Burn Management Flashcards
High Risk Populations
Elderly Young children Physically disabled Mentally ill Workers in hazardous conditions
Skin Functions
Protective cover
regulates body temp
shields deep structures from injuries
protects nerve endings
Skin Anatomy : Epidermus
Regenerates
Skin Anatomy: Dermis
Nerve Damage and Sensory loss occurs
Does not regenerate: requires graphing
Classification of Burns is determined by
Type of burn
Depth of burn
TBSA= total body surface are involved in burn
Thermal Burn
Flames, steam, metal, frost bite
Chemical Burn
Acids: Usually work/industrial
Splash burns
Electrical Burn
Currents (usually the worst type of burns)
Radiation Burn
Sun burn, cancer survivors
Friction Burn
Vehical accidents: impact w/ gravel
Burn Depth: Superfical Partial Thickness
Damage to the epidermis and upper layer of dermis
Intact blisters and pain (pain indicates nerve endings are intact)
Heal w/in 7-21 days w/ minimal to no scaring
Burn Depth: Deep Partial Thickness
Injury to epidermis and severe damage to dermis
Blotchy & whitish
+ pressure sense
- light touch
3-5 weeks healing; often grafted
Once skin is grafted & haled sensory return is very limited
Burn Depth: Full Thickness
Usually smaller patches of area
Both epidermis and dermis are destroyed
May damage subcutaneous fat, muscle & bone tissue
Wounds are white and waxy
- sensation d/t destruction of dermal nerve endings
Require surgical care grafting or amputation
Medical Issues Related to Burns
Infection
Pulmonary complications (CO2 intake: house fires)
Metabolic COmplications: burns result in an increased need for calories: pts. have rapid weight loss: calories (protein) help promote healing and regulate body temp.
Cardiac/Circulatory complications: large demands are placed on vital organs. Pt. has increased swelling & fluid build up.
Heterotophic Ossification: pt. lay done tissue on tendons (sensative to ROM)
Neuropathy
Medical Management : Escharotomy
Surgical procedure done to circumfuernatal burns to releave compression. They make an incision to provide space for fluid to build up
Addition medical management: wound care
Medical Management: Septic Shock
Toxins are released into the body: bactira is in the blood stream resulting into a drastic drop in BP, increased confusion & agitation, increase in temp.
Medical Management: Excision
Removal of dead tissue
Drugs
Narcotics: morphine: used to calm & quiet pt. also avoid the pt. from using their caloric intake.
Analgesics: tylenol: inflimation
Antacids: stress ulcers
Antibiotics: Oral & topical: ant itch medication
Graft Types: Autograft
From pt; permanent
Graft Types: Homograft (allograft)
Skin donor; temporary (stapled)
Graft Types: Xenograft (heterograft)
Pigskin; temporary
Graft Types: Bilayer skin substitiute
Permanent skin substitute
Graft Type: Sheet Graft
Full Thickness Scar massage (passive & active) Focus on mobility & ROM on dorsal side to avoid claw deformity
Graft type: Mesh graft
Perforated to increase surface area
Key to healing grafts
Do not move any area that is freshly grafted.
They should be imobolized (7-10) days
Hypertrophic Scars
Increase in the following: vacularity, fibroblasts, myofibroblast, interstitial fluid, collagen
Jobst Garments (compression garments) used to prevent scaring. Prevent webbing (i.e. axilla, neck, flexion contractors, elbow, knees)
Issues w/ Jobst: compliance: provide the pt. w/ peer support & before & after pictures
Burn Eval: acute Phase
Edema Functional A/PROM (pumping) Strength (bed mobility) Sensation: pressure, localization Self care skills: low level A w/ dressing, glicerin swabs, urinal use
Burn Tx : Acute Phase
Prevent loss of jt./ skin mobility
Prevent loss of strength/endurance
Control edema (positioning vs manual manipulation)
Self-care skills
Education of pt./family - ON EVERYTHING (Jobst, splinting) education should be repeated frequently
Psychosocial support (body image)
Burn Splint : PAN Splint
Not a resting hand splint
Prevents claw deformity
Applyed w/ curlex wrapping vs straps
Wrist: flexion, MP: Flexion, IP: Extension
Boutiner deformities also occur along w/ extensor tendon ruptures
Hand ROM
Wrist flexion = finger extnesion and vice versa
Prevents stress on joints
Post Surgical - Operative Phase : Eval
Functional A/PROM (goniometry, keep exact records of ROM)
Strength: Dyno/Pinch, 9 hole peg (very standardized)
Self care: address the need for adaptive equipment (large handled devices, button hooks)
Sensation: dependent on wounds: 2point descrimination, localization (look at safety)
Mental status: coping and depression
Motivation
Post Surgical - Operative Phase : Tx
Positioning
Splinting: moves from static to dynamic
Exercises: increase strength, fine & gross motor exercises, adapt as they heal
Self-care : increased refinment & adaptive strategies
Cognitive stim: (d/t smoke inhalation) adaptive strategies
Psychosocial adjustment
Rehab Phase : Eval
Increased persions A/PRROM (still standardized) Strength Sensation: sems winstein Coordination: build of 9 hole peg ADL's: move from self care to IADL's & Driving skills
Rehab Phase: Tx
Focus: Maximizing Functional Abilities
Positioning: still prevention contractors (sleep positioning)
Splinting
Sensory Reeducation: Compensation, visual awarness (safety)
Exercise: more active vs passive
ADL’s: still push towards IADL’s
Work-related skills
Scar control: SPF, hats, cover ups, used year round
Pt./family education
Dynamic Burn Splint: MP’s are in
Flexion
Follow UP: Out pt OT or Burn Clinic
Life Long Ongoing reconstructive/plastic surgeries Exercise Scar control Splinting Positioning Work-Related Skills
Psychosocial Issues
Fear isolation guilt frustration loss grief body image disturbance
