Burns

Question 1

Superficial (first degree) burns involve? S&S?

Answer 1

Epidermis only, heals in 3-7 days, no blisters, minimal pain

Question 2

Superficial partial thickness burn (superficial second degree) burns involve? S&S? Example?

Answer 2

Epidermis and upper dermis, heals in 7-21 days, redness and wet blisters, moderate pain, painful

Sunburn

Question 3

Deep partial thickness burns (deep second degree) involve? S&S?

Answer 3

Epidermis, deep dermis, sweat glands and hair follicles, severe pain, c/c-out blisters, could turn into full-thickness burn, 21-35 days to heal possible hypertrophic scarring, sensation could be impaired

Question 4

Full thickness (third degree) burns involve?

Answer 4

Epidermis, dermis, N endings, pain free d/t N endings damaged, pale and non-blanching, white and waxy, non elastic, SKIN GRAFT required, increased hypertrophic scarring risk

Question 5

Sub-dermal burn (fourth degree) burn

Answer 5

fat, muscle, bone? charring present

If electrical, destruction of N ending pathway may be significant, surgical intervention

Question 6

Mechanism of burns

thermal
radiation
chemical
electrical (high voltage DC vs low voltage AC??)

Answer 6

DC - throws individual, blunt trauma also generally involved

AC - Multiple M contractions, cannot voluntarily remove hand from source

Question 7

What occurs during medical management emergent phase 0-72 hours?

Answer 7

Sustain life with hydration, temp control, escharotomy and fasciotomy, wound dressings

Question 8

What occurs during acute phase of medical management, 72 hours or until wound closes?

Answer 8

Surgical and nonsurgical debridement, skin grafts, protein rich diet

Question 9

Define split thickness, full thickness grafts and meshed vs sheet grafts?

Answer 9

Split thickness is full epidermal and partial dermal, good chance of graft survival

Full thickness is epidermal, dermal and fat layers, decreased chance of adherence increased cosmetic appeal

meshed, spreads over larger area, sheet direct

Question 10

OT EVAL

Answer 10

HX and roles
ROM 72 hours post-op
sensation and strength when wounds are healed
ADL & roles ASAP

Question 11

Anti-deformity splinting during emergent phase for:

hands
neck, elbows, knees
shoulder
hip

Answer 11

intrinsic plus
ext
abduction
extension

Question 12

Acute phase interventions?

Answer 12

eval
anti deformity positioning, anti contracture positioning
edema management participation in ADLs
education

Question 13

What are anti-deformity positions during acute phase for:

Neck
Trunk
Shoulder
elbow
forearm
wrist
hip
ankle

Answer 13

slight ext, neutral
ext
90 degree abd, ext rotation, retracted
ext
neutral or supinated
dorsal burn 
- 30 degrees ext, 
volar burn
-30-45 ext
10-15 degrees abd, neutral ext
neutral, 5 degrees dorsiflexion

Question 14

How long do you wait to begin AROM

Answer 14

5-7 days

Question 15

How long is someone immobilized after graft?

Answer 15

3-10 days or until graft adherence

Question 16

Donor site immobilization period?

Answer 16

2-3 days if there is no active bleeding

Question 17

Walking after LE graft?

Answer 17

5-7 days post

Question 18

Name some temporary interim bandages/garments?

Answer 18

Coban, tubular supports, spandex bicycle shorts, TED Hose, isotonic gloves with compression silicone (Otoform)

Question 19

When are custom compression garments initiated?

Answer 19

When sites are > 2 weeks out and not closing spontaneously

Question 20

When is a hypertrophic scar most apparent and active?

Answer 20

Apparent:
6-8 weeks

Active: 4-6 months

Question 21

How long does it take for a scar to mature?

Answer 21

Up to 1-2 years

Question 22

What is heterotrophic ossification and what needs to be done in therapy if one occurs?

Answer 22

Bone in joint soft tissue

No PROM

Hard end feel

Usually requires surgical intervention

Question 23

What kind of graft causes loss of heat tolerance?

Answer 23

Split thickness

Question 24

What is boutonniere deformity, when do you need to worry about it and what are precautions?

Answer 24

Flexion of PIP, hyperextension of DIP, damage to central slip

dorsal hand burns

NO composite flexion, active or passive until extensor hood integrity is confirmed

Question 25

At what degree of burn may you need to worry about sensory damage and when do you test?

Answer 25

Deeper than deep partial thickness

after wound is closed

Question 26

What testing is important when you have an electrical burn?

Answer 26

Gross sensory on affected limb