Burn Injury

Question 1

First degree burn

Answer 1

superficial on the epidermis

painful, does not blister, does not scar

Question 2

Second degree burns

Answer 2

partial or intermediate thickness

Either superficial (epidermis) which do not require surgery and might scar or intermediate (dermis) which require surgery and scar

Blisters and weeps

Increased depth = increased risk of infection and increased risk of scars

Question 3

Third degree burns

Answer 3

Full thickness, through the dermis

Dry

insensate to light touch

small areas will heal and scar substantially

large areas require skin grafts

high risk of infection

Question 4

Fourth degree burns

Answer 4

Involves muscle or bone

Leads to loss of the burned part

Question 5

Systemic Inflammatory Response Syndrome/Sepsis

Answer 5

1. Burn injury causes DAMPs and PAMPs to be released
2. Hypovolaemic shock and vascular leak, immune and inflammatory response, metabolic changes
3. These lead to immunosuppression, bacterial multiplication, and hypermetabolism
4. Leading to SIRS and/or Sepsis
5. Multiple organ failure
6. Death

Question 6

What causes fluid shift?

Answer 6

1. Edema formation due to increased permeability because of inflammatory mediators released. Increase in capillary hydrostatic pressure at burn wound.
2. Loss of integrity in the interstitial space. More fluid flows into the interstitial space
3. Loss of oncotic gradient between plasma and interstitium so fluid does not go back into the capillary
4. Progressive intravascular fluid loss and hypovolemia. Resuscitation is required to prevent multiorgan failure and cardiovascular collapse. The resuscitation causes further edema

Question 7

What causes muscle protein breakdown following burns?

Answer 7

occurs due to a systemic inflammatory response triggered by the burn injury, leading to elevated stress hormones like cortisol and catecholamines, which promote muscle protein breakdown while suppressing protein synthesis, further exacerbated by impaired nutrition and disuse atrophy from immobilization

muscle is getting broken down so the amino acids are used to repair other tissue

Question 8

Implications for PT/OT treatment

Answer 8

Pts with severe burns are immobilized with splints and casts to allow wound healing

Begins with PROM to maintain joint motion and prevent contracture

AROM and functional activities begin when appropriate to preserve strength and function

Question 9

Why is exercise important following burns?

Answer 9

Severe burns result in reduced cardiorespiratory capacity, muscle strength, and endurance

Aerobic and strength rehab exercises improve these over standard care

Question 10

Burn injury place of occurance and gender

Answer 10

Mostly at home and in males