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Burn Management Flashcards

(92 cards)

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1
Q

(true/false) Burns are a systemic problem

A

true

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2
Q

How are burns assessed?

A

By their thickness (not by staging or wagner scale)

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3
Q

What is the most common treatment technique to manage large body surface area burns?

A

hydrotherapy

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4
Q

Any burn > __% TSA requires specialized care

A

9

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5
Q

What are burn wounds at high risk for if they travel over a joint?

A

contracture

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6
Q

(gentile/aggressive) ROM/Positioning/splinting interventions are required for optimal management of burns

A

aggressive

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7
Q

What is considered as part of standard care for burns?

A

compression garments

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8
Q

What is the role of the epidermis?

A

protection
waterproofing
regeneration

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9
Q

What is the primary cell type found in the epidermis?

A

keratinocyte

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10
Q

definition: layer of integumentary system
- thin
- superficial
- avascular

A

epidermis

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11
Q

What are the 5 layers of the epidermis from superficial to deep?

A
  1. stratum corneum
  2. stratum lucidum
  3. stratum granulosum
  4. stratum spinosum
  5. stratum basale
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12
Q

What is the role of the basement membrane zone?

A

prevent shearing (Rete Pegs)

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13
Q

What is the primary cell of the dermis?

A

fibroblast

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14
Q

What is the role of the dermis?

A

tensile strength
nutrition to epidermis
encloses the epidermal appendages

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15
Q

What structures does the dermis contain?

A
  • collagen
  • elastin
  • blood vessels
  • lymphatics
  • nerves
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16
Q

What are the two layers of the dermis?

A

papillary and reticular

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17
Q

definition: layer of integumentary system
- superficial
- loosely organized collagen
- vascular eminences

A

papillary dermis

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18
Q

definition: layer of integumentary system
- deep
- thick/dense
- organized collagen
- merge with hypodermis

A

reticular dermis

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19
Q

What layer of the skin contains sensory nerve receptors?

A

dermis

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20
Q

What nerve receptors are damaged if a burn goes to the epidermis? What is impacted?

A

free nerve endings - superficial pain and itch
merkel’s disks- touch

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21
Q

What nerve receptors are damaged if a burn goes to the papillary dermis? What is impacted?

A

meissner’s corpuscle- touch
ruffini’s corpuscles- heat
krause’s end bulb- cold

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22
Q

What nerve receptors are damaged if a burn goes to the reticular dermis? What is impacted?

A

pacinian corpuscles- pressure and vibration

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23
Q

What feature of a burn causes cell death?

A

heat absorption

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24
Q

who is at the highest risk for burns?

A

children <3 y/o
adults >70 y/o

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25
What are the 4 main causes of burns? Rank them.
1. thermal 2. electricity 3. chemicals 4. hot gas, friction, radiation
26
Presence of deep electrical damage exceeds just surface damage due to ___.
resistance
27
What physiological change to cold injuries save the core body temperature and organs?
peripheral vasoconstriction
28
What burn approximation tool is commonly used for pediatric cases?
lund and brower approximation
29
>___% TBSA partial thickness burn requires a specialized burn unit
25
30
"first degree burn"
superficial burns
31
s/s - red/pink irritated epidermis - painful - tender - no blisters - minimal to no edema
superficial burns
32
How do superficial burns heal?
spontaneously with no scarring
33
"superficial second-degree burn"
superficial partial thickness burn
34
s/s - bright pink/red inflamed dermis - intact blisters - moist surface - weeping - painful (due to exposed nerve endings) - sensitive to temperature and touch - moderate edema
superficial partial thickness burn
35
How does a superficial partial thickness burn heal?
spontaneous with minimal scarring and discoloration
36
What layers of the skin does a superficial partial thickness burn affect?
epidermis papillary dermis
37
What layers of the skin does a deep partial thickness burn affect?
epidermis, papillary dermis, reticular dermis
38
(true/false) hair follicles and sweat glands are damaged with deep partial thickness burns.
false
39
"deep second degree burns"
deep partial thickness burn
40
s/s - broken blisters - wet surface - pressure sensitivity (but not to light touch) - significant edema
deep partial thickness burns
41
How do deep partial thickness burns heal?
slow healing with extensive scarring
42
"third degree burns"
full thickness burn
43
s/s - white/charred/black/tan/red - non-blanching - poor circulation - leathery - rigid - dry skin appearance - depressed area
full thickness burn
44
"fourth degree burn"
subdermal full thickness burn
45
s/s - charred appearance - visible subcutaneous tissue - muscle and neurologic damage - tissue defects
subdermal full thickness burn
46
- the most significant and prolonged area in contact with offending agent - Greatest risk of full thickness injury and tissue necrosis
zone of coagulation
47
- Partial thickness injury with compromised blood flow - Can be preserved with correct management - Can be preserved if severity of the burn is not excessive
zone of stasis
48
- Vasodilated and increased cellular activity - Cells help support the zone of stasis - help prevent necrosis of the zone of stasis
zone of hyperemia
49
superficial/ superficial partial thickness burns heal by re-epithelialization within ______ days.
5-10 days
50
deep partial thickness burns heal by re-epithelialization within ______ weeks.
2-3 weeks
51
What is harvested with a split-thickness skin graft (STSG)?
epidermis and a small portion of the dermis
52
What is harvested with a full thickness skin graft (FTSG)?
epidermis and dermis
53
types: - STSG - FTSG
autograft
54
types: - allograft - xenograft - dermal substitute
temporary graft
55
definition: skin graft from another person
allograft (homograft)
56
definition: skin graft from another species.
xenograft (heterograft)
57
definition: skin graft created in a lab
dermal substitutes
58
How long does it take most skin grafts to adhere?
5 days
59
Vascularity is restored to a skin graft in about ___ hours.
48 hours
60
What has to happen to the graft for vascularity to be maintained?
It must remain immobile
61
What are the common causes of graft failure?
- excessive edema and/or bacteria - mobility of the graft - inadequate excision to healthy tissue prior to application
62
What do escharotomies and fasciotomies do?
- decompress underlying tissue - improve circulation - prevent/treat compartment syndome
63
Edema resolves within __-__ days if caused by burn shock.
7-21 days
64
What MSK condition is associated with burns > 20% TBSA?
heterotpic ossification
65
What are the highest risk locations for heterotopic ossification due to the risk of contracture?
elbow, shoulder, hip
66
Renal impairment can occur with burns due to excessive _____.
myoglobin from muscle destruction
67
Polyneuropathy is associated with > ___% TBSA burns.
20%
68
What are the common locations of local neuropathies caused by burns?
brachial plexus, ulnar nerve, peroneal nerve, median nerve
69
PTSD is seen in ___% of burn survivors after 1 year.
45%
70
A position of ___ is the position of contracture.
comfort
71
What are the temperature parameters of a hubbard tank/whirlpool for an adult?
95-100 degrees
72
What are the temperature parameters of a hubbard tank/whirlpool for a child?
90 degrees
73
What is the maximum amount of time a burn victim should be in a hubbard tank/whirlpool
30 minutes
74
Scar tissue has more ___ and less ____ than normal skin.
More chondroitin-4-sulfate Less hyaluronic acid
75
Scar tissue has (more/less) collagen organization and elasticity.
less
76
definition: progressive elongation of skin/scar over time in response to prolonged force
tissue creep
77
What are the parameters for PROM/AROM in burn victims?
10-30 reps for 2-3x/day
78
When splinting/positioning, you should maintain tissue at the end range of elongation in the (same/opposite) position of the burn wound location.
opposite
79
What are the parameters for manual stretching?
low load, 3x5 sets for 30-60 second hold for each motion
80
splinting type: airplane splinting position:
90-120 degrees shoulder ABD
81
splinting type: elbow conformer splinting position:
elbow EXT
82
splinting type: wrist cock up splint splinting position:
wrist EXT
83
splinting type: hand splint splinting position:
MP FLX IP EXT phalanx ABD
84
splinting type: hip splint splinting position:
hip ABD and EXT
85
splinting type: knee conformer splinting position:
knee EXT
86
Pressure application should be provided during the ___ process of burns/scar management.
remodeling process
87
Wounds requiring __-__ days for closure should receive a pressure garment.
14-21 days
88
Ace wraps provide __-__ mmHg of pressure.
10-15 mmHg
89
Tubular support bandages provide __-__ mmHg of pressure.
10-20 mmHg
90
Custom pressure garments can provide up to ___ mmHg of pressure.
25 mmHg
91
How long should a patient use a scar-mgmt pressure garment?
12-24 months or more
92
Remodeling of scar tissue can take up to __ months.
24 months

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