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PT Selected Topics > Burn Management > Flashcards

Burn Management Flashcards

1
Q

Burns are a ______ problem, not just an integumentary issue

A

systemic

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2
Q

Burns are asses by ___________, not by staging or Wagner scale

A

thickness

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3
Q

Hydrotherapy is commonly used in the management of _______________

A

large body surface area burns

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4
Q

Any burn over ________% TBSA requires specialized care

A

9

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5
Q

Burn wounds are high risk for ____________ development when they span a joint

A

contracture

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6
Q

Burns are at a greater risk of developing __________________ scarring than other wound varieties

A

Hypertrophic or keloid

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7
Q

Aggressive ____________ interventions are required for optimal management of this patient population

A

ROM/positioning/splinting

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8
Q

_____________ garments are standard of care

A

compression

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9
Q

The epidermis is thin, __________ and _________

A

superficial and avascular

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10
Q

The roles of the epidermis

A

protection, waterproofing, and regeneration

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11
Q

Primary cell of the epidermis

A

keratinocyte

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12
Q

Keratinocyte

A

produces keratin which is the primary structural protein of the skin

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13
Q

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

A

Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale

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14
Q

The basement membrane zone is the interface of the ___________ and ___________

A

epidermis and dermis

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15
Q

What is the key component of the basement membrane zone?

A

rete pegs

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16
Q

What do the rete pegs in the basement membrane do?

A

prevent shear

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17
Q

What is the primary cell of the dermis?

A

fibroblast

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18
Q

What are the roles of the dermis?

A

Tensile strength and nutrition to the epidermis

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19
Q

What does the dermis contain?

A

Collagen and elastin, blood vessels, lymphatics, nerves, and it encloses the epidermal appendages

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20
Q

What do fibroblasts produce?

A

Collagen

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21
Q

The dermis is located _________ to the epidermis and basement membrane

A

deep

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22
Q

What are the two layers of the Dermis?

A

Papillary and reticular

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23
Q

Papillary layer of the dermis is _______, has _________ collagen, and has ____________

A

superficial, loosely organized, vascular eminences

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24
Q

The Reticular layer of the dermis is _______, has ___________ collagen, and merges with the _______________

A

deep, thick/densely organized, hypodermis

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25
Q

The dermis contains _________ nerve receptors

A

sensory

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26
Q

The ____________ of a burn will determine sensory functions likely to be impaired

A

depth

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27
Q

Free nerve endings are located where and do what?

A

epidermis and dermis; pain and itch

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28
Q

Merkel’s disks are located where and do what?

A

stratum spinosum; touch

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29
Q

Meissner’s corpuscle are located where and do what?

A

Papillary dermis; touch

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30
Q

Ruffini’s corpuscle are located where and do what?

A

papillary dermis; warm/hot

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31
Q

Krause’s end bulb are located where and do what?

A

papillary dermis; cold

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32
Q

Pacinian corpuscle are located where and do what?

A

reticular dermis; pressure and vibration

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33
Q

What is a burn

A

energy from the heat source is transferred to the body and heat absorption causes cell death

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34
Q

Severity of a burn depends on what?

A

contact time, temperature, duration, and type

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35
Q

How many burn injuries are there a year in the US?

A

1.4 - 2 million

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36
Q

Who is at highest risk for a burn?

A

children under 3 and adults over 70

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37
Q

Most burns are ____________ (75% ______, 13% ____________, 5% __________ = 85-95% heat)

A

Thermal; flame, hot liquid, contact

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38
Q

About _____% of burns are due to electricity

A

3

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39
Q

About ________% of burns are chemical

A

1-2

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40
Q

Chemical burns can be caused by ________________

A

contact, ingestion, or inhalation of strong acids/alkalis

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41
Q

1% or less for each type of burn comes from ___________, _________, and _______________

A

hot gases, friction, and radiation

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42
Q

Not all burns are form a hot source, you can also have a ___________ injury

A

cold

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43
Q

Cold injuries are due to either __________ or ____________

A

overexposure to cold air/water or core body temp decreases

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44
Q

Hypothermia and frostbite are both cold injuries due to _____________________

A

overexposure to cold air/water

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45
Q

When a cold injury occurs due to core body temp decreases, ____________ occurs and tissue forms _____________, and __________ and _________ can occur

A

peripheral vasoconstriction; ice crystals; necrosis and gangrene

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46
Q

The ____________ is used to triage/approximate severity/extent of a burn, but is inaccurate in pediatric pts

A

rule of 9s

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47
Q

What is more commonly used than the rule of 9s in pediatric burns?

A

Lund and Browder

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48
Q

Lund and Browder is based on age associated changes in ___________: representation of body parts changes based on growth and development with infant head = _______% TBSA, and adult head = ________% TBSA, and it subdivides body structures farther than the rule of 9s

A

TBSA; 19; 7

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49
Q

burn depths

A

Superficial, partial thickness (superficial or deep), and full thickness (subdermal)

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50
Q

superficial burns are red/pink irritated _____________, painful, tender, no _________, min/no _________, and heal spontaneously with no __________ (sunburn)

A

epidermis, blisters, edema, scarring

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51
Q

First degree burns

A

superficial burns

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52
Q

Superficial partial thickness burns are bright pink or red, have an inflamed _______, are located in the __________ or __________, they have intact ________, moist surfaces, __________ are ____________ (exposed nerve endings), sensitive to temp and touch, have moderate ________, spontaneous healing, and minimal scarring/discoloration

A

dermis, epidermis and papillary dermis, blisters, weeping, painful, edema,

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53
Q

severe sunburn, scalds, brief contact thermal and dilute chemicals are examples of what kinds of burns?

A

superficial partial thickness

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54
Q

Superficial second degree burns

A

superficial partial thickness

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55
Q

Deep partial thickness burns are red/waxy white, have blanching with slow _____________, is located in the __________, ________, or __________, have broken blisters, a ___________ surface, are sensitive to ____________ but not light touch (_________________ damaged), have significant edema (damaged dermal vessels), Slow _____________, extensive ______________, and hair follicles and sweat glands are __________

A

capillary refill; epidermis, papillary dermis, and reticular dermis; wet; pressure; merkel’s discs/meissner’s corpuscles; healing; scarring; intact

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56
Q

Deep partial thickness burns are due to ____________________

A

contact with hot liquids, chemical burns, and flash burns

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57
Q

Deep second degree burns

A

deep partial thickness

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58
Q

Full thickness burns are what colors?

A

white, charred, tan, black, or red

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59
Q

Full thickness burns are non-blanching, have poor ____________, are located in the ___________, _____________, and ___________ tissue.

A

circulation; epidermis, dermis, subcutaneous

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60
Q

third degree burns

A

full thickness burns

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61
Q

Full thickness burns can be due to _____________

A

immersion scald, exposure to chemicals or electrical current, or prolonged flame/steam

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62
Q

If a full thickness burn has a ____________, ___________, or __________ skin appearance or the area is _____________ than it requires skin grafting or will have extensive scarring

A

leathery, rigid, dry; depressed

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63
Q

Subdermal full thickness burns have a ________ appearance, visible ___________ tissue, and have _____________ and _________ damage

A

charred, subcutaneous, muscle, neurologic

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64
Q

Fourth degree burns

A

subdermal full thickness burns

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65
Q

Subdermal full thickness burns can be caused by ___________________

A

electrical, prolonged thermal contact or exposure to strong chemicals

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66
Q

Subdermal full thickness burns cause tissue defects, require _____________, and cause ______________

A

skin grafting; extensive scarring

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67
Q

What are the 3 zones of burn injury?

A

zone of coagulation, zone of stasis, and zone of hyperemia

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68
Q

Zone of coagulation

A

central most area or most significant/prolonged contact with offending agent; greatest risk for developing a full thickness injury, and/or tissue necrosis

69
Q

Zone of stasis

A

partial thickness injury with compromised blood flow; with proper wound and medical management, this area of tissue may be preserved or may be lost depending on severity and appropriateness of management

70
Q

Zone of hyperemia

A

vasodilation and increased cellular activity; cells from this area, help to support zone of stasis

71
Q

Superficial and superficial partial thickness burns heal by ___________ in how long?

A

re-epithelialization; in 5-10 days

72
Q

Deep partial thickness burns: surface heals by __________ and depth heals by ____________ in ____________

A

re-epithelialization; scar formation; 2-3 weeks

73
Q

Full thickness wounds: if small _________ or __________, but usually require ____________

A

contract or scar; skin grafting

74
Q

3 common burn related surgical interventions

A

skin grafts, escharotomy, and fasciotomy

75
Q

autograft

A

removed from the donor site and placed on the same individual

76
Q

What are two types of autografts?

A

Split-thickness skin grafts (STSG) and Full-thickness skin grafts (FTSG)

77
Q

Split-thickness skin grafts (STSG)

A

epidermis and portion of dermis harvested

78
Q

2 types of Split-thickness skin grafts (STSG)

A

Meshed and sheet

79
Q

Meshed Split-thickness skin grafts (STSG)

A

processed to increase surface area that can be covered

80
Q

Sheet Split-thickness skin grafts (STSG)

A

more cosmetic, covers less surface area

81
Q

Full-thickness skin grafts (FTSG)

A

Epidermis and all of the dermis harvested, very durable

82
Q

For a Full-thickness skin grafts (FTSG), the donor site itself must be __________ or _____________

A

grafted or closed by primary intention

83
Q

Most skin grafts we hope to be permanent are ____________

A

autografts

84
Q

A temporary graft is usually rejected in __________

A

2-3 weeks

85
Q

Types of temporary grafts

A

allograft (homograft), xenograft (heterograft), and dermal substitutes

86
Q

Allograft (homograft)

A

from another person

87
Q

Xenograft (heterograft)

A

from another species

88
Q

Skin grafts are held in place by what 3 things

A

surface tension, staples, and sutures

89
Q

Vascularity is estabilished in about _________: requires the graft to ___________ in the wound bed and it lacks _________________ initially requiring _____________ wrapping in dependent position

A

48 hours; remain immobile; vasomotor tone; light compression

90
Q

Most skin grafts are adhered in _____________

A

5 days

91
Q

Donor site heals via _____________

A

epithelialization

92
Q

What are 3 common causes of graft failure?

A

excessive edema or bacteria, mobility of graft, and inadequate excision to healthy tissue prior to application

93
Q

Early ambulation results in _____________ graft take than delaying ambulation

A

better

94
Q

Escharotomy

A

incision through Eschar into subcutaneous tissue, releases superficial tissue to decompress underlying tissue, and improves circulation

95
Q

Fasciotomy

A

incision through fascia, improves circulation, and decompresses underlying tissue

96
Q

Integumentary system issues related to burn injury

A

scarring, altered thermoregulation, sensory changes, and UV sensitivity

97
Q

What are the two types of scarring?

A

keloid and hypertrophic

98
Q

Scarring can lead to _______________

A

contracture, deformity, and impaired cosmesis

99
Q

Respiratory system pathology related to burns

A

Inhalation injury, edema in lungs, and circumferential thoracic and abdominal burns

100
Q

Inhalation injury is the primary cause of death and can be due to _____________

A

pulmonary edema, ARDS (acute respiratory distress syndrome), and carbon monoxide

101
Q

cardiovascular system pathology related to burn injury

A

Burn shock

102
Q

Burn shock: Increased _____________ leakage and causes _______ (large amount in 8-36 hours and resolves in 7-21 days), reduced _____ : decreased intravascular volume causes dec ____ and ________ as much as ______% for 1st ________ days

A

extravascular/interstitial fluid, edema; CO; SV and MAP; 50; 2-4

103
Q

Burn shock causes decreased intravascular fluid volume, which causes increased __________, which leads to increased _____________ and therefore an increased risk of ____________

A

hematocrit, blood viscosity, VTE

104
Q

Large amounts of ___________ are given early in the burn process to combat burn shock

A

IV fluids

105
Q

Musculoskeletal system pathology related to burns

A

Rhabdomyolysis/Muscle break down (atrophy/weakness) and heterotopic ossification

106
Q

Heterotopic ossification: Associated with burns < _____% TBSA, highest risk locations: _______________ which contribute to _________; have point specific pain and a possible bony end fee

A

20; elbow, shoulder, and hip; contracture

107
Q

Immune system pathology related to burns: high risk of ________________ which is the most common complication of a burn: they cause loss of ___________ function, there’s endogenous/exogenous bacteria, and they’ll have an altered __________ response

A

sepsis and infection; barrier; immune

108
Q

Renal impairments due to burn

A

excessive myoglobin (muscle destruction) impairs renal function, and decreased perfusion (hypovolemia) reduces GFR (glomerular filtration rate) which causes acute renal failure

109
Q

Neurologic system pathology related to burn: polyneuropathy - due to _________ and associated with >__________% TBSA and local neuropathy - regional and electrical burns with common locations being: _______________

A

Neurotoxicity; 20; brachial plexus, ulnar, peroneal, and median nerves

110
Q

Other pathologies related to burns are ophthalmic and auditory losses as well as psychosocial: acute - ______ or ________; or chronic - _____________, __________, or _________

A

delirium, anxiety; depression, PTSD (in 45% of survivors at 1 year), and sleep disturbance

111
Q

Severe pain is an obstacle to rehab, position of comfort is the position of ____________, so we want to pre-medicate prior to PT intervention, and they’re going to need extensive PT __________

A

contracture; education

112
Q

Burn wound care has the same general principles as other wounds: cleanse, _______ dressings to remove - don’t try to _________, ___________ wound environment, appropriate dressing, and need a more frequent use of ________________ with this population

A

cut; unwind; moist; topical antimicrobials

113
Q

Burn wound care: _____________ for large BSA wounds - cleanse/dressing removal; uses a __________ or __________: temp _________ deg for adults, _____ deg pediatric, and < ______ min submersion

A

submersion; hubbard tank or whirlpool; 95-100; 90; 30

114
Q

Debridement

A

removal of devitalized tissue

115
Q

PT can perform what kinds of debridement?

A

Autolytic, mechanical, enzymatic, and selective/sharp

116
Q

Need to be careful when using topical antimicrobial agents as they may be ____________

A

cytotoxic

117
Q

Topical antimicrobial agents

A

Silver Sulfadiazine: gram + and –, Mafenide acetate (sulfamylon): typical wound flora, Silver nitrate: broad spectrum bacteriostatic (also stops focal bleeding), and Bacitracin/polysporin: gram +

118
Q

Silver Sulfadiazine: gram + and – is used for which common infecting agents?

A

Pseudomonas aeruginosa (gram - rod) and Staphylococcus aureus (gram + cocci)

119
Q

Mafenide acetate (sulfamylon): typical wound flora is used for which common infecting agents?

A

Pseudomonas aeruginosa (gram - rod)

120
Q

Bacitracin/polysporin: gram + is used for which common infecting agents?

A

Staphylococcus aureus (gram + cocci)

121
Q

Common infecting agents

A

Pseudomonas aeruginosa (gram - rod), Staphylococcus aureus (gram + cocci), Proteus mirabilis (gram - rod), and Escheria coli (gram - rod)

122
Q

Scar tissue has less _________________ and more ________________ than normal skin

A

hyaluronic acid; chondroitin 4 sulfate

123
Q

Scar tissue is less _____________, the collagen is ________________, maximal tissue length is __________, contributes to scar banding and contracture risk, and needs ____________ application several times a day

A

elastic; less organized; reduced; moisturizer

124
Q

Skin and scars S/P burn require stretching and positioning through ______________, stressing relaxation and static splinting, and tissue creep which is ___________________ that requires a low load prolonged stretch (LLPS) and a minimum of 3 minutes at end range per motion involved and allows for ____________ and tissue expanders

A

soft tissue mobilization and transverse fiction massage; progressive elongation over time in response to prolonged force; dynamic splinting

125
Q

GOAL OF BURN REHAB

A

PREVENT/TREAT BURN SCAR, CONTRACTURE, AND RELATED DEFORMITY

126
Q

What should be documented when assessing a wound?

A

Extent and distribution, Location, Depth, Tissue quality, drainage, % viable vs necrotic tissue, odor, appearance, measurement

127
Q

Burn rehab positioning/splinting

A

Maintain tissue at end ROM/state of elongation, in position opposite the location of the burn wound

128
Q

Burn rehab manual stretching: low load _____ second hold repeated ______ times per motion with at least 3 minutes of end range time, may incorporate contract relax/hold relax and PNF patterns of movement, and need pt education on _______________ (caregiver training is super important!)

A

30-60; 3-5; self-stretching

129
Q

If the neck is burned, what is the likely contracture?

A

flexion

130
Q

If the anterior axilla is burned, what is the likely contracture?

A

Adduction

131
Q

If the posterior axilla is burned, what is the likely contracture?

A

Extension

132
Q

If the antecubital space is burned, what is the likely contracture?

A

elbow flexion

133
Q

If the Forearm is burned, what is the likely contracture?

A

Pronation

134
Q

If the wrist is burned, what is the likely contracture?

A

Flexion

135
Q

If the dorsal hand is burned, what is the likely contracture?

A

MCP hyperextension, IP flexion, thumb add

136
Q

If the palmar hand is burned, what is the likely contracture?

A

Finger flexion, thumb flexion/adduction

137
Q

If the hip is burned, what is the likely contracture?

A

Flexion, add, ext, rotation

138
Q

If the knee is burned, what is the likely contracture?

A

flexion

139
Q

If the ankle is burned, what is the likely contracture?

A

plantar flexion

140
Q

Preventative positioning

A

direction opposite of likely contracture

141
Q

Splinting is used to ________________

A

prevent or correct contracture and protect joint and tendons

142
Q

Static splinting

A

No moving parts, positioning only immobilize; and is modified once increased motion is obtained

143
Q

Dynamic splinting

A

LLPS, has moving parts, applies constant force

144
Q

Airplane position

A

shoulders abducted 90-120

145
Q

Elbow conformer

A

keep elbow extended

146
Q

Wrist cock up splint

A

keep wrist extended

147
Q

hand splint

A

keep MPs flexed, IPs extended, and digits abducted

148
Q

Hip slint

A

keep hips abducted and extended

149
Q

Knee conformer

A

keep knee extended

150
Q

Ankle splint

A

keep foot dorsiflexed

151
Q

Goals of exercise for burn rehab

A

reduce edema, prevent contractures, recondition, increase strength and mobility, promote independence

152
Q

ROM exercise is best performed when and why?

A

during dressing changes; no restriction from bulky dressings

153
Q

AROM should be performed when

A

immediately after burn but wait 1 week after skin grafting

154
Q

AAROM promotes ________ and ___________

A

scar tissue elongation and self-management

155
Q

PROM promotes ______________ and consists of ____________

A

scar tissue elongation; LLPS

156
Q

For conditioning, as long as we are not threatening a new skin graft, all modes of exercise are appropriate, and we want to put emphasis on _________________

A

strengthening muscle groups opposite of likely scar formation

157
Q

What does pressure application to scars during the remodeling process do?

A

Reduces hypertrophy of scar, Realigns collagen, Decreases interstitial edema in hypertrophic scars reducing their severity, Reduces chondroitin A sulfate and increases hyaluronic acid concentration, and Reduces mast cell’s release of histamine reducing edema

158
Q

Wounds with <____ days healing time-not likely to require pressure garment

A

14

159
Q

Wounds requiring _______ days for closure should receive pressure Garment

A

14-21

160
Q

Wounds requiring more than _____ days to heal require pressure Garment; at least _______ mmHg required, but possibly as high as ________ mmHg

A

21; 5-15; 25

161
Q

Elastic band (ace wraps): _______ mmHg and need _____________

A

10-15; frequent rewrapping

162
Q

tubular support bandages (tubigrip): ________ mmHg

A

10-20

163
Q

Custom pressure garments: ________mmHg

A

25

164
Q

Compression/pressure garments should be worn for __________ hours a day within _______ days of initial injury

A

23; 60

165
Q

pressure garments duration of use: _______________; remodeling continues for up to __________ months, but what is an issue with this

A

12-24 months; 24; compliance

166
Q

what’s the problem with pull on compression garments?

A

it results in increased shear forces

167
Q

What massage techniques are sometimes used for burns?

A

effleurage, petrissage, transverse friction, iastm

168
Q

What thermal modalities are sometimes used for burns (not acutely) and why?

A

ultrasound, diathermy, and moist heat; used to improve tissue extensibility prior to stretching

PT Selected Topics (7 decks)

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