30 Questions
The zone of coagulation is characterized by vasodilation and erythema.
False
The zone of stasis can recover if adequate perfusion is restored within 1 to 2 weeks after injury.
False
Microemboli in the zone of stasis can improve local circulation.
False
The process of widening and deepening of the original area of necrosis is known as conversion.
True
The zone of hyperemia receives the most thermal energy and sustains severe cellular injury.
False
The zone of hyperemia generally takes longer than 7 to 10 days to recover.
False
A pulse that is weak and rapid is a sign of hypovolemic shock
True
The burn severity index consists of 10 variables
False
A urinary output of 30 mL/hr is indicative of hypovolemic shock
False
Joint ROM assessment is not a component of burn management evaluation
False
A hematocrit level of 45 is indicative of hypovolemic shock
False
Mobility and ambulation assessment is not a component of burn management evaluation
False
The Ring method is used to measure edema by comparing the circumference of the affected limb to the unaffected limb.
True
Grade 1+ pitting edema corresponds to a 6 mm depression that disappears rapidly.
False
The Water displacement method is a simple and efficient method for measuring edema.
False
Girth measurements are a type of volumetric measurement method.
False
The Water displacement method is suitable for patients who are unable to immerse their hands in water.
False
Grade 4+ pitting edema corresponds to a 4 mm depression that disappears in 10-15 seconds.
False
Breathing exercises, including deep breathing exercises and incentive spirometry, are more effective for young children than adults.
False
Suctioning, cough training, and postural drainage are all techniques used for limb elevation to control edema.
False
The desired position to prevent inability to open or close the mouth and inability to close the eyes fully is to elevate the head above the level of the heart for the first 24 hours.
False
A neutral rotation is recommended to prevent cervical flexion in the neck.
True
Shoulder abduction of 90 degrees is used to prevent adduction, extension, and internal rotation of the shoulder.
True
Elevating the head of the bed up to 30 degrees can help minimize facial edema in patients with facial or inhalation injuries.
True
Flexing shoulders to 90 degrees in sidelying can cause pull on brachial plexus
False
Wrist extension of 30 degrees is recommended in burn management
True
Cubital fossa and elbow extension are used to prevent shoulder protraction and kyphosis
False
ROM exercises may be better tolerated when combined with immersion hydrotherapy and timely pain and/or anxiety medications
True
Aerobic exercise should be commenced immediately after the burn injury
False
During the acute stage of rehabilitation, the exercises should be modulated to prevent heart rate from exceeding 20 beats per minute above the patient's resting heart rate
True
Study Notes
Local Response to Burn Injury
- Local effect involves 3 burn zones:
- Zone of Coagulation: point of maximum damage, irreversible tissue loss due to coagulation of proteins, characterized by coagulation, ischemia, and necrosis
- Zone of Stasis: area of cellular injury and compromised tissue perfusion, RBCs and platelets aggregate, may form microemboli, further impeding local circulation
- Zone of Hyperemia: outer edges of tissue affected by burn, receives least thermal energy, minimal cellular injury, characterized by erythema due to vasodilation, generally recovers within 7-10 days
Systemic Effect of Burn Injury
- Signs and symptoms of hypovolemic shock:
- Restlessness, anxiety
- Skin: pale, cold, clammy
- Temperature below 37°C
- Pulse: weak, rapid, systolic BP
- Urinary output < 20 mL/hr
- Urine specific gravity >1.025
- Thirst
- Hematocrit 35
- Blood urea nitrogen (BUN)
Burn Management Evaluation
- Components of evaluation:
- Patient demographic data and history
- Burn severity index
- Edema and limb circumference
- Sensory assessment
- Muscle strength assessment
- Joint ROM assessment
- Flexibility assessment
- Mobility and ambulation assessment
- Endurance assessment
- Function activities assessment
- Neurological and psychological factors assessment
Burn Severity Index (BSI)
- Abbreviated Burn Severity Index (ABSI) is a five-variable scale
- Variables associated with increased burned patient mortality rate in deep burns
Edema and Limb Circumference
- Assessment methods:
- Observation by comparison to the sound limb
- Palpation to determine type of edema (pitting or non-pitting)
- Measurement using water displacement, girth measurement, or ring method
- Edema grading:
- Grade 0+: No pitting edema
- Grade 1+: Mild pitting edema
- Grade 2+: Moderate pitting edema
- Grade 3+: Moderately severe pitting edema
- Grade 4+: Severe pitting edema
Volumetric Measurement Method
- Gold standard tool for measuring edema
- Utilizes principle of water displacement
- Disadvantages: time-consuming, difficult to move, requires specialized equipment, messy
Physical Therapy Management
- Breathing exercises:
- Deep breathing exercises and incentive spirometry exercises for adults
- Straws, singing games, and bubble blowing for young children
- Pulmonary hygiene:
- Suctioning, cough training, and postural drainage
- Positioning and splinting:
- To place burned body part in a position opposite to the direction of anticipated deformity
- Techniques to achieve desired position:
- Elevate head above the level of the heart for the first 48 hours
- Slight extension, neutral rotation, and avoid hyperextension
- Shoulder abduction 90 degrees, flex shoulders to 90 degrees
- Trunk extension, shoulder retraction
- Wrist extension 30, MCP flexion 75, IP flexion 0-5, and thumb abduction
- Therapeutic exercises:
- Range of motion exercises (active and active assisted)
- Mobility training (bed mobility and ambulation training)
- Aerobic exercise: walking, cycling, jogging, and swimming
This quiz covers the local and systemic response to burn injuries, including the three burn zones and the importance of controlling respiratory distress and shock.
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