Burns Flashcards
True or False: temperature <111 F or 44C will not damage local tissues unless exposure is for prolonged periods
True
True or false: In the temperature range between 111F to 124 F the rate of cellular death doubles with each degree rise in temperature; short exposure will lead to cell destruction
True
Thee Zones or Burn wound …. list them
- Zone of coagulation
- Zone of stasis
- Zone of hyperemia
Describe the zone of coagulation
Cells are irreversibly injured, cell death occurs
Describe the zone of stasis
Cells are injured; may die without specialized treatment, usually within 24-48 hours
Describe the zone of hyperemia
Minimal cell injury; cells should recover
List the types of burns.
- Epidermal Burn (1st degree)
- Superficial Partial-thickness Burn (2nd degree burn)
- Deep Partial-thickness Burn (2nd degree burn)
- Full-thickness Burn (3rd degree)
- Subdermal Burn (4th degree)
Characteristics of Epidermal Burn (1st degree)
- Damage to epidermis only
- Pink or red appearance; no blistering (dry surface)
- Minimal Edema
- Tenderness, delayed pain
How long does it take Epidermal burns to heal?
3-7 days (spontaneous healing)
No scarring
Describe the surface appearance/pain of epidermal burns
No blisters, dry surface
Describe the characteristics of a Superficial partial thickness burn
- Epidermis and upper layers of dermis are damaged
- Bright pink/red appearance
- Balancing with brisk capillary refill
- Blisters, moist surface, weeping
- Moderate edema
- Painful, sensitive to touch, temperature changes
How long will it take a superficial Partial-thickness Burn to heal
7-21 days (Spontaneous healing)
Minimal or no scarring; discoloration
Characteristics of Full-thickness burn
- Severe damage to epidermis and dermis with injury to nerve endings (may extend into muscle)
- White (ischemic), charred, tan or black appearance
- No balancing; poor distal circulation
- Parchment-like, dry leather surface; depressed area
- Little pain; nerve endings are destroyed
When is removal of Escher and skin grafting necessary secondary to destruction of dermal and epidermal tissue
For full thickness burns
Describe the healing of Deep partial-thickness burns
Slow + occurs through scar formation and reepithelialization
Excessive scarring without preventative treatment
Describe characteristics of Full-thickness burn
- Severe damage to epidermis and dermis with injury to nerve ending; hair follicles and sweat glands
- Mixed red or waxy white appearance
- Balancing with slow capillary refill
- Broken blisters, wet surface
- Marked edema
- Sensitive to pressure but insensitive to light touch or soft pin prick
Describe Characteristics of Subdermal Burn (4th degree)
- Complete destruction of epidermis, dermis with involvement in subcutaneous tissue and muscle
- Charred appearance
- Destruction of vascular system, may lead to additional necrosis
- From electrical burns; prolonged contact with flame
- Additional complications likely with electrical burns; ventricular fibrillation, acute kidney damage, spinal cord damage
Describe the healing process for subdermal burn
Heals with skin grafting and scarring
Requires extensive surgery; amputation may be necessary
Which type of burn is extremely painful due to irritation of nerve endings contained in the dermis?
Superficial partial-thickness burns
Which burns will be highly sensitive to temperature changes, exposure ot air and light touch?
Superficial partial-thickness burns
If a patient presents with a superficial partial-thickness burn a therapist should focus on removing what?
Blisters should be evacuated due to blister fluid increasing the inflammatory response which retards wound healing
What is the hallmark of a deep partial-thickness burn?
Marked edema
True or false: With a deep partial-thickness burn light touch and sharp/dull sensation is lost, but deep pressure is retained (retention of pacinian corpuscle)
True
How would a therapist differentiate between a deep partial-thickness burn and full thickness burn
If hair follicles and new hair growth are present, indicates deep partial-thickness burn
How many weeks will a deep partial thickness burn heal?
3-5 weeks
True or false: the development of hypertrophic and keloid scares are a frequent consequence of Deep Partial-thickness burns.
True
According to the rule of nines the head and neck is classified as what %?
9%
According to the rule of nines the anterior trunk is classified as what %?
18%
According to the rule of nines the Posterior trunk is classified as what %?
18%
According to the rule of nines the Bilateral anterior arm, forearm, and hand is classified as what %?
9%
According to the rule of nines the Bilateral posterior arm, forearm, and hand is classified as what %?
9%
According to the rule of nines the genital region and hand is classified as what %?
1%
According to the rule of nines the Bilateral anterior Leg and foot is classified as what %?
18%
According to the rule of nines the Bilateral posterior Leg and foot is classified as what %?
18%
List the complications of burn injury
- Infection
- Pulmonary complications (especially in facial burns from smoke inhalation + pneumonia)
- Metabolic complications
- Restrictive Lund disease
- Cardiac and circulatory complications
True or false: Metabolic demands may increase up to 50% in a 25% TBSA
True
With burns what should the recommended room temperature be kept at?
86 degrees F because if you place a burn patient in a room with Norma temp, excessive heat will be lost and further exaggerate teh stress response
True or false: Core temperature in burn patients increases by 1.8-2.6 F
True
Due to altered metabolism, what energy source is used for energy?
Protein from muscle tissue is preferentially used as source of energy
This + bedrest leads to muscle atrophy and weakness
Patients with greater than 20% TBSA are high susceptible to _________ __________.
Heterotopic Ossification
Elbows, hips, and shoulders most common
True or false: Peripheral neuropathy in patients with burns can take two forms: Polyneuropathy or local neuropathy
True. Most neuropathies resolve over time but some may be long term
Most common nerves: brachial plexus, ulnar nerve, and common peroneal nerve
Due to the loss of sebaceous glands in epidermal burns what is important for avoiding a dry, cracked wound.
Moisturizing creams
Dermal healing results in ____________. Scars are initially red or purple, later become white
Scar formation (replaced by connective tissue)
Providing emergency care to burn wounds what should the therapist do?
- Immersion in cold water if <1/2 the body and injury is immediate
- Cover burn with sterile bandage or clean cloth; no ointments or creams!!
True or false: Ointments and creams should be applied to burns for emergency care
False.
Name the ointments that may be used with burns.
- Bacitracin
- Polymyxin B
- Neomycin
What medication is used to penetrate through Escher?
Sulfamylon
Avoid with sulfa drug allergies
When using silver sulfadiazine who should this not be used on?
- Pregnant women
- Infants <2 months
- Sulfa drug allergies
What dressings are commonly used with burns?
- Silver-impregnated
- Hydrogens
- Petroleum-impregnated
- And gauze dressings