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______: sunburn: erythema, no blisters, mild edema, desquamation, no scar formation.
(obj 2)_____ _____ _____: epidermis completely destroyed, painful, sensitive to temperature changes and air movement. Red appearance and lesion will blanch. Blisters are typical. Moderate edema. Healing in 7-10 days.
superficial partial thickness
(obj 2)_____ _____ _____: sensation to pressure intact, reduced sensation to light touch and pin prick. Slow capillar yrefill, and appears red, or waxy white. Burn reaches vascular system in the dermis, causing marked edema in the intersitium/exudates/water loss by evaporation. Surviving skin appeandages provide pathway for epithelial migration to create islands of new skin. Heals in 3-5 wks (in uncomplicated). Hypertrophic/kelloid scarring is common.
deep partial thickness
____ _____: epidermis and dermis completely destroyed, and may extend into subcutaneous fat. Escar can be black to red to white, and especially if circumferential will require escharatomy because of trapped fluid underneath. Insensate MUST BE GRAFTED.
(obj 2) ______: to muscle and bone
(objective 5)Rule of 9's
- Head: 4.5%
- Arms: 4.5% each
- Legs: 9% each
- abdomen/back: 18% each
- groin: 1% each hahahahahahahahahaha
Five factors that effect seriousness and prognosis of burn injury:
- 1. location (face, neck, perineum, hand, foot, head)
- 2. TBSA (total body surface area)
- 3. Depth
- 4. comorbidities
- 5. age
Overall healing rate is __ day of healing time for each percent of TBSA (uncomplicated case).
A person with ___% TBSA cannot have all of that area grafted at once, so priorities are set and grafting is done sequentially.
What do you do for anterior neck burns:
Joint positions to guard against:
1. Ankle ____
2. Knee ____
3. Hip ___ and ___
4. Spinal ____
- stagger two mattresses longitudinally so the head would hang over the end into extension.
- 1. Ankle PF
- 2. Knee Flex
- 3. Hip flex and ER
- 4. Spinal Flexion
-Shoulder/axillary splinting would be appropriate if there is less than ____d of ABD. (different for adults and children how? and avoid what position for brachial plexus injuries).
- more rigid for children
- horizontal abd
Elbow in __ and full ____.
If there is a posterior burn the patient should alternate between what 2 positions every 2 hours?
supination and full extension
supination and full extension and 30d of elbow flex
Palmar hand burn: what position
Dorsal Hand burn: what position
- palmar- flat and fingers spread "paddle"
- dorsal- intrinsic plus position: wrist ext; MCP 70d; IP 0d; thumb: abd, wide web space.
____= self- e.g. from thigh; culturing/growing epithelial tissue froma sample of keratinocytes taken from the patient. Requires 20-30 days-yields only epidermal tissue.
____/____= pig or hand
Types of Autografts:
____ ____ skin graft: used for critical zones (face and hands, for cosmetic and functional requirements); the donor site will require split thickness graft to cover it.
____ ____ skin graft: donor site will be more painful, because nerve endings are cut; may be meshed to increase the surface area it is able to cover.
full thickness skin graft
split thickness skin graft
* a new graft firs appears ___ and then becomes ____ in a matter of hours as vascularization occurs. Dressing provides compression to promote adherence.
* _____ with a splint ____ and ____ to the graft.
* avoid ______
*may need initial ____ to prevent increased vascular pressure from causing graft to come loose.
*monitor for odor, adherence, drainage, hematoma under graft, infection.
*surgeion typically orders resumption of ROM __-__ days after grafting. (except if graft is not an autograft, but rather a skin substitute).
- *white and then pinkish
- *immobilized with a splint distal and proximal
- *avoid friction
Start AROM-AAROM after fluid resuscitation within ______ hrs.
Perform ROM _____ during waking hours.
Take precaution with ROM to ____ and ____.
Wait __ to __ days after autografting has occurred.
When clear face mask if applied, all contours of the face should be ______.
Joint Mobs: Grades ___ ___ for acute; Grades ___ ___ once scar matures
- 12-24 hours
- every hour
- exposed tendon and dorsal hand burn
- 3-5 days
- Grades I and II
- Grades I-IV
_____ ______: associated with large joints; caused by burn with immobilization, lone bone fx, hip replacement, neuro conditions (TBI and SCI).
Aggressive ____ carries risk of creating the above mentioned.
Rehab: after immobilization and NSAIDS, begin therapy with ___ ___ ____ ROM.
- Heterotropic Ossification
- gentle pain-limited
_____ ______: 75% of occurences are by blunt injury which causes hemorrhage in the deep muscle tissue. Not typically associated with joints like HO; easily identified by radiographs.
Immobilized for ___ to ___ weeks followed by initation of gradually increasing exercise to the muscle group with NSAIDS.
- Myositis Ossificans
- 2-4 weeks
Burns most suseptible to scarring are ___ ____ ____ burns that were not grafted, and that take longer than __ weeks to heal.
Burn survivor will be suseptible to scarring up to __ to ___ monthes post burn, that most active phase first ___ to ___ months.
Mature scar: flat, pliable, soft
Hypertrophic scarring: the 3 R's
___ ____ ____
____ scar "mushrooms" beyong boundary of the wound. AA, Asians and children are more suseptible.
- deep partial thickness burns
- Red, Raised, Rigid
Scar massage should be done ___ to ____ times a day in drier climates usually with lotion that doesn't drip off the hands.
Apply enough pressure to cause ____ to area.
Perform scar massage ___ minutes per square inch.
For larger areas, use the ____ of the hand.