Burns

Question 1

How are burns classified?

Answer 1

Type eg thermal, chemical or electrical
Depth - superficial, partial, full
Size of burn - %TBSA rule of nines

Question 2

Describe a superficial burn

Answer 2

Epidermis destroyed
Red, hypersensitive, rapid capillary return
Wound closes spontaneously in 7-10days

Question 3

Describe a partial thickness burn

Answer 3

Superficial partial thickness - epidermis and superficial dermis destroyed
Red to pink, hypersensitive, rapid capillary return
Spontaneous closure 14 days

Deep partial thickness - epidermis and deep dermis destroyed
Creamy white, decreased light touch, delayed capillary return, >14 days closure

Question 4

Describe a full thickness burn

Answer 4

Epidermis, dermis and underlying structures destroyed
White, tan, black, leathery
No light touch
No capillary return
>3 weeks closure, needs grafting

Question 5

Describe pathophysiology of burn healing

Answer 5

Inflammatory phase (1-5/7)
Proliferation phase (5/7-3/52) - fibroblasts produce collagen (disoriented) then differentiate into myofibroblasts - contractile, pull edges together. SCAR CONRACTURE. Epidermis and dermis not connected.

Remodelling phase (3wks - 18months) - cross linking collagen in parallel

Question 6

Describe the initial medical Mx for a burn patient

Answer 6

Ax
Tetanus injection
Fluid
Airway Mx
Inhalation injury Mx
Escharatomies
Skin grafting
Prevention and Mx infection

Question 7

Describe the pathophysiology of an inhalation injury

Answer 7

Acute pulmonary insufficiency (36hrs) - hypoxia due to CO, atelectasis due to coughing and bronchospasm, upper airway oedema
Pulmonary oedema (6-72hrs) - surfactant is denatured, decreased lung compliance
Bronchopneumonia (3-10days) - pseudo membrane sheds, plugging and decreased secretion clearance, distal atelectasis

Question 8

Briefly describe the layers of the skin

Answer 8

Epidermis - keratin toughens and waterproofs, no blood vessa, melanin for UV protection
Dermis - papillary and reticular layer, blood and lymph vessels, elastin and collagen
Epidermal appendages - heart follicles, sweat glands, centre for regeneration of epidermis

Question 9

What are the consequences of an inhalation injury immediately and longer term?

Answer 9

Immediate - bronchospasm, denatured surfactant, high levels of CO bound to haemoglobin and decreased PaO2, pulmonary oedema
Mid - pseudomembrane formation and shedding
Long term - bronchiectasis, recurrent chest infections, pulmonary fibrosis, persistent impairment of lung function, respiratory mm weakness, tracheal stenosis

Question 10

Discuss positive and negative effects of physiotherapy interventions for a patient with a burn injury

Answer 10

Early mobilisation - prevent contractures and deconditioning, minimise mm catabolism. Causes PAIN and can compromise wound healing and graft take
EOR holds - 1min+ improve ROM and prevent contractures, compromise wound healing
Contract-relax - as above
Exercise and stretch opposite to contracture

Question 11

Discuss modifications to physio for burns patients to minimise detrimental effects

Answer 11

Time with pain meds
Protect wound with padding and coban for early mobility
NWB activity