Management of burn injuries Flashcards
1
Q
what can cause a burn injury
A
- friction
- electrical
- chemicals
- thermal (flame, contact, scald, frostbite)
- radiation
2
Q
Thermal injury
A
- most common type of burn injury
- scald is most common (water, oil, tar)
- flame is second most common
- direct or indirect contact
3
Q
thermal injury: severity
A
- proportional to contact time, temperature and type of insult
- less time needed for full thickness burns in infant, toddlers or elder at same temperatures
4
Q
Chemical injury
A
- direct contact with either acidic or basic caustic agents
- gold standard treatment: copius irrigation with cool water (some agents this is not right)
be aware of MSDS information if working with chemics
5
Q
chemical injury: severity
A
- noted by duration of contact, strength/concentration and nature of agent
- burning process continues until chemical is sufficiently diluted
- burn from alkaline chemicals tend to be more severe than those caused by acids
6
Q
electrical burns
A
- complex injuries from electrical current passing through the body
- involves skin and organ systems
- damage caused by tissue resistance or direct electrical damage to tissue
7
Q
severity and types of wound involved with electrical burns
A
- creates entrance wound (site of contact)
- exit wound (1 or more exit sites)
- often appears as healthy appearing skin covering deep necrosis
- severity depends on current duration of contact and voltage
8
Q
Frostbite
A
- severe localized cold-induced caused by freezing of tissues
- occurs when unprotected skin is exposed to temperatures < 21 degrees
- causes cold induced cell death and localized tissue ischemia
9
Q
classification of frostbite
A
- similar to burns
- superficial: pallor, pain, edema, large clear fluid blisters with edema and erythema
- deep: hemorrhagic blisters mummification with bone and muscle necrosis
10
Q
burns: classification
A
- superficial thickness: painful, does not blister, does not scar
- particial or intermediate thickness: superficial partial thickness or deep partial thickness (requires surgery)
- full thickness: dry, insensat to light touch
- fourth degree: involved muscle to bone
11
Q
Superficial burns
A
- first degree
- epidermis only
- pink, red, dry surface no blisters
- resting inflammatory pain and tender to touch
- superficial burns are not included in TBSA calculations
12
Q
Superficial partial thickness
A
- epidermis and papillary dermis
- second degree
- blisters, moist, bright red surface
- very painful, sensitive touch
13
Q
Deep partial thickness burn
A
- second degree
- destroys epidermis, papillary layer and reticular layer of dermis
- mottled white appearnace; will not blanch
- does not blanch due to imapired vascularity/cap refill
- insensate to pain assoicated, remain sensate to light touch, vibration, pressure and stretch
- debridement recommended
14
Q
full thickness burn
A
- epidermis, dermis, subcutaneous tissue
- dry, firm, leathery, white and red/black
- no blanching/refill
- insensate to touch, pain associated with associated viable tissue
- most treated with excision and grafting
15
Q
size of burn injury
A
- total body surface area - %
- estimate to predict total fluid/caloric requirements, guiding interventions and predictor of morbidity and mortalitiy
16
Q
methods to calculate size burn injury
A
- rule of nines: adult patients with large burn areas
- rule of sevens: adult patietns with BMI > 35 due to abdomen being Disproportionate
- lund and browder: pediatric patients
- palmar surface are: small and scattered patterns (size of person’s hand)
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17
Q
rule of nines
A
- divides body into 11 area = to 9% each with 1% for genitalia
- front of arms - 4.5
- toso = 18% (front)
- front of leg = 9%
- face (front) = 9%
18
Q
Lund and browder
A
- chart to measure burns allowing for age development
- preferred for pediatric units
19
Q
Palmar surface area
A
- equates to patients own palm and fingers to a specific percent of TBSA
- best for smaller and scattered patterns
20
Q
American burn association criteria for referral to regional burn unity
A
- partial thickness burns that encompass greater than 10% TBSA
- burns that involve the face, hands, feet, genitalia, perineum, or major joints
- full thickness burns in any age groups
- electrical burns, including lightning injury
- chemical or inhalation injury
- burn injury in patients with preexisting medical conditions that can complicate management, prolong recovery, or affect mortality
- any patients with burns and concomitant trauma in which burn injury poses the greates risk of morbidity and mortality
- burn children in hospitals without qualitified personnell or equipment for the care for children
- burn injuriy in patients who will require special social, emotional or rehab intervention
21
Q
pathophysiology of burns: skin
A
- normal barrier/protection is lost
- increase fluid loss and pathogen invasion
22
Q
pathophysiology of burns: pain
A
- from tissue damage
- stimulation of nociceptors from inflammation
- anxiety increases pain perception
23
Q
pathophysiology of burns: cardiovascular
A
- fluid shift from vascular system to interstitium
- may cause significant edema
- decreased perfusion to core organs and organ failure
- decreased cardiac output and increased heart rate
24
Q
burn shock
A
- perfusion unable to meet demand of body tissues
- deprive tissue of oxygen and nutrients and waste products accumulate
25
pathophysiology of burns: increased metabolism
- response to injury and bacterial load
- BMR may double or triple
- risk for malnutrition
- sustained hyperglycemia
26
pathophysiology of burns: immune system:
- sepsis and infection common
- loss of skin barrier function
- decreased tissue perfusion reduces immune cells to area
- neutrophils that reach are often ineffective
- eschar, blister fluid breed bacteria
- immune response stressed by severe burn injury
27
pathophysiology of burns: pulmonary smoke inhalation
- pulmonary edema, result of fluid shift
- hypoxia, dyspnea
- pneumonia
- ARDS
28
pathophysiology of burns: psychological
- posttraumatic disorder
- disrupted sleep
- confusion/delirium
- depression
29
pathophysiology of burns: other organ failure
- kidney
- ulcers
- ileus
30
burn treatment: escharotomy
- surgical
- medial and lateral incisions through eschar to allow expansion of subdermal space and decompression of tissues
31
burn treatment: excision
- surgical intervention
- removal of burn eschar to prepare wound bed for skin grafting
32
burn treatment: skin graft
- surgical intervention
- transferring surgically removed skin from one are of body to cover damaged or missing skin
33
skin grafts
| types
- donor site: harvested from health tissue
- meshed graft: skin graft expanded by meshing harvested skin
- sheet graft: non meshed
- split thickness skin graft: superficial partial thickness depth
- full thickness
34
local wound care for superficial thickness burns
- encourage reepethelialization and moisturizer use
35
# management of burns
local wound care: partial thickness
- prepare for primary healing
- cleanse
- antibacterial agent (silver sufadiazine)
- debate: re blister debridement (if blaster causes issue)
- petroleum impregnated gauze covered with plain gauze secured with netting
- once healed use moisturizer
36
local wound care: full thickness
- prepare wound for surgical management by controlling infection
- cleanse
- treat with antimicrobial topical agent directly to wound or to gauze then placed on wound
37
local wound care: sub dermal burn
- treat to maintain moist wound environment until surgical coverage completed
38
Complications of burns
- amputation: especially with 3rd degree high volt electrical burns
- photosensitivity: abnormal reaction to sunlight, discoloration can last 2-3 years after burn
- pruritus: lasts 6 montsh to 2 years due to dryness and destroyed subaceous glands, scratching prolongs recovery)
- hypertrophic scar: common with deep 2nd degree burns
- contracture: deep 2nd or 3rd degree
- heterotopic ossification: rare complication of full thickness burns, occurs 1-3 months after injury often UE
39
PT interventions for burns
- positioning: enhance healing, reduce edema, prevent of reduce contracture, prevent ulcers, improve pulmonary hygiene
- ROM exercise: BID every joint, active vs passive
- mobility training: increase independence as soon as medically stable
- breathing exercises: deep breathing and incentive spirometry
- aerobic exercise: start slow (initially 20 BPM above resting HR progress to 50-70% max HR
40
contracture prevention
