Burn Management Intermediate Phase

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Questions and Answers

List three factors that influence the selection of a specific agent and dressing for a burn wound.

Wound depth, location of the injury, and presence of infection.

Briefly describe the primary goal of wound cleansing during burn wound care.

The primary goal is to remove loose tissue to allow for proper visualization of the burn wound.

What is the main purpose of enzymatic debridement, and for what type of burn wounds is it often reserved?

The purpose is to hasten eschar separation and wound healing. It is often reserved for deep partial-thickness wounds with signs of healing, or full-thickness burns in patients not suitable for surgery.

Explain why early excision and grafting are considered beneficial in burn management.

Early excision and grafting decrease hospital stay and greatly increase patient survival rates. Signup and view all the answers

Why is autograft considered the 'ideal replacement' for lost skin in burn injuries?

Autograft is ideal because it is the patient's own skin and will not be rejected by the body. Signup and view all the answers

What is the most common donor site for split-thickness skin grafts, and why is it preferred?

The thigh is the most common donor site because it allows for obtaining a continuous donor sheet of skin. Signup and view all the answers

Describe the key difference in application between sheet grafts and meshed grafts, and explain why this difference exists.

Sheet grafts are used on exposed areas like the face for cosmetic appearance, while meshed grafts are used when skin is limited to maximize coverage. Signup and view all the answers

What is the purpose of meshing a skin graft, and what is a common expansion ratio used?

Meshing a skin graft expands it to cover a larger wound area when unburned skin is limited. A common expansion ratio is 1:2 to 1:4. Signup and view all the answers

In burn wound debridement, what tools are typically used for the removal of loose tissue during wound cleansing?

Tweezers and scissors are typically used, often aided by gauze dressing removal and hydrotherapy. Signup and view all the answers

Under what circumstances might a burn surgeon choose to apply a full-thickness skin graft, even though split-thickness grafts are more common?

A burn surgeon might choose a full-thickness skin graft to allow for the best function in certain anatomical areas, such as the eyelids. Signup and view all the answers

When does the intermediate phase of burn management typically begin?

The intermediate phase typically begins 48 to 72 hours after the initial burn injury. Signup and view all the answers

What is the primary method used for cleansing burn wounds in most burn centers, and why is it preferred?

Hydrotherapy is the favored method. It allows for thorough wound cleansing and uses water to help remove topical agents and necrotic tissue during dressing changes. Signup and view all the answers

Is burn wound care considered a sterile or clean procedure? Explain the difference.

Burn wound care is a clean, not sterile, procedure. Sterile technique aims to eliminate all microorganisms, while clean technique focuses on reducing the overall number of microorganisms. Signup and view all the answers

Why is the temperature often kept high during burn dressing changes?

The temperature is often set as high as 90°F (32.2°C) to prevent the risk of hypothermia in burn patients. Signup and view all the answers

Besides wound cleansing, what other important assessments and interventions take place during burn dressing changes?

During dressing changes, nurses and providers assess the wound for healing progress and signs of infection. Physical and occupational therapists may also assess the wound and the patient's range of motion and function. Signup and view all the answers

What are the main priorities of medical management during the intermediate phase of burn care?

The priorities shift to wound healing and closure, pain management, ensuring optimal nutrition, and continued prevention of infection. Signup and view all the answers

How has the practice of hydrotherapy evolved in burn centers?

It has evolved from total immersion in tanks or tubs to the use of portable shower trolleys with disposable plastic liners. Signup and view all the answers

Describe the typical duration and complexity of burn dressing changes.

Burn dressing changes are extensive, physically demanding, and time-consuming, often lasting 2 to 4 hours. Signup and view all the answers

Study Notes

Intermediate Phase of Burn Management

Begins 48-72 hours after initial injury
Focus shifts from life-threatening issues to wound healing, pain management, nutrition, and infection prevention
Continued respiratory and circulatory monitoring remains crucial

Wound Care Practices

Hydrotherapy: Preferred cleansing method at most burn centers
- Enables thorough cleaning and removal of residual agents/tissue
- Recent methods use portable shower trolleys to reduce cross-contamination
- Bedside care is option for patients not tolerating extensive hydrotherapy
Clean Technique: Not sterile, aims to reduce microorganisms
- Uses clean field, gloves, and instruments
- Dressing changes can last 2-4 hours
- Patient rooms often maintained at 90°F (32.2°C) to prevent hypothermia
- Assessing wound progression and infection signs is critical during each dressing change
- Physical and occupational therapists assess wound and function/range of motion during dressing changes
Topical Medications/Dressings: Many types are available
- Choice depends on wound depth, location, infection status, and provider preference

Wound Debridement

Wound Cleansing: Often done with mild soap/chlorhexidine and sterile water/saline with gentle debridement.
- Debridement removes loose tissue to visualize burn wound
Debridement Types:
- Mechanical: Uses tweezers, scissors, gauze removal, and hydrotherapy
- Enzymatic: Applies proteolytic ointment; hastens eschar separation; often used for deep partial-thickness wounds or full-thickness burns not needing surgery
- Surgical: Used if mechanical and enzymatic methods are unsuccessful

Surgical Treatment and Wound Closure

Early Excision and Grafting: Reduces hospital stay and improves survival
- Performed when patient is hemodynamically stable
- Common for large full-thickness burns within 24-48 hours of admission
Autografts: Preferred method; patient's own skin
- Harvesting epidermis and partial dermis from unburned area (donor site)
- Common donor sites include the thigh, scalp, and scrotum
- Can be reharvested numerous times
- Sheet grafts: For areas needing a seamless cosmetic look (face, hands)
- Mesh grafts: Used when unburned skin is limited to maximize wound coverage; have holes for expansion (expansion ratio 1:2 to 1:4)
Full-thickness grafts: Used for specific anatomical areas (eyelids) for optimal function.

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Description

Explore the critical aspects of burn management during the intermediate phase, which begins 48-72 hours after the initial injury. Understand wound care practices including hydrotherapy and clean techniques aimed at promoting healing and preventing infection. Key monitoring and assessment strategies are emphasized to ensure patient safety and recovery.