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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
Positioning: hips, knees, feet/ankles
- ext/neutral, 15-30degrees abduction - full extension - neutral
26
What should you consider during ROM/mobilization?
- 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
types of grafts: slough
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
types of grafts: non-slough
- 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
Where do they most commonly get donor sites from?
thigh, back, buttocks, groin area
30
What are special considerations for the grafted pts?
- 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
When does compliance with HEP decrease, and how do you keep their interest?
- transition between acute and OP | - include their interests and make it fun!
32
When do you do all the scar management techniques?
when they're almost healed and the wound is closed | -lotion massage, pressure garments
33
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?
- 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
What do you use burn garments for, and how long should they wear them?
- hypertrophic scarring - 23hrs/day, 18-24 months for an adult, 203 years in kinds - replace them every 304 months
35
When do you measure for custom fitted burn garments?
measure once they're almost healed
36
What kind of OP follow up should the pt set up?
- PT/OT - scar management clinic - burn camp
37
You always have to think about abuse when there's a peds burn. How does this effect your discharge plan?
``` 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
How should OP work with kids with burns?
- 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
What is silvadene?
- 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
What is Mepilex AG?
- 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
Why is silver so ballin?
- anti-microbial - anti-inflammatory - kills most common wound pathogens on contact - little to no resistance - low incidence of allergic reaction
42
What is mepilex?
- no silver! - foam dressing, silicone contact layer - no trauma on removal - waterproof outer layer - many uses, including pressure sores
43
What is aquacel AG?
- 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
What is xeroform?
- 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
What is acticoat?
- 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
Let's talk about wound vacs, baby
- 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
Do they use whirlpool for burns?
- 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
What is tubigrip?
- can be washed and reapplied - multiple sizes - easy to make work for multiple sites - decreases edema, scar formation - cheap
49
What are scar products?
- 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
When are scar products used?
- mostly in mature phases of scarring - 2-3 months after burn is completely healed - used before burn garments
51
What monofilament shows loss of protective sensation?
If you can't feel a 5.07 monofilament, you have lost protective sensation?
52
Where do you do the monofilament test?
- dorsal midfoot | - plantar foot: first, third, fifth digits; first, third, fifth MT heads, medial and lateral midfoot, calcaneus
53
What's the diabetic foot screen got in it?
- 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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