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Medcon Rehab IV > Burns: Thermal Injuries Lecture + Burns Quiz > Flashcards

Burns: Thermal Injuries Lecture + Burns Quiz Flashcards

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1
Q

How Common?

A

Males>Females until >70yo

*Why??→ Geriatric smoking on O2

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2
Q

What are Burns?

5 Categories/Types to discuss:

A
  1. Thermal
  2. Electrical (Entrance/Exit wound)
  3. Chemical
  4. Radiation (think Cx)
  5. Other
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3
Q

Classification: Burn Depth

Breaking the components down

A
  • 1st Deg:
    • Superficial Thickness
  • 2nd Deg:
    • Superficial Partial Thickness
    • Deep Partial Thickness
  • 3rd Deg:
    • Full Thickness
  • 4th Deg:
    • Subdermal
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4
Q

Classification: Burn Depth

Breaking it down by Epidermis, Dermis, SubQ Tissues

A
  • Epidermis: SUPERFICIAL BURN: 1st Degree
  • Dermis: PARTIAL-THICKNESS BURN: 2nd Degree
    • Superficial partial thick
    • Deep partial thick
  • SubQ Tissues: FULL-THICKNESS BURN: 3rd or 4th Degree
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5
Q

Name the 5 Depths of Burns

A
  1. Superficial Thickness→ 1st Degree
    1. Sunburn
  2. Superficial Partial Thickness→ 2nd Degree
    1. Partially thru dermis
  3. Deep Partial Thickness→ 2nd Degree
    1. All way thru dermis
  4. Full (think Fat) Thickness→ 3rd Degree
    1. SubQ fat to bone
  5. Subdermal→ 4th Degree
    1. Bones, ligs, mm’s, tendons
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6
Q

Burn Descriptions + Pics

Superficial Thickness Burn= 1st Degree Burn

A

“Classic sunburn”

  • Red
  • Dry
  • Painful→ always bc epidermis

*Usually heals w/in 3-4d w/out scar

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7
Q

Burn Descriptions + Pics

Superficial Partial-Thickness Burn= 2nd Degree Burn

A
  • Pink-red
  • Painful
    • bc dermis still intact
  • Blisters*, Moist, Blanching, Edema

*Heals 7-10d w/ min. scarring and min. wound contraction

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8
Q

Any time you see PARTIAL-THICKNESS you know its __________

A

2nd Degree Burn*****

Then just distinguish bw Superf OR Deep!!!!!!!

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9
Q

Burn Descriptions + Pics

Deep Partial Thickness Burn= 2nd Degree Burn

A
  • Pale*
  • Painful→ pot. pain or NO pain, depends on depth*
  • LESS moist
  • Cap refill absent or prolonged
  • Edema
  • Diminished Sensation
    • Deep pressure intact, Pinprick may not be

*May heal 21-35d→ Most likely req grafting, Hypertrophic or keloid scarring w/ pot. sig wound contraction

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10
Q

Burn Descriptions + Pics

Full Thickness Burn= 3rd Degree Burn

*thru epi and dermis

A

“The black, charred, leathery, waxy eschar one”

  • Black charred, or mottled red/brown, or pale, or waxy white eschar formation
  • Leathery appearance
  • May be insensate
  • NO cap refill
  • Edema
  • NO pain bc vascularization burned

*May heal 4-6wks; grafting req’d, sig hypertrophic scarring and wound contraction

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11
Q

Burn Descriptions + Pics

Subdermal Burn= 4th Degree Burn

A

MM or bone exposed one

  • Complete destruction: epidermis, dermis, and SubQ tissue
  • DRY
  • Charred appear., mm or bone may be exposed

*Always req’s grafting; poss. mm flap for coverage; definite hypertrophic scarring

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12
Q

Classification: Burn Size

Total Burn Surface Area (TBSA)

3 Methods

A
  1. Rule of Nines→ NPTE*****
  2. Lund & Browder Chart
  3. Palm Method
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13
Q

Classification: Burn Size

Rule of Nines***

KNOW IT!!!!

100-age-%surf area burned==> chance survival

A

See pics

  • Adult Values
    • Head/Neck= 9%
    • Anterior trunk= 18%*
    • Posterior trunk= 18%
    • Anterior arm, forearm, hand= 9%
    • Genitals= 1%
    • Anterior leg, foot= 18%
    • Posterior leg, foot= 18%
  • Child <1yo
    • Has 9% taken from LE and added to the head/neck region.
      • 1% is distributed back to the LEs for ea yr of life until 9yo→ when head considered same size as adult*
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14
Q

Classification: Burn Size

MOST ACCURATE MEASURE?

A

Lund and Browder Burn Chart

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15
Q

Classification: Burn Size

Palm Method (exactly what it sounds like)

A
  • The palm of the adult hand (just palm) is Equal to→ .5% TBSA (Total Burn Surface Area)
  • 2 palms= 1%
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16
Q

3 Classifications of Burns:

A
  1. Burn Depth→ Thickness
  2. Burn Size→ How much surface area
  3. MOI→ How it happened
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17
Q

Classification: Mech of Injury (MOI)

5 Classes

A
  1. Thermal
  2. Electrical (Enter/Exit wound)
  3. Chemical
  4. Radiation (think Cx)
  5. Other
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18
Q

Classification: Mech of Injury (MOI)

Thermal Injury

A
  • Flames, hot liquids (scalded), steam, semi-solids, contact w/ hot obj
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19
Q

Classification: Mech of Injury (MOI)

Electrical Injury

A
  • Pure→ Entrance AND Exit sites
  • Arc→ Electricity flows external to body
  • From→ faulty electrical wiring, high-voltage power lines, lightening
  • **Effects ALL body tissues in its path
    • Nerves→ blood vessels→ Mm→ Skin→ Tendon→ Fat→ Bone
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20
Q

Effects ALL body tissue in its path****

Nerves→ blood vessels→ mm→ skin→ tendon→ fat→ bone

A

Electrical Injuries***

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21
Q

Entrance/Exit wounds

A

Electrical Injuries****

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22
Q

Classification: MOI

Chemical Burn

A
  • Strong Acid
    • Industrial cleaners, household rust removers
  • Alkali (base)
    • Lime, lye, household cleaners, hydroxides
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23
Q

Classification: Mech of Injury (MOI)

Radiation Burn

A
  • Sunburn**
  • Medical (oncology radiation, excess X-ray exposure, etc.)
  • Nuclear power plant explosions; Atomic bombs
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24
Q

Classification: Mech of Injury (MOI)

Other “Burns”

A
  • Road Rash
    • Need to be cleaned well, debris/foreign bodies removed*
  • Frost Bite
    • Occurs when tissue temp is 35.6*F (2*C)
      • NOTE: W/ frostbite→ body shunts blood to proximal trunk to keep warm, therefore no bloodflow to distal extremities (hence, black frostbitten toes)
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25
Systems Affected by Burns: ## Footnote **One she mentions**
CV, Pulmonary, Renal, Metabolic/GI Tract
26
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Location will dictate (is assocd w/) 2 things:**
* **Location** influences **severity** * **Location** is associated w/ **specific complications\***
27
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Cardiac Systemic Response** **\*24-48 hr survival link**
* **3 in red:** * **Decd blood pressure** * **Decd CO or SV (CO=HR\*SV)** * **Incd HR** * **Other:** * Microvascular fluid shift (fluid TO burn area) * Gen impairs in cell memb function * Inc in burn tissue osmotic pressure * **Hypovolemia, edema\***
28
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Cardiac Systemic Response** **Vascular Edema**
* Most pronounced first 72hrs * \*Limits ROM/function * Maybe limit venous return * Fluid resuscitation INCs edema formation * **Mgmt of edema is an important role of rehab of burns**
29
Classification: **Burn Location/Systems Affected by Burns** **Pulmonary Systemic Responses**
* Injury occurs to **lungs** in several ways: * Direct heat trauma, Lack of O2, Inhaled chemicals * Edema→ Obstruction (OLDs common)→ Impaired gas exchange→ ARDS→ Edema (restarts cycle)
30
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Pulmonary Systemic Responses** **Inhalation Injury** **20% of burn mortalities**
* **Signs of Inhalation Injury:** * Facial burn, Singed nasal hair * Harsh cough, Hoarseness * Resp distress, Hypoxemia
31
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Renal Systemic Responses**
* Hormone secretion: * ADH * Aldosterone→ vasodilator * **BOTH= fluid retention** * **Renal failure**
32
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **GI Systemic Response**
* **HypERmetabolism\*** * 2-3x the BMR\* * Lasts up to 1yr * Greater nutritional needs→ think about it…your metabolism is now TRIPLE to heal the burns… think PRO, Meat!!! * Ileus→ blockage in GI system * Wt loss---- bc metabolism so HIGH, tough to keep up!!!
33
Classification: **Burn Location/Systems Affected by Burns** ## Footnote **Bone Fx's** **\*think Electrical (bc effects everything in path) or Chemical burns**
* Electrical or Chemical burns * Can effect **any bone in body** * Vertebral compression fx's OR Long bone fx's
34
Burn Sequela from **falls or other traumas** ## Footnote **Think about it…. if trauma or a fall from high window or anywhere….**
* TBI * SCI * Fx's ## Footnote **ALL MAKE SENSE!!!**
35
Healing Systems with Burns ## Footnote **Those involved in…. OR take these into account as working when we have severe burn**
* **PNS**→ more pain as nerves regen * **Infx→** extensive burns lead to infx's * **Hypertrophic Scar Formation→** scars mean healing
36
Mature Scars ## Footnote **Triple P→ P,P,P** **How scars SHOULD BE:**
* **P**ale * **P**lanar * **P**liable
37
Scar Development: **Timeline** **of Scar Tissue Restriction** **How quickly will this scar form and restrict indiv?** ALL FIRST
* **Burn Scar Contracture→** 1-4d * **Tendons and Sheaths→** 5-21d * **Adaptive MM Shortening→** 2-3wks * **Ligament & Joint Capsule→** 1-3mos ***NOTE:** Timing of Scar Mgmt is key to prevention and producing **_permanent_ change*****\***
38
Scar Development: **Timeline** **of Scar Tissue Restriction** ## Footnote **How quickly will this scar form and restrict indiv?** **Burn Scar Contracture**
1-4d
39
Scar Development: **Timeline** **of Scar Tissue Restriction** ## Footnote **How quickly will this scar form and restrict indiv?** **Tendons and Sheaths**
5-21d
40
Scar Development: **Timeline** **of Scar Tissue Restriction** ## Footnote **How quickly will this scar form and restrict indiv?** **Adaptive MM Shortening**
2-3wks
41
Scar Development: **Timeline** **of Scar Tissue Restriction** ## Footnote **How quickly will this scar form and restrict indiv?** **Ligament & Jt Capsule**
1-3mos
42
Keloid Scarring ## Footnote **\*think “raised up and puffy” one**
Overgrowth OUTSIDE of wound margin, **puffy\***
43
Hypertrophic Scarring ## Footnote **\*Think “scar tissue” one**
* Thick **scar tissue, raised from wound surface** BUT remains in area of injury, contracts, produces scar bands, **painful/itchy**
44
Burns and Abuse Child Abuse w/ Burns
see pics but **NOTE:** * Familiar obj patterns→ cigarettes, forks, curling iron, stove top * Burns suggestive of forced immersion→ **stocking presentation** * **The burns are in isolated areas (see pics) that are in areas where surrounding area is NOT burned, or areas where looks like child was forced to stay in one position while being burned, or cig burns** **YOU MUST REPORT!!**
45
Sx Mgmt of Burn Wounds ## Footnote **Name all first:**
* **Autografts (skin from self)** * **Homografts/Allografts (Temporary)** * **Heterografts (Temporary)** * **Free Flap/Free tissue transfer** * **Pedicle graft** * **Skin substitutes**
46
Sx Mgmt of Burn Wounds: ## Footnote **Autografts** **2 types:**
* **STSG- Split Thickness Skin Grafts** * Epi + Part of dermis * **FTSG- Full Thickness Skin Grafts** * Epi + ALL of dermis
47
Sx Mgmt of Burn Wounds ## Footnote **Homografts/Allografts (temp)** **Heterografts (temp)**
* Homo/Allografts (temp) * Cadaver * Fetal memb's * Hetero (temp) * Xenograft (pigskin)
48
Graft Procedure pics ## Footnote **Steps 1-3**
Note the **Mesh-like material** ## Footnote **\*this allows _granulated tissue_ to come up thru mesh and heal wound**
49
**Split Thickness Skin Grafts (STSG's)** **Ex's**
see pics Notice the **mesh,** then they just stitch or staple around edges!!!
50
**Mobilization Guidelines AFTER Skin Graft** **AKA Protocols** **LE Graft _Over_ Joint(s)** **POD# 1-4**
* **POD #1:** Lateral move bed to chair, \***NO ROM** * **POD #2:** Observe graft during dressing change * Amb w/ ACE wrap support if no graft shift or bleeding * **\*Limtd** **AROM only** * **POD #3:** Observe graft, Amb w/ ACE, \***Full AAROM _if graft stable_** * **POD #4:** Observe graft, \***PROM permitted (only NOW can we put hands on them for ROM)**
51
**Mobilization Guidelines AFTER Skin Graft** **AKA Protocols** **LE Graft _NOT_ Over Joint(s)**
* **POD #1:** Amb w/ ACE wrap support if no graft shift or bleeding, **AROM, AAROM, PROM OK for _surrounding joints_\***
52
**Mobilization Guidelines AFTER Skin Graft** **AKA Protocols** **Buttock Grafts**
NO OOB Rx until **POD #2\*\*\***
53
PT Wound Care for Grafts ## Footnote **Only 2 dressings used for skin graft:**
Composite Dressings (big band-aid one) Foam Dressings see pics and go back to charts!!!!
54
Characteristics assocd w/ **Superficial Thickness Burn (1st Degree Burn)**
Dry and Painful Dmg ONLY to **epidermis, classic terrible sunburn**
55
Characteristics assocd w/ **Superficial or Deep Partial Thickness Burn (2nd Degree Burn)?**
Blisters or Pale and Painful ## Footnote **pain w/ edema** **Superf→ wet w/ blisters AND blanchable** **Deep→ moist and pale NOT blanchable**
56
Characteristics assocd w/ **Full Thickness Burn (3rd Degree Burn)?**
White waxy eschar formation ## Footnote **dry as leather, NOT painful bc insensate, NOT blanchable, w/ edema** **common in burn ICU\***
57
Characteristics assocd w/ **Subdermal Burn (4th Degree Burn)?**
Charred w/ exposed mm ## Footnote **Destroy epi, dermis, subQ tissue** **Charred w/ exposed tendons, mms, bones** **\*think stage 4 pressure ulcer**
58
MOST ACCURATE method of **calculating Total Burn Surface Area (TBSA)**
Lund and Browder Chart
59
Which **MOI** of a burn can cause **bone fx, nerve damage; vascular damage and Exit wounds?**
Electrical Injury
60
Which terms describe healthy, mature, scar? ## Footnote **Triple-P's!**
Pliable, Planar, Pale
61
Correct body pos. for a burn pt in bed w/ **shoulder burn is \_\_\_\_\_\_\_\_\_\_\_**
Shoulder ABD 90\*

Medcon Rehab IV (18 decks)

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