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OCCTH 584 > Burns > Flashcards

Burns Flashcards

1
Q

What are the primary functions of skin?

A
  1. Protective covering
  2. Prevent excessive loss of body fluids
  3. Regulate body temperature through the evaporation of water
  4. Sensation
  5. Vitamin D synthesis
  6. Resist mechanical stresses
  7. Cosmetic covering for personal identity
  8. Absorption of selected substances
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2
Q

True or False: Epidermis is vascular.

A

False. Epidermis is avascular and contains no blood vessels.

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3
Q

Which layer of the skin provides strength and elasticity of the skin?

A

Dermis

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4
Q

What are the 3 layers of skin?

A

Epidermis
Dermis
Hypodermis

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5
Q

What structures does the hypodermis contain?

A

Blood vessels

Fat

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6
Q

What structures does the dermis contain?

A

Nerve endings, hair follicles, sweat glands, blood vessels

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7
Q

What are the 3 stages of wound healing? How long do they last?

A
  1. Homeostasis and inflammatory stage (0-96 hours): Coagulation, removal of tissue debri and bacteria
  2. Proliferative stage (day 4-12): Skin continuity re-established, matrix contraction starts, formation of new capillaries
  3. Maturation and remodelling phase (day 13 onward): Reorganization of new collagen, scar remodelling (up to 2 years)
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8
Q

What is primary closure of a wound?

A

A wound that is re-approximated or closed by suture, staples, or tape

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9
Q

What is secondary intent of a wound?

A

A wound that is kept moist and allowed to granulate and re-epithelialize rather than using primary closure, in cases of contaminated wounds

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10
Q

What is delayed primary closure of a wound?

A

Compromise between primary closure and secondary intent; Treated initially by secondary intent to eliminate bacteria, then primarily closed when the wound is clean.

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11
Q

When is skin grafting used?

A

Used for large wounds that cannot be closed with normal healing processes in a timely manner

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12
Q

What are flaps?

A

Tissues that contain its own blood supply and are transferred over avascular areas such as bone and tendon

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13
Q

How does age affect wound healing?

A

Older age = Slower healing time

Younger age = Faster healing time, more scarring

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14
Q

How does diabetes affect wound healing?

A

Slower wound healing time

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15
Q

How do medications and treatments like chemotherapy, radiation, and immunosuppressants affect wound healing?

A

Slower healing time, increased risk of graft loss

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16
Q

What kind of diets are needed for wound healing?

A

High protein diets

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17
Q

How are burns categorized into minor and major?

A

Major burn ≥ 10% total body surface area

Minor burn ≤ 10% total body surface area

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18
Q

What is 1st degree or superficial burn?

A

Only the epidermis is injured

No blistering

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19
Q

What is 2nd degree or partial thickness burn?

A

The dermis is injured to different degrees (superficial, moderate, deep)

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20
Q

What is 3rd degree or full thickness burn?

A

The dermis is fully injured and the hypodermis is exposed

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21
Q

What is 4th degree burn?

A

Muscle/bone/tendon exposure

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22
Q

What is the rule of 9s?

A

A rule/chart that divides the body into sections that represent 9% of total body surface area

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23
Q

True or False: The rule of 9s work for both adults and pediatric patients.

A

False. The rule of 9s only work for adults.

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24
Q

The size of the patient’s hand (palm + fingers) is equal to __ % of the patient’s total body surface area.

A

1%

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25
Q

How long does it take for a 1st degree or superficial burn to heal?

A

<7 days

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26
Q

How long does it take for a 2nd degree or partial thickness burn to heal?

A

7-21 days

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27
Q

Which skin layers do superficial partial thickness burns involve?

A

Epidermis

Top layers of the dermis

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28
Q

True or False: Superficial partial thickness burns have intact or open blisters.

A

True.

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29
Q

What is the colour of superficial burns?

A

Very red

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30
Q

What is the colour of superficial partial thickness burns?

A

Red to pale pink

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31
Q

Superficial partial thickness burns are [likely/unlikely] to scar.

A

Unlikely

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32
Q

What does the colour of the burn indicate?

A

How much blood flow is going to the burn

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33
Q

Which skin layers do moderate to deep partial thickness burns involve?

A

Epidermis

Lower layers of the dermis

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34
Q

Which type of burns start to have reduced sensation to light touch or damage to nerves?

A

Moderate to deep partial thickness

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35
Q

True or False: Moderate to deep partial thickness burns do not have blisters.

A

False. Moderate to deep partial thickness burns do have intact or open blisters.

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36
Q

How long does it take for moderate to deep partial thickness burns to heal?

A

> 21 days

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37
Q

True or False: Moderate to deep partial thickness burns requires grafting.

A

True.

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38
Q

Moderate to deep partial thickness burns are [likely/unlikely] to scar.

A

Likely

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39
Q

Which skin layers do full thickness burns involve?

A

Epidermis
All layers of the dermis
Not bone or tendons

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40
Q

What is the colour of moderate to deep partial thickness burns?

A

Range from red to pale pink to white

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41
Q

What is the colour of full thickness burns?

A

White and leathery to black and charred

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42
Q

Full thickness burns are [dry/wet].

A

Dry

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43
Q

True or False: Full thickness burns are very painful.

A

False. Because nerve endings have been damaged, full thickness burns result in no pain nor light touch.

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44
Q

What is escharotomy?

A

Cutting of the burnt tissue to relieve pressure from edema and prevent blood flow loss

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45
Q

What type of burns result in 4th degree burns?

A

Electrical burns

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46
Q

Which skin layers do 4th degree burns involve?

A

Epidermis
All layers of the dermis and hypodermis
Tendons and bones

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47
Q

What is the colour of 4th degree burns?

A

White and leathery to black and charred

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48
Q

4th degree burns are [dry/wet].

A

Dry

49
Q

True or False: 4th degree burns heal on their own.

A

False.

50
Q

What are the 3 classifications of frostbite?

A
  1. Frostnip – Epidermis involvement
  2. Superficial forstbite – Some dermis involvement, with blister formation
  3. Deep frostbite – Through dermis and subcutaneous tissue involvement
51
Q

Which take longer to assess, burns or frostbites?

A

Frostbites

52
Q

What is laser doppler imaging?

A

Imaging a burn with infrared to show how much blood flow is going to the wound

53
Q

What do the red, yellow, and blue indicate on laser doppler imaging?

A

Red - Will heal within 14 days
Yellow - Will heal in 14-21 days
Blue - Will heal in > 21 days

54
Q

What is debridement?

A

Shaving off layers of dead skin down to healthy skin

55
Q

What is tangential vs. fascial excision?

A

Tangential: Shaving down skin
Fascial: Shaving down to the fascia

56
Q

What are the common donor sites for grafts?

A

Upper leg, buttocks, and the back where the skin tends to be thicker

57
Q

What are the four types of grafts?

A
  1. Split thickness skin grafting
  2. Full thickness skin grafting
  3. Artificial derma matrix (Integra)
  4. Allograft
58
Q

What is the purpose of splinting grafting sites?

A

Prevent movement in the joints and the affected skin to prevent stretching and promote healing

59
Q

When is meshed grafting used?

A

Coverage of larger burn wounds with less donor site available
Promote draininage of fluids postoperatively

60
Q

What are the pros and cons of meshed grafting?

A

Pros: Can cover a larger area with less skin. Allows fluid to drain through the mesh holes.
Cons: Can take longer to heal. The larger the expansion ratio, the more fragile the graft becomes. Can produce more scar and create greater contracture formation.

61
Q

When is sheet grafting used?

A

For smaller burns and burns to more visible areas like the face and hands

62
Q

What are the pros and cons of sheet grafting?

A

Pros: More cosmetically appealing, less contracture of graft site.
Cons: Minimal coverage, can have fluid/hematoma collection under the graft, less expansion ability.

63
Q

What is MEEK grafting?

A

Epidermal level skin taken from the patient’s own body is cut into squares then expanded, so that islands of skin graft is created and eventually heal together.

64
Q

When is MEEK grafting used?

A

When minimal donor site is available.

65
Q

What are the pros and cons of MEEK grafting?

A

Pros: Can get coverage when minimal donor is available.
Cons: Longer healing times and increased scar production.

66
Q

What is full thickness graft?

A

Epidermal and dermal levels of skin taken from the patient’s own body via scalpel excision and secured via primry closure

67
Q

When is full thickness graft used?

A

Coverage of smaller burn wounds

68
Q

What are the pros and cons of full thickness graft?

A

Pros: Minimal scarring, faster healing time, lower donor site pain
Cons: No ability to expand.

69
Q

What is a flap?

A

Epidermal and dermal levels of skin along with subcutaneous fat and vasculature that is harvested and placed over the defected area

70
Q

When are flaps used?

A

Coverage of exposed bone, tendon, and deeper structures. Also for scar release and reconstructions.

71
Q

What are the pros and cons of flaps?

A

Pros: Minimal scarring, lower donor site pain.
Cons: No ability to expand, risk of failure if vascularization not maintained, requires multiple procedures.

72
Q

What is artificial dermal matrix (Integra)?

A

An artificial collagen matrix that becomes vascularized and allows for the development of a wound bed for autograft.

73
Q

When is artificial dermal matrix (Integra) used?

A

Exposed bone or tendon (i.e. full thickness bones)

74
Q

What are the pros and cons of artificial dermal matrix (Integra)?

A

Pros: Allows for grafting over exposed bone or tendon, and if flap is not an option.
Cons: Very expensive, takes a long time to vascularize.

75
Q

What is allograft?

A

Skin from a human donor that is not the patient

76
Q

When is allograft used?

A

When there is no donor site available
If wounds are too infected for autograft.
Used as a temporary method of covering open burn wounds

77
Q

What are the pros and cons of allografts?

A

Pros: Can provide faster coverage of burn wounds when autografting is not an option.
Cons: Can easily shear off and eventually will slough off.

78
Q

How does surgery change ROM in burned areas?

A

Increased ROM

79
Q

What are the goals of OT in acute phase of burns?

A 
Edema management
Preservation of joint ROM and skin mobility
Protect vulnerable tissues (tendons and grafts)
Promote occupational performance
Provide psychological support
Monitor cognitive function
Education of patient and careivers
Psychosocial support
80
Q

What kinds of strategies can be used for edema management if the patient is unconscious?

A

Elevation via splinting, propping, etc.

81
Q

What are some general strategies for edema management in acute burn patients?

A

Elevation
AROM exercises
Participating in ADLs
Compression (only if no open wounds nor fresh grafting)

82
Q

How should the neck be positioned in acute burn patients?

A

No pillow under head
Rolled towel under the neck
Neck splint

83
Q

How should the shoulders be positioned in acute burn patients?

A

Abduction foam wedges
Airplane splints
Side tables with pillows

84
Q

How should the elbows be positioned in acute burn patients?

A

Elbow extension splint or slab

85
Q

How should the hips be positioned in acute burn patients?

A

Minimal flexion at hips when patient is in bed

Foam wedge between knees to abduct hips

86
Q

How should the knees positioned in acute burn patients?

A

Laying flat in bed

Knee extension splints

87
Q

How should the ankles be positioned in acute burn patients?

A

Foot drop splints/plates

Propping ankles against bed footboard with pillows

88
Q

What are the factors that should be considered when using splints for acute burn patients?

A

Medical status (stability, life support)
Patient cooperation and alertness
Patient comfort (watch out for pressure necrosis)
Ease of application (simple to apply and well-labeled)

89
Q

Why are individuals with significant burn injuries at an increased risk of developing pressure injuries?

A

Reduced skin integrity resulting from their burns

Immobility after injury

90
Q

What are common pressure injury sites?

A 
Occiput
Scapulas
Elbows
Spinous processes
Coccyx and sacrum
Ischial tuberosities
Heels
91
Q

What are the indications for cognitive assessment in burn patients?

A 
Disorientation
Memory loss
Impulsive behaviours (on unit or leading up to their trauma)
Amotivation
Persistent delirium
92
Q

What are the contradindications for cognitive assessment in burn patients?

A

Acute delirium
Alcohol/drug withdrawal
Unstable acute medical condition
Significant pain

93
Q

What is the STEPS tool?

A

A tool for interacting with strangers

Includes: Self-talk, Tone of voice, Eye contact, Posture, and Smile

94
Q

What is the Rehearse Your Response (RYR) tool?

A

A tool to use when people ask questions about you or your loved one about your/their burns

95
Q

What is the staring tool?

A

The easiest and fastest way to stop the uncomfortable moment of others staring at you or your loved one

96
Q

What are the goals of OT in the rehabilitation phase of burn wounds?

A

Reduce contractures & improve joint mobility
Edema management
Initiate burn scar management
Promote independence with BADLs/IADLs
Restore activity tolerance, muscle strength, and coordination
Ongoing education
Continued psychosocial support
Enabling role resumption and community reintegration

97
Q

How long does scar tissue remain active?

A

6-24 months

98
Q

How is cording and contracture addressed in the rehabilitation phase?

A 
Edema management
Compression
Serial casting
Splinting
ADLs
Exercises
99
Q

What are the common compression methods?

A

Tubigrip
Coban wrapping
Tensor wrap

100
Q

What are ways to remodel scar?

A

Decreasing blood flow to the scar which may decrease fibroblast
Aligning collagen more parallel to the epidermis by applying pressure
Reducing the interstital space between collagen fibrils by applying pressure
Increasing local temperature of the scar by adding external heat

101
Q

How often should compression garments be worn?

A

As close to 24 hours/day as possible, removing for personal hygiene and wound care

102
Q

Why should compression garments be monitored regularly?

A

Burn survivors may change body size.

Over the time, garments may stretch.

103
Q

Why are inserts sometimes used?

A

To increase compression, local temperature, and moisture to areas of more aggressive hypertrophic scar

104
Q

Inserts are used [under/above] compression garments.

A

Under

105
Q

What kinds of materials are inserts made of?

A

Silicone pads
Velfoam
Neoprene
Conformer

106
Q

How long and how often should scar massage be performed?

A

30 minutes 3 times a week

107
Q

True or False: Scar massage should blanche the scar.

A

True. There should be good blood flow to the scar.

108
Q

Scar massage should be performed when the scar is [not on/on] stretch.

A

On stretch

109
Q

True or False: Scar massage can be applied to the scar without preparing the scar.

A

False. Lotion should be applied to scar prior to massage.

110
Q

What is the purpose of splinting in the rehabilitation phase of burn wounds?

A

To influence the overall length of the scar tissue to prevent contracture of the scar tissue, by applying gentle force to the scar tissue over a prolonged period of time.

111
Q

What type of contracture is common with dorsal hand burns?

A

Ulnar deviation and external rotation of the D5

112
Q

What are static progressive splints?

A

Immobilize and hold a force a desired length, and the force can be adjusted to a new point of elongation and allow for adaptation in length.

113
Q

How does serial casting remodel scar?

A

Continuous stretch to elongate scar tissue
Compression
Increase in the local surface temperature of the scar
Increased hydration of scar

114
Q

How often should serial casting be done to be most beneficial?

A

Frequently, e.g. daily

115
Q

Why is activity tolerance a concern in burn survivors?

A

They lose a lot of muscle mass after their injury.

Their strength and endurance are significantly reduced due to spending weeks to months in bed.

116
Q

What are the OT roles in follow-up for burn survivors?

A

Continued scar management (garments, inserts, splints, education).
Monitor community reintegration and psychosocial concerns.

117
Q

In the case of mild burns (≤ 2nd degree), do we want the patient to do AROM activities, or no?

A

We want the patient to move the body part so that the tissue is kept mobile.

118
Q

What types of clients (and their family members) should be educated for burn prevention?

A

Sensation loss
Cognitive changes that affect safety in the kitchen
Geriatric clients who may have difficulty getting out of the tub quickly

OCCTH 584 (10 decks)

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