1.20 Burns 4 Flashcards
contamination vs. infection
- any wound bed will be contaminated because it’s an open sore
- doesn’t mean it’s infected
How do you know if a wound bed is infected?
- take a culture (flush with saline, swab wound bed)
- count of bacteria is 10^5 or higher to be considered infected
s/s of infection
- change in amount/color of discharge
- fever (systemic)
- odor (must irrigate, then smell)
- increased redness
- fatigue/general malaise
What are the complications of burns?
- infection
- pulmonary
- metabolic
- cardiovascular
- heterotopic ossification
- pathological scars
metabolic complications of burns
- takes a crap ton of calories to heal a wound (burn/pressure ulcer)
- body spends a lot of energy healing
What are some of the cardiovascular complications of burns?
- hypovolemia (loss of plasma)
- BP plummets, HR increases (trying to increase stroke volume
- can go into shock at any time
pulmonary complications that arise because of burns
inhalation injury
burns and heterotopic ossification (where, who, picking up on it)
- typically occurs in the joints
- can occur in spinal cord injury and TBI as well as burn victims
- harder to pick up on in burn patients
normal scar characteristics
- stay in the borders of the original wound
- flat/close to flat with our normal anatomy
hypertrophic scars
grows slightly beyond wound borders (height)
keloid scars
- keep remodeling and adding more collagen
- scar moves outside the borders
- takes over tissue adjacent to original wound
Who commonly gets keloid scars?
people of color (due to melanin content of skin)
scar management: what should you do if you notice even a hypertrophic scar? implications to PT?
- begin management and possible referral to plastic surgeon to keep it from progressing
- can create contractures
PT’s role with burn patients
- prevent contractures
- appropriate positioning (within MD’s guidelines)
- exercise when we can
- patient education on skin care
exercising a burn patient
- always monitoring grafts
- don’t want to do too much and make the graft fall off
- keep other complications from happening
big complications a PT should worry about when exercising a burn patient
- bedsores
- PE
- DVT
- pneumonia
severe burn patients: Wolff’s law
- form follows function
- tissue laid down following lines of stress
severe burn patients: maturation phase
6 months to 2 years
- constantly addressing ROM and scars
- apply low pressure long duration
severe burn patients: How do we apply low pressure for long duration to address scars?
- compression garments (stress) to be worn every day (23 hours)
- at least 12-18 months
fibrous band of scar tissue: how to address?
- may do taping to pull fibers in certain directions
- MD will do a z-plasty if taping doesn’t work (middle portion of the z bisects the band)
How often to burn patients need to put lotion on?
1-2x per day
PT education on skincare for burn patients: amounts
if they put too much on, the skin won’t absorb and it will become macerated
PT education on skincare for burn patients: type?
- unscented, hypoallergenic, plain soap
- no smelly lotions, generic
- vitamin e, lubriderm, aquaphor, etc
graft: skin from your own body
autograft
graft: same species, cadaver tissue
allograft
graft: different species
xenograft
graft: skin substitutes
biosynthetics
- can take a sample, send it to a lab, and they manufacture pieces of the person’s own skin
- time is a factor
- use temporary porcine graft
To use autograft, the burn cannot be
covering the whole body
autograft: thickness?
usually split thickness
autograft: Why is this the best type if available?
body sees it as its own tissue and grows quickly
How does the body heal with allograft tissue?
- gives our body a matrix to grow into
- not revascularized as well » peels off by the tim our bodies re-epithelialize
Most xenografts come from
pigs
Why would xenografts be used?
if there are no donors readily available
benefit to biosynthetic grafts
- can create specialized shapes (i.e. gloves)
- made from the person’s own skin cells
