Burns Flashcards
1
Q
What are the primary functions of skin?
A
- Protective covering
- Prevent excessive loss of body fluids
- Regulate body temperature through the evaporation of water
- Sensation
- Vitamin D synthesis
- Resist mechanical stresses
- Cosmetic covering for personal identity
- Absorption of selected substances
2
Q
True or False: Epidermis is vascular.
A
False. Epidermis is avascular and contains no blood vessels.
3
Q
Which layer of the skin provides strength and elasticity of the skin?
A
Dermis
4
Q
What are the 3 layers of skin?
A
Epidermis
Dermis
Hypodermis
5
Q
What structures does the hypodermis contain?
A
Blood vessels
Fat
6
Q
What structures does the dermis contain?
A
Nerve endings, hair follicles, sweat glands, blood vessels
7
Q
What are the 3 stages of wound healing? How long do they last?
A
- Homeostasis and inflammatory stage (0-96 hours): Coagulation, removal of tissue debri and bacteria
- Proliferative stage (day 4-12): Skin continuity re-established, matrix contraction starts, formation of new capillaries
- Maturation and remodelling phase (day 13 onward): Reorganization of new collagen, scar remodelling (up to 2 years)
8
Q
What is primary closure of a wound?
A
A wound that is re-approximated or closed by suture, staples, or tape
9
Q
What is secondary intent of a wound?
A
A wound that is kept moist and allowed to granulate and re-epithelialize rather than using primary closure, in cases of contaminated wounds
10
Q
What is delayed primary closure of a wound?
A
Compromise between primary closure and secondary intent; Treated initially by secondary intent to eliminate bacteria, then primarily closed when the wound is clean.
11
Q
When is skin grafting used?
A
Used for large wounds that cannot be closed with normal healing processes in a timely manner
12
Q
What are flaps?
A
Tissues that contain its own blood supply and are transferred over avascular areas such as bone and tendon
13
Q
How does age affect wound healing?
A
Older age = Slower healing time
Younger age = Faster healing time, more scarring
14
Q
How does diabetes affect wound healing?
A
Slower wound healing time
15
Q
How do medications and treatments like chemotherapy, radiation, and immunosuppressants affect wound healing?
A
Slower healing time, increased risk of graft loss
16
Q
What kind of diets are needed for wound healing?
A
High protein diets
17
Q
How are burns categorized into minor and major?
A
Major burn ≥ 10% total body surface area
Minor burn ≤ 10% total body surface area
18
Q
What is 1st degree or superficial burn?
A
Only the epidermis is injured
No blistering
19
Q
What is 2nd degree or partial thickness burn?
A
The dermis is injured to different degrees (superficial, moderate, deep)
20
Q
What is 3rd degree or full thickness burn?
A
The dermis is fully injured and the hypodermis is exposed
21
Q
What is 4th degree burn?
A
Muscle/bone/tendon exposure
22
Q
What is the rule of 9s?
A
A rule/chart that divides the body into sections that represent 9% of total body surface area
23
Q
True or False: The rule of 9s work for both adults and pediatric patients.
A
False. The rule of 9s only work for adults.
24
Q
The size of the patient’s hand (palm + fingers) is equal to __ % of the patient’s total body surface area.
A
1%
25
How long does it take for a 1st degree or superficial burn to heal?
<7 days
26
How long does it take for a 2nd degree or partial thickness burn to heal?
7-21 days
27
Which skin layers do superficial partial thickness burns involve?
Epidermis
| Top layers of the dermis
28
True or False: Superficial partial thickness burns have intact or open blisters.
True.
29
What is the colour of superficial burns?
Very red
30
What is the colour of superficial partial thickness burns?
Red to pale pink
31
Superficial partial thickness burns are [likely/unlikely] to scar.
Unlikely
32
What does the colour of the burn indicate?
How much blood flow is going to the burn
33
Which skin layers do moderate to deep partial thickness burns involve?
Epidermis
| Lower layers of the dermis
34
Which type of burns start to have reduced sensation to light touch or damage to nerves?
Moderate to deep partial thickness
35
True or False: Moderate to deep partial thickness burns do not have blisters.
False. Moderate to deep partial thickness burns do have intact or open blisters.
36
How long does it take for moderate to deep partial thickness burns to heal?
>21 days
37
True or False: Moderate to deep partial thickness burns requires grafting.
True.
38
Moderate to deep partial thickness burns are [likely/unlikely] to scar.
Likely
39
Which skin layers do full thickness burns involve?
Epidermis
All layers of the dermis
Not bone or tendons
40
What is the colour of moderate to deep partial thickness burns?
Range from red to pale pink to white
41
What is the colour of full thickness burns?
White and leathery to black and charred
42
Full thickness burns are [dry/wet].
Dry
43
True or False: Full thickness burns are very painful.
False. Because nerve endings have been damaged, full thickness burns result in no pain nor light touch.
44
What is escharotomy?
Cutting of the burnt tissue to relieve pressure from edema and prevent blood flow loss
45
What type of burns result in 4th degree burns?
Electrical burns
46
Which skin layers do 4th degree burns involve?
Epidermis
All layers of the dermis and hypodermis
Tendons and bones
47
What is the colour of 4th degree burns?
White and leathery to black and charred
48
4th degree burns are [dry/wet].
Dry
49
True or False: 4th degree burns heal on their own.
False.
50
What are the 3 classifications of frostbite?
1. Frostnip -- Epidermis involvement
2. Superficial forstbite -- Some dermis involvement, with blister formation
3. Deep frostbite -- Through dermis and subcutaneous tissue involvement
51
Which take longer to assess, burns or frostbites?
Frostbites
52
What is laser doppler imaging?
Imaging a burn with infrared to show how much blood flow is going to the wound
53
What do the red, yellow, and blue indicate on laser doppler imaging?
Red - Will heal within 14 days
Yellow - Will heal in 14-21 days
Blue - Will heal in > 21 days
54
What is debridement?
Shaving off layers of dead skin down to healthy skin
55
What is tangential vs. fascial excision?
Tangential: Shaving down skin
Fascial: Shaving down to the fascia
56
What are the common donor sites for grafts?
Upper leg, buttocks, and the back where the skin tends to be thicker
57
What are the four types of grafts?
1. Split thickness skin grafting
2. Full thickness skin grafting
3. Artificial derma matrix (Integra)
4. Allograft
58
What is the purpose of splinting grafting sites?
Prevent movement in the joints and the affected skin to prevent stretching and promote healing
59
When is meshed grafting used?
Coverage of larger burn wounds with less donor site available
Promote draininage of fluids postoperatively
60
What are the pros and cons of meshed grafting?
Pros: Can cover a larger area with less skin. Allows fluid to drain through the mesh holes.
Cons: Can take longer to heal. The larger the expansion ratio, the more fragile the graft becomes. Can produce more scar and create greater contracture formation.
61
When is sheet grafting used?
For smaller burns and burns to more visible areas like the face and hands
62
What are the pros and cons of sheet grafting?
Pros: More cosmetically appealing, less contracture of graft site.
Cons: Minimal coverage, can have fluid/hematoma collection under the graft, less expansion ability.
63
What is MEEK grafting?
Epidermal level skin taken from the patient's own body is cut into squares then expanded, so that islands of skin graft is created and eventually heal together.
64
When is MEEK grafting used?
When minimal donor site is available.
65
What are the pros and cons of MEEK grafting?
Pros: Can get coverage when minimal donor is available.
Cons: Longer healing times and increased scar production.
66
What is full thickness graft?
Epidermal and dermal levels of skin taken from the patient's own body via scalpel excision and secured via primry closure
67
When is full thickness graft used?
Coverage of smaller burn wounds
68
What are the pros and cons of full thickness graft?
Pros: Minimal scarring, faster healing time, lower donor site pain
Cons: No ability to expand.
69
What is a flap?
Epidermal and dermal levels of skin along with subcutaneous fat and vasculature that is harvested and placed over the defected area
70
When are flaps used?
Coverage of exposed bone, tendon, and deeper structures. Also for scar release and reconstructions.
71
What are the pros and cons of flaps?
Pros: Minimal scarring, lower donor site pain.
Cons: No ability to expand, risk of failure if vascularization not maintained, requires multiple procedures.
72
What is artificial dermal matrix (Integra)?
An artificial collagen matrix that becomes vascularized and allows for the development of a wound bed for autograft.
73
When is artificial dermal matrix (Integra) used?
Exposed bone or tendon (i.e. full thickness bones)
74
What are the pros and cons of artificial dermal matrix (Integra)?
Pros: Allows for grafting over exposed bone or tendon, and if flap is not an option.
Cons: Very expensive, takes a long time to vascularize.
75
What is allograft?
Skin from a human donor that is not the patient
76
When is allograft used?
When there is no donor site available
If wounds are too infected for autograft.
Used as a temporary method of covering open burn wounds
77
What are the pros and cons of allografts?
Pros: Can provide faster coverage of burn wounds when autografting is not an option.
Cons: Can easily shear off and eventually will slough off.
78
How does surgery change ROM in burned areas?
Increased ROM
79
What are the goals of OT in acute phase of burns?
```
Edema management
Preservation of joint ROM and skin mobility
Protect vulnerable tissues (tendons and grafts)
Promote occupational performance
Provide psychological support
Monitor cognitive function
Education of patient and careivers
Psychosocial support
```
80
What kinds of strategies can be used for edema management if the patient is unconscious?
Elevation via splinting, propping, etc.
81
What are some general strategies for edema management in acute burn patients?
Elevation
AROM exercises
Participating in ADLs
Compression (only if no open wounds nor fresh grafting)
82
How should the neck be positioned in acute burn patients?
No pillow under head
Rolled towel under the neck
Neck splint
83
How should the shoulders be positioned in acute burn patients?
Abduction foam wedges
Airplane splints
Side tables with pillows
84
How should the elbows be positioned in acute burn patients?
Elbow extension splint or slab
85
How should the hips be positioned in acute burn patients?
Minimal flexion at hips when patient is in bed
| Foam wedge between knees to abduct hips
86
How should the knees positioned in acute burn patients?
Laying flat in bed
| Knee extension splints
87
How should the ankles be positioned in acute burn patients?
Foot drop splints/plates
| Propping ankles against bed footboard with pillows
88
What are the factors that should be considered when using splints for acute burn patients?
Medical status (stability, life support)
Patient cooperation and alertness
Patient comfort (watch out for pressure necrosis)
Ease of application (simple to apply and well-labeled)
89
Why are individuals with significant burn injuries at an increased risk of developing pressure injuries?
Reduced skin integrity resulting from their burns
| Immobility after injury
90
What are common pressure injury sites?
```
Occiput
Scapulas
Elbows
Spinous processes
Coccyx and sacrum
Ischial tuberosities
Heels
```
91
What are the indications for cognitive assessment in burn patients?
```
Disorientation
Memory loss
Impulsive behaviours (on unit or leading up to their trauma)
Amotivation
Persistent delirium
```
92
What are the contradindications for cognitive assessment in burn patients?
Acute delirium
Alcohol/drug withdrawal
Unstable acute medical condition
Significant pain
93
What is the STEPS tool?
A tool for interacting with strangers
| Includes: Self-talk, Tone of voice, Eye contact, Posture, and Smile
94
What is the Rehearse Your Response (RYR) tool?
A tool to use when people ask questions about you or your loved one about your/their burns
95
What is the staring tool?
The easiest and fastest way to stop the uncomfortable moment of others staring at you or your loved one
96
What are the goals of OT in the rehabilitation phase of burn wounds?
Reduce contractures & improve joint mobility
Edema management
Initiate burn scar management
Promote independence with BADLs/IADLs
Restore activity tolerance, muscle strength, and coordination
Ongoing education
Continued psychosocial support
Enabling role resumption and community reintegration
97
How long does scar tissue remain active?
6-24 months
98
How is cording and contracture addressed in the rehabilitation phase?
```
Edema management
Compression
Serial casting
Splinting
ADLs
Exercises
```
99
What are the common compression methods?
Tubigrip
Coban wrapping
Tensor wrap
100
What are ways to remodel scar?
Decreasing blood flow to the scar which may decrease fibroblast
Aligning collagen more parallel to the epidermis by applying pressure
Reducing the interstital space between collagen fibrils by applying pressure
Increasing local temperature of the scar by adding external heat
101
How often should compression garments be worn?
As close to 24 hours/day as possible, removing for personal hygiene and wound care
102
Why should compression garments be monitored regularly?
Burn survivors may change body size.
| Over the time, garments may stretch.
103
Why are inserts sometimes used?
To increase compression, local temperature, and moisture to areas of more aggressive hypertrophic scar
104
Inserts are used [under/above] compression garments.
Under
105
What kinds of materials are inserts made of?
Silicone pads
Velfoam
Neoprene
Conformer
106
How long and how often should scar massage be performed?
30 minutes 3 times a week
107
True or False: Scar massage should blanche the scar.
True. There should be good blood flow to the scar.
108
Scar massage should be performed when the scar is [not on/on] stretch.
On stretch
109
True or False: Scar massage can be applied to the scar without preparing the scar.
False. Lotion should be applied to scar prior to massage.
110
What is the purpose of splinting in the rehabilitation phase of burn wounds?
To influence the overall length of the scar tissue to prevent contracture of the scar tissue, by applying gentle force to the scar tissue over a prolonged period of time.
111
What type of contracture is common with dorsal hand burns?
Ulnar deviation and external rotation of the D5
112
What are static progressive splints?
Immobilize and hold a force a desired length, and the force can be adjusted to a new point of elongation and allow for adaptation in length.
113
How does serial casting remodel scar?
Continuous stretch to elongate scar tissue
Compression
Increase in the local surface temperature of the scar
Increased hydration of scar
114
How often should serial casting be done to be most beneficial?
Frequently, e.g. daily
115
Why is activity tolerance a concern in burn survivors?
They lose a lot of muscle mass after their injury.
| Their strength and endurance are significantly reduced due to spending weeks to months in bed.
116
What are the OT roles in follow-up for burn survivors?
Continued scar management (garments, inserts, splints, education).
Monitor community reintegration and psychosocial concerns.
117
In the case of mild burns (≤ 2nd degree), do we want the patient to do AROM activities, or no?
We want the patient to move the body part so that the tissue is kept mobile.
118
What types of clients (and their family members) should be educated for burn prevention?
Sensation loss
Cognitive changes that affect safety in the kitchen
Geriatric clients who may have difficulty getting out of the tub quickly
