Final Exam Flashcards
List the types of acute burns
- TENS/SJS
- Friction injuries
- Frostbite
- IV infiltrates
- Pressure injuries
- Traumatic amputations
List the types of reconstructive burns
- Congenital conditions
- Scar contractures
- Cleft lip and palate
- Dog bites
- Port wine stains
- Congenital hairy nevus
T or F? Burn injuries change capillary permeability into the size of RBCs, then the edema goes to the burn site leaving the body hypovolemic
True
T or F? Over-resuscitation (too much fluid) can cause excess edema, stress kidney function, pulmonary complications, heart failure, etc.
True
Compartment syndrome can affect the ___________________, especially if the burn is circumferential
area of a burn
What are the 4 factors for assessing a burn?
- Mechanism of injury
- Depth of injury
- TBSA% (total body surface area)
- Other influential factors (PMH, social history)
What are the 3 zones of a burn?
- Zone of hyperemia
- Zone of stasis
- Zone of coagulation
List the types of burns
- Thermal
- Chemical
- Electrical
- Friction
List the different types of thermal burns
- Flame
- Scald
- Contact
- Flash
- Friction
- Sunburn
T or F? pH of chemical can affect treatment of a chemical burn
True
How should you treat a chemical burn?
Flush with water to remove any chemicals
Describe electrical injuries
- May cause damage to the skin and to internal tissues
- EKG should be done on al patients with electrical burns to rule out cardiac issues
- Common in hands/fingers
Describe friction burns
- Most common: Treadmill belt, road rash, vacuum brushes
- Radiographs should be taken to rule out fractures with trauma history
- Deep injuries over thin skin on fingers can mean tendon involvement
Describe the burn classification scale (+ healing times)
First Degree:
- Superficial (<7 days)
Second Degree:
- Superficial partial thickness (7-21 days)
- Deep partial thickness (21-35 days)
Third Degree:
- Full Thickness (>30 days)
Fourth Degree:
- Full thickness (N/A)
What is the “wallace rule of nines”
A tool used to estimate the TBSA (Total burn surface area)
Alternative: Lund & Browder chart
List he TBSA% of the human body
Head: 9%
Torso: 36%
Arms: 9% each
Legs: 18% each
Genitalia: 1%
Which factors affect how a patient is treated
- Age
- PMH/comorbidities
- Body areas involved
- Medical status
- Additional trauma
- Social concerns
How should you prevent infection of a burn?
Superficial/Smaller injuries:
- Topical agent (bactroban, bacitracin)
Deeper injuries:
- Soak with different agent (silver, sulfamylon, etc.)
T or F? A superficial second degree burn would be appropriate for barrier dressing
True
How should you debride necrotic/dead tissue
- Collagenase
- In-clinic debridement
- Mod sedation procedures
- Tangential excision in operating room
List the priorities of wound closure (in order from most to least important)
- Survival
- Function
- Appearance
T or F? The likelihood of scarring is most likely if it takes more than 14 days
True
How should a clinician manage a scar?
- Scar massage
- Pressure garment
- Topical silicone
- Laser treatments (surgical)
- Z-plasty (surgical)
- Release and graft (surgical)
If a patient has a palmar burn, their hand should be _______ when in a splint
If a patient has circumferential burns, their hand should be _____________ or ___________
Fisted
Extended of slight flexion
How long does a scar take to mature?
At least 12 months
List the characteristics of immature/active scars, and mature scars
Immature Scars:
- Red
- Raised
- Ridged
Mature Scars:
- Pale
- Planar
- Pliable
T or F? Hypertrophic scars stays between the wound borders, keloids expand beyond the wound borders
True
Patients with thermal burns should receive immediate care if…
- full thickness burn
- partial thickness >/= 10% TBSA
- partial or full thickness burns on the face
- patient has burn and other comorbidities
List the healing times for different burns
Superficial: <7 days
Superficial partial thickness: 7-21 days
Deep partial thickness: 21-35 days
Full thickness: >30 days
Full thickness (to bone, muscle, subcutaneous): N/A
What is an abrasion?
- Wound caused by friction to the skin’s surface
- May be superficial or partial thickness
Ex: skinned knee, road rash, floor burn, raspberry
What do abrasions look like?
- May or may not be contaminated
- Mild, stinging sensation
- Light to mod bleeding
- Rarely progress to be chronic wounds
- Risk for infection if patient is older or immunocompromised
Which interventions should be used with abrasions?
- Irrigate with water or saline
- Selective or non-selective debridement
- Clean wounds should be covered with a moisture-retentive dressing
- Contaminated wounds should use antimicrobial and gauze
- Patient can shower but not bathe/swim until skin barrier is restored
Potential dressings: Film + Gauze
What is a laceration?
- Caused by cutting or tearing of the skin surface
- Ranges from partial thickness to deep structures
- Smooth or irregular
- Varying degrees of contamination
- May bleed profusely
Which interventions should be used with lacerations?
- Clean, minor wounds do not require tetanus prophylaxis (puncture wounds sometimes do)
- Monitor for infection and dehiscence
- May shower but not bathe or swim without an occlusive dressing
- Excessive bleeding would be referred to emergency care facility
What is a skin tear?
- Traumatic wound resulting from shear or friction forces that separate the epidermis and dermis
- Partial thickness
- Extremely common and typically avoidable
- Most common on arms, hands, pretibial region
- Most common with elderly individuals
What does a skin tear look like?
- Linear tear or flap
- Wound edges can be approximated and may have tissue defect
- Slight serous drainage
- Minimal bleeding
- Minimal pain
Which interventions should be used with skin tears?
- Irrigate with saline or water
- Treat with skin sealant
- Moisture retentive dressing (hydrogel, gauze)
- Avoid adhesives
- Typically heal without complication
- Watch for infection (especially in the elderly)
Describe surgical wounds
- Keep clean and dry for 24-48 hours
- Minimal draining/bleeding
Precautions:
- Sutures are more likely to cause inflammation than staples
- May have delayed sensitivity or allergic reaction to chemical agents
Describe a dehisced surgical wound
- Typically occurs 4-14 days after surgery
- Present with .5-3.4% of abdominopelvic surgeries
- High mortality rate
- Contraindications include estim, pulse lavage, US
Patient factors include: malnutrition, diabetes, anemia, COPD, steroids, smoking
T or F? Dehisced surgical wounds result from too much tension on the wound edges
True
Describe radiation-induced skin damage
- Those receiving both radiation and chemo are at greater risk for skin reactions
- 95% of individuals who receive radiation get some type of skin damage
- Inhibits inflammatory response and proliferative phase of healing
Patient factors: Age, comorbidities, meds, nutrition, hydration, immune function
What do radiation-induced skin reactions look like?
- Ranges from dermatitis to full thickness tissue loss
- Begins as early as 2-3 weeks of treatment start date (can last up to 4 weeks after finishing)
- Mild reactions include inflammation, slight erythema, local edema
- Dry, scaly, itchy, hyperpigmented skin due to sebaceous glands
- Late tissue injury causes radiation fibrosis
- Ulcers may occur up to an average of 9 years later
Describe the grading scale of radiation-induced skin reactions
Grade 1:
- Faint erythema
- Decreased sweating response
- Epilation
- Dry desquamation
Grade 2:
- Bright erythema
- Tender to touch
- Mod edema
- Moist desquamation
Grade 3:
- Moist desquamation with pitting edema
Grade 4:
- Ulceration or necrosis
Which interventions should be used with radiation-induced skin reactions?
- Protect from mechanical forces (shear, friction, pressure)
- Avoid perfumes
- Should wear loose fitting clothing
- Washing the area w water and maybe mild soap
- Moisturize the intact skin
- Desquamation benefits from silver dressing
List the do’s and dont’s for patients with irritated skin
Do
- Perform daily skin checks
- Bathe daily or less often using a mild soap
- Protect the skin
- Drink plenty of non-caffeinated, non-alcoholic fluids
- Apply sunscreen to areas with radiation fibrosis
Don’t
- Wear constrictive clothing
- Scratch skin even if itchy
- Use a hot tub
- Use adhesive bandages
- Massage during active treatment
What is pyoderma gangrenosum?
- Noninfectious, progressive necrotizing skin condition
- 75% of patients have a systemic inflammatory condition
Presentation:
- Begins as a small, painful papule, vesicle or pustule on LE or trunk
- Generally a cluster of ulcerations that rapidly expand
- Progresses to full thickness ulcerations with irregular, purple borders
- Undermining and lack of dermal support lead to epidermal necrosis
- Differential diagnosis includes cancer, vasculitis, primary infection, drug induced skin reaction, spider bite, chronic VI
Takes 1-3 years to heal
Which interventions are used for pyoderma gangrenosum?
- Medications
- Corticosteroids
- Local wound care
T or F? Pyoderma gangrenosum is slow wound healing (69% of wounds resolve after 1 year)
True
T or F? Pyoderma gangreneosum recurrence is common
True
What type of wound is caused by friction to the skin’s surface?
Abrasion
Patients with abrasions or lacerations are advised to not do what
Take baths or go swimming without an occlusive dressing
Which population is most vulnerable to skin tears?
Infants and the elderly
Which modalities are contraindicated for dehisced (broken) surgical wounds
- EStim
- US
- Pulse lavage (w/ suction)
