Wounds + Burns Flashcards
Define “wound”
a disruption of the continuity of the skin
What is the largest protective organ?
The skin - forms a barrier between the body and external environment.
What are the three layers of the skin?
- epidermis
- dermis
- sub-dermal/sub-cutaneous
What layer of the skin is continuously sloughing off and removed?
epidermis
What 2 components is the dermis composed of? What does this allow for?
Elastin and collagen - gives the tissue flexibility and strength.
What are 6 things contained within the dermis?
- sebaceous (oil) glands
- sweat glands
- hair follicles
- nerve receptors
- blood
- lymphatic vessels
What 3 things are contained within the sub-dermal/sub-cutaneous layer?
- adipose tissues
- large bv’s
- deep hair follicles
Define “abrasion”
a superficial wound with ragged edges - usually resulting from a scrape or tear leading to a loss of skin
Should you let an abrasion air dry to reduce pain?
No - after cleaning, a dressing is applied to keep it moist for pain reduction (the wetter, the better)
Define “laceration”
increased tissue loss with ragged edges
What might be done after a laceration has been cleaned?
sutures or tape may be used to bring edges together
Define “incision”
clean, approximated edges resulting from a sharp edges object (sutures or tape used to secure together)
What is an animal bite a combination of?
crush, laceration and puncture wounds
Define “puncture”
clean edges with a small entry, can penetrate deeply - i.e. bullet wound or stepping on a nail.
Define “burns”
a specific type of wound caused by an external agent of varying severity
What are 7 classifications used to assessing the severity of a burn?
- depth of burn
- amount of tissue burned
- area of burn
- cause of burn
- age of person burned
- pre-existing illness
- associated injuries (i.e. smoke inhalation and #’s)
How many possible degrees are there when assessing depth of a burn?
4 degrees
Describe a 1st degree burn presentation:
redness and pain, and some mild localized edema (affects epidermis)
What can cause a 1st degree burn?
Usually the result of prolonged exposure to low intensity heat or quick exposure to high intensity heat
How does healing of a 1st degree burn present?
Within a week the epidermis sloughs off so healing is rapid and without scar tissue - skin discolouration may occur
What is the distinguishing feature of a 2nd degree burn?
presence of blistering
extends to the dermis aka PARTIAL (superficial or deep) thickness burn
What does the increased depth of a burn, increase the presentation of?
edema, risk of infection and often DECREASED pain
What is the difference between a 3rd and a 4th degree burn?
3rd degree will affect all 3 layers of tissue, whereas 4th degree will affect all 3 skin layers, along with FASCIA, MUSCLE and possibly CLOSELY LYING BONE
4th degree burns are generally painless!
Why is a 4th degree burn painLESS
Due to the depth of tissue damage there will be substantial damage to dermis structure INCLUDING NERVES!
What degree burn would skin grafts be needed for?
4th degree
What are 2 causes of thermal burns?
- heat: open flame, hot liquid
2. extreme cold
What are 4 categories of causes of burns?
- thermal
- chemical
- radiation
- electrical
What category of cause of burn is a sun burn?
radiation
What category of cause of burn appears to heal more slowly than the rest?
chemical
How does the entry site of an electrical burn present?
black at its centre surrounded by a ring of white necrotic tissue and an outer ring that is HYPEREMIC (xs blood)
What category of cause of burn leads to the greatest number of amputations?
electrical
What central nervous system damage may present with electrical burns?
- memory loss
- HA’s
- personality changes
- deafness
- visual disturbances
- convulsions
- weakness/paralysis
(may be temporary or permanent).
What % of the body would need to have 2nd degree burns in order to lead to hospitalization?
15-25% of greater of the total surface area (% determined by “Rule of Nine”)
** children are 10 to 20% of total surface area.
What % of the body would need to have 3rd degree burns in order to lead to hospitalization?
10% or greater.
What specific areas of a 3rd degree burn would result in hospitalization?
face, eyes, ears, perineum, hands or feet
What % do the trunk, arm and leg account for regarding the “rule of nine,” respectively?
- trunk = 36%
- arm = 9%/arm
- 18%/leg
What can thoracic burns affect?
Thoracic burns can affect breathing.
What is the most common cause of death when it comes to burns?
sepsis
Systemic circulation will be affected when burns cover what percentage of the body?
25-30%
When treating structures near a healing burn, what direction should direct pressure be used in?
toward the injury site to avoid pulling/tugging at the wound site
In the healing process of burns, aAROM and pROM are introduced how long after a period of immobilization?
~10 days
Why do burns affect thermoregulation even long after healing?
damage to sweat glands = body can’t get rid of excess heat through evaporation fo sweat
What are the CI’s in treating someone with burns?
- no oil around wound site
- avoid direction contact with lesion
- modify hydro for altered temperature sensitivity
- no rROM in acute phase
