Burns Flashcards
3 risk factors for developing hypertrophic scars (HTS).
1) young age
2) dark skin
3) meshed skin grafts
What causes HTS?
Overproduction of collagen fibers
The Vancouver Scar Scale (VSS)17 is a 0- to 15-point
scale to assess scar characteristics of pliability, height, pigmentation, and vascularity and was chosen to numerically
assess the left foot HTS. A higher number on the VSS indicates a less OR more aggressive scar.
MORE aggressive
Burn injury results in increased/decreased resting energy expenditure.
Increased
***Hypermetabolism (11), muscle wasting (15), and insulin resistance (20, 21)
are all hallmarks of the stress response to major burns.
**this could last years
In a study looking at the effects of exercise on muscle peak torque, burned patients were
subsequently randomized to one of two treatments: home-based exercise program focusing
on range of motion exercises or supervised isokinetic leg exercise. Did the HEP or supervised group display greater gains in muscle peak torque?
Supervised
If there is a serious burn resulting in muscle wasting of one muscle in an antagonist pair, what could be the resulting deficit?
chronically flexed joints
What intervention can help reduce number of overall corrective surgeries and contracture releases needed?
RET (exercise therapy)
Which drugs have positive effects on lessening tachycardia, hypermetabolism, and muscle catabolism?
Propanolo and B Blockade (propanolol used long term and may also improve VO2 peak and muscle mass)
Which drug can increase skeletal muscle protein which can lead to improved muscle mass.
Oxandrolone
What is most common type of burn in children under 5yoa?
A) scald
B) contact
C) flame
SCALD
A majority of scald burns occur in 1) kitchen/bathroom and ones that occur in kitchen/bathroom are more severe.
1) Kitchen
2) Bathroom
Which formula to determine TBSA in burn patients under age 15?
Berkow formula
Head of infant is what percent of body surface?
20% (adult is 9%)
What type of burn is indicative of abuse
Circumferential with clear line of demarcation (indicate limb dipped in hot water)
When a child is dipped into hot tub of water where would burns be found and why?
Buttocks, deer, perineum due to child reflexively moving into flexed position
What layers of skin are affected in superficial burn
Epidermal later
Does fluid loss occur in superficial burns?
No (therefore not included in TBSA calculations)
What skin layers are affected in partial thickness burns
Also note difference between superficial partial and deep partial
Epidermis and dermis
Superficial: primarily the papillary dermis
Deep: reticular dermis
Are superficial partial thickness burns likely to form scar tissue?
No
If a deep partial thickness burn does not heal in ___ days then it should be considered for skin grafting.
21
Full thickness burns extend through what layers of skin.
Epidermis, dermis, and subcutaneous adipose tissue
When patients limit movement in a swollen limb, edema persists I’m in tissue spaces around tendons, joints, and ligaments. If motion is not restored what can happen to this fluid
Fluid will organize into adhesions
3 immediate ricks/concerns following burn incident
1) Hypovolemia
2) Poor temperature regulation
3) Infection
5 Signs of ill fitting or improperly applied splint
1) Maseration – white moist skin
2) Inflammation
3) Numbness
4) Tingling
5) Pain (EXCEPT low throbbing pain = normal background pain)
2 reasons to increase splint wear time
1) Decrease in ROM
2) compensatory movements
Exercise to joints proximal and distal to skin graft are or are not recommended in acute phase after graft?
NOT recommended as it can decrease graft stability
What burn uses arm trough splint?
Axilla
When what joint is burned you don’t want to be in frog leg position?
Knee
