burn care & management

true or false: burn centers treat soft tissue infections in addition to burn injury

true

criteria for burn center referral

-partial thickness burns greater than >10% TBSA

-full thickness any size any age (more critical >5% TBSA)

-burns on face, hands, feet, genitalia, perineum, or major joints OR any burn that is circumferential

-any third degree burns-high voltage electrical burns, including lightning injury

-chemical burns or inhalation injury-burn injury in those with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality

-burns and concomitant trauma in which the burn injury poses the greatest risk of morbidity or mortality

-burn injury in clients who will require special social, emotional, or rehabilitative intervention

how long does it take for a burn to declare itself?

48-72 hours

what are the three zones of injury?

coagulation stasis hyperemia

zone of ________ = area of burned tissue that is irreversible and no longer viable

coagulation

zone of ________ = potentially reversible if appropriate burn intervention is administered

stasis

the zone of hyperemia (zone 3) is completely reversible UNLESS there is an infection in which zone?

zone 2 - stasis

zone of ________ = area of unburned tissues around zone 2 (stasis)

hyperemia

which zone of injury is where burn care tries to mitigate due to it being the most damaged zone?

zone 1 - coagulation

after a burn, it is important to run the area under ______ water for 20 minutes to restore normal temperature

cool

what are the two main concerns associated with burn injury?

infection control, fluid replacement

burns are classified based on _______ and ______

depth; severity/SA

what are the four terms defining the depth of penetration or thickness of skin injured?

- superficial

- superficial partial thickness

- deep partial thickness

- full thickness

which type of burn is not included in TBSA calculations since it does not involve the dermis?

Superficial

which type of burn affects the epidermis only and involves erythema of the skin that may be warm to the touch and dry?

Superficial

superficial burns usually heal within ____ days

3-4

the ________ is the tough outer layer of the skin composed of epithelial tissue

epidermis

the epidermis is _________ which means the nutrients need to come from the dermis

avascular

in "thin" skin (legs, back, forearms, etc), there are ____ layers; however, "thick" skin is comprised of an extra layer known as the ________ _______

4; stratum lucidum

layers of the epidermis

- stratum corneum (superficial)

- statrum lucidum (thick skin ONLY)

- stratum granulosum

- stratum spinosum

- stratum basale (deepest)

superficial partial thickness burn injuries extend into the ________ ________ and can be referred to as "second degree burn"

papillary dermis

presentation of superficial partial thickness burns

- severe pain & swelling

- sensation is present

- blanching with pressure

- blistering

- moist/pink

superficial partial thickness burns usually occur due to ________ which can be associated with hot liquid or steam

scalding

which type of burn injury heals within 2-3 weeks by re-epithelization from dermal appendages and rarely forms a hypertrophic scarring or contracture?

superficial partial thickness

______ is a term referring to a healing process where the top layer of skin sheds off

Slough

the _______ _________ ________ is composed of dermal papillae and epidermal pegs that create a bond in order to withstand friction and shear forces of the skin

dermal epidermal junction

the dermal epidermal junction flattens with age which makes geriatric skin more susceptible to skin _______ and affects the healing process

tearing

which part of the dermal epidermal junction allows the nutrients from the dermal vasculature to pass through the avascular epidermis and permits re-epithelialization?

basement membrane

deep partial thickness burn injuries extend into the _________ ________ and are formerly known as "third degree burns"

reticular dermis

deep partial thickness burns lack nociceptive sensation but can still feel

- vibration

- rapid pressure

- stretch

- light touch

- sustained pressure

which type of burn injury has the following characteristics?- mottled white appearance

- does not blanch with pressure

- impaired capillary refill

deep partial thickness

deep partial thickness burns can cause permanent damage to

- hair follicles

- sebaceous glands

- epidermal cells responsible for re-epithelialization

deep partial thickness burn injuries heal within 3-9 weeks by _________ and requires surgery since re-epithelialization cannot occur

contraction

which type of burn injury will require debridement and grafting and will form a hypertrophic scar and contracture?

deep partial thickness

which layer of skin has the following characteristics? - composed of collagen & elastin - vascular - shiny appearance - capillary beds and blood vessels

dermis

the papillary region of the dermis lies just below the epidermis and includes ____ that make connection to stratum basale (capillaries)

dermal papillae

which region of the dermis consists of dense irregular connective tissue and makes up 80% of the dermal thickness?

Reticular

the _______ region of the dermis gives increased structural support to the skin by anchoring the glands, hair follicles, nerves, and blood vessels in place

reticular

the _______ ______ muscle is located within the reticular dermis where anchors itself to the hair follicle and is involved in extending the hair straight up when cold or scared

arrector pili

the dermis assists in ________ _______ and thermoregulation

infection control

which layer of the skin provides sensation as it contains nerve receptors associated with light touch, deep touch, and pain?

Dermis

__________ are the main cells found in the dermis that produce collagen and elastin

Fibroblasts

_______ are inflammatory cells located in the dermis which function to release histamine

Mast

_________ are cells located in the dermis which function in phagocytosis of dead skin cells

Macrophages

hair _________ and ________ glands are two critical sources of re-epithelialization

follicles; sebaceous

which accessory organ / appendage functions to keep skin from drying out and destroys some pathogens on the skin?

sebaceous glands

_______ sweat glands are responsible for odor and are located in the armpit & groin and are also sexual attractants

Apocrine

_______ sweat glands are the simple sweat glands located on the palms, soles, forehead and upper lip

Eccrine

in a ______ _______ burn, injury can reach the hypodermis and may possibly burn through the subcutaneous layer

full thickness

in a full thickness burn injury, there is a loss of skin barrier function which indicates

no possibility of healing from the wound base as all of the dermal regenerative cells have been obliterated

which type of burn injury has the following characteristics?- leathery brown or black eschar - dry - no capillary refill / blanching - pigmentation is fixed - pink/white may be present - shrinks or contracts due to dead tissue - no sensation

full thickness

what is only type of excision that PTs are allowed to perform?

selective sharp debridement (just nonviable tissue)

the ________ is not technically apart of the skin and is composed of adipose/fat cells, vascular supply, and connective tissue

hypodermis

the ________ binds the skin to the underlying structures (muscles, bones) and supports the dermis and epidermis

hypodermis

the hypodermis is composed of

-loose CT

- vascular supply

- adipose cells

superficial thickness burns depth/characteristics

depth:epidermis

characteristics:pain, redness, mild swelling

superficial partial thickness burns depth/characteristics

depth: dermis (papillary region)

characteristics:pain, blisters, splotchy skin, severe swelling

deep partial thickness burns depth/characteristics

depth: dermis (reticular region)

characteristics:white, leathery, relatively painless

full thickness burns depth/characteristics

depth:hypodermis (subcutaneous tissue)

characteristics:charred, insensate, eschar formation

which type of burn injury? - painful- does not blister- does not scar

superficial

which type of burn injury? - do not require surgery, but may scar and be more painful - blisters / weeps

superficial partial

which type of burn injury? - require surgery and form more scars - less painful - blisters/weeps

deep partial

which type of burn injury?- dry - insensate to light touch and pin prick - small areas will heal with substantial scar or contracture - large areas require skin grafting - high risk of infection

full thickness

TBSA is used to estimate _____ and ______ requirements and predicts morbidity and mortality

fluid; calorie

the "rule of nines" is used for rapid and easy assessment of burn injuries in adults with BMI < ___ but the "rule of sevens" is used if the individuals BMI is > _____

35

the ______-______ chart is a more accurate method and is useful in the pediatric population, but it is more time consuming

lund-browder

Rule of Nines for Burns diagram

-

a ________ burn is a result of the direct energy transfer to the tissue in relation to temperature and contact time

thermal

Types of thermal burns

- scald - flame - contact - frostbite

a _______ burn is a type of thermal burn that is a result of contact with hot liquids

scald

true or false: a scald burn is the most common burn etiology in the developed countries

true

Grease burns are scald burns. Why is this more worrying than water?

the substance stays on the skin longer

140 deg F can take 3-5 seconds to cause a

deep partial thickness burn

_______ is the second most common mechanism of burns and smoke inhalation is a major concern

Flame

Inhalation injury should be suspected if the physical examination reveals

- singed nasal hairs

- voice changes

- carbonaceous sputum (black colored)

- stridor (noisy breathing)

_______ burns are a result of skin contact with hot objects such as metals, plastic, glass or coal

Contact

in contact burns, the depth of the burn is in relation to ________ of contact and ______ of object

duration; temperature

Frostbite most commonly occurs at temperatures below ____ and is due to ____________

-28.4º F

- the slow freezing of tissues and subsequent intra- and extra-cellular crystal formation

frostbite results in injury that progresses from _______ to _______ extremities and other exposed structures such as the ears and nose

distal; proximal

frostbite: low temperatures = _________ of blood vessels

vasoconstriction

frostbite injuries are mostly ________ since the medium is the cold air which requires referral to a burn center

circumferential

________ is a good prognostic factor in frostbite injuries

Sensation

for a frostbite / cold burn injury, surgical intervention is delayed for ____-____ days to allow the injury to fully declare itself

10-14

true or false:fingers and toes can self amputate in a frostbite injury

true

treatment for frostbite

- rewarm the body rapidly - vasodilators (tPA)

_____ injury occurs secondary to acid or base making contact with the skin

Chemical

Which chemical burns are less severe - acid or base? Why?

ACID - coagulation necrosis protein eschar impairs further penetration

Why are Basic chemical burns worse?

liquefication necrosis of tissue -->deeper penetration

________ burns are dependent on type of energy source, total dose and time administered, location and size of exposed areas

Radiation

______ radiation burns = skin changes within first 6 weeks

Acute

______ radiation burns = skin changes for months to years

Chronic

Presentation & Treatment of Radiation burns

- tight, flaky, warm, dry

- treat: moisturize

true or false: electrical burns can be caused by both high and low voltages

true

individuals are usually kept for 24-48 hours post _______ injury to monitor the heart on telemetry due to the involvement of organ systems

electrical

electrical currents cause muscle ___

tetany

electrical burns travel from least to most resistance: ______ has high resistance and will heat up causing injury to adjacent muscle and lead to compartment syndrome which requires a fasciotomy

bone

Least to most resistance for electrical burns

- blood

- vessels

- nerves

- muscle

- skin

- tendon

- fat

- bone

road rash is a type of ______ _____ _______ burn injury

superficial partial thickness

TBSA determines ________ resuscitation & ________

fluid; nutrition

initial assessment includes the "ABCs" - what does this mean?

Airway breathing circulation