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MultiSystem Management > Exam 2-Peds Burns, Burn lab > Flashcards

Exam 2-Peds Burns, Burn lab Flashcards

1
Q

What’s the most common cause of burns in kids under 6?

A

scalding

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2
Q

What is Sevens Johnson Syndrome?

A
  • the epidermis separates from the dermis
  • not a burn, but acts like one-it’s an allergic reaction to something
  • the get blisters head to toe
  • they don’t leave scarring the first time, and the second time is lethal so you have to figure out what causes it
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3
Q

Superficial burn (first degree)

A
  • red and dry, painful, no blistering
  • can have mild edema
  • blanches with pressure
  • only involves epidermis
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4
Q

Superficial partial thickness (second degree)

A
  • epidermis and papillary dermis damaged
  • blanches with pressure; pink to red
  • moist; moderate edema; fluid on skin (exudate)=protein
  • blisters, extremely painful, sensation intact
  • possible grafting (wound not healing)
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5
Q

Deep partial thickness (deep second degree)

A
  • epidermis, papillary dermis, various depths of deep dermis damage
  • red/pink-white appearance: waxy texture
  • usually no blisters; moist in areas, but usually dry
  • possible grafting
  • can convert to full thickness injury
  • less painful (sensitive to pressure, but not light touch or pin prick)
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6
Q

Full thickness (third degree)

A
  • epidermis, both dermis, and depths of subcutaneous tissue damaged
  • waxy-white to charred black; dry leathery, parchment like; doesn’t blanch with pressure
  • thrombosed vessels, severe edema
  • painless
  • needs grafting, doesn’t heal spontaneously
  • unknown healing time frame: depends on if graft takes, how much takes, etc
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7
Q

Subdermal burn

A
  • charred black
  • severe edema
  • medical coma
  • can’t heal spontaneously-grafting, amputation; frequently don’t survive
  • involves underlying tissues; subcutaneous tissues evident
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8
Q

How do superficial burns heal?

A

minimal edema, spontaneous healing w/out scars after initial peeling; dryness an itching during healing
takes a few days

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9
Q

How do superficial partial thickness burns heal?

A

moderate edema; spontaneous healing with minimal scarring; some discoloration
takes 7-10 days

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10
Q

How do deep partial-thickness burns heal?

A

marked edema; slow healing w/ excessive scarring; artificial lubrication needed for healing w/out grafting
takes 3-5 weeks

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11
Q

How do full thickness burns heal?

A

depressed burn area; grafting necessary; significant scarring
takes an unknown amount of healing time

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12
Q

How do subdermal burns heal?

A

tissue defects; grafting or amputation necessary; significant scarring
takes an unknown amount of healing time

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13
Q

The rule of nines for TBSA gets weird when one body part isn’t fully covered, or more than one part is involved, kind of patchy-like. So what do they do?

A

Use the pt’s palm as 1% of the body and measure like that

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14
Q

The appearance of burns can change all the time. How long does it take to see just how extensive the damage is? Should you change the TBSA any time?

A
  • the extent of the burn may not declare itself until 72 hours after the burn because of dressing changes, cutting things off, wiping things away, etc
  • recalculation of TBSA% could be changed w/ first or second dressing change due to the amount of debridement that may occur
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15
Q

How do you assess circumferential burns?

A
  • color, capillary refill, patient’s temp

- palpate and doppler pulses (they’ll have smaller pulses)

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16
Q

What can happen with circumferential burns?

A

they can cause compartment syndrome with nerve and tissue damage; have to do a escharotomy, because eschar and edema develop full thickness circumferential burns of the chest and extremeties which can push inwards and damage inside things
-CAN NOT do escharotomies on dorsal hand

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17
Q

What are indications of inhalation damage?

A
  • facial burns
  • singed nose hair
  • cough
  • hoarseness
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18
Q

What should you keep a burn pt’s room temp and why?

A

they lose heat excessively, so you should keep the temp at 86degrees

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19
Q

What are reasons heterotopic ossification may occur?

A
  • full thickness burns
  • delayed/prolonged healing
  • > 20% TBSA burned
  • spesis
  • immobilization
  • high protein intake
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20
Q

When might polyneuropathy occur?

A

adults with >20% TBSA burns
(15-30%)
-may resolve over time

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21
Q

When should you assess positioning/splinting?

A

-should be assessed and managed in the first 48 hrs of admission, because after that scarring sets in and edema is full

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22
Q

Why do we want to position and splint well?

A
  • it’s a key for rehab
  • reduces recovery time, increases number of surgeries, decreased healing time with grafts, decreased contracture risk, decreased edema, allows you to maintain or increase ROM
23
Q

Positioning guidelines: neck, shoulders, elbows

A
  • slight extension/neutral
  • 90degrees abduction, moderate extension/rotation
  • full extension
24
Q

Positioning: wrists, MCPs, IPs, thumbs

A
  • extension up to 5degrees
  • 70-80degrees flexion
  • etension
  • abduction and opposition
25
Q

Positioning: hips, knees, feet/ankles

A
  • ext/neutral, 15-30degrees abduction
  • full extension
  • neutral
26
Q

What should you consider during ROM/mobilization?

A
  • pts and caregivers are extremely painful and fearful
  • compare ROM to baseline throughout length of stay unitl full movement is achieved
  • -2-3x a day
  • affected & nonaffected joints, two joint muscles
  • aggressive ROM while sedated to try to gain degrees
  • active->active assisted ROM while awake throughout the day
  • pt specific HEP given to caregivers (2-3xday)
  • upright time in bed to reduce vasovagal response
  • OOB activities: ADL training if stalbe, transfers/transition, ambulation/stairs
  • grafts: postop day 5
27
Q

types of grafts: slough

A

meant to slough off, not stay on, because they have over 40% burns and don’t have room for a donor site

  • porcine: OR time; up to 7 days, helps to protect new skin underneath and stimulate growth
  • oasis: pig skin, doesn’t require OR time
  • allograft: cadaver skin
28
Q

types of grafts: non-slough

A
  • autograft
  • -STSG: split thickness; epidermis and superficial dermis; trunk, thigh, knee burns
  • -FTSG: full thickness; full dermal; face, etc for cosmesis
  • -mesh: multiple holes in graft skin to cover more areas; 1:1, 1:2, 1:3; stuff that can be covered by clothes
  • -sheet: no holes, used for smaller or specific areas
29
Q

Where do they most commonly get donor sites from?

A

thigh, back, buttocks, groin area

30
Q

What are special considerations for the grafted pts?

A
  • POD 3- outer dressings removed and graft assessed
  • POD 5-typically bed rest until day 5 if graft would be compromised; staples remove about day 5; ROM, ambulation, and ADLs are restarted by physician
31
Q

When does compliance with HEP decrease, and how do you keep their interest?

A
  • transition between acute and OP

- include their interests and make it fun!

32
Q

When do you do all the scar management techniques?

A

when they’re almost healed and the wound is closed

-lotion massage, pressure garments

33
Q

Lotion massage: how often, who does it, how do you do it, what kind of lotion, what does it do, and what happens as you do it more? What’s the last resort?

A
  • 4-6xday
  • PT/OT, RN or parents/giver
  • small circles up and down, side to side, minimal pressure initially
  • non-scented, non-alcohol lotions; cocoa butter, no baby lotion
  • decreases itching
  • progress to scar massage with increased pressure as skin becomes stronger
  • pressure therapies
34
Q

What do you use burn garments for, and how long should they wear them?

A
  • hypertrophic scarring
  • 23hrs/day, 18-24 months for an adult, 203 years in kinds
  • replace them every 304 months
35
Q

When do you measure for custom fitted burn garments?

A

measure once they’re almost healed

36
Q

What kind of OP follow up should the pt set up?

A
  • PT/OT
  • scar management clinic
  • burn camp
37
Q

You always have to think about abuse when there’s a peds burn. How does this effect your discharge plan?

A 
They may not go home with who they came with, so you need to make sure the new caregiver(s) are educated about HEP and burn care.
-set up a follow up phone call
38
Q

How should OP work with kids with burns?

A
  • focus on increasing ROM, independence in ADLs
  • assess pressure garments: kids grow fast!
  • keep family on board!
  • it takes 18-24 months before the scar reaches full maturation
39
Q

What is silvadene?

A
  • anti-microbial cream for partial thickness injuries
  • typically changed 2xday with secondary absorptive dressing
  • can be painful-wipe off with each dressing change
  • dry wounds
40
Q

What is Mepilex AG?

A
  • foam dressing impregnated with silver
  • silicon non-stick contact layer
  • absorbs exudate to maintain a moist wound bed
  • inactivates wound related pathogens (MRSA) w/in 30mins with sustained effect up to 7 days
41
Q

Why is silver so ballin?

A
  • anti-microbial
  • anti-inflammatory
  • kills most common wound pathogens on contact
  • little to no resistance
  • low incidence of allergic reaction
42
Q

What is mepilex?

A
  • no silver!
  • foam dressing, silicone contact layer
  • no trauma on removal
  • waterproof outer layer
  • many uses, including pressure sores
43
Q

What is aquacel AG?

A
  • dressing impregnated with silver
  • feels like felt
  • absorbs exudate and forms a gel, so non-traumatic on removal
  • fills burn/wound and traps bacteria
  • can get into wound more
44
Q

What is xeroform?

A
  • petroleum based dressing, protective dressing, maintains moisture
  • anti-microbial; can use with double antibiotic ointment
  • must be changed daily or every other day; can be done at home
45
Q

What is acticoat?

A
  • silver impregnated
  • can be left on for several days; can be difficult to remove and traumatic to new skin; firm adhesion to skin, which makes ambulation and ADLs painful
  • moisture activates silver
46
Q

Let’s talk about wound vacs, baby

A
  • negative pressure dressing
  • non-adherent layer, sponge on wound bed, keeps bed free of excess exudate, promotes increased blood flow
  • changed 2xweekly or every 48hrs
  • pts can go home with vac and come back for dressing changes
  • used for deep wounds or burns awaiting questionable grafting
  • get bacteria out of wound bed
47
Q

Do they use whirlpool for burns?

A
  • used less these days, but frequently used in the past
  • can be beneficial for certain patients
  • -removing dressings, especially for kids they don’t want to sedate so long
  • -therapeutic: scalding water burns
48
Q

What is tubigrip?

A
  • can be washed and reapplied
  • multiple sizes
  • easy to make work for multiple sites
  • decreases edema, scar formation
  • cheap
49
Q

What are scar products?

A
  • elastogel: undergarment to increase compression and scar management
  • elastomer putty: scar treatment, in conjunction with compression garments or splints, usually in difficult to conform areas
  • mepiform:silicone dressing, well healed burns
  • silopad: soft, stretchy fabric with polymer gel pad that releases mineral oil to soften and moisturize skin
  • topigel: flatter and softer hypertrophic and keloid scar
50
Q

When are scar products used?

A
  • mostly in mature phases of scarring
  • 2-3 months after burn is completely healed
  • used before burn garments
51
Q

What monofilament shows loss of protective sensation?

A

If you can’t feel a 5.07 monofilament, you have lost protective sensation?

52
Q

Where do you do the monofilament test?

A
  • dorsal midfoot

- plantar foot: first, third, fifth digits; first, third, fifth MT heads, medial and lateral midfoot, calcaneus

53
Q

What’s the diabetic foot screen got in it?

A
  • neuro screen-5.07 (MT heads, heel, medial and lateral arches)
  • tendon jerks (knee, ankle)
  • muscle strength-5/5 or nothing (tib ant, tib post, gastroc/soleus)
  • circulation-dorsalis pedis, tib poster, capillary refill 10, great toe ext >50 deg
  • nails: over grown, thickened, missing, discolored
  • skin
  • foot deformities
  • footwear

MultiSystem Management (6 decks)

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