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2012-05-15 12:54:38

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  1. causes and characteristics of superficial burns / first degree burns
    Causes: sunburn, flash, scald

    Char: epidermis only, erythema, painful, heals fast (3-5 days) physiologically unimportant
  2. Superficial Partial Thickness burns
    effects what part of skin
    Boiling water, flash flame, steeam

    Epidermis and a little dermis
  3. Superficial Partial Thickness burns, signs and symptoms
    blisters, very red, pain, wet and weepy, heels in 10-14 days, rarely causes permanent skin change
  4. Deep Partial Thickness burns -- caused by? effects?
    Flame, chemicals

    Epidermis, most of dermis, and some skin appendages (sweat glands, sebaceous glands, hair follicles)
  5. Deep Partial Thickness burns signs/symptoms
    pain, red/white/yellow areas, not as weepy as superficial second degree, large blisters, edema, heals in 3-4 weeks, scars
  6. Full Thickness (3rd degree) burns caused by? effects?
    Prolonged exposure to flame, hot water, chemical or electrical burns

    Epidermis, dermis, appendages in dermis
  7. Signs and symptoms of full thickness burns
    white, red, black, or brown. dry, leathery, and firm. thrombosed vessels, minimal pain initially, often requires skin grafting, takes a long time and heals poorly if left alone.
  8. 2 types of autograft
    1 - sheet graft - skin applied as a solid sheet

    2 - meshed graft - small holes are added to let it stretch to cover a greater area and allow the wound to drain
  9. 2 depthss of autografts
    split thickness skin graft -- epidermis and part of dermis

    full thickness skin graft -- epi and all of dermis
  10. burn ward, goals of splinting
    improve positioning, pressure relief, decrease edema, maintain or improve ROM, immobilize skin graft, protect exposed joint, tendons, and other structures, assist w ADLs
  11. exercise baskics for burn pts
    AROM is most functional

    no forceful PROM

    no resistive exercises while in hypermetabolic state
  12. what kind of burns don't scar? which scar the most?
    superficial partial thickness burns usually do not scar

    deep partial and full thickness scar most
  13. what age group scars most?
    kids, bc they're hypermetabolic, so they lay down more scar tissue

    (but early healing or grafting can reduce scarring)
  14. signs of hypertrophic scarring
    erythema, elevated skin level surface (collagen), blanching white upon stretch (myofibroblasts)
  15. stages of hypertrophic scarring
    • Immature: red, raised rigid
    • Semimature: pink, raised, semi-rigid
    • Mature: pale, planar, pliable
  16. Vancouver scale for hypertrophic scar assessment measures what?
    • pliability
    • vascularity
    • pigmentation
    • height
  17. burn treatmetn pressure principles
    • positive pressure - constant and controlled, a bit over the capillary pressure of 23mmHg --- this lowers vascularity which decreases myofibroblast activity and collagen synthesis, and it encourages better orientation of the collagen during scarring phase
    • apply it 24h/day for about 1 year or until scars are mature!!!
    • begin wearing it when wounds are healed/closed
  18. TCC reduces pressure by what % compared to shoe w orthosis or barefoot?
    • 75% reduction in FF pressures compared to shoe w orthosis
    • 87% down from barefoot
  19. indications for TCC
    planar ulcerations, charcot's joints, post op reconstruction immobilization, chronic venous stasis wound
  20. contraindications for TCC
    acute infection or inflamed tissue, bad edema, wanger grade greater than 2 (or up to 4, debatable), ulceration other than WBA foot
  21. Wagner scale
    • 0 = no loss of protective sensation, but at risk
    • 1 = superficial ulcer
    • 2 = full thickness ulcer
    • 3 = deep ulcer with or without osteomyelitis, abscess, or joint sepsis
    • 4 = gangreen
    • 5 = extensive gangrene, needs amputation
  22. necessary to have _ degrees of DF and _ degrees of great toe extension for normal gait
    10 and 60
  23. compensatory mechanisms for equinus or inadequate DF
    early heel rise observable at HS

    subtalar pronation, rearfoot eversion, forefoot abd at midstance

    recurvatum at knee in mid stance w hip flexion

    collapse of midfoot, development of "rocker foot" deformity
  24. lymphedema stages
    • 0 - at risk
    • 1 - reversible (has pitting)
    • 2 - irreversible (no more pitting bc stuff turned fibrotic and hard)
    • 3/4 - elephantiasis (hard, heavy, abnormal shapes)
  25. lymphatic fluids big feature
    high protein concentration, therefore hydrophilic
  26. "mechanical insufficiency" regarding lymphedema
    lymphedema is a "high-protein load edema." Only the lymphatic system transports and absorbs high-protein load fluids (lymph fluids). Lymph fluid is essentiall the fluid in the body that can't be transported out of cells via the normal means of osmosis.
  27. high protein edema
    edema where there is a buildup of proteins in the interstitium

    proteins that aren't reabsorbed into the compormised lymphatic system stay in the body and attract more water, hence, more swelling
  28. Primary lymphedema def

    due to aplasia, hypoplasia, or hyperplasia (no, less, more lymphatics)
  29. Secondary lymphedema caused by...?
    injury, trauma, radiation therapy, lympy node dissection, skin infections, surgery, cancer, etc.

    or in third world countries, cause by parasites
  30. Stemmer's sign
    sign of lymphedema: dorsal hump on hand, heaviness, soreness, fatigue, discomfort
  31. lymphedema onset
    distal to proximal gradual onset
  32. Complet Degongestive Therapy involves...?
    Manual Lymphatic Drainage (MLD = massage), compression bandaging, exercises, intensive skin care