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Wound Care > Burns and Burn Rehabilitation > Flashcards

Burns and Burn Rehabilitation Flashcards

1
Q

What qualifies as a NON-COMPLEX burn?

A

Minor burn

Any partial thickness thermal burn covering

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2
Q

What is a critical area?

A

Hands

Feet

Face

Perineum

Genitalia

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3
Q

What qualifies as a COMPLEX burn?

A

Major burn

Affects a critical area

All chemical and electrical burns

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4
Q

What is the epidemiology of burns in children (1-4)?

A

20% of all patients who sustain burns

70% due to scalding

Boys twice as much

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5
Q

What is the epidemiology of burns in older children and adolescents (5-14)?

A

10% of all patients who sustain burns

Often due to illicit activities involving accelerants and flames or electrocution

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6
Q

What is the epidemiology of burns in the working age (15-64)?

A

60% of all patients who sustain burns

Flame burns

1/3 are work-related incidents

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7
Q

What is the epidemiology of burns in elderly people (>65)?

A

10% of all patients who sustain burns

Scalds, contact burns, flame burns

Due to the effects of aging: immobility, slowed reactions, decreased sensation

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8
Q

What are the classifications of THERMAL burns?

A

Flame

Scalds

Contact

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9
Q

What is a FLAME thermal burn?

A

Causes burns of any depth and often a mixture of depths

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10
Q

What is a SCALD thermal burn?

A

Spilling of hot drink or liquid

Tend to cause superficial burns and may involve a large area of skin

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11
Q

What is a CONTACT thermal burn?

A

Skin touches a hot object

Tend to cause full thickness burns

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12
Q

What are the characteristics of radiation burns?

A

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
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13
Q

What are the characteristics of electrical burns?

A

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

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14
Q

What are the characteristics of chemical burns?

A

Acids, alkalis/bases, organic products

Tend to cause full thickness burns
- Tissues continue to be damaged until the chemical is completely removed

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15
Q

What are the three ZONES of LOCAL response to burns?

A
  1. ZONE OF COAGULATION/NECROSIS
    - Center of wound
    - No tissue perfusion
    - Irreversible tissue damage due to the coagulation of proteins
  2. ZONE OF STASIS
    - Surround central zone of coagulation
    - Decreased tissue perfusion
    - Some chance of tissue recovery with optimal management
  3. 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
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16
Q

What causes SYSTEMIC pathophysiological response to burns?

A

Complex burns with more than 20-30% of TBSA

Systemic hypotension

Bronchoconstriction

3x increase in BMR

Reduced immune response

17
Q

What are the three most common tools for evaluating the area assessment of a burn?

A

Lund and Browder Chart

Wallace’s Rule of Nines

Palmar surface (Hand area ~ 1% of body area)

18
Q

Respectively, how are wounds classified instead of saying 1st, 2nd, and 3rd degree?

A

Superficial

Partial thickness

Full thickness

19
Q

What are the characteristics of a SUPERFICIAL EPIDERMAL burn?

A

APPEARANCE:
- Red and moist/glistening

BLISTERS:
- None

CAPILLARY REFILL:
- Brisk

SENSATION:
- Painful

TREATMENT:
- Usually heals within 7 days, no scarring

20
Q

What are the characteristics of SUPERFICIAL DERMAL burns?

A

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

21
Q

What are the characteristics of DEEP DERMAL burns?

A

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

22
Q

What are the characteristics of FULL THICKNESS burns?

A

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

23
Q

How do you manage NON-COMPLEX burns?

A

See ppt slide 13

24
Q

What are proper cleaning practices for burns?

A

Irrigation with normal saline or warm tap water

Topical solutions with antiseptics can be used

25
Q

What are proper debridement practices for burns?

A

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

26
Q

What are the characteristics of a good burn dressing?

A

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

27
Q

How do you know what the proper dressing selection for a burn would be?

A

See ppt slide 16

28
Q

How is burn pain managed?

A

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

29
Q

What nutritional advice should you give a patient who is managing their burn?

A

Protein required to prevent protein catabolism and muscle wasting

Estimated 2g/kg/d

Enteral feeding (tube feeding) versus parenteral feeding (delivered via blood)

30
Q

What are the main areas you should educate your burn patient in?

A

Nutrition

Skin care

Burn itch

Hypertrophic scarring

31
Q

What is hypertrophic scarring?

A

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

32
Q

What are the 3 R’s of hypertrophic scarring?

A

Raised

Red

Rigid

Other features: altered pigmentation, contractures, altered sensation, pain, itch

33
Q

When does hypertrophic scarring typically take place?

A

4-6 weeks following injury to the deep dermis

34
Q

What are the methods of managing hypertrophic scarring?

A

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

Wound Care (12 decks)

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