Lecture 4 Burns

Question 1

Where do most burns occur?

What % are severe burns?

What;s the most common way adults and kids get burned?

Answer 1

In adults - 70% at home; in kids - kitchen and bathroom.

10% are severe

Adults burned with flame (44%) and kids get scalded (55%)

Question 2

Whats the pathophys of burns?

Answer 2

Heat >44ºC causes denaturation of proteins + loss of plasma membrane integrity = cell+tissue damage

Cell necrosis - 1 sec @ 69ºC; 1 hour @ 45ºC

Question 3

How is burn severity determined/

Answer 3

1. TBSA (total body surface area) - rule of 9’s
2. Location burned
3. Depth of burn

Question 4

What is a severe burn according to the classification criteria?

Answer 4

> 20% (>10% in very old or young) TBSA

> 5% full thickness

Question 5

Explain burn depth

Answer 5

Superficial = epidermis only
Partial thickness = superficial+mid+deep dermal
Full thickness = down to subcutaneous fat/mm/bone

Question 6

Explain the burn wound model

Answer 6

Zone of coagulation - irreversible tissue necrosis at the centre of the burn due to exposure to heat, chemicals or electricity; extent is dependent on the temperature/concentration and the duration of exposure.

Zone of ischemia - surrounds the zone of coagulation; surrounds the zone of circulation; damaged but potentially viable tissue; but this zone will progress to full necrosis if ischemia isn’t reversed

Zone of hyperaemia - area of reversible increase in blood flow/circulation

Question 7

How do you determine prognosis of a burn?

Answer 7

Age + TBSA %

<80 = good prognosis
80-100 = life threatening
>100 = poor prognosis

Question 8

Explain burn shock

Answer 8

Large burns >20-30% TBSA = whole body edema = hypovolemic shock = fall in plasma volume = fall in Q = risk of multiorgan failure

Question 9

Which types of burns (i.e thickness) scar?

Answer 9

MId dermal and full thickness burns

Mid dermal
- if healed 14-21 days - might scar
> 21 days will scar

Full thickness
- definite scar

Question 10

Which factors are assoc with poor healing post skin graft op?

Answer 10

Age
Smoking
Diabetes
Non compliance with post op immob
Circulation/vascular issues

Question 11

Who’s more likely to scar?

Answer 11

Younger pt
Skin type (darker more likely)
Genetics
Longer healing time

Question 12

What do active scars do and how can we address it?

Answer 12

Contracts - stretch it
Raises - compress it
Hardens and dries - moisturize it

Question 13

How do contractures develop?

Answer 13

Collagen fibres bridge wound from burn healing - contraction of wound - low elastin content - skin contracts - 2º mm, tendon, joint contractures

Question 14

What are problem areas for contractures?

Answer 14

Flexor surfaces
Axilla
Genitalia
Elbow, Neck

Question 15

What are the 3 ways to prevent contractures

Answer 15

Positioning
- position of comfort is the position of deformity so you have to get them out of it

Splinting
- for LL, UL, mouth; can be worn at night to prevent contractures

Exercises

• perform during dressing changes
• passive then active - anti gravity
• get them functional
• use whatever equipment you have available to you

Question 16

How are raised scars treated?

Answer 16

Compression

• worn 23/24
• short term edema and long term scar management

Question 17

What are the aims of exercise in burns?

Answer 17

SPERM

Scar tissue stretch
Physical function
Edema+immob effects reduction
ROM
Mental/social well being