Burns and Burn Rehabilitation Flashcards
What qualifies as a NON-COMPLEX burn?
Minor burn
Any partial thickness thermal burn covering
What is a critical area?
Hands
Feet
Face
Perineum
Genitalia
What qualifies as a COMPLEX burn?
Major burn
Affects a critical area
All chemical and electrical burns
What is the epidemiology of burns in children (1-4)?
20% of all patients who sustain burns
70% due to scalding
Boys twice as much
What is the epidemiology of burns in older children and adolescents (5-14)?
10% of all patients who sustain burns
Often due to illicit activities involving accelerants and flames or electrocution
What is the epidemiology of burns in the working age (15-64)?
60% of all patients who sustain burns
Flame burns
1/3 are work-related incidents
What is the epidemiology of burns in elderly people (>65)?
10% of all patients who sustain burns
Scalds, contact burns, flame burns
Due to the effects of aging: immobility, slowed reactions, decreased sensation
What are the classifications of THERMAL burns?
Flame
Scalds
Contact
What is a FLAME thermal burn?
Causes burns of any depth and often a mixture of depths
What is a SCALD thermal burn?
Spilling of hot drink or liquid
Tend to cause superficial burns and may involve a large area of skin
What is a CONTACT thermal burn?
Skin touches a hot object
Tend to cause full thickness burns
What are the characteristics of radiation burns?
Acute effects manifest within 6 weeks after radiation exposure
- Erythema–similar to superficial burn
- Higher doses can result in partial thickness injuries
Chronic effects can manifest months-years after exposure
- Progressive and permanent
- Rarely heal without surgical intervention
- Necrotic bone, periwound tissue changes with increased vascularity and sloughing
- Loss of hair
What are the characteristics of electrical burns?
Extent of tissue damage is determined by the voltage of current
- Low = small, deep contact burns at entry and exit points
- High = extensive deep tissue damage and sometimes limb loss
These burns may interfere with the cardiac cycle and cause arrhythmias
What are the characteristics of chemical burns?
Acids, alkalis/bases, organic products
Tend to cause full thickness burns
- Tissues continue to be damaged until the chemical is completely removed
What are the three ZONES of LOCAL response to burns?
- ZONE OF COAGULATION/NECROSIS
- Center of wound
- No tissue perfusion
- Irreversible tissue damage due to the coagulation of proteins - ZONE OF STASIS
- Surround central zone of coagulation
- Decreased tissue perfusion
- Some chance of tissue recovery with optimal management - ZONE OF HYPEREMIA
- Periphery of the wound
- Good tissue perfusion
- Tissue recovery likely
- Zones are dynamic
- Usual process of repair occurs around the edges
- If the zone of stasis is not properly managed, tissue will die and will cause the wound to get deeper and grow wider
What causes SYSTEMIC pathophysiological response to burns?
Complex burns with more than 20-30% of TBSA
Systemic hypotension
Bronchoconstriction
3x increase in BMR
Reduced immune response
What are the three most common tools for evaluating the area assessment of a burn?
Lund and Browder Chart
Wallace’s Rule of Nines
Palmar surface (Hand area ~ 1% of body area)
Respectively, how are wounds classified instead of saying 1st, 2nd, and 3rd degree?
Superficial
Partial thickness
Full thickness
What are the characteristics of a SUPERFICIAL EPIDERMAL burn?
APPEARANCE:
- Red and moist/glistening
BLISTERS:
- None
CAPILLARY REFILL:
- Brisk
SENSATION:
- Painful
TREATMENT:
- Usually heals within 7 days, no scarring
What are the characteristics of SUPERFICIAL DERMAL burns?
APPEARANCE:
- Red/Pale pink
BLISTERS:
- Large
CAPILLARY REFILL:
- Brisk, but slower than superficial epidermal
SENSATION:
- Painful
TREATMENT:
- Usually heals within 2-3 weeks, no scarring
What are the characteristics of DEEP DERMAL burns?
APPEARANCE:
- Dry, blotchy/mottled and cherry red stained appearance
BLISTERS:
- May be present
CAPILLARY REFILL:
- Absent
SENSATION:
- Variable
TREATMENT:
- May require surgical intervention, possible scarring
What are the characteristics of FULL THICKNESS burns?
APPEARANCE:
- Dry, leathery, white or black (charred); eschar may be present
BLISTERS:
- None
CAPILLARY REFILL:
- Absent
SENSATION:
- Absent
TREATMENT:
- Seldom heal with conservative treatment; usually requires surgical intervention
How do you manage NON-COMPLEX burns?
See ppt slide 13
What are proper cleaning practices for burns?
Irrigation with normal saline or warm tap water
Topical solutions with antiseptics can be used
What are proper debridement practices for burns?
Normal debridement of necrotic tissue
Management of blisters
- Blisters greater than 1 square cm should be “de-roofed” (popped) and the remaining dead skin should be removed with sterile scissors
What are the characteristics of a good burn dressing?
Maintains a moist wound environment
Contours easily
Non-adherent
Maintains close contact with the wound bed
Easy and painless to apply/remove
Protects against infection
Cost-effective
FOR MOST NON-COMPLEX SUPERFICIAL DERMAL BURNS, A SIMPLE NON-ADHESIVE CONTACT LAYER WITH A SECONDARY ABSORBENT LAYER IS EFFECTIVE
- Only need to change secondary layer, leave the contact layer
How do you know what the proper dressing selection for a burn would be?
See ppt slide 16
How is burn pain managed?
Often poorly managed, underestimated, and under-treated
Superficial burns can be extremely painful especially with dressing changes
Patients often describe “pain” when it is actually itching
- Educate them accordingly
What nutritional advice should you give a patient who is managing their burn?
Protein required to prevent protein catabolism and muscle wasting
Estimated 2g/kg/d
Enteral feeding (tube feeding) versus parenteral feeding (delivered via blood)
What are the main areas you should educate your burn patient in?
Nutrition
Skin care
Burn itch
Hypertrophic scarring
What is hypertrophic scarring?
Results from build-up of a dense, thick, non-uniform layer of collagen fibers
Different than keloid scars which can grow beyond the boundaries of the original wound
What are the 3 R’s of hypertrophic scarring?
Raised
Red
Rigid
Other features: altered pigmentation, contractures, altered sensation, pain, itch
When does hypertrophic scarring typically take place?
4-6 weeks following injury to the deep dermis
What are the methods of managing hypertrophic scarring?
Massage and moisturizing
Pressure garments
- Thought to encourage realignment of the collagen fibers and quicken scar maturation
Contact media
- Silicone gel sheets
- Elastomer molds
Laser scar therapy
PT!!!!!
- Improve and maintain mobility and function
- Splinting to stretch scar tissue or prevent contracture formation
