Burns

Question 1

What are the 3 general causes of burns?

Answer 1

1. Chemical
2. Thermal
3. Electrical

Question 2

A thermal burn is classified as direct or indirect contact with flame, hot liquid or steam the severity of the burn is influenced by 3 factors which are:

Answer 2

1. Contact time
2. Temperature
3. Type of insult

Question 3

A chemical burn can be due to acids, bases, industrial accidents or assaults. These types of burns are more likely to cause what type of damage and how is severity of the burn influenced?

Answer 3

More likely to cause full thickness damage (alkali more severe)
Severity dependent on
1. Contact time: burning continues until substance is diluted or removed. Need to thoroughly irrigate for 20-30 min
2. Chemical concentration
3. Amount of chemical

Question 4

For a chemical burn irrigation should be done for how long?

Answer 4

20-30 min

Question 5

Electrical burns can occur with low and high voltage currents. Severity is influenced by

Answer 5

1. High volt currents cause more damage and AC burns injuries are more severe
2. Also dependent on contact time

Question 6

T/F with electrical burns skin may not be severely damaged despite deep tissue injury due to the differences in resistance.

Answer 6

T

Question 7

If a partial thickness burn becomes infected what can happen?

Answer 7

it can convert from partial -thickness to full thickness

Question 8

Chemical burns can take ____hours to develop

Answer 8

24-72 hours

Question 9

Describe 5 key characterisitics of Superficial Burns aka first degree

Answer 9

1. Involves ONLY the epidermis
2. Dry, bright red/pink skin that blanches upon pressure
3. Resolves within 3-5 days without scarring
4. Skin may peel
5. Skin barrier function is maintained
6. Blistering is not present
   ex: sunburns, minor flash burns

Question 10

Describe key 5 characteristics of Superficial part-thickness burns aka superficial 2nd degree

Answer 10

1. Involves the epidermis and papillary dermis
2. Blistering
3. local erythema and edema
4. Blanchable, refill is immediate
5. heal within 10-14 days, common after closure to have itching and hypersentivitiy

Question 11

Brief Contact burns
Flash burns
brief contact burns with dilute chemicals
are examples of what type of burn

Answer 11

superficial 2nd degree

Question 12

Describe 5 key characteristics of deep partial thickness burns aka deep 2nd degree

Answer 12

1. Involves dermis and epidermis
2. Mottled areas of red with white eschar, blistering possible
3. Decreased pinprick
4. Intact pressure sensation
5. Blanchable but slow capillary refill, takes greater than/= 3 weeks to heal

Question 13

Severe sunburns, scald, flash burn brief contact with dilute chemical are all examples of

Answer 13

deep 2nd degree burn

Question 14

Describe 5 key characterisitics for full-thickness burns aka 3rd degree

Answer 14

1. Involves destruction of the epidermis, dermis to subcutaneous
2. Mottled white/black, dry leathery eschar, very painful
3. can’t feel light touch
4. most require surgical debridement and grafting
5. Scarring and contracture likley

Question 15

Prolonged contact with flame, immersion scald injury are examples of what type of burn

Answer 15

3rd degree

Question 16

Describe key characteristics of subdermal burns aka 4 degree burns

Answer 16

1. Destruction beyond dermis into fat, muscle, tendon and bone
2. Charred and mummified
3. permanent nerve damage
4. Areas with no viable tissue
5. Require sx and possible amp

Question 17

Electical burns, strong chemical burns are examples of what type of burn

Answer 17

subdermal or 4 dgree

Question 18

Lund-Browder classfication is appropiate in determining total body surface area to classify burns in what population

Answer 18

children under 16, subdivides body segments into percentages based on age.

Question 19

Rule of 9
Head, front and back of each UE
the front of each LE
the back of each LE =______%

Anterior and posterior trunk_____%

Answer 19

9%

18%

Question 20

T/F the palmar method is highly unreliable and inaccurate

Answer 20

T

Question 21

Classification of Burns
Minor Burn for a Child
%FT
%PT

Answer 21

%FT= < 1%
%PT= <5%

Question 22

Classification of Burns
Moderate Burn for an Adult
%FT
%PT

Answer 22

%FT= 2-5%
%PT= 10-20%

Treat Inpatient

Question 23

Classification of Burns
Moderate Burn for a Child
%FT
%PT

Answer 23

%FT=1-5%

%PT=5-10%

Question 24

Classification of Burns
Major Burn for an Adult
%FT
%PT

Answer 24

%FT= >5%
%PT=>20%

treat in specialized burn unit

Question 25

Classification of Burns Major Burn for a Child %FT %PT

Answer 25

%FT= >5% | %PT=>10%

Question 26

Name the Zone Central portion of the burn that has suffered irreparable damage and is characterized by coagulation, ischemia, necrosis.

Answer 26

Zone of Coagulation

Question 27

The zone of coagulation may expand up to

Answer 27

48 hours after initial burn injury

Question 28

Name the Zone Surrounds central necrotic region, and represents an area of cellular injury and compromised tissue perfusion. RBCs and platelets form microemoboli, further impeding circulation. If perfusion is not restored in 1-2 days cells will NOT survive.

Answer 28

Zone of stasis

Question 29

In which zone can conversion occur, the process of widening orginial area of necrosis

Answer 29

Zone of stasis

Question 30

Name the zone outer edges of tissues affected by burn injury. tissues here receive least thermal energy and sustain only minimal cellular injury. Erythema is key characteristic. Recovers in 7-10 days after injury

Answer 30

Zone of Hyperemia

Question 31

What happens if you place a bandage on a burn and it is too tight?

Answer 31

create a volume change in the area of the burn

Question 32

Burn Patients have multisystem damage. The cardiovascular system is most like to affect a patient that has ____% TBSA and places that patient at high risk for _____.

Answer 32

greater than 15%, burn shock

Question 33

A massive shift causing decreased blood volume (hypovolemia and edema) is known as

Answer 33

Burn shock, tissue necrosis, organ failure and death are possible

Question 34

Inhalation injuries/damage to the pulmonary system cause up to ___% of burn deaths.

Answer 34

20%

Question 35

What does inhalation do to lung compliance?

Answer 35

it decreases it leading to hypoxemia

Question 36

When should a practioner suspect lung involvement?

Answer 36

1. Carbonaceous sputum is present 2. closed space injury 3. burns to neck/face/torso

Question 37

Need to monitor what vital signs and promote what in patients that have inhalation injuries?

Answer 37

1. Monitor breathing 2. Monitor O2 sta 3. encourage aggressive pulmonary hygeine may need to look inside nose and mouth

Question 38

What happens to the basal metabolic rate in burn patients?

Answer 38

the rate doubles or triples. Increase in core temp Sustained hyperglycemia Increased fat catabolism

Question 39

When does the metabolic rate peak after initial burn injury?

Answer 39

7-17 days post major burn injuries

Question 40

T/F patients who have suffered a major burn with have a decrease in body mass

Answer 40

T

Question 41

____% of burn patient deaths are due to infection

Answer 41

75, sepsis and infection very common

Question 42

What is necessary to reduce risk of infection?

Answer 42

1. rapid skin coverage 2. Aggressive debridement 3. Prophylactic topical antimicrobials

Question 43

What is the most commonly psychological disorder seen in burn patients?

Answer 43

PTSD, anxiety, depression, distrubed sleep common

Question 44

What is the key motto for PT interventions with burn rehab?

Answer 44

Give patient control over their reahb

Question 45

T/F you should always tell a patient what to expect before a procedure

Answer 45

T

Question 46

For burn patients how will the cardiovascular system present?

Answer 46

1. Patient will be Hypotensive 2. Patient will have resting tachycardia 3. Burn shock 4. Hypvolemia 5. Edema

Question 47

For burn patients how ill the pulmonary system present?

Answer 47

1. Patient can be hypoxic 2. Patient can present with SOB 3. Patients are prone to pneumona and ARDS 4. Will have increased pulmonary vasicular resistance

Question 48

Name 4 common organ system dysfunction that burns can affect?

Answer 48

1. kidneys 2. GI 3. Ulcers 4. Ileus

Question 49

What are 3 precautions a PT should be aware of when treating a burn patient?

Answer 49

1. Domestic Violence 2. Need to prevent and anticipate compliations 3. Ensure Adequate pain control

Question 50

What are 5 complications to burns?

Answer 50

1. Contractures 2. Infections 3. Deconditioning 4. Pulmonary dysfunciton 5. Pressure ulcers

Question 51

Burns require repeated bouts of what types of debridement?

Answer 51

mechanical, sharp or enzymatic. Always remove blisters

Question 52

What type of technique should be used for large TBSA burns to prevent infection

Answer 52

sterile

Question 53

Topical antimicrobials are the standard for preventing infection. List 3

Answer 53

1. sliver sulfadiazine 2. mafeninde acetate 3. bacitarcin

Question 54

What is the most common type of dressing for burns?

Answer 54

Topical antimicrobial covered with nonadherent impregnated gauze, bulky guaze dressing. (limit bulk so that movement is encouraged) Use short-stretch compression wrap to decrease edema and scarring

Question 55

Name 4 types of scar management interventions

Answer 55

1. silicone gel sheets 2. ultrasound 3. paraffin 4. MOISTURIZE, apply several times a day

Question 56

T/F darker skinned individuals have higher incidence of hypertrophic scarring and keloids

Answer 56

true

Question 57

List the 4 items in the vancouver scale and what is the scale used for?

Answer 57

``` used to describe quality of the scare tissue after a burn includes 1. Vascularity 2. Pliability 3. Pigmentation 4. Height ```

Question 58

Lower scores on the vancouver scale indicate what?

Answer 58

less severe scar tissue (range 0-14)

Question 59

When is ROM contraindicated for a burn patient?

Answer 59

for non-stabilized fx, cardiovascular instaiblity, extubation within 8 hours of tx, exposed tendon

Question 60

When moving a patient with a lower leg graft with compression wrap what is important to note before gettting this patient out of bed

Answer 60

make sure they have compression wrap on before getting out of bed. Limits edema, prevents venous pooling, increased venous return and reduces risk of DVT

Question 61

Burn patients and aerobic exercise what would target HR be

Answer 61

50-70% of predicted max

Question 62

Patient with an anterior neck burn what is the predicted position of contracture and how can we prevent the contracture

Answer 62

predicted position would be into cervical flexion Prevent by having the patient be supine without a pillow, use a small towel roll to support cervical lordosis

Question 63

Patient with axilla/shoulder burn what is the predicted position of contracture and how can we prevent the contracture?

Answer 63

adducted, restricted elevation prevent by abducting at least 90 deg and ER

Question 64

Patient with anterior hip/thigh burn what is the predicted position of contracture and how can we prevent the contracture?

Answer 64

Hip flexion lay patient flat supine with hip extended.

Question 65

Dynamic splints assist with

Answer 65

contracture management

Question 66

Whirlpool is easier for what? Pulsed lavage with suction you tend to use on what type of wound? Paraffin is not indicated for what type of wound?

Answer 66

- ROM - small wounds - open wounds

Question 67

T/F PT should time interventions with medications

Answer 67

T

Question 68

Surgical Interventions 1. Performed on patients with medium and large full thickness burns 2. Incision through eschar and subcutaneous tissue to release tissue contristing ciruclation 3. Incision through fascia to release pressure improve distal circulation, due to volume changes.

Answer 68

1. Debridement 2. Escharotomy 3. Fasciotomy

Question 69

What type of graft is prefferred with skin grafting?

Answer 69

autografts from univolved areas. Xenografts or allografts are for temporary converage

Question 70

What type of graft is the epidermis and parts of the dermis removed and replaced with a mesh or sheet

Answer 70

Split-thickness graft

Question 71

What type of graft requires removal of epidermis and entire dermis layer. Required greater vascular support from recipient area and is typically used on face feet and hands for cosmesis.

Answer 71

Full-thickness skin grafts

Question 72

Name 4 reasons for graft failure

Answer 72

1. Infection 2. eschar 3. Insufficienct immobilization 4. Fluid collection under graft

Question 73

Classification of Burns Minor Burn for an Adult %FT %PT

Answer 73

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