Flashcards in Burns Deck (124)
True or False: temperature <111 F or 44C will not damage local tissues unless exposure is for prolonged periods
True or false: In the temperature range between 111F to 124 F the rate of cellular death doubles with each degree rise in temperature; short exposure will lead to cell destruction
Thee Zones or Burn wound .... list them
1. Zone of coagulation
2. Zone of stasis
3. Zone of hyperemia
Describe the zone of coagulation
Cells are irreversibly injured, cell death occurs
Describe the zone of stasis
Cells are injured; may die without specialized treatment, usually within 24-48 hours
Describe the zone of hyperemia
Minimal cell injury; cells should recover
List the types of burns.
1. Epidermal Burn (1st degree)
2. Superficial Partial-thickness Burn (2nd degree burn)
3. Deep Partial-thickness Burn (2nd degree burn)
4. Full-thickness Burn (3rd degree)
5. Subdermal Burn (4th degree)
Characteristics of Epidermal Burn (1st degree)
1. Damage to epidermis only
2.Pink or red appearance; no blistering (dry surface)
3. Minimal Edema
4. Tenderness, delayed pain
How long does it take Epidermal burns to heal?
3-7 days (spontaneous healing)
Describe the surface appearance/pain of epidermal burns
No blisters, dry surface
Describe the characteristics of a Superficial partial thickness burn
1. Epidermis and upper layers of dermis are damaged
2. Bright pink/red appearance
3. Balancing with brisk capillary refill
4. Blisters, moist surface, weeping
5. Moderate edema
6. Painful, sensitive to touch, temperature changes
How long will it take a superficial Partial-thickness Burn to heal
7-21 days (Spontaneous healing)
Minimal or no scarring; discoloration
Characteristics of Full-thickness burn
1. Severe damage to epidermis and dermis with injury to nerve endings (may extend into muscle)
2. White (ischemic), charred, tan or black appearance
3. No balancing; poor distal circulation
4. Parchment-like, dry leather surface; depressed area
5. Little pain; nerve endings are destroyed
When is removal of Escher and skin grafting necessary secondary to destruction of dermal and epidermal tissue
For full thickness burns
Describe the healing of Deep partial-thickness burns
Slow + occurs through scar formation and reepithelialization
Excessive scarring without preventative treatment
Describe characteristics of Full-thickness burn
1. Severe damage to epidermis and dermis with injury to nerve ending; hair follicles and sweat glands
2. Mixed red or waxy white appearance
3. Balancing with slow capillary refill
4. Broken blisters, wet surface
5. Marked edema
6. Sensitive to pressure but insensitive to light touch or soft pin prick
Describe Characteristics of Subdermal Burn (4th degree)
1. Complete destruction of epidermis, dermis with involvement in subcutaneous tissue and muscle
2. Charred appearance
3. Destruction of vascular system, may lead to additional necrosis
4. From electrical burns; prolonged contact with flame
5. Additional complications likely with electrical burns; ventricular fibrillation, acute kidney damage, spinal cord damage
Describe the healing process for subdermal burn
Heals with skin grafting and scarring
Requires extensive surgery; amputation may be necessary
Which type of burn is extremely painful due to irritation of nerve endings contained in the dermis?
Superficial partial-thickness burns
Which burns will be highly sensitive to temperature changes, exposure ot air and light touch?
Superficial partial-thickness burns
If a patient presents with a superficial partial-thickness burn a therapist should focus on removing what?
Blisters should be evacuated due to blister fluid increasing the inflammatory response which retards wound healing
What is the hallmark of a deep partial-thickness burn?
True or false: With a deep partial-thickness burn light touch and sharp/dull sensation is lost, but deep pressure is retained (retention of pacinian corpuscle)
How would a therapist differentiate between a deep partial-thickness burn and full thickness burn
If hair follicles and new hair growth are present, indicates deep partial-thickness burn
How many weeks will a deep partial thickness burn heal?
True or false: the development of hypertrophic and keloid scares are a frequent consequence of Deep Partial-thickness burns.
According to the rule of nines the head and neck is classified as what %?
According to the rule of nines the anterior trunk is classified as what %?
According to the rule of nines the Posterior trunk is classified as what %?
According to the rule of nines the Bilateral anterior arm, forearm, and hand is classified as what %?
According to the rule of nines the Bilateral posterior arm, forearm, and hand is classified as what %?
According to the rule of nines the genital region and hand is classified as what %?
According to the rule of nines the Bilateral anterior Leg and foot is classified as what %?
According to the rule of nines the Bilateral posterior Leg and foot is classified as what %?
List the complications of burn injury
2. Pulmonary complications (especially in facial burns from smoke inhalation + pneumonia)
3. Metabolic complications
4. Restrictive Lund disease
5. Cardiac and circulatory complications
True or false: Metabolic demands may increase up to 50% in a 25% TBSA
With burns what should the recommended room temperature be kept at?
86 degrees F because if you place a burn patient in a room with Norma temp, excessive heat will be lost and further exaggerate teh stress response
True or false: Core temperature in burn patients increases by 1.8-2.6 F
Due to altered metabolism, what energy source is used for energy?
Protein from muscle tissue is preferentially used as source of energy
This + bedrest leads to muscle atrophy and weakness
Patients with greater than 20% TBSA are high susceptible to _________ __________.
Elbows, hips, and shoulders most common
True or false: Peripheral neuropathy in patients with burns can take two forms: Polyneuropathy or local neuropathy
True. Most neuropathies resolve over time but some may be long term
Most common nerves: brachial plexus, ulnar nerve, and common peroneal nerve
Due to the loss of sebaceous glands in epidermal burns what is important for avoiding a dry, cracked wound.
Dermal healing results in ____________. Scars are initially red or purple, later become white
Scar formation (replaced by connective tissue)
Providing emergency care to burn wounds what should the therapist do?
1. Immersion in cold water if <1/2 the body and injury is immediate
2. Cover burn with sterile bandage or clean cloth; no ointments or creams!!
True or false: Ointments and creams should be applied to burns for emergency care
Name the ointments that may be used with burns.
2. Polymyxin B
What medication is used to penetrate through Escher?
Avoid with sulfa drug allergies
When using silver sulfadiazine who should this not be used on?
1. Pregnant women
2. Infants <2 months
3. Sulfa drug allergies
What dressings are commonly used with burns?
4. And gauze dressings
What is an allograft?
Use of other human skin (cadaver)
What is a xenografts?
Use of skin from other species (pigskin, fish scales)
Combination of collagen and synthetics
Laboratory grown form patient’s own skin
Use of patient’s own skin
Contains epidermis and upper layers of dermis from donor site
Full thickness graft
Containers epidermis and dermis from donor site
A site where health skin is taken and used as graft
A site that has been burned and requires a graft
Skin graft that is altered to creat a mesh-like pattern in order to cover a larger surface area
A skin graft that is transferred directly from the unturned donor site to the prepared recipient site
At what temperature should the Whirlpool tubs be set at?
98.6 F -104 F (37-50C)
True or False: Removing dressings from burns is more painful removing in water.
False; Less painful, but most burn patients will still require pain medications prior to wound care
When caring for burn wounds what are the 5 things a therapist should observe? (A DOSE)
What are a few characteristics of an infected wound?
1. Thick, prudent drainage
4. Brownish-blackish discoloration
5. Rapid separation of Eschar
6. Boils in adjacencies tissue
7. Conversion of a deep partial-thickness burn to a full-thickness burn
What instrument’s are used during Sharp Debridement?
Surgical Scissors or scalpel or forceps
What is the goal of sharp debridement?
Remove sloughed epidermis and loose eschar + pockets of pus are drained
*must perform carefully so bleeding is minimal
Therapist is using open technique while managing a burn wound. Describe what that means.
Open techniques means to apply topical agent without dressings.
Allows for ongoing inspection of the wound and observation of healing
Topical medication must be reapplied throughout the day
A therapist is using a closed technique is the management of wounds ? What is meant by this?
Closed technique consists of applying dressings over a topical agent
What is contraindicated when cleansing burn wounds?
Describe autolytic dressings.
Use of moist dressings such as hydrogels or hydrocolloids to help remove eschar
What are examples of mechanical wound debridement?
1. Wet to dry dressings
2. Pulsed lovage
3. Gentle washing
What contracture is commonly seen in the neck with burns?
Flexion (sometimes lateral flexion)
What is the best position to place the neck in a burn patient?
Hyperextension using a firm (plastic) cervical orthosis
What is a common contracture at the shoulder with burn victims?
Adduction + IR + extension
What is the best position to place the patient in to avoid shoulder contractures?
Place UE in abduction + Flexion + ER using Axillary splint (airplane splint)
What is a common contracture at the elbow with burn victims?
Flexion and pronation
What position should the elbow placed in to avoid contracture?
Extension + Supination using posterior arm splint
What is a common deformity seen at the hand with burn victims?
Claw hand (intrinsic minus position)
How should the hand be positioned to avoid contracture in the hand?
Wrist extension (15 degrees) + MP flexion (70 degrees) + PIP/DIP extension + thumb ABduction
Position in intrinsic plus position with resting hand splint
What contracture is usually seen in the hip with burn victims?
Flexion + Adduction
What position should the hip be placed in to avoid contracture?
Extension + abduction + neutral rotation
What is a common contracture seen at the knee with burn victims?
What position should the knee be placed in to avoid contracture in burn victims?
Extension using posterior knee splint
What contracture is commonly seen at the ankle with burn victims?
What position should the ankle and foot be placed in to avoid contracture in burn victims?
Dorsiflexion using neutral splint or AFO
True or false: all joints should be taken through FULL ROM for burn victims
Postgrafting how long should physical therapy be postponed ?
3-5 days to allow grafts to heal
A therapist is schedule his burn patients physical therapy sessions. When is the most appropriate time to schedule these sessions?
30-45 minutes post pain medications and be aware of dressing/wound cleansing tissue
Describe a primary excision
Surgical removal of eschar. Removes peripheral layers fo eschar until vascular tissue is exposed for skin graft placement
When does prim excision typically occur?
Within 1 week of injury
True or false: with the use of most skin substitutes (autologous skin)ROM exercises may be delayed and shearing forces must be avoided
What are common donor sites?
Back, Thighs, and Buttocks
True or false: The thinner the skin graft, the better adherence and the thicker the skin graft the better cosmetics.
What kind of graft are the head neck and hands typically covered with?
Sheet graft (no alteration following harvesting from donor site)
What are the first priorities of intervention with burn patients?
Resolution of edema and preserving ROM
When can active exercise be initiated with burn patients?
The day of admission
True or False: After a surgeon determines it is safe to begin exercise after a recent skin graft, the therapist should begin with gentle ROM, first passive then active.
False; therapist should begin with ACTIVE and then passive in needed
When should AAROM and PROm be initiated?
If patient cannot fully achieve AROM
True or False: To keep the burn wound moist it should be lubricated prior to exercise.
True. Lubricate that wound man
True or false: heat may be used to increase the pliability of the wound if they wounds are well healed at the beginning of a session.
When ambulation is initiated the LE should be wrapped in elastic bandages in ______ - _______ pattern to support new grafts and promote venous return.
When applying pressure dressings, what patterns should be used on the LE, UE, and trunk?
LE— figure eight pattern
What topical agent is most commonly used for burns?
What is a disadvantage of silver sulfadizine?
Does not penetrate eschar
What topical agent for burns will penetrate eschar?
List the advantages of Mafenide Acetate.
2. Penetrates eschar
3. May be used with or without occlusive dressings
List the advantages of silver sulfadiazine.
1. Can be used with or without dressings
3. Applied directly to the wound
4. Broad - spectrum
5. Effective against yeast
Which medication is effective against yeast?
This medication may cause metabolic acidosis, can compromise respiratory function, may inhibit epitheliazliation, and is painful too apply. What medication is being describe.
What medication is not effective gains pseudomas and may impair thyroid function as well as it is painful to apply.
Which medication is antifungal and is easily removed with water?
Which medication is a bacteriocidal medication?
Which medication is non-allergenic and dressing application is painless?
Which medication has poor penetration, discoloration (making assessment difficult), and can cause severe economic electrolyte imbalances? Removal of dressing is also painful
Which medication has caused resistant strains and is ototoxic, and nephrotoxic ?
Gentamicin, which can be covered or left open to air
Which medication may lead to overgrowth of fungus and pseudomonas and is painful to apply?
What are Pressure garments used for during post-acute rehab?
Prevent hyper trophic scarring or keloid formations
What kind of scarring is most common with burns?
What kind of massage is typically indicated to loosen adhesions between cutaneous scare tissue and underlying structures.
Deep friction massage
decreases sensitivity and increase pliability
When is compression therapy to reduce hypertrophic scarring typically indicated?
Recommended for burns requiring >14 days to heal
The use of sustained compression from ____ to _____ mm Hg is believed to create an enviroment that faculties Balance of collagen synthesis and lysis, improving scar structure.
How long are compression garments used for?
22-23 hours/day until scars have matured
Silicone or foam inserts may be necessary for sufficient pressure over small concave areas
When should compression therapy begin?
Between 2 weeks and 2 months and up to 2 years