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Medical Conditions II > Thermal Injuries > Flashcards

Thermal Injuries Flashcards

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USMLE® Step 1 flashcards
1
Q

Burn Causes include:

A
  • thermal
  • chemical
  • electrical
  • radiation
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2
Q

burns are ____ injuries

A
  • multi-system

- especially if burn is greater than 25% TBSA

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3
Q

TBSA

A

total body surface area

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4
Q

thickness of burn determines_____

A

-extent of tissue damage

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5
Q

Hypertrophic scarring can result from_____

A

-partial- and full- thickness burns

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6
Q

Burn Classifications

A
  • superficial partial thickness
  • deep partial thickness
  • full thickness
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7
Q

Sunburns are a type of ____

A

1st degree burn

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8
Q

Superficial Partial Thickness

A
  • epidermis and dermal papillae (can involve some of basal cell layer)
  • 2-3 weeks to heal (re-epithelialization)
  • no scar
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9
Q

Superficial Partial Thickness S/Sx

A
  • erythema
  • wet
  • shiny
  • surface
  • edema
  • painful
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10
Q

Deep Partial Thickness

A
  • significcant damage to dermis
  • 3-4 weeks for healing with scar tissues (may hypertrophy and contract)
  • may need skin graft
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11
Q

Deep Partial Thickness S/Sx

A
  • erythema
  • blisters
  • white
  • waxy
  • pliable
  • pain to deep pressure
  • cold
  • may be insensitive to light touch
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12
Q

Full Thickness

A
  • epidermis and dermis destroyes
  • possible subq also
  • skin graft to heal
  • scar may hypertrophy and contract
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13
Q

Full Thickness S/Sx

A
  • brown/black, deep red, white
  • dry surface
  • edema
  • painless
  • insensate
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14
Q

Rule of Nines

A
  • assessment of burn size
  • arms/head=9% each
  • Legs, ant/post trunk=18% each
  • genitals=1%
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15
Q

Rules of Nines for Kids

A
  • head=12%
  • trunk ant/post=18%
  • arms=9%
  • Legs=16.5
  • genitals=1%
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16
Q

Burn Impairments

A
  • shift of body fluids to interstitial spaces
  • loss of tissue
  • loss elasticity
  • scar hypertrophy
  • scar contraction
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17
Q

Capillary walls during injury

A
  • more permeable
  • fluid flows out of vessels to interstitial space
  • take in nutrients, WBC and oxygen to injured area
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18
Q

Burn Intervention

A
  • Airway & Breathing
  • Fluid Resuscitation
  • Escharotomy
  • Fasciotomy
  • Nutrition
  • Pain management
  • wound management
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19
Q

Escharotomy

A

-release of scar tissue

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20
Q

Fasciotomy

A

-release of fascia

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21
Q

Burn Surgical Management

A
  • skin graft

- muscle flap

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22
Q

Skin Graft

A
  • full thickness burns require (unless very small)

- large area burns require graft (regardless of depth)

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23
Q

Graft Site

A

-location of burn that will be covered by homograft or autograft

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24
Q

Donor Site

A

-area that contributes the skin in autograft

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25
Q

Autograft

A

-from another part of same body

26
Q

Allograft

A

-graft from same species (cadaver or other person)

27
Q

Heterograft

A
  • (zenograft)

- from another species (pigskin)

28
Q

CEA

A
  • Cultured Epithelial Autograft

- skin of pt grown in lab

29
Q

Integra, Apligraf, dermagraft

A

-dermal replacements

30
Q

Sheet Graft

A
  • more cosmetically appealing
  • requires larger donor site
  • always used on face and hands
31
Q

Meshed Graft

A
  • can be expanded

- waffle-like appearance

32
Q

Burn Rehab Focus

A
  • positioning
  • splinting
  • ROM
  • function/gait
  • ADLs
  • Scar Management

-START IMMEDIATELY!!! DAY ONE!!!

33
Q

Scar Formation

A
  • deep wounds heal with scar tissue
  • fibrous tissue replaces normal tissue
  • goal: minimize hypertrophic scars
34
Q

Position of comfort is _____

A

the position of deformity

35
Q

Position to prevent:

A
  • contractures
  • decubitus ulcers
  • control edema
36
Q

Indications Splinting

A
  • prevent contractures
  • protect exposed joints/tendons
  • when ROM is decreasing
  • 4-5 days post graft to immobilize graft area
37
Q

Position for Burn pts

A
  • Vitruvian Man

- (da Vinci)

38
Q

Functional Potential of hand

A

(safe, intrinsic plus)

  • slight wrist ext with ulnar deviation
  • MCP at 90*
  • IP at 0*
  • Thumb IP 0*-some flexion
  • Thumb opposition
39
Q

ROM & Ex’s goals

A
  • prevent contractures
  • joint integrity
  • maintain tendon gliding
  • prevent adhesions
  • reduce edema
40
Q

Contractures can form in ____

A

1-3 DAYS

41
Q

ROM most effective during____

A

bathing

42
Q

ROM is usually ____

A

Painful

43
Q

__/10 is highest amount of pain pt should have during therapy

A

4/10

44
Q

ROM/Ex’s Precautions

A
  • edema
  • med equip
  • IV’s
  • tubes
  • exposed joints/tendons
  • Heterotopic ossification
  • associated injuries
  • escharotomy/fasciotomy
  • new autograft sites
  • unstable/fragile autograft sites
  • neuropathies
  • cellulitis
45
Q

Heterotopic Ossificatoin

A
  • accum of unstructured bone around joint
  • sudden dramatic decrease in ROM
  • specific joint pain
  • only AROM until surgically removed
46
Q

Prevention of HO

A
  • at elbow, limit ex’s to AROM or gentle AAROM

- (not PROM)

47
Q

Mobility Goals

A
  • increase functional independence
  • increase ROM, strength, endurance
  • prevent DVTs
  • improve pulmonary status
  • prevent postural hypotension
48
Q

Mobility Options

A
  • bed mobility
  • transfer training
  • cardiac chair
  • up to chair
  • ambulation (limit use of AD)
49
Q

Scar management

A
  • ROM/Ex’s
  • functional mobility
  • compression therapy/garments
  • scar massage
  • modalities
50
Q

Function of Compression Therapy

A
  • control of hypertrophic scarring
  • promotes healing
  • assist w/ venous return
51
Q

Indications for Compression therapy

A
  • partial- or full-thickness burns
  • can initiate with minimal open areas (still have bandages on)
  • measure for custom garments after temporary compression has been used
52
Q

Types of Temporary Compression Therapy

A
  • ACE wraps
  • compressogrip/tubigrip
  • support hose
  • foam neck collars
  • coban
  • isotoner gloves
53
Q

custom compression garmets

A
  • name brand
  • must be measured for them (after graft healed)
  • 25-30 mmHg pressure
54
Q

Phases of PT Burn Management

A
  • Emergent and resuscitation phase
  • Acute phase
  • rehabilitation phase
55
Q

Inpatient Rehab follow up

A
  • rehab unit
  • outpatient
  • home health
  • vocational rehab
  • work hardening
56
Q

Burn Outpatient Assessment

A
  • ROM (joint by joint)
  • Scars
  • Pressure Garment/splint
  • ADL/Mobility
  • Activity level (back to work/sports/hobbies/school)
  • Psycholosocial Adjustments
  • Complications (pruritis, sleeplessness)
57
Q

Psychological Issues

A
  • PTSD
  • depression
  • feelings of guilt
  • anxiety
  • re-integration back to society
58
Q

Supportive Services

A
  • family support groups
  • burn survivor support group
  • burn camp
  • community activities & education
  • the american burn association
  • the phoenix society
  • the world burn congress
59
Q

PT during Emergent Phase

A
  • control edema
  • AAROM
  • mobility
  • positioning/splinting
  • ADL/Transfers
60
Q

PT during Acute Phase

A
  • splinting/positioning
  • AROM
  • WB and Ambulation
  • ADL
  • graft and donor site management
  • discharge planning
61
Q

PT during Rehab Phase

A
  • Skin care
  • scar eval
  • pressure garmets
  • ROM (AROM, PROM)
  • ADL
  • Strength/endurance
  • Therapeutic modalities
  • school/work function

Medical Conditions II (34 decks)

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