Burns: ch. 7

Burns causes

Direct contact with______sources.

1. Chemical

2. Electrical

3. Radiation

4. Thermal

When do burns occur?

Energy from heat source is transferred to the tissue of the body

Factors influencing severity of burn

1. Depth

2. Size (TBSA)

3. Location

4. Age

5. General health

6. Mechanism of injury

What are thermal burns caused by?

Exposure to or contact with flames, hot liquids, steam, semisolids (like tar), or hot objects.

What causes chemical burns?

Tissue contact with or ingestion, inhalation, or injection of strong acids, alkalis, or organic compounds.

How are electrical burns generated?

By heat produced when electrical energy passes through the body.

What causes radiation burns?

Exposure to radioactive sources.

Who has highest risk of burn injuries?

1. Children 3-

2. Adults 70+

Risk factors for burns

1. Inadequate adult (S)

2. Psychomotor disorders

3. Rural locations

4. Mobile home residence

5. Occupation

6. Lack of smoke detectors

7. Fireworks

8. Misuse of cigarettes

Superficial Burn

Involves only the outer layer of the epidermis; area may be red with slight edema; healing occurs without peeling or evidence of scarring in 2 - 5 days.

Superficial Partial-Thickness Burn

Involves the epidermis and the upper portion of the dermis; involved area may be extremely painful and exhibit blisters; healing occurs with minimal to no scarring in 5 - 21 days.

Deep Partial-Thickness Burn

Involves complete destruction of the epidermis and the majority of the dermis; involved area may appear to be discolored with broken blisters and edema; damage to nerve endings may result in moderate levels of pain; hypertrophic or keloid scarring may occur; in absence of infection, healing will occur in 21 - 35 days.

Full-Thickness Burn

Involves complete destruction of the epidermis and dermis along with partial damage to the subcutaneous fat layer; involved area typically presents with eschar formation and minimal pain; patients will require grafts and are susceptible to infection; weeks to months to heal depending on the size of the area and if grafts are warranted.

Subdermal Burn

Involves complete destruction of the epidermis, dermis, and subcutaneous tissue; may involve muscle and bone, often require multiple surgical interventions and extensive healing time.

What is the most common life threatening complication involved with burns?

Infection

Head & neck rule of 9s

9%

Ant trunk rule of 9s

18%

Post trunk rule of 9s

18%

(B) ant arm, forearm & hand rule of 9s

9%

(B) post arm, forearm & hand rule of 9s

9%

Genital region rule of 9s

1%

ant BLE rule of 9s

18%

Post BLE rule of 9s

18%

PTA involvement with burn wound care

1. Minor burns consisting of cleansing

2. Removal of a damaging agent

3. Debridement of loose, nonviable tissue

4. Application of topical antimicrobial creams/ ointment and sterile dressing

Home care instructions for burns

1. Observation for s/s of infection

2. AROM exercise

Therapeutic interventions for burns

1. wound management, irrigation, debridement advanced wound dressings

2. Postioning and immobilization after skin grafting to prevent unwanted movement and shearing of grafts

3. Scar and contracture prevention management

4. Exercise, amp, and ADLs

5. Compression/ elastic garments

Allograft (Homograft)

Skin graft taken from another human

Autograft

A permanent skin graft taken from a donor site on the patient's own body

Heterograft (Xenograft)

A temporary skin graft taken from another species

Mesh Graft

A skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area

Age with higher mortality rates from burns

1. children 4-

2. adults 65+

Factors that increase complication and mortality rates for adults with burns

1. Obesity

2. Alcoholism

3. Cardiac disorders

4. Disorders that impair peripheral circulation

Decreases chances of infections and increases chance of survival

Earlier identification of non-salvageable limbs

Initial treatment interventions

1. Deep breathing (facilitate lung expansion)

2. Wound healing promotion

3. Reduce edema formation

4. Promote venous return

5. Prevent/ minimize deformities and hypertrophic scarring

6. Increase ROM, strength, and function

7. Increase (I) in ADL and self care

8. Encourage emotional and psychological well-being

How often to perform ROM

2 hours unless contraindicated with skin grafts

Desensitization interventions

1. Variable texture, pressure, and vibratory sensations

2. 5 to 10 minutes, 3 to 4 times per day