Ch 12 - Burn Rehabilitation

Question 1

What is the #1 cause of accidental deaths in children <2 yo?

Answer 1

Burns

Majority result of abuse

Question 2

Describe burns in relation to accidental death and age.

Answer 2

#1 <2 yo
#2 <3 yo
#3 <19 yo

Question 3

What inflammatory mediators are released upon thermal injury?

Answer 3

Histamine
Prostaglandins
Thromboxane
Catecholamines (Epi, NE)

Question 4

Describe a 1st degree burn.

Answer 4

Injury to outer layer of the epidermis
No injury to the dermis
Erythema but no blistering

Question 5

Describe a 2nd degree burn.

Answer 5

Injury to full epidermis + superficial layer of the dermis but basal layer of the dermis remains
Blistering

Question 6

Describe a 3rd degree burn.

Answer 6

Injury to full epidermis + most of dermis

White eschar due to compromised blood flow

Question 7

Describe a 4th degree burn.

Answer 7

Destruction of all skin layers + subdermal tissue injury to fat/connective tissue, muscle, nerve, and bone

Question 8

Describe a superficial partial thickness burn.

Answer 8

Epidermis and upper third of dermis injured

Question 9

Describe a deep partial thickness burn.

Answer 9

Epidermis and most of dermis injured

Question 10

Describe a full thickness burn.

Answer 10

All layers destroyed

Question 11

Describe the rule of 9’s.

Answer 11

– Head = 9% BSA 
– Each UE = 9% BSA 
– Each LE= 18% BSA
– Ant trunk = 18% BSA 
– Post trunk = 18% BSA 
– Perineum = 1% BSA

Question 12

When should burn patient’s be hospitalized?

Answer 12

Most moderate and all major burns

Question 13

What is the Parkland formula?

Answer 13

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

Question 14

What vaccine should be given to burn patients?

Answer 14

Tetanus toxoid

Question 15

Describe a Full thickness skin graft.

Answer 15

Utilizes all layers of epidermis and dermis

Will not contract as it matures

Question 16

Describe a Split thickness skin graft.

Answer 16

Meshed at the time of harvest, giving largest possible area of coverage
Will contract as it heals

Question 17

What are layers of the epidermis?

Answer 17

Stratum basale 
Stratum spinosum 
Stratum granulosum 
Stratum lucidum
Stratum corneum 
Melanocytes

Question 18

What are wound consequences of the epidermal burns?

Answer 18

Source of proliferating cells
Dec protection
Inc water loss
Microorganism growth
Entry of noxious agents
Repeated sunburn

Question 19

How much pressure is needed to counteract the contraction of a scar?

Answer 19

25 mmHg

Question 20

Describe Splint positioning for elbow burns.

Answer 20

Elbow extended and forearm supinated

Question 21

Describe Splint positioning for dorsal hand burns.

Answer 21

– 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

Question 22

What does Splinting exposed joints prevent?

Answer 22

Ankylosis of the joint capsule

Question 23

Describe Splinting of exposed tendons?

Answer 23

Splinted in the slack position to allow revascularization

Question 24

Describe adequate nutrition for burn healing.

Answer 24

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

Question 25

What is the most common site of HO joint involvement in burns in adults?

Answer 25

Ebow>shoulder

Question 26

What is the most common site of HO joint involvement in burns in children?

Answer 26

Elbow>hips

Question 27

What is MRSA furunculitis?

Answer 27

Hard, indurated boils that are painful with minimal purulence involving burned or non-burned area