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Clinical Medicine - OT > Week 9 - Burns > Flashcards

Week 9 - Burns Flashcards

1
Q

What is the function of the skin?

A 
To be a barrier
 - Protecting underlying tissue from injury
- Immune system: bacterial infection
- Water loss
Regulate temperature
Sensory organ
Psycho-social function
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2
Q

What are the 3 layers of skin?

A

The epidermis, dermis and hypodermis

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3
Q

What is the Epidermis?

A

Superficial outer layer
Avascular
Semi-permeable barrier

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4
Q

What is the dermis?

A

The inner layer of the two main layers of the skin. The dermis has:

  • Connective tissue
  • Blood vessels
  • Sebaceous (oil) glands
  • Sweat glands
  • Afferent nerve endings
  • Hair follicles
  • Parallel collagen fibres
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5
Q

What is the hypodermis?

A

It is the bottom layer of skin in your body. It consists of:

  • loose fatty connective tissue
  • cutaneous nerves
  • Skin appendages
  • Lymphatics
  • Blood vessels
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6
Q

How are burns classified?

A

Aetiology, size and depth

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7
Q

What are burn injury aetiologies (mechanism of the burn)?

A 
Thermal (scald, flame, contact, frostbite)
Chemical
Electrical
Radiation
Friction
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8
Q

What is the wallace rule of nines?

A

The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate the total body surface area affected by a burn.

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9
Q

What percentage of the wallace rule of nines classifies a major injury?

A

> 20%

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10
Q

What are the depths of burns?

A 
Epidermal
Superficial partial thickness
Mid-dermal partial thickness
Deep-dermal partial thickness
Full thickness
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11
Q

What is an epidermal burn?

A

Only affects the epidermis

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12
Q

What is the appearance of an epidermal burn?

A

Red, may have delayed blisters

Blanches

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13
Q

What is the sensation of an epidermal burn?

A

Intact sensation, hypersensitive/painful

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14
Q

What is the management of an epidermal burn?

A

Conservative

Heals within 7 days

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15
Q

What is a superficial partial thickness burn?

A

Affects the epidermis and superficial (papillary) dermis

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16
Q

What is the appearance of a superficial partial thickness burn?

A

Red
Blanches
Wet, may have blisters

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17
Q

What is the sensation of a superficial partial thickness burn?

A

Intact sensation, hypersensitive/painful

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18
Q

What is the management of a superficial partial thickness burn?

A

Conservative

Heals within 14 days

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19
Q

What is a mid-dermal partial thickness burn?

A

Affects the epidermis and partial dermis

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20
Q

What is the appearance of a mid-dermal partial thickness burn?

A

Pale pink to dark pink, may have delayed blisters

Blanching is sluggish

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21
Q

What is the sensation of a mid-dermal partial thickness burn?

A

Intact sensation, can be painful although less than superficial

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22
Q

What is the management of mid-dermal partial thickness burns?

A

Conservative or surgical

Heals in 14-21 days

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23
Q

What is a deep-dermal partial thickness burn?

A

Affects epidermis and deep dermis

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24
Q

What is the appearance of a deep-dermal partial thickness burn?

A

Mottled red and white
Absent blanching
Blistering

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25
What is the sensation of a deep-dermal partial thickness burn?
Reduced sensation | May feel pressure sensation
26
How is a deep-dermal partial thickness burn managed?
Surgical | full recovery takes 12-18 months
27
What are full thickness burns?
Affect epidermis, dermis and underlying tissues
28
What is the appearance of a full thickness burn?
White or tan, waxy, charred absent blanching rigid, inelastic, leathery
29
What is the sensation of a full thickness burn?
Absent
30
How is a full thickness burn managed?
Surgical | full recovery 12-18 months
31
What is the appearance of an electrical burn?
Entry and exit wound | Blanching absent
32
What is the sensation of an electrical burn?
Absent at entry and exit sites
33
What is the management of electrical burns?
Extensive surgical debridement | May require amputations
34
What is an inhalation injury?
Affects upper and lower airway
35
What is the appearance of an inhalation burn?
Associated with facial burns, enclosed spaces Oedema of airway May have associated chemical injury
36
How are inhalation burns managed?
Close monitoring Intubation and airway support Regular bronchoscopy
37
The aim of first aid in burns is?
To treat the zone of stasis
38
What are the 3 zones of Jackson's burn model?
1. Zone of necrosis - site of the burn 2. Zone of stasis - area with a reduction of circulation, damaged but potentially viable tissue, can become necrosis if no treatment 3. Zone of hyperaemia - characterised by a reversible increase in blood flow and inflammation
39
Why do we not use ice to treat burns?
Causes vasoconstriction, we want blood flow to the burn to assist healing
40
What does first aid for burns involve?
Stop the burning process Cooling the burn: 20 minutes under cool running water in the first 3 hours Remove: Clothing, jewellery, watches that are not stuck to the burn Cover: cover the burn, warm the patient
41
How long do burns progress for?
48 hours
42
What are the 3 types of conservative burns treatment?
Wound care, Infection control and pain management
43
What does wound care involve?
``` Clean the wound Debride non-viable tissue Remove large blisters Shave hair Appropriate wound dressings ```
44
What does infection control involve?
Antibiotics Wound care Frequent assessment
45
What does pain management involve?
Background | Procedural
46
How are burns surgically managed?
Skin grafts
47
What is the aim of surgical management for burns?
Remove all non-viable tissue Achieve viable wound bed Close wound using body’s own tissue
48
What are the benefits of surgical management of burns?
``` Reduced risk of infection Dampen systemic inflammatory response Decreased time to re-epithelialisation Reduce number of painful debridement required Reduced length of stay Better functional and aesthetic outcome ```
49
What considerations need to be made for surgical management of burns?
They require a period of immobilisation post op It creates a new wound It will scar May require interim measures if wound is infected Very deep wounds may require reconstructive surgery
50
How does skin grafting work?
Wound is excised and cleaned Donor skin is harvested This skin is inset to area of defect and held in place with staples or sutures It is then dressed and immobilised
51
What causes graft failure?
Hematoma beneath graft Excessive bacteria on site Movement of the graft on the wound bed Necrotic tissue is not completely excised
52
What are the skin changes after a burn?
Hair loss Dryness Pigment changes Temperature regulation and tolerance changes
53
What is scar contracture?
Loss of skin elasticity | Causes reduced ROM
54
What are musculoskeletal changes after burn injury?
Decreased muscle strength and endurance | Amputation
55
What are neurological changes after burn injuries?
Sensory change Neuropathy Cognitive impairment
56
What are respiratory and cardiovascular changes that can occur after burn injury?
Reduced pulmonary function and exercise capacity
57
What are changes that can happen relating to dysphagia and dysphonia after a burn injury?
Swallowing and communication are affected.
58
What nutritional changes can be caused by burn injury?
Hypermetabolism
59
What psychological changes can result from burn injury?
``` Anxiety Low mood/motivation Low self esteem Irritability, anger, fluctuating moods Flash backs/reliving event Hypervigilance and avoidance Difficulty with relationships ```
60
What are the functional implications of a burn injury?
``` Reduced independence Reduced work tolerance Fatigue Reduced dexterity Changes in role and identity Social interactions ```
61
What is scar management?
Scar treatment may include massaging, exercise programs, silicone gel or injections with the goal of lightening the scar and reducing sensitivity
62
What are the features of a hypertrophic scar?
``` Red Raised Thick Inelastic Pruritic/painful/hypersensitive Dry ```
63
What are the risk factors for hypertrophic scarring?
Severity and depth of injury Prolonged healing >3 weeks, infection or extended inflammatory response Age > 40 Genetics Location of injury - joints, neck, UL, chest
64
What are the 5 principles of scar management?
``` Wound healing Oedema management Splinting and positioning Moisture Pressure ```
65
How is wound healing managed?
Good wound care which results in faster healing, early closure and less infection which reduces scarring
66
How is oedema managed?
Normal part of healing but if it doesn't resolve, as it is high in protein it can reduce nutrient flow and waste disposal. Can cause reduced movement and tissue fibrosis.
67
Why are splints used in scar management?
``` To maintain ROM prior to grafting To immobilise post operatively Sustain stretch It can be static, progressive or dynamic It follows contracture lines ```
68
How does moisture help with scarring?
Regular moisturising helps prevent trans-epidermal water loss and hydrates the skin, which will improve barrier function, reduce infection, reduce itch, and reduce hypersensitivity.
69
What are the benefit of silicone in scar management?
Hydrating of the skin and can provide a hydrating environment for the skin without causing maceration.
70
How do pressure garments work in scar management?
``` Reduce blood flow to the scar Reduces collagen synthesis Improves orientation of collagen fibres Reduces oedema Reduces Itch ```
71
Who are compression garments suitable for?
Any patient which meet the criteria of hypertrophic scarring
72
When should compression garments be used?
Within 2 weeks of re-epithelialisation for 6-24 months+
73
How long should compression garments be worn per day?
23 hours
74
What pressure should compression garments apply?
24-30mmHg

Clinical Medicine - OT (35 decks)

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