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Lecture 4c - Burns Flashcards

1
Q

Where do most burn injuries occur?

A

In home, mostly in kitchen & bathroom

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2
Q

How do thermal burns occur?

A

direct/indirect contact w/ flame, hot liquid, steam

most common type of burn

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3
Q

What are some common causes of chemical burns?

A

acids, bases, industrial accidents, assaults, includes cement and asphalt

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4
Q

T/F chemical burns cause partial thickness burns

A

False

More likely to cause full thickness skin damage than thermal.

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5
Q

Do alkaline or acidic chemicals create more severe burns?

A

Alkaline chemicals

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6
Q

Are AC or DC burns more severe?

A

AC

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7
Q

What dysfunctions do we see after electrical burns?

A
  • MSK dysfunction
  • neurological injuries
  • acute single & multiorgan system dysfunction
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8
Q

What depth of burn is this?

only epidermis, sunburn or flash burn, skin looks bright red or pink and blanches under pressure

A

Superficial Burns

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9
Q

What depth of burn is this?

no blisters, may exfoliate, should resolve spontaneously in 3-5 days

A

Superficial Burns

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10
Q

What depth of burn is this?

epidermis & papillary dermis, severe sunburns, brief contact burns, scalds, flash burns and brief contact with dilute chemicals

A

Superficial Partial-Thickness Burns

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11
Q

What depth of burn is this?

May look moist, weeping, blistered skin with local erythema and edema, painful, should heal with normal care 10-14 days, after closing, hypersensitivity and itching are common

A

Superficial Partial-Thickness Burns

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12
Q

What depth of burn is this?

Epidermis and dermis, contact with hot liquids or objects, flash burns, chemical burns, characterized by mottled areas of red with white eschar, may have blisters, may be painful and have areas of insensitivity

A

Deep Partial-Thickness Burns

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13
Q

What depth of burn is this?

Decreased pinprick sensation but intact pressure sensation, may have epithelial islands from epidermal appendages, may need grafting, watch for hypertrophic scarring and contracture formation

A

Deep Partial-Thickness Burns

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14
Q

What depth of burn is this?

Epidermis and dermis to subQ, from an immersion scald injury, prolonged contact with a flame or steam, contact with electrical currents or exposure to chemicals

A

Full Thickness

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15
Q

What depth of burn is this?

Mottled white, gray or black, can be multiple depths, little pain usually, heal by epithelialization/contraction, may need surgical debridement

A

Full Thickness Burns

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16
Q

What depth of burn is this?

1st degree

A

Superficial Burns

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17
Q

What depth of burn is this?

superficial 2nd degree burns

A

Superficial Partial-Thickness Burns

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18
Q

What depth of burn is this?

Deep 2nd degree burns

A

Deep Partial-Thickness Burns

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19
Q

What depth of burn is this?

3rd degree burn

A

Full Thickness Burns

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20
Q

What depth of burn is this?

4th degree burn

A

Subdermal Burns

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21
Q

What depth of burn is this?

destruction beyond the dermis into fat, muscle, tendon and/or bone; electrical, prolonged thermal contact or exposure to strong chemicals

A

Subdermal burns

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22
Q

What depth of burn is this?

Have charred or mummified appearance, needs extensive surgicial intervention-fasciotomy, escharotomy, grafting, amputation

A

Subdermal Burns

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23
Q

What is the rule of nines?

A

Divides integument into areas roughly equivalent to 9% of TBSA

consistently overestimates size of burn injury, fastest and easiest

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24
Q

What is the Lund-Browder Classification?

A

pediatric scale to account for different head and limb size

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25
What is the Palmar Method?
Uses the area of the palmar surface of hand to determine burn size, highly variable and should NOT BE USED
26
Which is the preferred method for estimating burn size?
Lund-Browder Classification * for all ages
27
What are the 3 integument zones of a burn?
1. **Zone of coagulation** (central portion) 2. **Zone of stasis** (compromised perfusion) 3. **Zone of hyperemia** (outer edge affected)
28
What are some CV system complications from burns?
* need **IV fluids** * **low BP** * often have **sinus tachycardia** leading to low cardiac reserves * monitor for **compartment syndrome**
29
What is burn shock?
Perfusion unable to meet demands of the body --> skin cells die & release enzymes that increase capillary permeability Q decreased by 50% for 2-4 hours after burn = even less perfusion
30
What percent of pts will need intubation at some point?
50%
31
Carbon monoxide has ___x greater affinity for binding O2 than Hemoglobin, carbon monoxide __________ and smoke inhalation account for half of deaths that occur after first 12 hours of a burn injury
**200x** greater affinity CO **poisoning**
32
Burns will cause basal metabolic rate to _____ or _____ with severe burns
Double or triple
33
What are some ways PTs can help treat burns?
1. Debridement 2. Infection Control 3. Dressings 4. Working as a team
34
What phase of healing do scars happen in?
Remodelling - and can cause abnormal healing
35
How do you clean scar tissue?
Gently cleaned daily using a mild, non-perfumed soap and water, then apply moisturizer throughout the day
36
____ ____ ____ can be used to reduce or prevent scarring and even up to 4 years after injury
Silicone gel sheeting
37
What are some warning signs of potential scar problems
* limited ROM * new onset of joint restrictions * banding of scar tissue with ROM or blanching with stretching of scar tissue
38
How does hypertrophic scarring appear?
Red, raised, fibrous lesions that stay **within the confines** of the original wound
39
What is hypertrophic scarring?
Overproduction of immature collage during **proliferative and remodeling phases**
40
How much more likely is hypertrophic scarring for darker skin?
15x more likely
41
How are keloids different from hypertrophic scarring?
Extend **beyond** the confines of the original wound
42
How long does it take for a burn scar contracture to form?
1-4 days
43
How long does it take for a tendon/sheath contracture to form?
5-21 days
44
How long does it take for adaptive muscle shortening?
2-3 weeks
45
How long does it take for ligamentous/joint capsule restriction?
1-3 months
46
If their **anterior neck** is burned, how should you position then?
Extension, no pillows
47
If their **circumferential neck** is burned, how should you position them?
Neutral toward extension
48
If their **posterior/asymmetrical neck** is burned, how should you position them?
Neutral
49
If their **shoulder/axilla** is burned, how should you position them?
Arm abduction to 90-110 degrees/ External rotation
50
If their **elbow** is burned, how should you position them?
Extension & supination
51
If their **wrist** is burned, how should you position them?
extension
52
If their **MCP** is burned, how should you position them?
MCP flexion at 90 degrees
53
If their **PIP/DIP** is burned, how should you position them?
PIP/DIP extension
54
If their **thumb** is burned, how should you position them?
Abduction
55
If the **web spaces between their fingers** is burned, how should you position them?
Finger abduction
56
If their **hip** is burned, how should you position them?
extension/neutral rotation/slightly abducted
57
If their **knee** is burned, how should you position them?
Extension
58
If their **ankle** is burned, how should you position them?
Neutral
59
How many hours a day should you wear transparent neck orthosis (TNO)?
18-24 hours each day; removed for eating, wound care, and facial exercises only
59
What is a Transparent neck orthosis?
See-through mask that is worn after a neck burn; splint helps the neck heal with the least scarring and maintaines neck length
60
What are some contraindications for ROM TEX?
nonstabilized fractures, cardiovascular instability, extubation within 8 hours of treatment, and exposed tendons
61
What is an escharotomy?
Surgical incision through burn wound eschar and into the subcutaneous tissues to **release tissues that may be constricting circulation**
62
What is a fasciotomy?
Surgical incision through the fascia to **release pressure and improve distal circulation**
63
When should skin graft be considered?
**Full thickness** and for **deep partial** thickness wounds wounds need to be free of necrotic tissue and infection
64
What is a xenograft?
From an animal
65
Which graft is from a cadaver?
Allograft
66
What is a biosynthetic graft?
Man made graft
67
68
What is a **mesh** split-thickness graft?
* makes regular small incisions to allow it to be stretched over a larger area * holes allow drainage through * graft is stapled down and non-adherent dressing covers it * **immobilized 1-5 days** to allow fibrin clot to form
69
What is a full thickness graft?
* removes **epidermis and dermis** * donor site is closed primarily or gets split thickness skin graft
70
What are 5 categories of biosynthetic grafts?
1. **cultured** epithelial autografts 2. Human skin allografts from **donated human** cadaver tissue 3. Allogenic matrices from **human neonatal** fibroblasts 4. **Composite** matrices 5. Acellular matrices from **porcine or bovine collagen**

Integ (14 decks)

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