Flashcards in Burns Deck (76):
What is skin?
- The soft outer covering of vertebrates
•The largest organ in the body
•Skin is .5 cm to 4.0 cm thick
T or F: Women have thicker skin than men.
False; men have thicker skin
T or F: The young and elderly have thicker skin than adults.
False; the young and elderly have thinner skin than adults
T or F: Skin on various parts of the body varies in thickness and blood flow
The skin is made up of what three different layers?
Epidermis, dermis, hypodermis
What layer are melanocytes found in? What is the purpose of melanocytes?
Epidermis; melanocytes produce a protective skin-darkening pigment melanin
What layer are langerhans cells found in? What are their purpose?
Epidermis; they protect your skin from infection and produce allergic reactions
What layer are merkel cells found in? what are their functions?
Epidermis; it is a touch receptor
What is the outermost layer of the skin called?
which layer of skin contains blood capillaries, hair follicles glands, nerve endings and receptors?
What layer of the skin is subcutaneous and contains fat and blood vessels?
What are the functions of the skin?
7.Vitamin D synthesis
How do you classify a burn?
By level of cellular injury
•Use of Laser Doppler Flowmetry (LDF), MRI, and thermography
•Most often clinical observation is the techniques used
T or F: Superficial burn is known as a second degree burn.
False; superficial is formally known as a first degree burn
T or F: Partial thickness is formally known as a first degree burn.
False; partial thickness is formally known as a second degree burn
T or F: Full thickness is formally known as a second degree burn.
False; full thickness is formally known as a third degree burn
What are the characteristics of a superficial burn?
•Damage to cells on the epidermis only
•Red painful intact skin
•Heals spontaneously within 1-7 days
•“Think sun burn”
What are characteristics of a superficial partial thickness?
•Damage to epidermis parts of the dermis
•Red, wet, edematous, painful, blisters
•Reepithelialize in 7-21 days
•Minimal to no scarring
•Hair may be spared/ grow back
What are characteristics of deep partial thickness?
•Severe damage to dermal layer
•Blotchy and white
•Healing 3- 5 weeks (sluggish)
•Grafted to expedite healing
•Infection can lead to full thickness easily
What are characteristics of full thickness?
•Destruction of the epidermis, dermis and sometimes muscle/bone
•5-14 days via skin graft
What is the incidence and prevalence of burns?
•Burn Injuries Receiving Medical Treatment: 450,000
•Fire and Burn Deaths Per Year: 3,400
•Hospitalizations Related to Burn Injury: 40,000, including 30,000 at hospital burn centers
–Survival Rate: 96.1%
•59% Caucasian, 19% African-American, 15% Hispanic, 7% Other
•44% fire/flame, 33% scald, 9% contact, 4% electrical, 3% chemical, 7% other
–Place of Occurrence:
•69% home, 9% occupational, 7% street/highway, 5% Recreational/Sport, 10% Other
What are the types of burns?
• Thermal Burns
• Electrical Burns
• Chemical Burns
How are thermal burns usually caused?
– contact with a hot surface
T or F: Thermal burns are most common in teenagers.
False; Most common in children and older adults
What are the most common mechanisms for thermal burns?
Hot drinks and hot bathwater
T or F: Thermal burns vary in depth secondary to length of exposure to heat source
What type of thermal burns tend to be superficial or partial thickness burns?
Scald burns tend to be superficial or partial thickness burns
What type of thermal burns tend to be partial and full thickness?
Flame burns are usually partial and full thickness; contact burns can be partial to full thickness
What two types of thermal burns are considered "dirty wounds"?
Flame and scald; because debris from the fire or hot liquid can
contaminate the wound
T or F: If the skin barrier is broken there is a greater
chance for infection
True; This may then change treatment option; such
as dressing choice
T or F: Electrical burns require special consideration because where the electrical current enters the body and exists
What type of burn typically has an entrance wound and an exit wound?
Do electrical burns require cardiac monitoring?
What type of burns are caused by high voltage, low voltage or lightning?
What type of burns are a result of reduction, oxidation, corrosion or the desecration of body tissue?
T or F: Chemical burns alter pH and metabolism.
What setting do chemical burns usually occur in?
What kind of burn can occur with misuse of household cleaners?
T or F: Chemical burns tend to be shallow.
False; chemical burns tend to be deep
T or F: Chemical agents have to be neutralized.
T or F: Frostbite is a type of burn.
False; it is not a burn
T or F: Frostbite is treated at burn centers because it involves the skin and underlying structures
T or F: The severity of a frostbite depends on length of exposure to cold.
T or F: In the pre-thaw base, the area should be padded and warmed in a water bath about 100-103 F.
False; it should be in a water bath about 104-107.6 F
What should you do in the post thawing phase?
Minimize inflammation process
How many degrees can frostbite be classified in?
Classified into 1st, 2nd, 3rd, 4th degree
T or F: Injured tissues die immediately.
False; it may not die immediately. Wound "declared"
What does TBSA stand for?
Total body surface area
Who is part of the burn team?
•Burn or plastic surgeon
•Burn therapist (occupational therapist, physical therapist)
What are the phases of burn management?
Emergent, acute, rehab
What phase is from 72 hours until wound is closed by healing or graft?
What phase is from the date of injury to 72 hours?
What phase occurs until scar maturation can take place 6 months to years?
What is part of the emergent medical treatment?
–2 to 3 x’s daily
•Establishment of tissues perfusion
–Blood back to area
•Eschar- Burned tissue
–Greek for scab
–Escharotomy and Fasciotomy
–Remove eschar and necrotic tissue
•Dressing for debridement
•Significant contracture risk
What do you do in the emergent phase OT treatment?
•Starts 0-72 hours post burn
•Prevention contracture via splinting and positioning
•Apply splints over burn dressing
-Splint as soon as possible to stabilize joints
–Positions that are opposite to the deformity
What are positions that are opposites to the deformity called?
How long can the acute phase medical treatment last?
Days to several months
What is part of the acute phase medical treatment?
•Skin grafting is completed if reepithelilzation has not occurred within 14 days or is not expected
What do you do for management of burn wounds?
–After the TBSA is calculated the burn is cleansed
–Whirlpool loosens necrotic tissue
–Full thickness burns or burn not expected to heal in 3 wks
•Temporary and Permanent wound covering
What are the types of grafts?
•Autografts skin from unburned area is used
–Xenographs (bovine skin)
–Allographs (cadaver skin)
What happens in the acute phase OT assessment?
–% burned (TBSA)
–Procedure (s) preformed
•ADL’s & IADL’s
•Psychosocial status and support systems
•Behavior and Communication
•Cognitive and perceptual status
•Neuromuscular status (ROM and Strength)
•Burn Scar Index (Vancouver Scar Scale) VSS
–1-13 score on Vascularity, height/thickness, pliability, and pigmentation
What happens in the acute phase OT treatment?
•ROM and Strength
•Splinting-Check daily fit
•Alternative Communication systems
•Clients treatment tolerance may limited
•Post-op splinting must be immobile 5-10 days
•Anti-deformity positions (table 40-1)
•Client and family education
•Support and psychosocial adjustment
What happens in the rehab phase?
•Continues from Acute phase and continues till scar maturation
–Can last up to 6 months
–Scar become pale and decreased rate of collagen production
•OT Role varies
•Hands on need not able to return home safely yet
•Hand therapy/ Upper quarter rehab
In what phase does the scar become pale and there is a decreased rate of collagen?
What happens in the rehab phase OT assessment?
•Assess capacities and abilities
What happens in rehab phase OT treatment?
•Goal = return to previous level of function
•Self care- ADL’s may have need for assistive devices
•Home management skills
•Patient and family education
•Return to work
What is part of scar management?
–Closed cell foam
T or F: A scar massage aides desensitization.
T or F: A scar massage can only be done by an OT
False; Done several times daily by OT initially and then by patient and family
–‘Desensitize’ the family to the scar
T or F: Scar massages help maintain suppleness.
How should you give a scar massage?
Massage to blanch, hold for a few seconds-client should report tension and not pain- feel pressure
What does hypertrophic scarring look like?
•Nodular collagen which can limit function
What are some complications of burns?
•Microstomia-oral commisure contracture
•Myositis ossificans ( about 13% of all patients with burns)
What are some surgical options for burns?
–OT can recommend this in contracture limits occupational performance
–Z-plasty-elongates soft tissue
T or F: Hand burns can lead to web space contractures and some precautions would be extensor tendon injuries.