Burn

Question 1

Burn causes

Answer 1

Heat, cold =, chemicals, electricity, friction, or radiation

Question 2

Skin fxns

Answer 2

Protection against: infections, UV Yas, fluid loss
Temp regulation
Sensation
Secretion of oils to lubricate skin
Vit D synthesis
Cosmetic appearance

Question 3

Two layers of the skin

Answer 3

Epidermis (outermost and a vascular)
Dermis (deepest layer

Question 4

Classification of burn injury

Answer 4

Depth
Total body surface

Question 5

Superficial (1st degree)

Answer 5

Sun burn (2-3 days)
Damage to epidermis only

Question 6

Superficial partial thickness (2nd degree)

Answer 6

Scald burn (like boiling water to skin)- looks like a marble. Intact blister. very painful
Damage to epidermis and into papillary dermis
7-10 days to heal. Minimal scarring

Question 7

Deep partial thickness burn

Answer 7

immersion scald- Marked edema
Broken blisters. Wet surface
Insensitive
Damage to epidermis and into reticular dermis
3-5 weeks to heel with scar formation (may require skin grafting)

Question 8

Full thickness; 3rd degree

Answer 8

Flame burn.
No hair follicles
Escher formation
Painless
Damage to epidermis, dermis, and partially into subcutaneous tissue
3-5 weeks with scarring formation

Question 9

Subdermal; 4tdegree

Answer 9

High voltage electrical burn (large exit burn and smaller entry wound- follows path of nerve)
Charred
Subcutaneous tissue visible
Damage to epidermis, dermis, into subcutaneous tissue, muscle, bone, and large nerves
Extensive healing time. Requires surgery, debridement and grafting.

Question 10

Total body surface area

Answer 10

Rules of Nines
Modified Lund-Browder chart

Question 11

Rules of 9:

Head and neck-
Anterior trunk-
Posterior trunk-
Right arm-
Left arm-
Pubic area-
Right leg-
Left leg-

Answer 11

Head and neck- 9%
Anterior trunk- 18%
Posterior trunk- 18%
Right arm- 9%
Left arm- 9%
Pubic area- 1%
Right leg- 18%
Left leg- 18%

Question 12

Children rules of 9

Head and neck-
Anterior trunk-
Posterior trunk-
Right arm-
Left arm-
Pubic area-
Right leg-
Left leg-

Answer 12

Head and neck- 18%
Anterior trunk- 18%
Posterior trunk- 18%
Right arm- 9%
Left arm- 9%
Pubic area- 0%
Right leg- 14%
Left leg- 14%

Question 13

Complications of burn injury

Answer 13

Infection
Pulmonary
Metabolic (increase metabolic activity due to negative nitrogen balance)
Cardiovascular
Heterotrophic ossification
Neuropathy
Amputation
Pathological scars

Question 14

Metabolic Complications

Answer 14

Increased metabolic rate
-Decreased energy stores
-Weight loss
-Muscle atrophy
-Increased evaporative heat loss

Question 15

Pulmonary complications

Answer 15

Inhalation injury due to smoke inhalation
Common cause of mortality in burn injury

Question 16

Cardiovascular complications

Answer 16

Increased capillary permeability leading to:
- fluid loss
- decreased cardiac output
Capillary permeability returns to normal after 24 hours
Fluid replacement therapy helps manage intravascular fluid loss

Question 17

Heterotopic ossification

Answer 17

Etiology unknown
Most common in elbow, hips no shoulders
Symptoms; decrease ROM and increase point pain tenderness

Question 18

Neuropathy complications

Answer 18

Usually due to poor management (tightness of bandages and splinting)

Question 19

Why would amputation occur

Answer 19

Subdermal burns. Usually electrical burns

Question 20

Hypertrophic scar

Answer 20

Raised, red , rigid

Question 21

Keloid scar

Answer 21

Type of hypertrophic scar that extends beyond the boundary of original wound

Question 22

Types of pathological scars

Answer 22

Hypertrophic scar
Keloid scar
Scar contracture (scar bands)

Question 23

Initial management

Answer 23

Establish and maintain an airway
Prevent cyanosis, shock, and hemorrhage
Establish baseline data
Fluid replacement
Clean the patient and wounds
Examine injury
Prevent and manage any pulmonary complications

Question 24

Wound care

Answer 24

Inspect wound
Clean wound
Debridement of wound
Prevent injection

Question 25

Permanent skin graft

Answer 25

Autografts- from patients own skin (commonly from thighs and back) - sheet graft -mesh great

Question 26

Temporary graft

Answer 26

Allograft (from the same species) Xenograft (from another species)

Question 27

Escharmatomies

Answer 27

Performed when Escher is restricting circulation

Question 28

Physical therapy management

Answer 28

Prevent scar formation contractures bring them back to normal Healing Maximal ROM

Question 29

PT Goals

Answer 29

Maximal function and minimal complications

Question 30

Positioning and splinting

Answer 30

Minimize edema Prevent contracture Preserve function

Question 31

AROM

Answer 31

Begin day of admission on all extremities and trunk Coordinate with pain medication and dressing changes Discontinue joints above and below skin graft for roughly 3-5 days

Question 32

PROM

Answer 32

Perform when patient is not alert or able to follow commands Perform on children If patient cannot fully achieve active ROM Stress should be applied in a gentle, gradual and sustained fashion

Question 33

Resistive

Answer 33

Monitor vital signs initially Proper hydration is vital Room temp may need to be adjusted

Question 34

Conditioning

Answer 34

Same as resistive All exercises should be done

Question 35

Ambulation

Answer 35

Begin as soon as possible Discontinue after LE skin grafting until safe to resume Use elastic wraps or TED stockings to minimize edema and stasis when upright, and to protect new graft

Question 36

Scar management

Answer 36

Pressure Dressings Massage

Question 37

Superficial burn

Answer 37

Erythema (just redness)

Question 38

Partial thickness burn (epidermis and upper part of dermis)

Answer 38

Blistering (may heal without a scar)

Question 39

Full thickness burn (epidermis and entire dermis)

Answer 39

Necrosis (will heal with scar)

Question 40

Subdermal burn (epidermis, dermis and subcutaneous tissue)

Answer 40

Extensive surgical and therapeutic management necessary to return patient to some degree of function.