Burns

Question 1

Superficial partial thickness

Answer 1

Blanches with pressure
Wet/Blistered
Increased sensitivity

Question 2

Deep Partial Thickness

Answer 2

White, waxy and dry
Non blanching
Pressure sensitivity only

Question 3

Full Thickness

Answer 3

Requires graft to heal
White/Charred
Decreased sensation

Question 4

Zones of Cellular Injury

Answer 4

Outside ring - zone of hyperemia (increased perfusion)

Middle ring - zone of stasis (decreased sensation

Inside ring - zone of coagulation (maximal damage)

Question 5

Cardiovascular response

Answer 5

Hypovolemic shock
Cardiac output changes
Electrolyte Imbalances
Edema

Question 6

Respiratory

Answer 6

Inhalation injuries
Sedation requiring mechanical ventilation
Respiratory failure

Question 7

Musculoskeletal

Answer 7

Loss of lean muscle mass and decreased bone density
Associated trauma/fractures
Amputation
Heterotopic Ossification
Exposed Tendons

Question 8

Integumentary

Answer 8

Loss of thermoregulation
Changes in sensation
Cosmesis

Question 9

Neurologic

Answer 9

Pain
Anxiety and PTSD
ICU Delirium
Peripheral Nerve Damage

Question 10

Metabolic

Answer 10

Hypermetabolic state
Nutrition is critically important

X2 increase in metabolic need

Question 11

Immunologic

Answer 11

Wound Infection
Sepsis

Question 12

Burn Assessment Lund and Browder Chart

Answer 12

% by region
Head, thigh and leg changes % with age

Question 13

Rule of Nines

Answer 13

% with head, torso, ab, legs and arm
Child and adult model

Question 14

Indications for Referral to Burn Center

Answer 14

Partial-thickness burns greater than 10% TBSA
Full-thickness burns in any age group
Burns involving the face, hands, genitalia, perineum
Circumferential burns
Chemical or high voltage electric burns
Inhalation injury
Patients with significant co-morbidities
Burn injury with additional trauma injuries
Patient will require special social/emotional or long-term care and rehabilitation

Question 15

Surgical Interventions

Answer 15

Autograph: Own body
Allograft: Cadaver/donor
Xenograft: Pig skin
Skin substitutes: man made matrix
Cultured epithelial cells: own grown cells

Question 16

Priorities for grafting

Answer 16

Survival
Function
Cosmetic Appearance

Question 17

Sheet Graft vs Meshed Graft

Answer 17

Sheet:
Improved cosmetic appearance
Graft of choice when there is more donor site available
Used on face, hands, feet

Meshed:
Slits are mechanically cut into graft to allow for stretch
Covers a larger surface area
Poorer cosmetic appearance
Often leads to hypertrophy and or contraction or shrinking of graft

Question 18

PT Treatment Focused

Answer 18

Splinting/Positioning
ADL’s
ROM
Balance Training
Gait training/Prosthetic Training
Endurance Training
Functional Mobility
Posture
Scar Management
Edema Management
Discharge Planning
Return to School/Work
Caregiver/Patient Education

Question 19

Splinting Goals

Answer 19

Support: Elongated position or position of greatest function
Minimize: Contractures
Protect: Tendons and joints
Prevent: Movement/disruption of new grafts

Question 20

Guidelines for Splinting

Answer 20

Splint over uniform dressings: Modify dressings if necessary, prior to splinting

Allow time out of splints for participation in active movement exercises/activities

Avoid bony prominences to prevent creation of pressure injury

ROUTINE SPLINT CHECKS!

Question 21

Risk factors for Scarring

Answer 21

Healing time > 14 days
Grafted wounds
Very young children
Re-harvested donor sites
Darker pigmented skin tones
Genetics

Question 22

Immature/Active Scars

Answer 22

the 3 R’s
- Red
- Raised
- Ridged

Question 23

Mature Scars

Answer 23

the 3 P’s
- Pale
- Planar
- Pliable

Question 24

Scar Assessments

Answer 24

Vascularity
Pigmentation
Pliability
Height