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THE BOARDS > Burns and pain > Flashcards

Burns and pain Flashcards

1
Q

burn classifications

A

1st degree: superficial
2nd degree: partial thickness (superficial and deep)
3rd degree: full thickness
4th degree: subdermal

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2
Q

superficial burn

A
  • epidermis
  • ex) sunburn, brief contact with hot liquid
  • pain: mild discomfort
  • peeling, dry, redness (erythema)
  • no blisters
  • healing: < 1 week
  • scar risk: none
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3
Q

partial thickness burn - superficial

A
  • epidermis + 1/3 dermis
  • ex) contact with hot metal (curling iron)
  • red, wet, blisters
  • pain: significant
  • healing: <2 weeks
  • scar risk: low
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4
Q

partial thickness burn - deep

A
  • epidermis + 2/3 dermis + hair follicles + sweat glands
  • ex) flames, exposure to intense heat
  • red AND white (poor blood flow)
  • pain: the most severe
  • healing: >2 weeks
  • scar risk: high
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5
Q

full thickness burn

A
  • epidermis + dermis + hair follicles + sweat glands + nerve endings
  • ex) chemical, extreme heat
  • pale, dry, does not blanche (turn white with pressure)
  • pain: none; nerve damage so no sensation
    peripheral pain
  • healing: months
  • scar risk: very high
    ** surgical intervention required **
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6
Q

subdermal burn

A
  • full thickness + underlying tissue (muscle, tendon, fat exposure)
  • ex) electrical burn, house fires
  • charring, *peripheral nerve damage
  • pain: none; nerve damage so no sensation
  • healing: months
  • scar risk: very high
    ** surgical intervention required **
    posible amputation
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7
Q

phases of burn recovery from medical management perspective

A
  1. emergent (survival)
    - fluid resuscitation, compartment syndrome
    - respiratory management
    - temperature and infection control
  2. acute phase (until wound closure)
    - non surgical: cleaning therapies, dressing changes, heals on own
    - surgical: cut & cover - grafts
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8
Q

types of grafts

A

xenograft: processed pig skin
allograft: cadaver skin
autograft: person’s own skin

full thickness vs split thickness
meshed vs sheet

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9
Q

rule of 9s

A
  • to assess the extent and severity of the burn
  • body percentage; surface area

head: 9
each arm: 9
each leg: 18
trunk/back: 36
groin: 1

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10
Q

OT eval other to include

A
  • occupational profile, ROM (72 hrs post op), joint mobility, strength, sensation, edema (all when wounds are healed)
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11
Q

ROM contraindications

A
  • avoid active flexion with a dorsal hand burn to prevent rupture
  • can do PROM of digits
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12
Q

sensation contraindications - electric burns

A

do a gross sensation screening to assess peripheral nerve damage

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13
Q

edema contraindications

A

no volometer with an open wound; use a circumferential assessment

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14
Q

OT intervention with burns

A
  • prevent deformity, contractures
  • address edema
  • positioning and splinting
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15
Q

positioning

A
  • start day 1
  • comfort = contracture -> no flexion or adduction (this is naturally what we want to do)

(think of titanic person or da vinci man)
neck: neutral, slight ext
axilla: shoulder abducted to 90 and ER
elbow: extended, forearm neutral
hips: neutral ext, slight abd
knees: ext, slight flex with anterior burn
ankles: neutral or dorsiflexed to prevent foot drop

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16
Q

UE safe position in splint

A

INSTRINSIC PLUS
dorsal burn –> volar splint
wrist: 15-30 deg ext
MCPs: 50-70 deg flex
IPs: full ext
thumb: abducted

17
Q

s/p graft

A
  1. immobilization and protection
  2. initiate movement: gentle AROM (or AA or P if can’t tolerate)
18
Q

what to look out for when starting movement

A
  • heterotopic ossification: bone formation in soft tissue –> do daily AROM in pain free range
  • soft tissue contracture –> serial casting or dynamic splint to stretch
19
Q

things to do in sessions

A
  1. skin conditioning: lubricate, massage, stretch, use lotion
  2. pain management: meds 30 min before, relaxation, visual imagery
  3. temporary compression: worn at all times except bathing cleaning and dressing changes
20
Q

hypertrophic scar

A
  • most common with deep second and third degree burns
  • appears 6-8 weeks after wound closure
  • 1-2 years to mature
  • compression garments should be worn 24 hours/day
21
Q

types of pain

A
  • acute (short)
  • chronic (long)
  • myofascial (muscles, tendons, or fascia)
  • fibromyalgia (musculoskeletal pain and fatigue disorder, tenderness of muscles and tissues
  • low back pain (most common work related injury, lumbar, from poor posture and body mechanics)
22
Q

pain assessment

A
  • determine location
  • evaluate intensity on a scale
  • onset and duration
  • description
  • functional assessment
23
Q

pain scales that commonly address function

A
  1. McGill Pain Questionnaire
  2. Pain Disability Index
  3. Functional Interference Estimate
24
Q

OT intervention for pain

A
  • modalities
  • proper positioning/postural techniques
  • splinting
  • gentle ROm
  • relaxation
  • using proper body mechanics in ADLs and at work
  • modify activities
  • ADL training
  • alternative exercise programs
25
Q

notes on positioning

A

NO pillows under head (can roll a towel under neck but want neck slightly flexed)

NO pillows under knees; want them extended

26
Q

precaution with dorsal hand burns

A

no composite flexion - flexion of the IPs in conjunction of flexion of MCPs - this could rupture the extensor tendons
want to keep fingers straight (IPs) - in the intrinsic plus position until surgeon clears

27
Q

precaution to burn intervention

A

NO thermal modalities - hot or cold
because no sensation

28
Q

“OT burn checklist”

A

what we commonly deal with

Feeling (sensory, pain)
Independence (ADLs, new ones with skin care too)
Range of motion (positioning and splinting)
Edema (compression)
Skin care (lubrication, massage, scar)

29
Q

burn rehab timeline - OT role (4 steps)

A
  1. Emergent - R
  2. Acute - FIRE
  3. Rehab - RISES
  4. Outpatient - SIRE
30
Q

steps post graft surgery

A
  1. immobilization phase
  2. gentle active range (bc they know how it feels)

THE BOARDS (31 decks)

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