Patho exam 2- Burns
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32 terms
Terms | Definitions |
|---|---|
 3 factors → mortality w/ burns | Age: higher risk if <48 months or >60 years old Burn size: higher risk if > 30% Inhalation injury (complicating factor) |
| burn center qualifications- 2/3rd degree | ● 2nd and 3rd degree burns > 10% in pts < 10 or > 50 years ● 2nd and 3rd degree burns >20% in all age groups ● 2nd & 3rd degree burns involving face, hands, feet, perineum, and/or all major joints |
| burn center qualifications- 3rd degree+ | ● 3rd degree burns >5% in all age groups ● Electrical burns, including lightning ● Chemical injuries with functional or cosmetic impairments ● Inhalation injuries ● Pts with pre-existing medical conditions ● Pts with associated trauma |
| 5 types of burns | Thermal Friction Chemical Frostbite Electrical |
| rule of 9's- adult | Head: 9%, 4.5% for front and back Arms: 9% each, 4.5% for front and back Legs: 18% each, 9% for front and back Torso: 36%, 18% for front and back Genitals: 1% |
| rule of 9's- children | Head: 17%, 8.5% for front and back Legs: 13% each, 6.5% for front and back The other body parts have the same values as the adult model |
| 4 levels of burns | Superficial partial burn (1st and 2nd degree) Deep partial burn (deep 2nd degree) Full thickness burn (3rd degree) 4th degreee burn (typically electrical) |
| Superficial partial burn (1st and 2nd degree) | ● Appears red or pink, bilstered, textured, wet, soft, swollen, and clean. Blanches. ● Involves the epidermal and possibly small parts of the upper dermal layer. Sensation is intact and burn is very sensitive to temperature, air, and touch. ● Wound closure in <14 days. ● Grafting not needed and scarring unlikely |
| Deep partial burn (deep 2nd degree) | ● Appears mottled red or waxy white ● Involves the epidermis and greater portion of the dermis ● Wound closure in 3-6 weeks ● Grafting may be needed, pressure therapy used for scarring |
| Full thickness burn (3rd degree) | ● Appears marbled, white or tan, waxy, leathery, and rigid. Covered with eschar and extremely swollen ● Entire epidermis and dermis layers affected including nerve endings, hair follicles, and sweat glands. Wound has no sensation ● Closure requires skin grafting and scarring is a major concern |
| 4th degreee burn (typically electrical) | ● Entry wound is charred and depressed, exit wound is dry and looks explosive. ● Structures involved are variable. There may be blood vessel thrombosis and nerve damage along path of electricity ● Extensive grafting and excision of necrotic tissue necessary. Amputation may be necessary. Definite scarring |
| severity of a burn factors | Age of victim Type of burn Past medical history and current medical status Body areas involved Additional Trauma |
| zone of coagulation | center of the burn where the most damage occurred; no sensation, skin is dead. The dead skin is called eschar and needs to be removed for the wound to heal. This area will need grafting |
| Zone of stasis | surrounds the zone of coagulation. The tissue is marginably viable and very painful, may need grafts. |
| Zone of hyperemia | surrounds the zone of stasis. The area has minimal cell injury and is expected to heal fully without grafting. |
| Acute phase of burn care | goal is to get the body covered. Tx can include escharotomies, fasciotomies, early excision, grafting, and permanant coverage. |
| Rehabilitation phase of burn care- acute | goal is to prevent contractures and maintain ROM Tx PROM, positioning, splinting |
| Rehabilitation phase of burn care- after wound closure | goal is return to function. Tx PROM → AAROM → AROM, dyanamic splints, strengthening, coordination, balance, endurance/activity tolerance, gait training, ADL's, scar mgmt and control (don't want hypertrophic & keloid), psychosocial, community re-entry, make-up, follow-ups |
| grafts for permanant coverage | Sheet grafts: smaller burn areas Meshed grafts: larger burn areas Cultured epithelial grafts: when the pt doesn't have adequate healthy skin to use the other methods, typically greater than 95%. Very expensive. |
| grafts for temp coverage | allografts (homograft): skin from human or cadaver, requires immunosuppressants xenograft (heterograft): skin from pig synthetic covering |
| neck | common deformity: flexion motion to be stressed: extension positioning: use double mattress, extend neck. w/ healing use rigid cervical orthosis |
| shoulder and axilla | common deformity: ADD and IR motion to be stressed: ABD, ER, flexion positioning: shoulder flexed and abd (airplane splint) |
| elbow | common deformity: flexion and pronation motion to be stressed: extension and supination positioning: alternate flexion and ext splints |
| Hand | common deformity: claw hand motion to be stressed: wrist extension; MCP flexion, PIP and DIP extension, thumb abd positioning: wrap fingers separately, intrinsic plus position (all of the stressed motions + large web space) |
| Hip and groin | common deformity: flexion and ADD motion to be stressed: all motions, esp hip ext and ABD positioning: hip neutral w/ slight ABD |
| Knee | common deformity: flexion motion to be stressed: extension positioning: posterior knee splint |
| Ankle | common deformity: plantar flexion motion to be stressed: all motions, esp dorsiflexion positioning: plastic ankle-foot orthosis w/ cutout for achilles tendon, and ankle in neutral |
| importance of splinting/positioning | prevent & treat contractures maintain ROM (especially lengthening) achieved during exercise or from surgical release protect a joint or tendon minimize edema (positioning) prevent tissue destruction (positioning) |
| rehabilitation phase focus | ROM continuing from PROM to AAROM and AROM Positioning and splinting with addition of dynamic splints, focus is on tight areas Strengthening Coordination and balance Endurance and activity tolerance Gait training ADL's Scar management |
| risks for hypertrophic scarring | Lengthened wound healing time (most important) Grafted skin Young children Reharvested donor sites Ethnic groups (darker skin = more risk) Area of the body |
| scar massage | softens tissue, breaking up the collagen matrix and adhesions to fascia |
| compression | Decreased blood flow causes hypoxia which reduces cell proliferation and collagen synthesis. Collagen reorients in a parallel fashion Decreases tissue edema Toughens the skin and decreases itching |
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