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Flashcards in Thermal Injuries Deck (61):
1

Burn Causes include:

-thermal
-chemical
-electrical
-radiation

2

burns are ____ injuries

-multi-system

-especially if burn is greater than 25% TBSA

3

TBSA

total body surface area

4

thickness of burn determines_____

-extent of tissue damage

5

Hypertrophic scarring can result from_____

-partial- and full- thickness burns

6

Burn Classifications

-superficial partial thickness
-deep partial thickness
-full thickness

7

Sunburns are a type of ____

1st degree burn

8

Superficial Partial Thickness

-epidermis and dermal papillae (can involve some of basal cell layer)
-2-3 weeks to heal (re-epithelialization)
-no scar

9

Superficial Partial Thickness S/Sx

-erythema
-wet
-shiny
-surface
-edema
-painful

10

Deep Partial Thickness

-significcant damage to dermis
-3-4 weeks for healing with scar tissues (may hypertrophy and contract)
-may need skin graft

11

Deep Partial Thickness S/Sx

-erythema
-blisters
-white
-waxy
-pliable
-pain to deep pressure
-cold
-may be insensitive to light touch

12

Full Thickness

-epidermis and dermis destroyes
-possible subq also
-skin graft to heal
-scar may hypertrophy and contract

13

Full Thickness S/Sx

-brown/black, deep red, white
-dry surface
-edema
-painless
-insensate

14

Rule of Nines

-assessment of burn size
-arms/head=9% each
-Legs, ant/post trunk=18% each
-genitals=1%

15

Rules of Nines for Kids

-head=12%
-trunk ant/post=18%
-arms=9%
-Legs=16.5
-genitals=1%

16

Burn Impairments

-shift of body fluids to interstitial spaces
-loss of tissue
-loss elasticity
-scar hypertrophy
-scar contraction

17

Capillary walls during injury

-more permeable
-fluid flows out of vessels to interstitial space
-take in nutrients, WBC and oxygen to injured area

18

Burn Intervention

-Airway & Breathing
-Fluid Resuscitation
-Escharotomy
-Fasciotomy
-Nutrition
-Pain management
-wound management

19

Escharotomy

-release of scar tissue

20

Fasciotomy

-release of fascia

21

Burn Surgical Management

-skin graft
-muscle flap

22

Skin Graft

-full thickness burns require (unless very small)
-large area burns require graft (regardless of depth)

23

Graft Site

-location of burn that will be covered by homograft or autograft

24

Donor Site

-area that contributes the skin in autograft

25

Autograft

-from another part of same body

26

Allograft

-graft from same species (cadaver or other person)

27

Heterograft

-(zenograft)
-from another species (pigskin)

28

CEA

-Cultured Epithelial Autograft
-skin of pt grown in lab

29

Integra, Apligraf, dermagraft

-dermal replacements

30

Sheet Graft

-more cosmetically appealing
-requires larger donor site
-always used on face and hands

31

Meshed Graft

-can be expanded
-waffle-like appearance

32

Burn Rehab Focus

-positioning
-splinting
-ROM
-function/gait
-ADLs
-Scar Management

-START IMMEDIATELY!!! DAY ONE!!!

33

Scar Formation

-deep wounds heal with scar tissue
-fibrous tissue replaces normal tissue
-goal: minimize hypertrophic scars

34

Position of comfort is _____

the position of deformity

35

Position to prevent:

-contractures
-decubitus ulcers
-control edema

36

Indications Splinting

-prevent contractures
-protect exposed joints/tendons
-when ROM is decreasing
-4-5 days post graft to immobilize graft area

37

Position for Burn pts

-Vitruvian Man
-(da Vinci)

38

Functional Potential of hand

(safe, intrinsic plus)

-slight wrist ext with ulnar deviation
-MCP at 90*
-IP at 0*
-Thumb IP 0*-some flexion
-Thumb opposition

39

ROM & Ex's goals

-prevent contractures
-joint integrity
-maintain tendon gliding
-prevent adhesions
-reduce edema

40

Contractures can form in ____

1-3 DAYS

41

ROM most effective during____

bathing

42

ROM is usually ____

Painful

43

__/10 is highest amount of pain pt should have during therapy

4/10

44

ROM/Ex's Precautions

-edema
-med equip
-IV's
-tubes
-exposed joints/tendons
-Heterotopic ossification
-associated injuries
-escharotomy/fasciotomy
-new autograft sites
-unstable/fragile autograft sites
-neuropathies
-cellulitis

45

Heterotopic Ossificatoin

-accum of unstructured bone around joint
-sudden dramatic decrease in ROM
-specific joint pain
-only AROM until surgically removed

46

Prevention of HO

-at elbow, limit ex's to AROM or gentle AAROM
-(not PROM)

47

Mobility Goals

-increase functional independence
-increase ROM, strength, endurance
-prevent DVTs
-improve pulmonary status
-prevent postural hypotension

48

Mobility Options

-bed mobility
-transfer training
-cardiac chair
-up to chair
-ambulation (limit use of AD)

49

Scar management

-ROM/Ex's
-functional mobility
-compression therapy/garments
-scar massage
-modalities

50

Function of Compression Therapy

-control of hypertrophic scarring
-promotes healing
-assist w/ venous return

51

Indications for Compression therapy

-partial- or full-thickness burns
-can initiate with minimal open areas (still have bandages on)
-measure for custom garments after temporary compression has been used

52

Types of Temporary Compression Therapy

-ACE wraps
-compressogrip/tubigrip
-support hose
-foam neck collars
-coban
-isotoner gloves

53

custom compression garmets

-name brand
-must be measured for them (after graft healed)
-25-30 mmHg pressure

54

Phases of PT Burn Management

-Emergent and resuscitation phase
-Acute phase
-rehabilitation phase

55

Inpatient Rehab follow up

-rehab unit
-outpatient
-home health
-vocational rehab
-work hardening

56

Burn Outpatient Assessment

-ROM (joint by joint)
-Scars
-Pressure Garment/splint
-ADL/Mobility
-Activity level (back to work/sports/hobbies/school)
-Psycholosocial Adjustments
-Complications (pruritis, sleeplessness)

57

Psychological Issues

-PTSD
-depression
-feelings of guilt
-anxiety
-re-integration back to society

58

Supportive Services

-family support groups
-burn survivor support group
-burn camp
-community activities & education
-the american burn association
-the phoenix society
-the world burn congress

59

PT during Emergent Phase

-control edema
-AAROM
-mobility
-positioning/splinting
-ADL/Transfers

60

PT during Acute Phase

-splinting/positioning
-AROM
-WB and Ambulation
-ADL
-graft and donor site management
-discharge planning

61

PT during Rehab Phase

-Skin care
-scar eval
-pressure garmets
-ROM (AROM, PROM)
-ADL
-Strength/endurance
-Therapeutic modalities
-school/work function