Burn Management Flashcards by Katherine Ussery

What are the three peak incidences for burns?

Children 1-5 2 to scalds
Adolescents 2 to accidents with flammable liquids
Men 16-40

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Which demographic has the highest incidence of burns?

Men 16-40

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What is the amount of time needed for follow-up post burn injury?

Minimum of 1 year

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What are the four classifications of burns?

Superficial
Superficial partial thickness
Deep partial thickness
Full thickness

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What are some characteristics of a superficial burn? (3)

Tender to touch
Dry, bright red, or pink skin that blanches under pressure
No edema or blisters

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A superficial burn involves what layer(s) of the skin?

The epidermis only

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What is the healing time for a superficial burn?

2-3 days with no scarring

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A superficial partial thickness burn involves what layer(s) of the skin?

Epidermis and papillary layer of the dermis

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What are some characteristics of a superficial partial thickness burn? (4)

Moist, weeping, (intact) blistered skin
Will blanch under pressure
Painful due to exposed nerve endings
Wound drainage

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What is the healing time for a superficial partial thickness burn?

7-10 days with minimal scarring

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A deep partial thickness burn involves what layer(s) of the skin?

Epidermis and dermis down to reticular layer - includes nerve endings, hair follicles, and sweat glands

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What are some characteristics of a deep partial thickness burn? (5)

Mottled areas of red with white eschar
May have large ruptured blisters
Sluggish capillary refill
Significant edema
Decreased sensation

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What is the healing time for a deep partial thickness burn?

3-5 weeks, split thickness skin graft is usually required

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A full thickness burn involves what layer(s) of the skin?

Epidermis and dermis

Subcutaneous tissue may also be involved

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What are some characteristics of a full thickness burn? (6)

Covered with eschar (black/deep red/white)
Necrotic, charred
Leathery, dry, rigid
Exposed deep tissues (tendon, muscle or bone)
Insensate
Peripheral vascular system damaged –> fluid leaks into interstitial spaces –> edema
Split thickness skin graft required

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What is an escharotomy?

an incision through the eschar to expose the fatty tissue below

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Why would a patient have an escharotomy?

To combat compartment syndrome

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What is a subdermal burn?

A burn from the dermis down through the subcutaneous tissue, muscle, and bone

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What would cause a subdermal burn?

Prolonged contact with flame, hot liquid, electricity, etc

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What would a subdermal burn look like?

Charred or mummified

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Will a subdermal burn need intervention?

Yes, it will not heal without intervention such as fasciotomy, escharotomy, grafting
Amputation is usually required however

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What is the breakdown of percentages of the TBSA classification for burns? (Rule of 9’s)

Head - 9%
Arms - 9% each
Trunk - 18% each for ant/post
Legs - 18% each

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What are three types of burns?

Thermal
Chemical
Electrical

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Which type of burn is most common?

Thermal

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What are some severity factors for thermal burns? (3)

Contact time Temp Type of insult

What are some severity factors for chemical burns? (4)

Alkali > acid Contact time Concentration Amount of chemical

What are some severity factors for electrical burns? (3)

AC > DC Contact time Voltage

What are some things to watch for with an electrical burn? (3)

Entrance and exit wounds Cardiac arrythmias Respiratory arrest

What is an inhalation injury?

An injury from inhaling smoke/hot air

The absence of a smoke detector increases the risk of death in a fire by what %?

60%

What is Stevens Johnson Syndrome (SJS)?

An immune complex mediated hypersensitivity disorder involving the skin and mucous membranes

What is SJS caused by?

Drugs, viral infections

How do you classify the severity of a burn? (5)

``` TBSA burned Depth of wound Age of pt PMH Part of body burned ```

Why would you see shock in a burn pt?

Hypovolemia ( ↑HR, ↓ BP, ↓ urine) Loss of plasma and extracellular fluid TBSA > 30%

When would you see hypermetabolism in a burn pt?

> 50% TBSA (may be 2.5 BMR)

What is involved the medical management of a burn? (7)

``` Maintain airway Determine extent/depth of injury Prevent fluid loss Prevent pulmonary and CV issues Clean pt and wounds Place dressings Surgical management ```

What are the three phases of burn management?

Resuscitive phase Wound coverage phase Reconstructive phase

What is involved in the resuscitive phase? (4)

IV therapy to compensate for fluid loss Escharotomy as needed NPO first 24 hr CV support as needed

What is involved in the wound coverage phase? (3)

Excision/debridement Dressings Grafting if needed

What are some common dressings used in burns? (5)

Silvadene - use on non-grafted burn or donor site Acticoat/Mepilex - impregnated with Ag Collagenase - for deeper burns or grafts with slough/eschar Bacitracin - for grafts or donor sites Sulfamylon - used on grafts with poor adherence (soupy or fragile)

What are four options for skin grafts?

Autograft (STSG) Allograft (cadaver skin) Xenograft (pig) Skin substitute (Integra)

What is the only skin graft that is permanent?

Autograft

What are some advantages of using a sheet STSG? (3)

Durable Limits contraction Cosmetic

What are some disadvantages of using a sheet STSG?

Difficult adherence

What are some advantages of using a mesh STSG? (3)

Covers more area Better if wound bed is irregular Better if wound bed is contaminated

What are some disadvantages of using a mesh STSG?

Less durable | Contracts more

What are some common STSG donor sites?

Thigh Leg Back Buttock

How many times can a donor site be harvested?

3-4

How would you treat a donor site?

As a partial thickness wound

What factors need to be present in the graft recipient area? (4)

Adequate vascularity Complete contact between graft and wound Adequate immobilization Few bacteria

What are some physical therapy goals for burn pts? (7)

``` Decrease edema Prevent contracture Maintain/improve strength and activity tolerance 3 day hold after STSG to LE for gait Pt edu D/C planning Manage scarring ```

What are some benefits of ace wrapping a burn?

Supports graft or burn area Promotes circulation Preventing hemorrhaging First phase of scar control

What shape will you use for ace wrapping a burn?

Spiral or figure 8

Can a pt sleep in an ace wrap?

When should ROM be performed?

Upon admission

What are some benefits of ROM? (5)

``` Reduce edema Promote circulation Prevent contractures Preserve jt mobility Promote max functional independence ```

What kind of burns have a greater chance of scar contracture?

Deeper burns

How pliable is burn scar tissue?

1/3 of normal skin

How should you keep burn scar tissue?

Elongated

How do you know if burn scar tissue is tight?

If it's white, it's tight

What are some contraindications to exercise in burn pts? (4)

Exposed joints Exposed tendon over PIPs DVT Comparment syndrome

How much exercise is too much exercise for burn patients?

You cannot over-exercise

How long should a skin graft be immobilized?

5-14 days

Do we want burn patients to be comfortable?

NO. THEY WILL FORM CONTRACTURES AND DIE!!!

What are some complications of facial burns?

Ectropion of eye | Ectropion of mouth

What is an ectropion of the eye?

The lower lid pulls away from the eye

What are some complications an ectropion of the eye? (3)

Excessive tear production Conjunctivitis Keratitis

What are some complications an ectropion of the mouth?

Difficulty managing secretions, liquids

What are potential some complications of a shoulder burn? (3)

Flexion or adducation contracture Scapular retraction of protraction contracture Limited chest wall expansion

What are potential some complications of a wrist burn? (2)

Flexion or extension contracture | Inability to ulnar deviate

What are potential some complications of a hip burn? (2)

Flexion contracture | Inability to fully extend hips during gait

What are potential some complications of a knee burn? (2)

Flexion contracture | Inability to fully extend knees during gait

What are potential some complications of a ankle burn? (2)

PF contracture | For deep partial and full thickness, which cross posterior ankle, consider multipodus boot

What are potential some complications of a MTP/IP burn? (2)

Can affect wearing shoes or push-off during gait | Use aggressive ROM

What is the most important rule of positioning for burn patients?

POSITION OF COMFORT = POSITION OF CONTRACTURE

What percentage of burn patients will develop hypertrophic scarring?

80% - the use of compression therapy is indicated for most burns

What benefits from compression therapy confer?

Mechanical thinning effect Decreases blood flow to area Reorganizes collagen bundles Decreases tissue water content

How long will patients need to wear compression garments after a burn?

1-2 years, 23 hours per day

Burn Management Flashcards

(78 cards)