Burn Management, PT Treatment Flashcards
What is typical emergent care for burns?
- Immersion of part in cold water
- Cover burns with sterile bandages or clean cloth
What should not be applied to an acute burn?
- Ointments
- Creams
What is the 4 step process to achieve asepsis and wound care of burns?
1) Removal of charred clothing
2) Wound cleansing
3) Topical Medications
4) Dressings
What are 3 ointments used as anti-bacterial agents for burns?
- Bacitracin
- Polymyxin B
- Neomycin
What topical agent should be avoided at term pregnancy and infants less than 2 months?
Silver sufadiazine
What topical agent for burns penetrates eschar?
Sulfamylon
What is the purpose of a dressing over a wound?
- Prevent bacterial contamination
- Prevent fluid loss
- Protect wound
What do dressings hinder?
ROM
What do dressings hinder?
ROM
What types of dressings are used for burns?
- Silver-impregnated
- Hydrogels
- Petroleum-impregnated
- Guaze
What should be monitored acutely following a burn?
- Arterial blood gases
- Serum electrolyte levels
- Urinary Output
- Vital signs
- GI function
What should be provided if there is GI dysfunction?
Nutritional support
What type of pain relief is provided following a burn?
- Morpine sulfate
How can infection be controlled following burns?
- Prophylaxis for tetanus
- Antibiotics
- Following standard precautions
What is the purpose of fluid replacement therapy?
Prevent and control shock.
What does fluid replacement therapy consist of?
- Fluid and blood replacement
What type of surgery can be performed to prevent tourniquet effects?
- Escharotomies
- Fasciotomies
When can surgical removal of eschar begin?
When Pt is stabilized
What is a graft?
Closure of a wound
What are 7 types of grafts performed post burns?
- Allograft
- Xenograft
- Biosynthetic graft
- Cultured skin
- Autograft
- Split-thickness graft
- Full- thickness graft
Which type of graft consists of collagen and synthetics?
Biosynthetic graft
Which type of graft consists of other human skin (cadaver, donor)?
Allograft
Which type of graft consists of upper layers of dermis and epidermis from donor site?
Split-thickness graft
Which type of graft consists of Pt’s own skin?
Autograft
Which type of graft consists of skin from other species?
Xenograft
Which type of graft consists of epidermis and dermis from donor site?
Full-thickness graft
What is the procedure termed that is used to resect a scar contracture?
Z-plasty (surgical incision in form of Z to lengthen burn scar
What are 2 types of Physical Therapy Interventions for Pt’s with burns?
- Wound care
- Rehabilitation
What are 3 wound care PT interventions?
- Hydrotherapy/ whirlpool
- Sharp debridement
- Autolytic dressings and enzymes
What is the purpose of a whirlpool treatment?
- Excise loose, charred, dead skin
- Remove dressings
- ROM exercises
- Anti-infection agents added to assist in infection control
What does sharp debridement consist of?
- Excision of eschar
What is the purpose of autolytic dressings?
- Selective removal of eschar
What are some cardiopulmonary directed PT goals following burns?
- Promote deep breathing and chest expansion
- Ambulation to prevent pneumonia
What are some cardiopulmonary directed PT goals following burns?
- Promote deep breathing and chest expansion
- Ambulation to prevent pneumonia
What is the common deformity of the neck following burns?
- Flexion of anterior neck
What interventions should be provided to prevent neck deformity?
- Stress hyperextension
- Position with firm plastic cervical orthosis
What is the common deformity of the shoulder following burns?
- Adduction, IR
What interventions should be provided to prevent shoulder deformity?
- Stress abduction, flexion, and ER
- Position with axillary/ airplane splint
What is the common deformity of the elbow following burns?
- Flexion with pronation
What interventions should be provided to prevent elbow deformity?
- Stress extension and supination
- Use posterior arm splint to position in extension
What is the common deformity of the hand following burns?
- Claw hand (intrinsic minus position)
What interventions should be provided to prevent hand deformity?
- Stress wrist extension (15 degrees), MP flexion (70 degrees), PIP and DIP extension, thumb abduction (instrinsic position).
- Position in instrinsic plus position with resting hand splint
What is the common deformity of the hip?
- Flexion with adduction
What interventions should be provided to prevent hip deformity?
- Stress hip extension and abduction
- Position in extension, abduction, neutral rotation
What is the common deformity of the knee following burns?
Flexion
What interventions should be provided to prevent knee deformity?
- Position in extension with posterior knee splint
What is the common deformity of the ankle following burns?
Plantar flexion
What interventions should be provided to prevent ankle deformity?
- Position with foot/ ankle in neutral with splint or plastic AFO
How can edema be controlled following burns with PT intervention?
- Elevation of extremities
- Active ROM
- Elastic supports
What should be performed to preserve ROM?
Active and passive ROM
What should ROM exercises be combined with?
- Dressing changes
- Hydrotherapy
- Medication doses
What exercise precautions should be taken following a graft?
- Discontinue exercise for 3 - 5 days to allow healing
What manual therapy can be performed to reduce scar formation?
Deep friction massage.
What can be applied to prevent hypertrophic scarring or keloid formation?
- Pressure garments
What roles can exercise play in rehab?
- Increase strength and ROM
- Increase acitivty tolerance and endurance
- Promote independence in ADLs
- Improve functional mobility
- Manage chronic pain
What roles can exercise play in rehab?
- Increase strength and ROM
- Increase acitivty tolerance and endurance
- Promote independence in ADLs
- Improve functional mobility
- Manage chronic pain
What psychosocial role does a PT play following burns?
Providing emotional support
