Burns Flashcards

1
Q

Burns Severity

A

Superficial–>Epidermis–>Erythema (redness)

Partial thickness–>
Epidermis & Upper part of dermis–>
Blistering (may heal without a scar)

Full thickness–>
Epidermis & entire dermis–>
- Vary from waxy white/ leathery gray/ charred and black
- dry and inelastic
- does not blanch with pressure
Necrosis (heal with scar)

Subdermal
Epidermis+dermis+subcutaneous tissue
–>Extensibe surgical and therapeutic Mx needed to return the patient to some degree of function

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2
Q

Zones of Burns

A

Zone of coagulation:
Max damage
Irreversible tissue loss

Zone of stasis
-decreased tissue perfusion
-main focus when treating burn injury

Zone of hyperemia
- invariably recover unless severe sepsis

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3
Q

Rule of Nine

A

Adult:
Head: 9%
Anterior trunk: 18%
Posterior trunk: 18%
One arm: 9%
One leg: 18%
Groin: 1%

Child (under 12 yo):
Head: 18%
Anterior trunk: 18%
Posterior trunk: 18%
One arm: 9%
One leg: 14%/13.5%
Groin: 1%

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4
Q

Effects of Burns on Cardiovascular system

A
  • Increase capillary permeabliltiy–>loss of fluid out of vessel–>interstitial edema+hypovolemia

Peripheral vasoconstriction–>Sympathetic nervous system–>redirect blood to essential organs

Hypotension & dec. organ perfusion

Myocardial depression and heart failure

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5
Q

Effects of Burns on respiratory system

A
  • Pulmonary edema–>by inhalation injuries
    Due to increase capillary permeablility
  • Bronchoconstriction, ARDS
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6
Q

Effects of Burns on Metabolic system

A
  • Hypothermia
  • Increase of metabolic activity–>rapid weight loss
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7
Q

Effects of Burns on MSK/renal system

A

MSK:
-susceptible to developing heterotopic ossification

Renal:
Kidney failure due to…
Loss of fluid–>poor perfusion
Inc myoglobin (muscle injury from burn)–>processed by kidneys

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8
Q

Sign of inhalation injury

A
  • Singed eyebrows/nasal hairs/burnt face
  • Black oral/nasal discharge
  • Swollen lips
  • Hoarse voice
  • Abnormal oxygenation
  • History of being enclosed in closed room

Process
* 24-48 hours: pulmonary edema
* 48 hours +: alveolitis, pneumonia, ARDS

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9
Q

Exercise Consideration

A

Skin graft:
- movement is CI (passive & active)
- surgeon decide when to start gentle ROM

patient needs to push through pain to maintain/improve ROM
- exercise after painkiller

Type of exercise:
- AROM first–>AAROM/PROM if can’t go full ROM
- High reps, serveral times a day
- elevation+AROM helps with edema

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10
Q

Exercise education tips

A
  • Use pressure garment
  • exercise after painkiller

Dry skin
- not open wound–>hydrate the skin
- cream for moisture–>prevent cracking/tearing

Massage
- before exercising–>increase tissue flexibility

Water:
- Hydration during exercise

Exercise enviornment:
- Avoid exercising in the heat/under the sun

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11
Q

Burn Positioning

A

Anterior neck:
Contracture: Flexion
Position: Extension+neutral rotation

Shoulder and axilla
Contracture: ADD, IR
Position: Flex, ABD, ER (airplane splint)

Elbow
Contracture: Flexion and pronation
Position: Extension and supination

Hand
Contracture: Claw hand
Position: PIP/DIP Ext, MCP Flex, Wrist Ext, Thumb Abd
Safe position of the hand:
- Wrist 30
- MCP 70
- DIP/PIP 0

Hip and groin
Contracture: Flex, Add
Position: Neutral/Slight Ext+Slight Abd

Knee
Contracture: Flex
Position: Ext

Ankle
Contracture: PlantarFlex
Position: Neutral

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12
Q

Donar sites

A
  • Autograft: same person body
  • Allogenic: different person
  • Xenogenic: different species
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13
Q

Manage Heat sensitivity while exercising

A
  • Avoid exercising in the heat and exposure to sun (e.g. exercise in air-conditioned room)
  • Protection from the sun is key if exercising outdoors
  • Cover up with a hat, long sleeves and use sunscreen
  • Start slow and build up to longer duration when exercising outside
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