SPECONLEC_S1_L2 - 73-109 Flashcards
Long Term Goal of medical mx for burns is:
To restore skin integrity, function and appearance
immediate goal is restore skin integrity t or f
f, this is the long term goal
Immediate Goal (Post Resucitation) of medical mx for burns:
a. Prevent infection
b. Decrease pain
c. Prepare wounds for grafting
d. Prevent contracture and scarring
e. Maintain strength and function
f. all
f. all
acute or initial medical mx of burns
transport
fluid replacement
determining the extent and depth of injury
wound cleansing
Topical Antibacterial Agents
Proper positioning for optimal joint placement
wound coverage
grafting
t or f goal of wound debridement is To remove dead tissue, prevent
infection, and promote
revascularization/reepithelialization
f, this is the goal of wound cleansing
what acute medical mx would help reduce the number of bacteria
Topical Antibacterial Agents
Topical antibacterial agent; effective against gram-negative or
gram-positive organisms; diffuses easily to eschar
Mafenide acetate (sulfamylon)
Most commonly used
anti-bacterial agent; effective against
Pseudomonas infections
Silver Sulfadiazine
Topical solution with antimicrobial function against gram-positive
and gram negative organisms.
Mafenide acetate solution (sulfamylon 5% solution) silver nitrate
t or f using mafenide acetate is effective against
Pseudomonas infections
f, using silver sulfadiazine
Maintains moist environment
Mafenide acetate solution (sulfamylon 5% solution) silver nitrate
Antiseptic germicide and astringent;
will penetrate only 1-2mm of eschar; useful for surface bacteria;
stains black
Mafenide acetate solution (sulfamylon 5% solution) silver nitrate
mafenide acetate soultion (sulfamylon 5% solution) silver nitrate will
penetrate only how many mm of what
1-2 mm of eschar
Bland ointment; effective against gram-positive organisms
Bicitracin/ Polysporin
Enzymatic debriding agent selectively
debrides necrotic tissue; no antibacterial action
Collagenase, accuzyme
_ applied with sterile glove_ directly to wound or impregnated into _ IN
silver sulfadiazine
white cream, 2-4 mm, fine mesh gauze
White cream applied __ to wound with thin _ layer how many times daily;
may be left undressed or covered with _ in mafenize acetate
directly, 1-2 mm, 2 times, thin layer of gauze
White cream applied with sterile glove 2-4mm directly to wound or
impregnated into fine mesh gauze in what topical medication
Silver Sulfadiazine
50-gram packet of white powder that is mixed with either 1000mL
sterile water or 0.9% sodium chloride soaked gauze in what topical
medication
Mafenide acetate solution (sulfamylon 5% solution) silver nitrate
Dressings or soaks used every __ hours; also available as _ to _ small
open areas in what topica ointment
2 hrs, small sticks, to cauterize, Mafenide acetate solution (sulfamylon 5% solution) silver nitrate
how many grams of packet of _that is mixed with either _
or _ soaked gauze in Mafenide acetate solution
(sulfamylon 5% solution) silver nitrate
50 gram, white powder, 1000 mL sterile water or 0.9% sodium chloride
t or f bicitracin is a thin layer of ointment
applied directly to wound and left closed
f, left open
Ointment applies to eschar and covered with
moist occlusive dressing with or without an antimicrobial agent.
Collagenase, accuzyme
thin layer of ointment applied directly to wound and left open
Bicitracin/ Polysporin
collagenzase is applied to __ and covered with __ with or wihtout
an antimicrobial agent
eschar, moist occlusive dressing
WOUND CLEANSING (2):
Debridement
Review methods in wound management
Removal of eschar is callled
Debridement
Removal of necrotic tissue is also called debirdement t or f
t
debridement would help in preventing bacterial proliferation t or f
t
dressing is done to prevent wound _
contamination
debreidement keeps microorganism at bay t or f
f, dressing
wound cleansing Prevent further injuries t or f
f, dressing
Apply pressure to control the hemorrhage in wound dressing t or f
t
t or f wound dressing Absorb wound drainage
and Assist in wound healing
t
two techniques of wound coverage (dressing)
open technique
closed technique
Applying a topical cream or ointment with or
without dressings (usually without)
OPEN TECHNIQUE
Applying dressings over a topical agent: what technique
Closed Technique
Allows for ongoing inspection of the
wound and examination of the healing process
OPEN TECHNIQUE
purpose of closed technique:
Hold topical antimicrobial agents on the
wound
Reduce fluid loss
Protect the wound
The topical medication must be reapplied throughout the week for open
technique
f, throughout the day
for closed technique, how many times should you change in a day
Change once to twice a day
Layers of closed technique:
1st - Non-adherent
2nd - Cotton padding
3rd - Gauze or elastic bandage
4th - Roller gauze
5th - Elastic wrap
Patient’s own skin, taken from an unburned
area
autograft
autograft is temporary coverage t or f
f, permanent
Taken from cadaver of own species: what kind of grafting
Homograft/Allograft
what kind of grafting is taken from non human like pigs
Heterografts/Xenografts
ARE A LIFE-SAVING
TECHNOLOGY FOR
LARGE, FULL-
THICKNESS, TOTAL
BODY SURFACE AREA
(TBSA) BURNS
CULTURED EPITHELIAL
AUTOGRAFTS (CEAS)
CULTURED EPITHELIAL
AUTOGRAFTS (CEAS) is used for __
LARGE, FULL-
THICKNESS, TOTAL
BODY SURFACE AREA
(TBSA) BURNS.
CEAs are composed of
AUTOLOGOUS
KERATINOCYTES
CEAs ARE CULTURED UNDER
CONDITIONS THAT
GENERATE __SUITABLE FOR
GRAFTING.
EPITHELIAL
SHEETS
what to put in subjective:
Patient’s background
Chief complaints
HPI
PMHx
Lifestyle
Social and Physical Environment
Patient’s goal
Preesisting limitations or previous injuries: what subj part
PMHx
part of subj where the pt will told you the first aid
administered
HPI
MOI is what part of subj
HPI
Objective
VS
OI
ROM
MMT/FMT
Sensory testing
wound assessment
cardiopulmonary assessment
antrhopometric measurement
PA, FA, GA
what to put in OI
Attachments
Splints
Site of wounds etc
what to put in wound assessment
% TBSA Classification
Burn type and depth
Wound dressings
Presence of grafting, graft sites
omts for Burn Outcome Measures
Burn Specific Health Scale -Brief (BSHS-B)
Burns Scar Index (Vancouver Scar Scale)
PTDx: what to put
Classification of burn injury
% TBSA
Severity of burn
determinants of prognosticating factors (5)
Severity of burns
Current health status
Age
Physical Condition
Mental condition
RISK FACTORS TO RETURN TO
WORK AFTER MAJOR BURN INJURY (6)
● Preburn psychiatric history
● Extremity burns
● Electric etiology
● Longer stay at hospital
● Inpatient rehabilitation
● Burn injury occurred at work
BARRIERS TO RETURN TO
WORK AFTER MAJOR BURN INJURY (5)
● Wound issues
● Neurologic problems
● Physical abilities, impaired mobility
● Working conditions (temperature, humidity, and safety)
● Psychosocial factors
Psychosocial factors in barriers include: (6)
○ Drug and alcohol dependence
○ Insomnia
○ Depression
○ Post Traumatic stress (nightmares, flashbacks)
○ Anxiety
○ Appearance issues and concerns over body image
Suggested goals and outcomes for the physical
therapy plan of care for the patient with burns include: (12)
○ Wound and soft tissue healing is enhanced.
○ Risk of infection and complication is reduced
○ Risk of secondary impairments is reduced.
○ Maximal range of motion is achieved
○ Pre-injury level of cardiovascular endurance is
restored
○ Good to normal strength is achieved
○ Independent ambulation is achieved
○ Independent function in ADL and IADL is increased
○ Scar formation is minimized
○ Patient, family, and caregiver’s understanding of
expectations and goals and outcomes is increased
○ Aerobic capacity is increased
○ Self-management of symptoms is improved
PT INTERVENTION (2)
positioning
splinting
what PT intervention prevent contracture formation
positioning and splinting
Splinting uses
Facilitate proper positioning
Prevention of joint contracture
Protecting skin grafts or fragile wounds
Assisting desired motions
to maintain hand at a functional position, what do u use
Hand splints
to avoid neck flexion (position of comfort);
to maintain at neutral or slight extension
neck brace
neck brace avoid _
neck flexion
to help reduce scarring/ maintain or decrease appearance of scars
Compression garments
to maintain patency of mouth, what do pts wear
face splints
to maintain foot at neutral position, what do pts wear
dorsiflexion brace
t or f Compression garments help maintain or decrease appearance of
scars which is why they are worn throughout the body or burned area
t
positioning strategy: ANTERIOR NECK common deformity
Flexion
positioning strategy: shoulder - axilla common deformity
Adduction and internal rotation
positioning strategy: elbow common deformity
Flexion and pronation
positioning strategy: hand common deformity
Claw hand (also called intrinsic minus position)
positioning strategy: hip and groin common deformity
Flexion and adduction
positioning strategy: knee common deformity
Flexion
positioning strategy: ankle common deformity
Plantarflexion
positioning strategy: anterior neck motions to be stresssed
Hyperextension
positioning strategy: shoulder axilla motions to be stressed
Abduction, flexion, and external rotation
positioning strategy: elbow motions to be stressed
Extension and supination
positioning strategy: hand motions to be stressed
Wrist extension; MCP flexion, proximal IP and distal IP extension; thumb abduction
positioning strategy: hip and groin motion to be stressed
All motions, especially hip extension and abduction
positioning strategy: knee motion to be stressed
Extension
positioning strategy: ankle motion to be stressed
All motions (especially dorsiflexion)
positioning strategy: anterior neck suggested approaches
Use double mattress; position neck in extension; with healing use rigid cervical orthosis
positioning strategy: shoulder axilla suggested approaches
Position with shoulder flexed and abducted (airplane splint)
positioning strategy: elbow suggested aproaches
Splint in extension
positioning strategy: hand suggested approaches
Wrap fingers separately.
Elevate to decrease edema.
Position in intrinsic plus position, wrist in extension, MBP in flexion, proximal IP and distal IP in extension, thumb in abduction with large web space
positioning strategy: hip and groin suggested approaches
Hip neutral (zero degrees of flexion/extension), with slight abduction
positioning strategy: knee suggested apporaches
Posterior knee splint
positioning strategy: ankle suggested approaches
Plastic ankle-foot orthosis with cutout at Achilles tendon and ankle positioned in neutral
The common deformity of the hand after burn injuries is in the claw
hand position or intrinsic plus. t or f
f
Significant factors involving mortality involvement
of the head, upper extremity, and the perineum. t or f
f
The free nerve endings that are found only in the
dermis, convey the sensation of pain and itch to the brain. t or f
f
Inhalation injuries are the most devastating type of burns. t or f
f
In electrical burns, PNS and CNS problems may occur
immediately after injury. t or f
f
In chemical burns, acidic products usually cause more
damage compared to alkali products.
f
Complete healing of superficial thickness
burns occurs in 7 to 10 days. t or f
t
The most common cause of burns in children 1 to 5 years
of age is scalding from hot liquids t or f
t
The tissue with the least resistance to electricity is the
blood as it is made up of water. t or f
f
Inhalation injuries are called carbon monoxide poisoning,
heat injuries, or smoke inhalation injuries. t or f
t
