Burns

Question 1

Electrical burn

Answer 1

entrance and exit wound
complications: cardia arrhythmias, respiratory arrest, renal failure, neurological damage and fxs
Example: lightning strike

Question 2

Chemical burn

Answer 2

sulfuric acid
lye
hydrochloric acid
gas

Question 3

Radiation burn

Answer 3

exposure to external beam radiation therapy
DNA is altered and ischemic injury may be irreversible
severe blistering and desquamation, non-healing wounds, tissue fibrosis, permanent discoloration and new malignancies

Question 4

Zone of stasis

Answer 4

less severe injury
reversible damage
surrounds zone of coagulation

Question 5

Zone of coagulation

Answer 5

most severe injury with irreversible cell damage

Question 6

Zone of hyperemia

Answer 6

surrounding zone of stasis
presents with inflammation
will fully recover without any intervention or permanent damage

Question 7

Superficial burn

Answer 7

outer epidermis
red with slight edema
Healing occurs without peeling or evidence of scarring in 2-5 days

Question 8

Superficial partial-thickness burn

Answer 8

epidermis and upper portion of dermis
extremely painful and exhibits blisters
minimal to no scarring 5-21 days

Question 9

Deep partial thickness burn

Answer 9

complete destruction of epidermis and majority of dermis
may appear discolored with broken blisters and edema
damage to nerve endings results in only moderate levels of pain
hypertrophic or keloid scarring may occur
without infection healing can occur in 21-35 days

Question 10

Chemical burns can occur from

Answer 10

iontophoresis

Question 11

When do chemical burns from ionto occur?

Answer 11

when skin pH increases or decreases beyond range of normal tolerance

Question 12

Chemical burns in ionto occur more severely under which electrode?

Answer 12

negative

Question 13

What factors contribute to chemical burns from ionto treatment?

Answer 13

delivered with excessive current
prolonged duration
electrode placement over defective skin areas with lower resistance

Question 14

Poor ionto electrode placement can contribute to

Answer 14

thermal burn in cases of excessive impedance or poor electrode contact

Question 15

Full-thickness burn

Answer 15

complete destruction of epidermis and dermis and partial damage to subcutaneous fat layer
eschar formation and minimal pain
requires grafts and are susceptible to infection

Question 16

Subdermal burn

Answer 16

complete destruction of epidermis, dermis and subcutaneous tissue
may involve muscle and bone
often requires multiple surgical interventions

Question 17

Rule of Nines:
Head and neck

Answer 17

9%

Question 18

Rule of Nines:
Anterior trunk

Answer 18

18%

Question 19

Rule of Nines:
Posterior trunk

Answer 19

18%

Question 20

Rule of Nines:
Bilateral anterior arm, forearm and hand

Answer 20

9%

Question 21

Rule of Nines:
Bilateral posterior arm, forearm and hand

Answer 21

9%

Question 22

Rule of Nines:
Genitals

Answer 22

1%

Question 23

Rule of Nines:
bilateral anterior leg and foot

Answer 23

18%

Question 24

Rule of Nines:
Bilateral posterior leg and foot

Answer 24

18%

Question 25

Child under one year head and neck rule of nines: This extra 9% is taken from LE.

Answer 25

18%

Question 26

Each year of life for a child, ___% is distributed back to lower extremities until age 9 when head is considered same proportion as adult.

Answer 26

1

Question 27

When is head considered same proportion for burn percentage as adult?

Answer 27

age 9

Question 28

If burn is anterior neck what is the anticipated deformity and possible splint?

Answer 28

flexion with possible lateral flexion soft collar, molded collar, Philly collar

Question 29

If burn is anterior chest and axilla, what is the anticipated deformity and possible splint?

Answer 29

shoulder adduction, extension and IR axillary or airplane splint shoulder abduction brace

Question 30

If burn is on elbow what is the anticipated deformity and possible splint?

Answer 30

flexion and pronation gutter splint, conforming splint, three-point splint, air splint

Question 31

If burn is at hand and wrist, what is the anticipated deformity and possible splint?

Answer 31

extension or hyperextension of MCP joints flexion of IP joints adduction and flexion of thumb flexion of wrist wrist splint thumb spica splint palmar or dorsal extension splint

Question 32

If burn is at hip, what is the anticipated deformity and possible splint?

Answer 32

flexion and adduction anterior hip splica abduction splint

Question 33

If burn is at knee what is the anticipated deformity and possible splint?

Answer 33

flexion conforming splint three-point splint air splint

Question 34

If burn is at ankle, what is the anticipated deformity and possible splint?

Answer 34

PF posterior foot drop splint posterior ankle conforming splint anterior ankle conforming splint

Question 35

Development of ___ scars is common with severe burn injuries.

Answer 35

hypertrophic

Question 36

Complications associated with hypertrophic scars

Answer 36

contracture adhesions hypersensitivity functional limitation poor cosmesis

Question 37

Scar assessment with General characteristics to note:

Answer 37

tonometer rating scales for scar characteristics location, sensation, texture, pigmentation, vascularity, pliability and height

Question 38

Scar massage should be done how?

Answer 38

friction

Question 39

When should scar massage from a burn occur?

Answer 39

not too soon or too aggressively

Question 40

Compression garments with burns

Answer 40

reduce hypertrophic scarring in burns that take more than 14 days to heal. Sustained compression from 15-35 mmHg worn 22-23 hours per day Start use of compression between 2 weeks and 2 months after wound closure or grafting continuing up to 2 years.

Question 41

What can be used for desensitization?

Answer 41

TENS compression

Question 42

Desensitization techniques should be performed for how many minutes how many times a day?

Answer 42

5-10 minutes 3-4 times daily

Question 43

Silver sulfadiazine advantages

Answer 43

can be used with or without dressings painless can be applied to wound directly broad-spectrum effective against yeast

Question 44

Silver sulfadiazine disadvantages

Answer 44

does not penetrate into eschar

Question 45

Silver nitrate advantages

Answer 45

broad-spectrum non-allergenic dressing application is painless

Question 46

Silver nitrate disadvantages

Answer 46

poor penetration discolors, making assessment difficult can cause sever electrolyte imbalances removal of dressing is painful

Question 47

Povidone-iodine advantages

Answer 47

broad-spectrum antifungal easily removed with water

Question 48

Povidone-iodine disadvantages

Answer 48

not effective against pseudomonas may impair thyroid function painful application

Question 49

Mafenide acetate advantages

Answer 49

broad-spectrum penetrates burn eschar may be used with or without occlusive dressings

Question 50

Mafenide acetate disadvantages

Answer 50

may cause metabolic acidosis may compromise resp function may inhibit epithelialization painful application

Question 51

Gentamicin advantages

Answer 51

broad-spectrum may be covered or left open to air

Question 52

Gentamicin disadvantages

Answer 52

has causes resistant strains ototoxic nephrotoxic

Question 53

Nitrofurazone advantages

Answer 53

bacteriocidal broad-spectrum

Question 54

Nitrofurazone disadvantages

Answer 54

may lead to overgrowth of fungus and pseudomonas painful application

Question 55

Allograft (homograft)

Answer 55

temporary skin graft from another human (usually a cadaver) covers a large burned area

Question 56

Autograft

Answer 56

permanent skin graft from donor site on patients own body

Question 57

Escharotomy

Answer 57

opens or removes eschar from a burn site to reduce tension on surrounding structure, relieve pressure from interstitial edema and subsequently enhance circulation

Question 58

Full-thickness graft

Answer 58

contains dermis and epidermis

Question 59

Heterograft (xenograft)

Answer 59

temporary skin graft taken from another species

Question 60

Mesh graft

Answer 60

altered to create mesh-like pattern in order to cover a large surface area

Question 61

Sheet graft

Answer 61

transferred directly from unburned donor site to prepared recipient site

Question 62

Split-thickness graft

Answer 62

contains only superficial layer of dermis in addition to epidermis

Question 63

Z-plasty

Answer 63

surgical procedure where cut z shape to eliminate scar contracture