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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
Q

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

A

Reduced sensation

May feel pressure sensation

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26
Q

How is a deep-dermal partial thickness burn managed?

A

Surgical

full recovery takes 12-18 months

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27
Q

What are full thickness burns?

A

Affect epidermis, dermis and underlying tissues

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28
Q

What is the appearance of a full thickness burn?

A

White or tan, waxy, charred
absent blanching
rigid, inelastic, leathery

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29
Q

What is the sensation of a full thickness burn?

A

Absent

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30
Q

How is a full thickness burn managed?

A

Surgical

full recovery 12-18 months

31
Q

What is the appearance of an electrical burn?

A

Entry and exit wound

Blanching absent

32
Q

What is the sensation of an electrical burn?

A

Absent at entry and exit sites

33
Q

What is the management of electrical burns?

A

Extensive surgical debridement

May require amputations

34
Q

What is an inhalation injury?

A

Affects upper and lower airway

35
Q

What is the appearance of an inhalation burn?

A

Associated with facial burns, enclosed spaces
Oedema of airway
May have associated chemical injury

36
Q

How are inhalation burns managed?

A

Close monitoring
Intubation and airway support
Regular bronchoscopy

37
Q

The aim of first aid in burns is?

A

To treat the zone of stasis

38
Q

What are the 3 zones of Jackson’s burn model?

A
  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
Q

Why do we not use ice to treat burns?

A

Causes vasoconstriction, we want blood flow to the burn to assist healing

40
Q

What does first aid for burns involve?

A

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
Q

How long do burns progress for?

42
Q

What are the 3 types of conservative burns treatment?

A

Wound care, Infection control and pain management

43
Q

What does wound care involve?

A 
Clean the wound
Debride non-viable tissue
Remove large blisters
Shave hair
Appropriate wound dressings
44
Q

What does infection control involve?

A

Antibiotics
Wound care
Frequent assessment

45
Q

What does pain management involve?

A

Background

Procedural

46
Q

How are burns surgically managed?

A

Skin grafts

47
Q

What is the aim of surgical management for burns?

A

Remove all non-viable tissue
Achieve viable wound bed
Close wound using body’s own tissue

48
Q

What are the benefits of surgical management of burns?

A 
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
Q

What considerations need to be made for surgical management of burns?

A

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
Q

How does skin grafting work?

A

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
Q

What causes graft failure?

A

Hematoma beneath graft
Excessive bacteria on site
Movement of the graft on the wound bed
Necrotic tissue is not completely excised

52
Q

What are the skin changes after a burn?

A

Hair loss
Dryness
Pigment changes
Temperature regulation and tolerance changes

53
Q

What is scar contracture?

A

Loss of skin elasticity

Causes reduced ROM

54
Q

What are musculoskeletal changes after burn injury?

A

Decreased muscle strength and endurance

Amputation

55
Q

What are neurological changes after burn injuries?

A

Sensory change
Neuropathy
Cognitive impairment

56
Q

What are respiratory and cardiovascular changes that can occur after burn injury?

A

Reduced pulmonary function and exercise capacity

57
Q

What are changes that can happen relating to dysphagia and dysphonia after a burn injury?

A

Swallowing and communication are affected.

58
Q

What nutritional changes can be caused by burn injury?

A

Hypermetabolism

59
Q

What psychological changes can result from burn injury?

A 
Anxiety
Low mood/motivation
Low self esteem
Irritability, anger, fluctuating moods
Flash backs/reliving event
Hypervigilance and avoidance
Difficulty with relationships
60
Q

What are the functional implications of a burn injury?

A 
Reduced independence
Reduced work tolerance
Fatigue
Reduced dexterity
Changes in role and identity
Social interactions
61
Q

What is scar management?

A

Scar treatment may include massaging, exercise programs, silicone gel or injections with the goal of lightening the scar and reducing sensitivity

62
Q

What are the features of a hypertrophic scar?

A 
Red
Raised
Thick
Inelastic
Pruritic/painful/hypersensitive
Dry
63
Q

What are the risk factors for hypertrophic scarring?

A

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
Q

What are the 5 principles of scar management?

A 
Wound healing
Oedema management
Splinting and positioning
Moisture
Pressure
65
Q

How is wound healing managed?

A

Good wound care which results in faster healing, early closure and less infection which reduces scarring

66
Q

How is oedema managed?

A

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
Q

Why are splints used in scar management?

A 
To maintain ROM prior to grafting
To immobilise post operatively
Sustain stretch
It can be static, progressive or dynamic
It follows contracture lines
68
Q

How does moisture help with scarring?

A

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
Q

What are the benefit of silicone in scar management?

A

Hydrating of the skin and can provide a hydrating environment for the skin without causing maceration.

70
Q

How do pressure garments work in scar management?

A 
Reduce blood flow to the scar
Reduces collagen synthesis
Improves orientation of collagen fibres
Reduces oedema
Reduces Itch
71
Q

Who are compression garments suitable for?

A

Any patient which meet the criteria of hypertrophic scarring

72
Q

When should compression garments be used?

A

Within 2 weeks of re-epithelialisation for 6-24 months+

73
Q

How long should compression garments be worn per day?

74
Q

What pressure should compression garments apply?

Clinical Medicine - OT (35 decks)

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