM if able
- Time pain medications
- During dressing changes
- Gentle ROM can begin 4-5 days after graft placement
