S1L2: Medical Management, PT Assessment & Intervention

Question 1

Long term goal vs. Immediate goal

● Prevent infection
● Decrease pain
● Prepare wounds for grafting
● To restore skin integrity, function, and appearance
● Prevent contracture and scarring
● Maintain strength and function

Answer 1

All are immediate goal except for: To restore skin integrity, function, and appearance

Question 2

T/F: Goal for acute: immobilization or positioning until pt is stabilized

Answer 2

True

Question 3

GOAL: To remove dead tissue, prevent infection, and promote revascularization/reepithelialization

Answer 3

wound cleansing

Question 4

used to help reduce the number of bacteria. Excess bacteria may lead to problems in healing

Answer 4

topical antibacterial agents

Question 5

Modified T/F: Acute Mx
a. Includes Fluid replacement, TBSA
b. Proper positioning for optimal joint placement is not part of acute mx as this should be part of the rehabilitation process later on

Answer 5

TF

B - Proper positioning for optimal joint placement is part of Acute MX

Question 6

Common Topical Medications used in Treatment of Burns

1.Enzymatic debriding agent selectively debrides necrotic tissue
2. effective against gram-positive organisms
3. Maintains moist environment

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 6

1. e
2. d
3. c

Question 7

Common Topical Medications used in Treatment of Burns

1.effective against gram-negative or gram-positive organisms
2. Most commonly used anti-bacterial agent;
3. Topical solution with antimicrobial function against gram-positive and gram negative organisms

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 7

1. b
2. a
3. c

Question 8

Common Topical Medications used in Treatment of Burns

1. Antiseptic germicide
   and astringent
2. will penetrate only 1-2mm of eschar; useful for surface bacteria; stains black
   3.no antibacterial action

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 8

1. c
2. c
3. e

Question 9

Common Topical Medications used in Treatment of Burns

1. Bland ointment
2. effective against Pseudomonas infections
3. diffuses easily to eschar

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 9

1. d
2. a
3. b

Question 10

Common Topical Medications used in Treatment of Burns

White cream applied with sterile glove 2-4mm directly to wound or impregnated into fine mesh gauze

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 10

A

Question 11

Common Topical Medications used in Treatment of Burns

White cream applied directly to wound with thin 1-2mm layer 2x daily; may be left undressed or covered with thin layer of gauze

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 11

b

Question 12

Common Topical Medications used in Treatment of Burns

50-gram packet of white powder that is mixed with either 1000mL sterile water or 0.9% sodium chloride soaked gauze

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 12

c

Question 13

Common Topical Medications used in Treatment of Burns

Dressings or soaks used every 2 hours; also available as small sticks to cauterize small open areas.

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 13

c

Question 14

Common Topical Medications used in Treatment of Burns

Thin layer of ointment applied directly to wound and left open

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 14

d

Question 15

Common Topical Medications used in Treatment of Burns

Ointment applies to eschar and covered
with moist occlusive dressing with or
without an antimicrobial agent.

a. Silver Sulfadiazine
b. Mafenide acetate (sulfamylon)
c. Mafenide acetate solution (sulfamylon
5% solution) silver nitrate
d. Bicitracin/ Polysporin
e. Collagenase, accuzyme

Answer 15

e

Question 16

Modified T/F:

A. Open technique refers to applying a topical cream or ointment with
dressings
B. It allows for ongoing inspection of the wound and examination of the healing process.

Answer 16

FT

A. With or WITHOUT DRESSINGS (usually without)

Question 17

T/F: In open technique, topical medication must be reapplied throughout the
day

Answer 17

True

Question 18

Modified T/F:

A. Closed technique refers to applying dressings over a topical agent
B. Open technique is better for interventions like exercises

Answer 18

TF

B - Closed technique is Better for interventions like exercises in order to keep the wound closed.

Question 19

T/F: Purpose of closed technique includes:
○ Hold topical antimicrobial agents on the wound
○ Reduce fluid loss
○ Protect the wound

Answer 19

True

Question 20

In closed technique, dressings are changed [] to [] a day

Answer 20

once to twice

Question 21

Arrange the layers in CLOSED TECHNIQUE from the innermost to outermost

Gauze or elastic bandage
Non-adherent
Cotton padding
Elastic wrap/gauze
Roller gauze

Answer 21

○ 1st - Non-adherent
○ 2nd - Cotton padding
○ 3rd - Gauze or elastic bandage
○ 4th - Roller gauze
○ 5th - Elastic wrap

Question 22

Procedure of putting viable tissue over the area wherein
the burn is extensive/deep

Answer 22

Grafting

Question 23

Identify the types of graft

○ Patient’s own skin, taken from an unburned area
○ Permanent coverage of the wound

Answer 23

Autograft

Question 24

Identify the types of graft

Taken from cadaver of own species (humans)

Answer 24

Homograft/Allograft

Question 25

Identify the types of graft from Non-human (Pigs, tilapia)

Answer 25

Heterografts/Xenografts

Question 26

T/F: ROM is important in all phases of burns d/t contractures or improper positioning

Answer 26

True

Question 27

T/F: you can perform break test MMT in acute conditions

Answer 27

False better to perform FMT

Question 28

T/F: You can do sensory testing in acute conditions

Answer 28

False, only chronic

Question 29

% TBSA Classification is under what heading?

Answer 29

Wound Ax

Question 30

T/F: You should perform cardiopulmonary assessment in burn patients

Answer 30

True. Poor cardiopulmonary condition may lead to decreased endurance and lead to difficulty when providing the pt c functional tasks

Question 31

T/F: Anthropometric measurement is not important because edema is not present in any forms of burns

Answer 31

False Some forms of burns present c edema

Question 32

T/F: PA & GA won’t be done if condition is still acute

Answer 32

True

Question 33

Give 2 Burn Outcome measures

Answer 33

○ Burn Specific Health Scale-Brief (BSHS-B) ○ Burns Scar Index (Vancouver Scar Scale)

Question 34

T/F: PTDx includes classification of burn injury, % TBSA and Severity of burn

Answer 34

True

Question 35

Risk Factors vs. Barriers 1. Burn injury occurred at work 2. In patient rehab 3. longer stay at hospital 4. wound issues 5. neurologic problems

Answer 35

1. R 2. R 3. R 4. B 5. B

Question 36

Risk Factors vs. Barriers 1. Preburn psychiatric history 2. Physical abilities, impaired mobility 3. Extremity burns 4. Physical abilities, impaired mobility 5. Electric etiology 6. Psychosocial factors 7. Working conditions (temperature, humidity, and safety)

Answer 36

1. R 2. B 3. R 4. B 5. R 6. B 7. B

Question 37

Initial intervention to prevent contracture formation

Answer 37

Positioning

Question 38

SPLINTING ○ General Indications: ■ Facilitate proper [] ■ Prevention/reduction of joint [] ■ Protecting skin [] or fragile [] ■ Assisting desired motions

Answer 38

SPLINTING ○ General Indications: ■ Facilitate proper positioning ■ Prevention/reduction of joint contracture ■ Protecting skin grafts or fragile wounds ■ Assisting desired motions

Question 39

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Anterior neck Common deformity: Motions to be stressed:

Answer 39

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Anterior neck Common deformity: Flexion Motions to be stressed: Hyperextension

Question 40

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Shoulder-Axilla Common deformity: Motions to be stressed:

Answer 40

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Shoulder-Axilla Common deformity: Adduction and internal rotation Motions to be stressed: Abduction, flexion, and external rotation

Question 41

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Elbow Common deformity: Motions to be stressed:

Answer 41

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Elbow Common deformity: Flexion and pronation Motions to be stressed: Extension and supination

Question 42

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Hand Common deformity: Motions to be stressed:

Answer 42

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Hand Common deformity: Claw hand (intrinsic minus) Motions to be stressed: Wrist extension MCP flexion, proximal IP and distal IP extension; thumb abduction

Question 43

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Hip and Groin Common deformity: Motions to be stressed:

Answer 43

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Hip and Groin Common deformity: Flex and ADD Motions to be stressed: All motions esp EXT and ABD

Question 44

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Knee Common deformity: Motions to be stressed:

Answer 44

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Knee Common deformity: Flex Motions to be stressed: Ext

Question 45

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Ankle Common deformity: Motions to be stressed:

Answer 45

POSITIONING STRATEGIES FOR COMMON DEFORMITIES Ankle Common deformity: PF Motions to be stressed: All motions expecially DF

Question 46

T/F: Suggested Approaches Anterior neck > Use double mattress position neck in flexion; with healing use rigid cervical orthosis

Answer 46

False - position neck in EXTENSION

Question 47

Suggested Approaches SH-Axilla > Position with shoulder [] and [] (airplane splint)

Answer 47

Position with shoulder flexed and abducted (airplane splint)

Question 48

Suggested Approaches Elbow > Splint in []

Answer 48

extension

Question 49

T/F: Suggested Approaches Knee > Anterior knee splint

Answer 49

False - posterior

Question 50

T/F: Suggested Approaches Ankle > Plastic ankle-foot orthosis with cutout at Achilles tendon and ankle positioned in neutral

Answer 50

True

Question 51

T/F: Suggested Approaches Hip > Hip neutral (zero degrees of flexion/extension), with slight adduction

Answer 51

False - slight degree of ABDuction

Question 52

T/F: Suggested Approaches Hand > Wrap fingers separately. Elevate to decrease edema. Position in intrinsic plus position

Answer 52

True

Question 53

Suggested Approach: Hand Position of intrinsic plus: Wrists = MCP = Proximal IP = Distal IP = Thumb =

Answer 53

wrist in extension, MCP in flexion, proximal IP and distal IP in extension, thumb in abduction with large web space