Week 3 Burn Eval Tx Flashcards
how do we manage wounds
wash with soap and water
debride lose nonviable tissue.
topical antibiotics to prevent infection
TF: we wrap fingers and toes all together
false, individually.
what is a basic burn cream
silver sulfadiazine
why use collagenase
enzymatic debridement for full thickness burns
why use silver nitrate
in place of silvadine in case of sulfa allergic patient
why use anticoat silver products or silver imprgenated gauze
antimicrobial
why use sulfamylon
to cover bone cartilage.
where do we use bacitracin
face and around the eyes
why do we start rehab right away
to prevent contractures .
what is the sum of stuff that leads to loss of function
wound contraction
prolonged immobilization
and scarring
leads to loss of function
during what phases of healing do we get issues
proliferation and maturation
why do we look at electrolytes
they can ooze out and we can get an imbalance. can have cramps and arrhythmia.
what happens to resting HR and BP
resting HR increase
BP decreases
why look at CBC
infection and blood loss
what are some things we do during evaluation
monitor vitals assess lines PROM and AROM hand function sensation and strength endurance mobility gait balance peripheral vascular integrity splinting and positioning
what must we consider with the mobility exam
burn location and where we put our hands.
dressings
avoid shearing forced (can touch, don’t shear)
compression and muscle pumping
vitals
gait belt
what happens to metabolic demand at rest with burn patients
it is higher, so you may need more breaks and longer rests.
thermoregulation in burn patients
impaired, may not tolerate activity and temperature well
how do we want to optimize healing time with patients after a burn
oral pain meds 60 minutes before
IV pain meds 15 minutes
what do we want to do with electrical burns
cardiac monitoring, motor and sensory exam.
how do we want to position patients
edema management and keeping them safe, but prolonged stretch positions with comfort and minimized contracture.
do we want to sit in flexion or extension or pretty neutral
neutral
what is the purpose of an elevating sling
attached overhead for edema management and contracture prevention
why do we want to be careful with prolonged and excessive elbow flexion
limits vascular flow and there is a risk of contracture
what is a leg elevating wedge
edema management, but riding foam, so watch for pressure injuries. (especially heals and lateral malleoli)
what is the benefit of a towel or blanket roll
promotes scapular retraction and neck extension
what caution must we consider with positioning
splints and positioning has the potential to cause skin breakdown if not used properly.
how do we want to wrap to give compression
figure * ACE distal to proximal, moderate stretch and with 50% overlapping.
what are some other things we want to consider with compression
pain control, edema management, and mobility
what is the caution, and why might we want to remove after walking? what conditions?
arterial insufficiency
impaired LE sensation
congestive heart failure
(things with poor blood flow)
when does ROM start
day 0, to prevent contracture
what might contraindicate ROM
trauma or fracture
how soon does contractile forces start within the skin
1-3 days
position of comfort = position of ___
deformity
What do we start with AROM or PROM
AROM
what does blanching tell us
if it is white it is tight
what are some good educational things to talk about with patients
if it is painful, it is right
painful, stretch more.
morning most difficult because shrinking at night (NIGHT SPLINT)
what might key you in that the patient needs splinting at night
mornings are most difficult and tightest.
is bleeding with stretching acceptable
yes, smaller amounts
some benefits of early PT
participate in recovery
promotes normal sleep wake cycles
presents negative effects of bedrest
safe and improves outcomes (psychologically, physically, functionally)
what are some perceived barriers
vents, time constraints, staff requirements, complexity of burn and surgery. medical lines and status and meds. DONT LET ANY OF THIS STOP YOU
why is reconditioning and weakness so likely in this population
immobile and in catabolic states
how long does the catabolic state last after a burn
months to years, still trying to heal
who is at a higher risk of muscle atrophy, other than ICU people
burns
what has been found to contribute early to critical illness myopathy and neuropathy
sepsis
