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Burns Flashcards

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1
Q

What are the types of burns?

A

Thermal
Chemical
Radiation
Electrical

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2
Q

Describe thermal burns

A
  • Caused by convection (touching) or conductione (via liquid such as air or steam)
  • Examples: contact with hot liquid, fire, or steam
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3
Q

Describe chemical burns

A
  • Occurs when chemical compounds come in contact with the body
  • Reaction continues until chemical compound is diluted at site of contact
  • Examples: sulfuric acid, Lye (sodium hydroxide), hydrochloric acid, and gasoline
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4
Q

Describe radiation burns

A
  • Occurs commonly with exposure to external beam radiation therapy
  • DNA is altered in exposed tissues and ischemic injury may be irreversible
  • Complications: severe blistering and desquemation, non-healing wounds, tissue fibrosis, permanent discoloration, and new malignancies
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5
Q

Describe electrical burns

A
  • Caused by electrical current through the body
  • Typically there is an entrance and exit wound
  • Complications: cardiac arrhythmias, respiratory arrest, renal failure, neurological damage, and fractures
  • Ex: lightening strikes
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6
Q

What is the zone of coagulation?

A

The area of the burn that received the most severe injury with irreversible cell damage

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7
Q

What is the zone of stasis?

A

The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation

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8
Q

What is the zone of hyperemia?

A

The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage

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9
Q

What is the severity and extent of burn dependent on?

A
  • gender
  • age
  • duration of burn
  • type of burn
  • affected area
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10
Q

How are burns classified?

A

Depth of tissue damage

  • superficial burns
  • superficial partial thickness burn
  • deep partial thickness burn
  • full thickness burn
  • subdermal burn
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11
Q

What are superficial burns?

A
  • only involves epidermis
  • area may be red with slight edema
  • no peeling or evidence of scarring
  • healing in 2-5 days
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12
Q

What are superficial partial-thickness burns?

A
  • involves epidermis and upper portion of dermis
  • may have pain and exhibit blister
  • minimal to no scarring
  • healing in 5-21 days
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13
Q

What are deep partial-thickness burns?

A
  • complete destruction of the epidermis and majority of dermis
  • discolored with broken blisters and edema
  • damage to nerve endings may result in moderate levels of pain
  • hypertrophic or keloid scarring may occur
  • healing in 21-35 days (if no infection present)
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14
Q

What are full-thickness burns?

A
  • complete destruction of epidermis and dermis along with partial damage to subcutaneous fat layer
  • eschar formation and minimal pain
  • require grafts
  • susceptible to infection
  • healing time varies significantly
  • smaller areas may or may not need grafts, take weeks to heal
  • larger areas need grafts, take months to heel
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15
Q

What are subdermal burns?

A
  • complete destruction of epidermis, dermis, and subcutaneous tissue
  • may involve muscle and bone
  • often require multiple surgeries
  • healing time is extensive
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16
Q

How much is the head and neck according to the rule of nines for an adult?

A

9%

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17
Q

How much is the anterior trunk according to the rule of nines for an adult?

A

18%

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18
Q

How much is the posterior trunk according to the rule of nines for an adult?

A

18%

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19
Q

How much is the bilateral anterior arm, forearm, and hand according to the rule of nines for an adult?

A

9%

-Each anterior surface of entire arm is therefore 4.5%

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20
Q

How much is the bilateral posterior arm, forearm, and hand according to the rule of nines for an adult?

A

9%

-Each posterior surface of entire arm is therefore 4.5%

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21
Q

How much is the genital region according to the rule of nines for an adult?

A

1%

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22
Q

How much is the bilateral anterior leg and foot according to the rule of nines for an adult?

A

18%

-Each anterior surface of leg and foot is 9%

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23
Q

How much is the bilateral posterior leg and foot according to the rule of nines for an adult?

A

18%

-Each posterior surface of a leg and foot is 9%

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24
Q

How much is the head according to the rule of nines for an 5 y.o.?

A

14%

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25
How much is the upper limb according to the rule of nines for an 5 y.o.?
9% each arm
26
How much is the torso according to the rule of nines for an 5 y.o.?
36%
27
How much is the low limbs according to the rule of nines for an 5 y.o.?
16% each leg (Posterior: 8%, Anterior: 8%)
28
How much is the head according to the rule of nines for an 1 y.o.?
18%
29
How much is the upper extremity according to the rule of nines for an 1 y.o.?
9% (each arm)
30
How much is the lower extremity according to the rule of nines for an 1 y.o.?
14% for each leg (7% anterior, 7% posterior)
31
What is the anticipated deformity for the anterior neck and what type of splinting should be used?
``` Deformity: flexion with possible lateral flexion Splint: -soft collar -molded collar -Philadelphia collar ```
32
What is the anticipated deformity for the anterior chest and axilla and what type of splinting should be used?
Deformity: shoulder adduction, extension, and medial rotation Splint: -axillary or airplane splint -shoulder abduction brace
33
What is the anticipated deformity for the elbow and what type of splinting should be used?
``` Deformity: flexion and pronation Splint: -Gutter splint -conforming splint -three-point splint -air splint ```
34
What is the anticipated deformity for the hand and wrist and what type of splinting should be used?
``` Deformity: -extension or hyperextension of MCPs -flexion of the IP joints -adduction and flexion of thumb -flexion of the wrist Splint: -wrist splint -thumb spica splint -palmar or dorsal extension splint ```
35
What is hypertrophic scarring?
- result of an imbalance between collagen synthesis and lysis during healing and can occur with any integumentary condition - common in relation to severe burn
36
What are complications from hypertrophic scarring?
- Contracture - adhesions - hypersensitivity - functional limitation - poor cosmesis
37
What is involved in scar assessment?
- using assessment devices such as a tonometer (measures pliability) and rating scales aid in quantifying scar characteristics - purpose is to objectively document observed characteristics - helpful in assessment and re-assessment of individual - not helpful in comparative assessment of a group
38
What general characteristics should be documented with scar assessment?
- location - sensation - texture - pigmentation - vascularity - pliability - height
39
What is scar massage?
used to manage scar healing - losen adhesions between cutaneous scar tissue and underlying structures - do not begin scar massage too soon or too aggressively: may cause re-injury or re-initiating the inflammatory process
40
Describe the benefits of scar massage
-Decreased sensitivity and improved pliability
41
How is scar massage performed?
- slow and firm | - utilizes perpendicular, parallel, circular, and or rolling strokes to mobilize tissue layers
42
When are compression garments recommended for burns?
- burns requiring 14+ days to heal | - reduces chance of hypertrophic scarring
43
How much pressure is applied with compression garments?
15-35 mmHg | -creates environment that facilitates balance of collagen synthesis and lysis and improves scar structure
44
How long are compression garments to be worn?
22-23 hours a day until scar has matured - garments are custom fit - begin wearing garments between 2 weeks and 2 months after wound closure or grafting - wear up to 2 yrs
45
How do you use the rule of 9s for a child?
- A child under 1: take 9% from lower extremities combined and add to head and neck reagion - each year of life 1% distributed back to BLE - at 9 y.o. head is considered to be the same proportion as an adult
46
What are the advantages and disadvantages to sliver sulfadiazine in burn care?
``` Advantages: -can be used with or without dressings -painless -can be applied to wound directly -broad-spectrum -effective agains yeast Disadvantages: -does not penetrate into eschar ```
47
What are the advantages and disadvantages to sliver nitrate in burn care?
``` Advantages: -broad-spectrum -non-allergenic -dressing application is painless Disadvantages: -poor penetration -discolors, making assessment difficult -can cause severe electrolyte imbalances -removal of dressings is painful ```
48
What are the advantages and disadvantages to povidone-iodine in burn care?
``` Advantages: -broad spectrum -antifungal -easily removed with water Disadvantages: -not effective against pseudomonas -may impair thyroid function -painful application ```
49
What are the advantages and disadvantages to mafenide acetate in burn care?
``` Advantages: -broad spectrum -penetratres burn eschar -May be used with or without occlusive dressings Disadvantage: -May cause metabolic acidosis -May compromise respiratory function -May inhibit epithelialization -painful application ```
50
What are the advantages and disadvantages to gentamicin in burn care?
``` Advantages: -broad spectrum -may be covered or left open to air Disadvantages: -has caused resistant strains -ototoxic -nephrotoxic ```
51
What are the advantages and disadvantages to nitrofurazone in burn care?
``` Advantages: -bacteriocidal -broad-spectrum Disadvantages: -May lead to overgrowth of fungus and pseudomonas -painful application ```
52
What is an allograft?
temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area
53
What is an autograft?
a permanent skin graft taken from a donor site on the patient's own body
54
What is a donor site?
a site where healthy skin is taken and used as a graft
55
What is escharotomy?
a surgical procedure that opens or removes eschar from a burn site to reduce tension on surrounding structure -relieves pressure from interstitial edema and subsequently enhance circulation
56
What is full-thickness graft?
a skin graft that contains the dermis and epidermis
57
What is a heterograft (xenograft)?
a temporary skin graft taken from another species
58
What is a mesh graft?
a skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area
59
What is a recipient site?
a site that has been burned and requires a graft
60
What is a sheet graft?
a skin graft that is transferred directly from the unburned donor site to the prepared recipient site
61
What is a split-thickness graft?
A skin graft that contains only a superficial layer of the dermis and addition to the epidermis
62
What is a Z-plasty?
A surgical procedure to eliminate a scar contracture. An incision in the shape of a "Z" allows the contracture to change configuration and lengthen the scar
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