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Flashcards in Burns Deck (28):
1

Deep partial thickness s Sx

Thick, rubbery scar
Poor hand/arm function
Poor skin integrity

Grafting better cosmetically and funtionally

2

Surgical burn management

Autograft: deep partial/full thickness-permanent

Allograft: temporary

Xenograft: pig skin-temporary

Skin substitute: temporary, special protocols

3

Split thickness skin graft (STG)

Advantages: durable, limits contraction, cosmetic

Disadvantages: difficult adherence

4

STSG mesh

Advantage: donor skin covers more of burn, better for irregularities or if wound bed contaminated

Disadvantages: less durable, contracts more

5

STSG donor site

Thigh, leg, back, buttock
Heals by re-epitheliazation.(7-14 days)

Can be harvested 3-4 times
treat as partial thickness wound

6

Graft recipient area requirements

Adequate vascularity
Complete contact
Adequate immobilization
Few bacteria

7

ACE wrap for burns

Supports graft/burn, promotes circulation, prevents hemorrhage

Figure 8 or spiral

No sleeping in ACE wrap

8

LE burn and ambulation

Apply compression: progressively dangle legs, walk immediately on stance

If grafted, progressively dangle: start at 1 min and observe for color change, bleeding, etc.

9

Contraindications to ex for burns

Exposed joints, tendons of PIP
DVT
Compartment syndrome

10

Position of contracture

Usually position of comfort

11

Facial complications of burns

Ectropion of eye: excessive tear production, conjunctivitis, keratitis

Ectropion of mouth: difficulty managing secretions, liquids

12

Shoulder complications of burns

Flexion or add contracture
Limited chest wall expansion

13

Burn numbers

500k a year
Males 16-40 most common

Children 1-5: 2* to scalds
Adolescents: 2* to accidents with flammable liquids

14

Superficial (First degree)

Sunburn
No blisters, bright red or pink.
Epidermis only, blanches under pressure.
Tender to touch
Spontaneous healing in 2-3 with no scar
No edema

15

Superficial Partial Thickness

Epidermis and papillary dermis.
Intact blisters c inflammation
Blanches under pressure.
Painful/sensitive.
Heals s surgical intervention in 7-10 days c minimal scarring
Immediate capillary refill

16

Deep partial thickness

Epidermis and dermis down to reticular layer.
Mixed red/waxy apperance.
Significant edema.
Heals in 3-5 wks, STSG usually required
Hypertrophic scarring common
Sluggish capillary refill

17

Full thickness burn

Epidermis and dermis, possibly subQ
Covered c eschar
STSG necessary
Edema

Beyond PT scope

18

Escharotomy

Swelling c circumferential burn

Decreases pressure, restore blood flow, save limb

19

Subdermal burn

Destruction from dermis through subQ tissue, muscle, bone
Prolonged contact
Charred or mummified appearance
Extensive sx/therapy

20

Rule of 9's

Head: 9%
Anterior trunk: 18%
Posterior trunk: 18%
Leg: 18% each
Arm: 9% each
Balls: 1%
Palm: 1% each

21

Types of burns

Thermal: direct contact: contact time, temperature, type of insult

Chemical: acids/bases: alkali>acid, contact time, concentration, amount

Electrical:AC>DC, contact time, voltage

22

Electrical burn

Destructive
Entrance and exit wounds
Cardiac arrhythmia, respiratory arrest

23

Inhalation injury

Increases morbidity/mortality: 60% of fire related death
Prolonged ventilation and bed rest

No smoke detector increases risk of death by 60%

24

Stevens Johnson Syndrome/TENS

Immune complex hypersensitivity

Skin and mucous membranes

Drugs, viral, infection.

Tens=greater than 30% of body

25

Complications of burns

Shock: hypovolemia, TBSA >30%
Pulmonary: inhilation injury
Hypermetabolism
Thermoregulation
Infection

26

Resuscitive phase

Nothing by mouth first 24 hrs
IV for fluid loss
Cardiopulm complications

27

Wound coverage phase

Excision/debridement
Dressings
Grafting

28

Dressings for burns

Siladene: non-graft or donor site
Acitcoat: impregnated c silver
Collagenase: deeper burns c slough/eschar
Bacitracin: grafts/donor sites
Sulamylon: grafts with poor adherence