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54 Cards in this Set
- Front
- Back
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Etiology of burns |
Thermal Chemical Electrical |
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Describe Thermal Burns |
Result from direct/indirect contact with flame, hot liquid, or steam Influenced by: Contact time, temp, type of insult |
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Describe Chemical Burns |
Acids, Bases, Industrial accidents, assualts. Most likely to cause full thickness damage |
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Chemical Burns severity are influenced by... |
Alkaline - more severe than acidic Contact time - continues until irrigated Chemical Concentration Amount of chemical |
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Describe electrical burns |
Low and high voltage currents Entrance wounds - depressed or charred Exit wound - larger explosive Skin may not be severely damaged despite deep tissue injury due to difference in resistance |
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What concomitant injuries can you have with electrical burns |
Fractures, muscle necrosis, neurological injuries, cardiac, pulmonary, other organ failure |
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Electrical burn severity influenced by... |
High voltage current causes more damage AC burn injuries are more severe Contact time |
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How to classify and characterize burns |
Depth of burn Total Body Surface Area Severity |
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Describe depth of burn injuries |
-In terms of degrees -Level of tissue involved -Usually not all one depth -Infection can inc depth -Chemical burns take 24-72 hours to fully develop |
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Describe SUperficial burns |
"First Degree" -Dry, bright red, or pink skin that blanches upon pressure -No dermal vessel damage -Resolves in 3-5 days without scarring Ex: Sun burn, minor flash burn |
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Describe superficial Partial Thickness burns |
"Superficial second degree burn" -Painful.moist, weeping, blistered with local erythema and edema -Blanches to pressure with immediate capillary refill -Heal within 10-14 days with minimal or no scarring Ex. Brief contact burns, flash burns, brief contact with dilute chemicals |
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Describe Deep partial thickness burns |
"Deep second-degree burns" -Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity -Blanches to pressure with Slow capillary refill -May take 3 or more weeks to heal -Scarring, pigment changes, contractures possible Ex. Severe sunburn, scald, flash burn, brief contact with dilute chemicals |
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Describe Full thickness burns |
"Third Degree Burns" -Initially look red then become mottled white/black dry, leathery eschar, and painful -Burned areas insensate to light touch -Scarring and contractures likely -Most require surgical debridement and grafting Ex. Prolonged contact with flam, immersion scald injury |
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Describe Subdermal Burns |
"Fourth Degree burns" -Charred, mummified appearance -Exposed deep tissues -Burned areas insensate to light touch -May have permanent nerve damage -Req surgery (fasciotomy, escharotomy, grafting) and possible amputation Ex. Electrical burn, s trong chemical burn |
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What is TBSA |
Total Body Surface Area -Rule of Nines -Lund and browder chart -Palm method - size of palm equals 1% |
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Describe the Lund Browder Classification |
-Takes into account variation of body proportion from child to adult -Appropriate for children under age 16 -Preferred by pediatric burn units |
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Describe the Lund and Browder Chart |
-Most accurate to calculate TBSA -Subdivides body segments into % TBSA based on age -Requires chart to calculation |
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Describe the rule of nines |
Divides body into areas of 9% or multiples of 9s -perineum is 1% -Head, front and back of each UE and LE -Ant - post trunk each equal 18% -consistently overestimates the size of burns in young teenagers |
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Describe the palmar method for TBSA |
Uses area of plantar surface of the patients hand to determine burn size Highly unreliable, inaccurate |
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How is burn severity determined |
(Size, depth, age) Minor: out patient Moderate: In patient Major: Specialized burn unit |
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Adult percentages for FT and PT burn classficiation |
(FT% - PT%) Minor: <2 , <10 Mod: 2-5 , 10-20 Major: >5 , >20 |
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Child percentages for FT and PT burn classficiation |
(FT% - PT%) Minor: <1 , <5 Mod: 1-5 , 5-10 Major: >5 , >10 |
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What are the "Zones" of the integ system? |
Zone of coagulation Zone of stasis Zone of Hyperemia |
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Describe Zone of coagulation |
-Central portion, irreparable damage -Characterized by coagulation, ischemia, necrosis |
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Describe Zone of Stasis |
-Area of cellular injury and compromised perfusion -Conversion: Widening and deepening of necrosis |
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Describe Zone of Hyperemia |
Outer edges, minimal cellular injury |
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Complications of bandaging burns |
Bandages that are too tight Undue pressure from splints Improper pt positioning |
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Effect of burns on Cardiovascular system |
Burn shock - massive fluid shift causing hypovolemia and edema Results in dec blood volume --> necrosis, organ failure, and death |
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Who is at risk for burn shock? |
Patients with more than 15% TBSA |
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What to be aware of regarding the CV system and its relation to burn care |
-Fluid resuscitation is vital -BP generally dec due to hypovolemia -Resting HR 100-120 bpm -Monitor peripheral pulses -Must monitor and manage edema |
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Effects of burns on the pulmonary system |
Inhalation inuries cause up to 20% of burn deaths -Smoke inhalation, carbon monoxide, pulmonary edema, pneumonia, ARDS |
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What to be aware of regarding the pulmonary system and its relation to burn care |
Suspect lung involvement if signed facial hair, carbonaceous sputum, closed space injury, burns to face/neck/torso Monitor for signs of breathing difficulties Monitor oxygen saturation Encourage aggressive pulmonaray hygiene |
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Effects of burns on metabolism |
Basal metabolic rate doubles or triples Inc in core temp Sustained hyperglycemia Inc fat catabolism Dec in body mass Peaks 7-17 days post major brun injury Greater nutritional needs |
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Effects of burns on the immune system |
75% of burn pt deaths due to infection -Sepsis and infection common -- Endogenousand exogenous bacteria --Decreasedtissue perfusion reduces immune system effectiveness --Neutrophilsless effective --Eschar,blister fluid, residual topical agents excellent medium for bacterial growth --Openwound for extensive periods of time |
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What to be aware of regarding the immune system and its relation to burn care |
Aggressive debridement and rapid skin coverage is necessary to reduce risk of infection Prophylactic topical anitmicrobials |
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Other system complications due to burns |
Multi-organ system dysfunction CNS dysfunction Acute kidney failure GI dysfunction/peristalsis/ileus/ulcers -Encourage early, controlled mobility |
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Psychological dysfunction and burns |
PTSD Anxiety/depression/disturbed sleep Extremely common |
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What to be aware of regarding psychological dysfunction and its relation to burn care |
Pt. education, control pain and anxiety Promote pt independence Involve family and friends |
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PT interventions for burns |
Coordination, communication, and documentation -Reinforce goals -Participate in pt rounds -Pt. edu -Give pt control over their rehab |
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Patient/Client related instruction |
-Ways to control pain -What to expect during procedures -How to care for wounds -Proper positioning -Edu on importance of skin care/scar management |
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Precautions for procedural interventions |
Screen for domestic violence Anticipate/prevent complications when possible -Contractures -Infection -Deconditioning -Pulmonary dysfunction -Pressure ulcers -Adequate pain control |
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Debridement for wounds |
-Foreign debris, residual topical agents, exudate, hair, necrotic tissue -Remove blisters (open and closed) -Consider enzymatic debridement is appropriate |
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Infection control with burns |
Sterile technique for large TBSA burns Topical antimicrobials are standard -Silver sulfadiazine -Mafenide -Bacitracin Signs of infection -Inc erythema/pain, foul odor, purulence -Inc in necrosis, fever, inc tachycardia |
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Dressings for burns
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Most common -Topical antimicrobial covered with nonadherent impregnated gauze, bulky gauze dressing Limit bulk to allow movement Short stretch compression wrap to dec edema and scarring |
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Scar management for burns |
Moisturizer Protect from friction/shear Scar mobilization Compression - req if wound take 3+ wks to close Consider silicone gel sheets/pads, ultrasound, paraffin Darker-skinned individuals > incidence of hypertrophic scarring and keloids |
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What is the vancouver scar scale |
Rates 4 scar qualities -Vascularity -Pliability -Pigmentation -Height Scores range from 0-14 Lower score indicates less severe scar tissue |
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Procedural interventions |
ROM Mobility training Breathing exercises Aerobic Exercise - target HR 50-70% of max predicted HR |
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Devices and equipment for burns |
Splints/Braces -Immobilize and protect grafts fractures, peripheral nerve injuries Dynamic Splints -Assists with contractures |
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Physical agents and modalities |
Whirl pool Pulsed lavage w/ suction Ultra sound Paraffin |
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Medical Interventions |
Pharmacological management -Ensure adequate control of pain and anxiety -Time procedures with medications |
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Surgical interventions |
Debridement -Early debridement often performed on pts with medium and large FT burns -Escharotomy - Incision through eschar and subcutaneous tissue to release tissue constricting circulation -Fasciotomy - incision through fascia to release pressure/improve distal circulation -Skin Graffting - Mainstay for FT or DPT burns/autographs/xenografts for temporary coverage -Split thickness grafts - removes epidermis and part of dermis -FT grafts - more durable and most cosmetic |
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What can cause graft failure |
Infection Eschar Insufficient immobilization Fluid collection under graft Prior surgery - areas that have been previously compromised |
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Surgical substitutes to grafting? |
Skin substitutes -Bi layered dressing with epidermal and dermal analog -Used on donor sites and wounds Cultured epithelial autographs -Cultures pt own cells -Grown in lab and stapled sutured in place |
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Benefits of skin substitutes |
Dec water loss Maintain wet, warm environment Provide physical barrier to infection Thermal Insulation Decrease pain Promote tissue granulation Less fq dressing changes Dec contraction Enhance healing |
