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UM - Integumentary > Thermal Injuries > Flashcards

Thermal Injuries Flashcards

1
Q

What are the risk factors of cold injuries?

A
  • lack of insulating body fat
  • old age
  • homelessness
  • drug and alcohol use
  • cardiac disease
  • psychiatric illness
  • motor vehicle problems
  • inadequate clothing
  • smoking in combination w/cold exposure
  • endocrine conditions
  • diabetes
  • SCIs
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2
Q

What area of the brain controls heat conservation?

A

The hypothalamus

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3
Q

Does ___ cause peripheral and visceral vasoconstriction?
a) parasympathetic activity
b) sympathetic activity

A

b) sympathetic activity

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4
Q

Who is at risk of developing frostbite?

A
  • military personnel
  • athletes using cryotherapy or participation in outdoor sports
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5
Q

What is superficial frost bite?

A

skin and subcutaneous tissue affected that when rewarmed, develops clear blisters

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6
Q

What is deep frostbite?

A

Affects bones, jones, and tendons where the skin remains white until thawed and when rewarmed, the skin forms hemorrhagic blisters.

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7
Q

T or F: Deep frostbite is more common on the face, ears, and extremities

A

False - that is superficial frostbite. Deep is on hands and feet

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8
Q

What are the favorable prognostic factors for frostbite?

A
  • retained sensation
  • normal skin color
  • clear fluid in blisters (not cloudy)
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9
Q

What are negative prognostic factors for frostbite?

A
  • non-blanching cyanosis
  • firm skin and dark
  • fluid-filled blisters
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10
Q

What are the functions of the epidermis?

A
  • protection, insulation, cosmesis
  • immune response
  • keratinocytes and melanocyte synthesis
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11
Q

What are the functions of the dermis?

A
  • thermoregulation
  • mechanical protection
  • hair folicles
  • conservation of fluids, electrolytes, and proteins
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12
Q

What is the function of the subcutaneous layer

A
  • Energy storage
  • trauma protection
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13
Q

What is the Zone of coagulation

A

The tissue that is destroyed at the time of injury

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14
Q

What is the zone of stasis

A

It surrounds the zone of coagulation with inflammation and low levels of perfusion

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15
Q

What is the zone of hyperemia

A

The zone where microvascular perfusion is not impaired although it may appear red

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16
Q

Which zone becomes necrotic within 48 hours following injury resulting in an expansion of the burn

A

Zone of stasis

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17
Q

What are the symptoms of a thermal burn?

A
  • red, blistered, or peeling skin
  • pain
  • shock (clammy skin, weakness, bluish lips/fingernails, and dec. alertness)
  • edema
  • white/charred skin
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18
Q

When should you suspect a chemical burn?

A

If an otherwise healthy person becomes ill for no apparent reason (and works in an environment chemicals could be present//you find chemical containers in the area)

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19
Q

What are the symptoms of a chemical burn?

A
  • Red/bluish skin and lips
  • breathing difficulty
  • convulsions or seizures
  • dizziness and headache
  • skin changes (hives, itching, swelling, N/V)
  • unconsciousness
  • abdominal pain
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20
Q

T or F: an electric burn may be more severe than it appears

A

True

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21
Q

What are the 3 methods that an electrical burn causes injury by?

A

1 - CA due to electrical effect on heart
2 - massive muscle destruction from current thru body
3 - thermal burns from contact w/electrical source

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22
Q

What are the symptoms of electrical burns

A
  • fatigue
  • fractures
  • H/A and unconsciousness
  • hearing impairment/vision loss
  • heart attack
  • hyperventilation and respiratory failure
  • loss of reflex control
  • muscle contraction and muscular pain
  • skin burns
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23
Q

Which type of current is more dangerous and why?

A

AC current bc the patient becomes frozen and can’t withdraw

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24
Q

What are potential complications from electrical burns

A
  • compartment syndrome
  • cardiac arrhythmias
  • renal failure
  • sepsis
  • neurological damage
  • hemorrhage
  • cataracts
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25
Q

What are the characteristics of a superficial burn?

A
  • DRY
  • Epidermis only
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26
Q

How long does a superficial burn typically take to heal?

A

3-7 days, with no scarring

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27
Q

What are the characteristics of a superficial partial thickness burn?

A
  • epidermis and superficial dermis
  • blisters, moist, weeping
  • hair present
  • possible edema
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28
Q

How long do superficial partial thickness burns take to heal?

A
  • 7-21 days, possibility of scarring but sensation still intact
29
Q

What are the characteristics of a deep partial thickness?

A
  • involves epidermis and most of the dermis
  • Cherry red or white
  • DRY
  • some hair
30
Q

How long does it take for a deep partial thickness burn to heal?

A

-3 -6 weeks with scarring present

31
Q

What do we need to be concerned about with deep partial thickness burns?

A

Can convert to full thickness burns if infected or if there is poor tissue perfusion

32
Q

What are the characteristics of a full thickness burn?

A
  • epidermis, dermis, and subcutaneous tissue
  • black, yellow, brown, or white
  • leather like
  • no sensation
  • may require amputation
33
Q

What tests and measures (general) do you want to complete post burn?

A
  • size
  • depth
  • inhalation?
  • edema
  • ROM
  • Gait
34
Q

What is the adult rule of nines?

A
  • Head: 9%
  • Arms: 9% each
  • Trunk: 36% total
  • Legs: 18% each
  • groin: 1%
35
Q

What are three tests and measures that measure total body surface area?

A
  • rule of the palm
  • rule of nines
  • Lund Browder scale
36
Q

What is the abbreviated burn severity index?

A

A 5 variable scale to assess burn severity & survival percentage
(Sex, age, presence of inhalation injury, presence of full-thickness burn, percent of TBSA burned)

37
Q

When should someone go to a specialized burn center?

A
  • ABSI >= 6
  • High-voltage electrical burns
  • burns associated w/other injuries
  • Most full thickness burns
38
Q

What is Phase 1 of medical management of burns?

A
  • establish and maintain airway
  • prevent cyanosis
  • prevent fluid loss
  • clean the wounds
  • prevent cardiopulmonary complications
39
Q

How much urine do we want our burn patients to produce per hour in order to know if they are getting enough?

A

20-30 cc/hour

40
Q

Why do we care about shock risk (PT)

A
  • Carefully monitor BP during exercise activity (it would decrease)
  • Monitor and manage edema
41
Q

How much does an inhalation injury increase risk of death?

A

20%

42
Q

When should you be concerned there may have been an inhalation injury?

A
  • closed space fire
  • soot in mouth/nasal passages
  • SOB, respiratory distress, wheezing, coughing
  • length of exposure
  • dark, carbon-stained mucus
43
Q

How is an inhalation injury dx?

A
  • breath sounds
  • spirometry
  • ABGs
  • bronchoscopy
44
Q

What is a secondary lung injury

A
  • unilateral smoke inhalation damages the contralateral lung
45
Q

What are the possible treatments for inhalation injuries?

A
  • ventilation
  • supplemental O2
  • airway control
  • bronchial hygiene
  • suctioning
  • therapeutic bronchoscopy
  • ventilatory strategies
  • pharmacologic adjuncts
46
Q

What is the most common complication from an inhalation injury?

A

Pneumonia

47
Q

What is the number one cause of death in patients with burns?

A

Infections

48
Q

What is the most common causative agent for infections
a) early
b) later

A

a) Staph Aureus
b) Pseudomonas and MRSA

49
Q

How do we control/prevent infections in burn pts?

A
  • Sterile technique if large/immunocompromised
  • clean for small/superficial
  • topical antibiotics
  • monitor for s/s of infection
50
Q

What are the purposes of wound dressings?

A

1 - comfort
2- metabolic
3- protection
4 - topical medications (hold them on)

51
Q

What is primary excision/debridement

A

Removal of eschar surgically to dec. need for repeated debridement and allow for more rapid healing

52
Q

What type of skin graft do they typically do?

A

Split thickness skin grafts (STSG) - meshed, sheet, or donor site

53
Q

Why might you use a meshed graft?

A
  • it stretches up to 10x the size of what it was
  • less coverage needed
  • allows blood and body fluids to drain from under the skin graft
54
Q

What are some disadvantages of meshed grafts?

A
  • less durable than sheet graft
  • larger slits = greater scarring
55
Q

When would you use a full thickness skin graft?

A
  • only for small areas bc it leaves the donor site as a full thickness wound
56
Q

What are some reasons a skin graft might fail?

A
  • poor wound bed
  • sheer
  • hematoma/seroma
  • infection
57
Q

How do skin grafts (both Full and split thickness) survive?

A
  • Plasmatic Imbibition
  • Inosculation (at day 3)
  • Angiogenesis (at day 5)
58
Q

How long does it take for a donor site to heal

A

8-14 days

59
Q

Why may you use artificial skin?

A

Temporary treatment of full thickness burns to help promote growth and protection of the skin, but will need to be replaced in 14 days

60
Q

When can you begin ROM post allograft/xenograft?

A

Day 1

61
Q

When can you begin ROM post autograft?

A

POD Day 5 - gentle

62
Q

What can occur (pathophys) in the cardiovascular system as a result of burns?

A
  • increased capillary permeability
  • edema
  • hypovolemia
  • impaired perfusion
  • burn shock
  • resting tachycardia
  • hypotension
  • dysrhythmias
  • compartment syndrome
63
Q

What can occur (pathophys) in the pulmonary system as a result of burns?

A
  • smoke inhalation
  • carbon monoxide inhalation
  • pulmonary edema
  • increased pulmonary vascular resistance
  • hypoxia
  • dyspnea
  • pneumonia
  • ARDS
64
Q

What can occur (pathophys) in the GI system as a result of burns?

A
  • higher caloric requirements
65
Q

What can occur (pathophys) in the metabolism as a result of burns?

A
  • Increased rate
  • Sustained hyperglycemia
66
Q

What can occur (pathophys) in the Immune system as a result of burns?

A

Impaired

67
Q

What psychological dysfunctions can occur as a result of burns?

A
  • sleep disruption
  • confusion/delirium
  • depression
  • inappropriate behaviours
  • depression
  • PTSD
68
Q

What is an important consideration when doing the subjective of an eval?

A
  • make sure you know before what the MOI of the fire was/extent of damage so you avoid asking about house set up/who they live with if something occured

UM - Integumentary (6 decks)

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