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Clinical Medicine > Clinical Management of Burn Injuries > Flashcards

Clinical Management of Burn Injuries Flashcards

1
Q

USAISR

A

US Army Institute of Surgical Research Burn Center (where all significant US Military burns are treated)

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2
Q

Criteria for Coming to Burn Center

A 
Burns > 10%
full thickness
sig burn to hands, face, feet
inhalation
chemical/electrical
burns in children
concomitant trauma
***patients with special socieconomic needs
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3
Q

Epidemiology of Burns

A

2million burns per year
2001 (500k nonfatal burns reported; 3423 fatalities)
mostly men

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4
Q

Prevalence of Burn Location

A 
25%--Arms and Hands
16%--Legs and Feet
6%--Upper Trunk
3%--Lower Trunk
5%--Other areas
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5
Q

High Risk Populations

A

Children
Elderly
Disabled
Military

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6
Q

Skin Anatomy

A 
Body's Largest Organ
5 Layers (CLGSB)
Basement membrane---super important
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7
Q

Basic Functions of SKin

A 
protection from infection,puncture/UV rays
conservation of body fluids
temp regulation
excretion/absorbtion
vitamin D production
sotrage of fat
physical appearance
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8
Q

Burn Injury Types

A

Thermal–most common, cover with clean/dry cloth, no ice or cold water soaks (flame/flash)
Electrical–cutaneous and internal injury, cardiac monitoring X 24hours
Chemical
Radiation Burns–sunburn

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9
Q

What Leads to Burn Depth

A

Temperature
Duration of Contact
Dermal Thickness
Blood Supply

(time temp factor for Cellular Death(down to dermis:)--worse for pediatrics/geriatrics
120deg, 5min
130deg, 30s
140deg, 5s
150deg, 1.5s
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10
Q

Burn Depth Terminology

A

Superficial
Superficial Partial (papillary)
Deep Partial (reticular)
Full Thickness

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11
Q

Superficial Burn Charcteristics

A

Epidermis only
Heal less that 10days
red
incovenience

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12
Q

Superficial Partial (PTB)

A 
epidermal and papillary
pain,blisters, moist
capillary refill present
MOST PAINFUL
---analgesia, elevation, ROM (can heal on own--minimize edema)
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13
Q

Deep Partial Characteristics

A 
Less pain
no blisters
dry
mottled (blotchy white/red)
absent/slow capillary refill

all dermal healing–granulation tissue from fibroblasts
about 30days
hypertrophic scar (so graft w/ static stress)—avoids contracture

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14
Q

Full Thickness

A 
entire thickness of epidermis and dermis
decreased pain
dry/leathery/white
absent capillary refill
many have thrombosed vessles
skin graft is absolutely needed 
escharotomy

—–excision and grafting (heals by contracture & epithelial ingrowth from edges)

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15
Q

Sub-Dermal Burns

A

Similar to FT but involves muscle, tendon, and or bone

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16
Q

What matters about burn severity

A 
Age
% Body Surface area 
Depth of Injury
Location (face, hands, genitalia)
Associated disease
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17
Q

Calculating Body Surface Area

A

Rule of Nines–See diagram

Better—-patient’s palmar surface=1%

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18
Q

Epithelial Wound Healing

A

begins within 24 hours
on surface of wound

Phase
1. migration
2. proliferation
3. differentiation
(but don't initially have rete pegs--more likely to shear)
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19
Q

Dermal Healing

A 
no your own skin---its scar formation
Inflammatroy Phase
1.Vascular--vasoconstrict/vasodilate 
2. Hemostatic
3. Cellular
4. Immune
Proliferation
1. collagen synthesis 
Maturation
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20
Q

SKin Graft

A

taking a papillary layer from another tissue and grafting on top

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21
Q

Escharotomy

A

cut skin to relieve pressure (use specific lines)

primarily for circumferential burn, FT burn, loss of pulse, restricted skin excursion

22
Q

Reconstructive Surgery Main Purposes

A

return to function

but also for astetic purposes (getting ear back)

23
Q

Wound Excision and Grafting Characteristics

A

Done all of the time
Burns > 30% TBSA require several operative sessions
remove devitalized tissue
and then graft

24
Q

Graft Priority

A
  1. Survival: get wound closed
  2. Function: hands,feet,joints, face
  3. Appearance: sheet graft on neck,face, and hands
25
Q

Grafting Types

A

Autograft
Allograft
Skin Substitutes

26
Q

Graft Application

A

Sheet v Mesh Graft
Secure Graft in Place
Graft Dressing
Splinting–to prevent contracture (only takes 4 days for a contracture)

27
Q

LIfe of the Graft

A

Day 1-Graft is white, lives of serum fluid, held in place by staples/fibrin clot
Day 2-4-Graft is pink, anastomosis (tissue connecting)
Day 5-7-Graft is pink and red, improved and increased circulation, graft adhered or taken

28
Q

Incidence of Burn Contracture

A 
12-21% of burn scar patient develop contracture 
Locations:
Hands: 35%-45%
Axilla: 19-21%
Elbow: 20%
Neck: 30%
29
Q

Purpose of Burn Rehabilitation

A
  • -Return to function (as always!!!)

- -prevention and treatment of burn scar contracture deformity and hypertrophic scarring

30
Q

Hypertrophic Scar v Keloid Scar

A

Hypertrophic: overgrowth of dermal components within boundaries of wound

Keloid: overgrowth beyond boundaries of the wound

31
Q

Immature Scar

A

red
raised
rigid

32
Q

Mature Scar

A

Pale
Planar
Pliable

33
Q

Normal SKin v Scar

A

Skin: collagen, elastin, ground substance, chondroitin sulfate–4%

34
Q

Timeline to ROM loss due to soft tissue injury

A

burn scar contracture—1-4days (have to elongate–gentle-slow pull!!!!)
tendons and sheaths—5-21days
adaptive muscle shortening–2-3weeks
ligament and joint capsule–1-3months

35
Q

Strategies for Avoiding Contractures

A

Splinting

36
Q

Burn Scar Treatment Objectives

A

prevent contracture

37
Q

Positioning and Splinting Objectives

A

Protective (prevent wound conversion, tissue destruction, contracture, deformity)

Corrective (correct contracture deformity)

Assistive (assist with function)

38
Q

Position of Comfort

A

Position of Contracture

39
Q

Protective Positioning (memorize chart)

A

extend flexor surfaces

position opposite position

40
Q

Types of Splints

A 
Functional Splint (static splint of hand)
Static Progressive Splint
Hand-Web Space Strapping Splint
Long Leg Splint
Abductor Wedge
Ankle Static
41
Q

Indications for Exercise

A

pretty much right away unless protecting a graft (in that case start in 5 days)

42
Q

Burn Rehabilitation Principles

A
  • Stretch
  • Emphasize the extreme to achieve the mean
  • Easy to maintain, hard to to regain
43
Q

Conditioning Exercise (lots of protein loss)

A

kjdhkjdh

44
Q

Edema Control

A

Assessment–figure 8

Treatment–eleveation, AROM, exercise, compression

45
Q

What is depedent control and why is it important

A

lshjhf

46
Q

Types of Pressure Dressing

A 
Elastic wrap (ace)
Self-Adherent Elastic Bandage
47
Q

Who Needs Compression Garments

A

Anyone who is at risk of hypertrophic scarring

48
Q

Other Forms of Scar Control

A

Silicone gel sheets
transparent face mask
medical intervention (surgical/steroid injections/topical creams)

49
Q

Desensitization

A

begin with slightly irritating stimuli

50
Q

Heterotrophic Ossifications (myositis ossificans) (HO)—Characteristics

A

More Common

Clinical Medicine (2 decks)

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