Ch 12 - Burn Rehabilitation Flashcards
What is the #1 cause of accidental deaths in children <2 yo?
Burns
Majority result of abuse
Describe burns in relation to accidental death and age.
#1 <2 yo #2 <3 yo #3 <19 yo
What inflammatory mediators are released upon thermal injury?
Histamine
Prostaglandins
Thromboxane
Catecholamines (Epi, NE)
Describe a 1st degree burn.
Injury to outer layer of the epidermis
No injury to the dermis
Erythema but no blistering
Describe a 2nd degree burn.
Injury to full epidermis + superficial layer of the dermis but basal layer of the dermis remains
Blistering
Describe a 3rd degree burn.
Injury to full epidermis + most of dermis
White eschar due to compromised blood flow
Describe a 4th degree burn.
Destruction of all skin layers + subdermal tissue injury to fat/connective tissue, muscle, nerve, and bone
Describe a superficial partial thickness burn.
Epidermis and upper third of dermis injured
Describe a deep partial thickness burn.
Epidermis and most of dermis injured
Describe a full thickness burn.
All layers destroyed
Describe the rule of 9’s.
– Head = 9% BSA – Each UE = 9% BSA – Each LE= 18% BSA – Ant trunk = 18% BSA – Post trunk = 18% BSA – Perineum = 1% BSA
When should burn patient’s be hospitalized?
Most moderate and all major burns
What is the Parkland formula?
4 mL/kg body weight divided by % BSA burned = 1/2 of the total calculated fluid requirement should be given in the first 8 hours.
Remaining amount over next 16 hours
What vaccine should be given to burn patients?
Tetanus toxoid
Describe a Full thickness skin graft.
Utilizes all layers of epidermis and dermis
Will not contract as it matures
Describe a Split thickness skin graft.
Meshed at the time of harvest, giving largest possible area of coverage
Will contract as it heals
What are layers of the epidermis?
Stratum basale Stratum spinosum Stratum granulosum Stratum lucidum Stratum corneum Melanocytes
What are wound consequences of the epidermal burns?
Source of proliferating cells Dec protection Inc water loss Microorganism growth Entry of noxious agents Repeated sunburn
How much pressure is needed to counteract the contraction of a scar?
25 mmHg
Describe Splint positioning for elbow burns.
Elbow extended and forearm supinated
Describe Splint positioning for dorsal hand burns.
– Wrist in 15 to 20 degrees of extension
– MCP in 60 to 70 degrees of MCP flexion
– PIP and DIP placed in full extension
– Thumb—slight IP flexion and palmar abduction
What does Splinting exposed joints prevent?
Ankylosis of the joint capsule
Describe Splinting of exposed tendons?
Splinted in the slack position to allow revascularization
Describe adequate nutrition for burn healing.
2,000 to 2,200 additional calories and 15 grams of nitrogen per square meter of BSA per day
Additional vitamin C, vitamin A, zinc, copper, and manganese
