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At what level of burn is there no pain bc the nerve endings are gone?
Full-thickness Burn (3rd degree)
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Burns - zones of injury - 3
- Zone of coagulation
- Zone of stasis
- Zone of hyperemia
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Burn Zone of coagulation - 2
- Cells are irreversibly injured
- Cell death occurs
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Burn Zone of stasis - 3
- Less severe damage than zone of coagulation - surrounds it
- Reversible damage
- Cells may die w/o specialized tx, within 24-48 hours
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Burn Zone of hyperemia - 3
- Minimal cell injury
- Surrounds zone of stasis
- Cells should fully recover within 7 days w/o any intervention or permanent damage
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Extent of burned area is determined by what? - 2
- % of the body's total surface area that has been burned
- Depth of burned areas
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Classification Systems for burns - 2
- Rule of Nines
- Lund-Browder
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Burns - % for Adults
- Head & neck - 9% (4.5% front + 4.5% back)
- Anterior trunk - 18%
- Posterior trunk - 18%
- Arms - 9% each (4.5% front + 4.5% back)
- Legs - 18% each (9% front + 9% back)
- Perineum - 1%
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Burns - % for children
- Head & neck - 17% (8.5% front + 8.5% back)
- Anterior trunk - 18%
- Posterior trunk - 18%
- Arms - 9% each (4.5% front + 4.5% back)
- Legs - 13% each (6.5% front + 6.5% back)
- Perineum - 1%
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Pulmonary complications of burns - 4
- Pneumonia
- Pulmonary edema (smoke inhalation)
- Airway obstruction (smoke inhalation)
- RLD from burns of trunk
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Metabolic complications of burns - 4
- INC metabolic/catabolic activity
- Weight loss
- (-) nitrogen balance
- DEC energy stores
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Cardiac complication of burns - 1
DEC CO d/t fluid/plasma loss
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1st degree burn - name
Superficial
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2nd degree burn - name - 2
- Superficial partial thickness
- Deep partial thickness
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3rd degree burn - name
Full thickness
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4th degree burn - name
Subdermal
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Superficial Burn (1st degree) damage is to - 1
Epidermis only
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1st degree burns are characterized by what? - 4
- Erythema: Pink or red appearance
- No blistering (dry surface)
- Minimal edema
- Tenderness, delayed pain
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Example of 1st degree burn - 1
Sunburn
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Healing of 1st degree burn - 1
Spontaneous healing in 2-5 days
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Scarring of 1st degree burn
No scarring
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Superficial Partial-thickness Burn (2nd degree) damage is to - 2
- Epidermis
- Upper layers of dermis
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Characteristics of Superficial Partial-thickness Burn (2nd degree) - 6
- Bright pink or red appearance
- Blanching w/brisk capillary refill
- Blisters, moist surface, weeping
- Moderate edema
- Painful, sensitive to touch
- Temperature changes
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Burns - healing of different stages
- I - spontaneous in 2-5 days
- II superficial - spontaneous in 7-21 days
- II deep - slow 3-5 wks
- III - full thickness - removal of eschar & skin grafting
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Burns - scarring at different stages
- 1st - no scarring
- 2nd superficial - no to min scarring + discoloration
- 2nd deep - hypertrophic/keloid scar + blanching
- 3rd full - Hypertrophic/keloid stays within boundaries of burn
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At what burn stage is there moderate edema?
Superficial Partial-thickness Burn (2nd degree)
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Healing of 2nd degree burn - superficial
Spontaneous healing in 7-21 days
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Healing of 2nd degree burn - deep
Slow - 2-5 wks
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Scarring of 2nd degree burn - deep - 2
- Hypertrophic/keloid scar
- Blanching
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Scarring of 2nd degree burn - superficial - 2
- Minimal or no scarring
- Discoloration
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Deep Partial-thickness Burn (2nd degree) Severe damage to - 5
- Epidermis & dermis
- W/injury in nerve endings, hair follicles, & sweat glands
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Characteristics of Deep Partial-thickness Burn (2nd degree) - 6
- Mixed red or waxy white appearance w/slow capillary refill
- Broken blisters, wet surface
- Marked edema
- Sensitive to P
- Insensitive to light touch or soft pin prick
- Severe pain
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At what burn stage is there marked edema?
Deep Partial-thickness Burn (2nd degree)
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At what burn stage is there - Insensitive to light touch or soft pin prick
Deep Partial-thickness Burn (2nd degree)
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Healing of Deep Partial-thickness Burn (2nd degree) - 2
Healing is slow: 3 to 5 weeks
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Scarring of Deep Partial-thickness Burn (2nd degree) - 2
- Hypertrophic and keloid scarring are common
- Blanching
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Full-thickness Burn (3rd degree) - 2
- Complete destruction of epidermis, dermis, & subcutaneous tissues
- May extend into muscle
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Full-thickness Burn (3rd degree) is characterized by - 6
- Tissues are white ischemic, gray, or black
- Parchment-like, dry leathery surface
- Escar formation
- No blanching; poor distal circulation
- Insensate or little pain (nerve endings ore destroyed)
- Often significant pain is experienced in the surrounding tissue, but not in the full-thickness area
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Healing of Full-thickness Burn (3rd degree) - 2
Removal of eschar & skin grafting are necessary d/t destruction of dermal & epidermal tissue
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Scarring of Full-thickness Burn (3rd degree) - 2
- Hypertrophic scarring & wound contracture
- Keloid (raised) scar that stays within boundaries of burn wound
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Tx of 3rd degree burn - 2
- Removal of eschar
- Skin grafting
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Subdermal Burn (4th degree) occurs from what?
- Prolonged contact with a flame
- Electrical burns
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Subdermal Burn (4th degree) - 2
Complete destruction of epidermis, dermis, w/involvement of subcutaneous tissues & involves bone & muscle
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Subdermal Burn (4th degree) is characterized by what? - 3
- Skin is charred
- Dry in appearance
- Mummified
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Tx for 4th degree burn - 1
Amputation
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Common deformity for anterior neck w/burns - what splinting is used? (3)
- Flexion w/possible lateral flexion
- Splints - Soft collar; molded collar; Philadelphia collar
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Common deformity for shoulder w/burns - what splinting is used? (2)
- ADD / IR / Extension
- Splints - axillary or airplane splint; sh ABD brace
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Common deformity for elbow w/burns - what splinting is used? (4)
- Flexion
- Splints - gutter splint; conforming splint; three-point splint; air splint
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Hand common deformity w/burns - 5 - what splinting is used? (3)
- Claw hand (intrinsic minus position)
- Stress wrist extension (15°)
- MP flexion (70°)
- PIP, and DIP extension
- Thumb ABD (intrinsic plus position)
- Splints - wrist splint; thumb spica splint; palmar ot dorsal extension splint
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Hip common deformity w/burns - 2 - what splinting is used? (2)
- Flexion & ADD
- Splints - anterior hip spica; ABD splint
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Knee common deformity w/burns - what splinting is used? (3)
- Flexion
- Splints - conforming splint; three-point splint; air splint
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Ankle common deformity w/burns - what splinting is used? (3)
- PF
- Splints - posterior foot drop splint; posterior ankle conforming splint; anterior ankle conforming splint
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What is an Allograft (homograft)?
When is allograft used w/burns?
- Same species, usually cadaver skin
- Temporary grafts for LARGE BURNS
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What is a Xenograft (heterograft)?
- Use of skin from other species, usually pigskin
- Temporary graft
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What is Autograft?
Use of patient's own skin
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What is Split-thickness graft?
Contains epidermis and upper layers of dermis from donor site
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What is Full-thickness graft?
Contains epidermis and dermis from donor site
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Epidermis/Upper layer of dermis - what type of graft?
Split thickness graft
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Epidermis & full dermis - what type of graft?
Full thickness graft
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Burns PT post grafts - 3
- Discontinue PT for 3-5 days to allow grafts to heal
- Elastic supports to help control edema
- P garments to help prevent hypertrophic scarring or keloid formation
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Topical medications & burns — applied 1-3 /day - 3
- Ointments - Bacitracin, Polymyxin B, Neomycin, Neosporin
- Silver sulfadiazine
- Sulfamylon
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Burns - avoid Silver sulfadiazine when? - 3
- @ term pregnancy
- <2 month="" old="" infants="" br="">W/sulfa drug allergies
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Dressings for burns - 4
- Silver impregnated
- Petrolium impregnated
- Hydrogels
- Gauze
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Surgical resection of scar contracture:
Z-plasty (surgical incision in the form of the letter Z used to lengthen a bum scar)
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Normal scar formation at 6 to 12 weeks looks like what?
Bright pink scar
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Normal scar formation at 12 to 15 months looks like what?
Changes to a soft lavender & finally faintly pink scar
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Scar - look - mature vs immature
- Immature - bright pink
- Mature - soft, white, flat
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Scar - time frame - mature vs immature
- Immature - 6-12 wks
- Mature - 12-15 months
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Keloid scar - define; describe; more common in who?
- Raised scar that extends beyond boundaries of original burn wound
- Red, raised, firm
- More common in women & w/dark skin
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Normal mature scar - describe (3); time frame
- Soft
- White
- Flat (takes over a year to occur)
- 12-15 months
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Immature scar - describe; time frame
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Epidermal healing is accomplished by what?
Protect how?
- Epithelialization
- Protect w/moisturizing creams
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Dermal healing accomplished by what?
Scar formation
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Initial tx for hypertrophic scars; how long?
Custom-made P garments - for 23 hrs/day often for 6-12 months
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Antibacterial agent that penetrates thick eschar
Sulfamylon
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