Integumentary - Burns Lecture

Question 1

1/3 to 1/2 of all burn victims are ______.

Answer 1

Children

Question 2

Fire and burn injuries are the ______ leading cause of death in children between 1 and 4 years old, and is the _____ leading cause of death in children between 5 and nine years old.

Answer 2

5th; 3rd

Question 3

Most burn injuries occur _____

Answer 3

In the home, primarily in the kitchen and bathroom

Question 4

The severity of a thermal burn is influenced by:

Answer 4

-contact time
-temperature
-type of insult

Question 5

What is the most common type of burn?

Answer 5

Thermal

Question 6

Chemical burns are more likely to cause _______ skin damage than thermal burns.

Answer 6

full thickness

Question 7

Burns from _____ chemicals are more severe than burns from acid chemicals.

Answer 7

Alkaline

Question 8

Etiology of chemical burns

Answer 8

-caused by bases, acids
-can include cement and asphalt
-thermal energy is produced when strong acids or alkalis react with body tissues

Question 9

Severity of a chemical burn is related to _______.

Answer 9

-contact time
-type of chemical
-chemical concentration
-amount of chemical

Question 10

The chemical burning processes continues until _________.

Answer 10

the chemical is removed or diluted

Question 11

True or false. Electrical burns are caused by only high volt contact.

Answer 11

False! They can happen by low or high volt contact

Question 12

Blood vessels and nerves have ____ resistance, whereas bones and muscles have ____ resistance to electricity.

Answer 12

Low; high

Question 13

A higher resistance leads to higher ____.

Answer 13

heat produced when electricity passes through

Question 14

What some other pathologies associated with electrical burns?

Answer 14

-MSK dysfunction
-neurological injuries
-acute single and multiorgan system dysfunction

Question 15

Which electrical burns are more severe, AC or DC?

Answer 15

AC burns are more severe!

Question 16

The severity of an electrical burn is influenced by _____.

Answer 16

-voltage
-contact time

Question 17

What are the causes of radiation burns?

Answer 17

-UV
-Xray
-cancer treatment

Question 18

Severity of a radiation burn depends on _____.

Answer 18

-dosage
-frequency
-total surface area
-location of the radiation

Question 19

Superficial burns

Answer 19

-1st degree burns
-only the epidermis involved
-ski looks red/pink, blanches w/ pressure
-no blisters
-resolves in 3-5 days
-ex. mild sunburns

Question 20

Superficial partial-thickness burns

Answer 20

-superficial 2nd degree burns
-involves epidermis and papillary dermis
-looks moist, weeping, w/ blisters
-edema + erethema + pain
-heals in 10-14 days
-after it heals, hypersensitivity and itching are common
-ex. severe sunburns, scalds, flash burns, brief contact with chemicals

Question 21

Deep partial-thickness burns

Answer 21

-deep 2nd degree burn
-involves epidermis and dermis
-red w/ white eschar
-may have blisters + pain + areas of insensitivity
-decreased pinprick but pressure sensation is intact!
-can lead to contractures or hypertrophic scarring
-ex. contact w/ hot liquids or objects, flash burns, chemical burns

Question 22

Full thickness burn

Answer 22

-3rd degree burn
-involves epidermis, dermis, and subcutaneous layer
-mottled white, gray, or black
-little pain usually
-heals by epithelialization/contraction, may need surgical debridement
-ex. immersion scald injury, prolonged contact w/ flame or steam, electrical currents, exposure to chemicals

Question 23

Subdermal burns

Answer 23

-4th degree burns
-destruction beyond the dermis into fat, muscle, tendon, bone
-charred or mummified appearance
-need extensive surgery
-prolonged thermal contact or exposure to strong chemicals

Question 24

Surgeries for subdermal burns

Answer 24

-fasciotomy
-escharotomy
-grafting
-amputation

Question 25

3 ways to estimate burn size

Answer 25

-Rule of nines -Lund-Browder classification -Palmar Method

Question 26

Rule of nines

Answer 26

-divides the body into areas of roughly 9% of the total body surface area -consistently overestimates the size of the burn injury -fastest and easiest to use

Question 27

Lund-Browder classification

Answer 27

-pediatric scale to account for different head and limb size -used for all ages and is the preferred method!

Question 28

Palmar Method

Answer 28

-uses the area of the palmar surface of the hand to determine burn size -highly variable, should not be used

Question 29

Classifications of burn severity

Answer 29

-minor -moderate -major Determined by the percentage of full and partial thickness injury to the wound

Question 30

The classification of a wound determines what?

Answer 30

Which setting to treat the patient. Also need to consider: -area of injury -age -comorbidities -smoking -cosmesis -polytrauma -pain

Question 31

Integumentary effects of burns

Answer 31

-zone of coagulation (central portion) -zone of stasis (compromised perfusion) -zone of hyperemia (outer edge affected)

Question 32

Psychological effects of burns

Answer 32

Pain management and patient education are key!

Question 33

What is burn shock?

Answer 33

perfusion is unable to meet demands of body tissue causes: -skin cell death -increased capillary permeability -venous dilation leading to edema and hypovolemia -cardiac output to decrease by 50% for 2-4 days after burn

Question 34

Burn shock usually happens with ____% of TBSA or more.

Answer 34

15%

Question 35

Electrical burns cause what cardiovascular issue?

Answer 35

Cardiac dysrhythmias

Question 36

What serious cardiovascular condition should you monitor for if someone has had a burn injury?

Answer 36

compartment syndrome

Question 37

People who have burns typically have sinus _____ which leads to low cardiac reserves.

Answer 37

tachycardia

Question 38

People with burn injuries typically have (high/low) BP

Answer 38

Low!

Question 39

50% of burn unit patients will require _____ at some point.

Answer 39

Intubation

Question 40

What are common pulmonary issues following a burn injury?

Answer 40

-pulmonary edema -acute respiratory distress syndrome -pneumonia -inflammation

Question 41

Inhalation injuries occur in _____% of burn unit patients.

Answer 41

5-35%

Question 42

Carbon monoxide has a _____x greater affinity for binding to O2 than hemoglobin.

Answer 42

200x

Question 43

_______ and ________ account for 1/2 of all deaths that occur after the first 12 hours of a burn injury.

Answer 43

Carbon monoxide poisoning and smoke inhalation

Question 44

Airways inflammation can lead to:

Answer 44

-occlusion -asphyxia -death

Question 45

Basal metabolic rate may ________ with severe burns.

Answer 45

double or triple

Question 46

People who have a burn injury require a significantly greater ______ than normal because of the need to repair the tissues and the metabolic effects.

Answer 46

nutrition

Question 47

After a burn, the core body temperature and skin temperate are _____ and there is a _____ in resting O2 consumption + excessive nitrogen loss

Answer 47

elevated; increase

Question 48

After a burn you should expect a decrease in ______.

Answer 48

body mass

Question 49

Up to ______% of burn unit deaths are related to infection

Answer 49

75%

Question 50

How do burn injuries affect the immune system?

Answer 50

-skin loses its barrier function w/ large wounds -decreased tissue perfusion causes a shortage of needed cells and resources -neutrophils are less effective -lots of eschar for bacteria -stress affects the immune system

Question 51

Antimicrobial medications are most effective (locally/systemically)

Answer 51

Locally!

Question 52

PT treatments for patients with burns

Answer 52

-debridement -infection control -dressings -working as a team

Question 53

What does debridement do?

Answer 53

Removes any necrotic or foreign material to help w/ healing and decrease infection risk

Question 54

What is often used as a local antimicrobial treatment in wounds?

Answer 54

Silver sulfadiazine cream

Question 55

What kinds of dressings do you want to avoid with burn injuries?

Answer 55

dressings that stick or are painful upon removal

Question 56

Scar tissue cleaning techniques

Answer 56

-gently cleaned w/ mild non-perfumed soap and water -apply moisturizer throughout the day