Burns: PT Interventions Flashcards
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
What is FIRST???
-
Wound Care*
- Debridement
- Cleansing
- Topicals
- dressing must allow for mobility*
- *ADD charts to this lecture!!!
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
In order:
-
Wound Care
- Debridement, Cleansing, Topicals
- Splinting
- Pos’ing to reduce deformity
- Mobility and breathing
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Wound Care First
Tx→ Debridement (Surgical)
- Surgical→ OR under anasthesia
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Wound Care (first)
Tx→ Debridement (NON-sx)
-
Mechanical debridement (non-sx)
-
Selective:
- Sharp Debridement: scalpel, scissors, tweezers
-
Non-Selective:
- Whirlpool, Pulse lavage, Wet→dry dressings
-
Selective:
-
Precautions:
- Anticoagulation tx (Heparin, Coumadin, Lovenox)***
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Wound Care (first)
Tx→ Cleansing
- Spray/non-submersion
- Submersion/Immersion w/ or w/out agitation
- Pulsed Lavage (w/ suction)
- Local wound care
Topicals for Burn Injuries
3 to know:
- Silver Sulfadiazine Cream 1% (SSD, Silvadene, Thermazene)** KNOW THIS ONE!
- Povidone-Iodine (Betadine)
- Bacitracin
Topicals for Burn Injuries
Silver Sulfadiazine Cream 1%
(SSD, Silvadene, Thermazene)
Indication, Adv’s/Disadv’s
- Indication→ burns and wounds of all sizes/depths
-
Adv:
- wide antimicrobial spectrum, lasts 24h
-
Disadv:
- does not penetrate eschar well
- cannot use w/ sulfa allergy or pregnant pts
- may be toxic to keratinocytes and fibroblasts
Topicals for Burn Injuries
Povidone-Iodine
(Betadine)
Indication, Advs/Disadvs
- Indication: FDA-approved for intact skin disinfectant, commonly used for road rash, “dirty” burns and infected wounds
-
Advs:
- broad spectrum antimicrobial
- antifungal*
-
Disadvs:
- cytotoxic, delays epithelialization (not for helping wound heal)
- systemic toxicity
- cytotoxic, delays epithelialization (not for helping wound heal)
Topicals for Burn Injuries
Bacitracin
Indications, Advs/Disadvs
-
Indication: Common for use on burned faces, superficial burns
- Petroleum based antibiotic ointment, for Gram + bacteria
-
Advs:
- Low $$
- used when pts have sulfa allergy
-
Disadvs:
- yeast superinfx, hypersensitivity/rash, ineffective for Gram - bacteria*
Topicals for Burn Injuries
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Splinting
________ is MOST effective for scar tissue realignment w/ focus on sustained end range stretch (giveaway)
Proloooonged Stretch***
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Splinting
Purposes?
- Control edema
- Maint. soft tissues in elongated state
- Prevent deformity
- Support/restore function and INDEP.
- Main/INC avail. ROM
- Protect exposed tendons, fx’s, P. Nerve injuries
- Preserve skin graft integrity
- *IF graft crosses joint→ WILL req. splinting!!)
- Also prevents hypertrophic scarring*
Sequence of PT Interventions for Pts w/ Burns
Aka Priorities
Splinting Considerations
Indications and Wear Time
-
Indicated:
- IF function or ROM is lost w/out splinting
- to protect skin graft
-
Wear time dep’s on condition:
- Usually→ 2-4hrs on, 2-4hrs off
- Intubated or sedated, post-graft→ Splint stays on at all times except skin checks
- Actively moving→ encourage ADLs and wear @ night only
Table 10-5: Therapeutic Pos’ing for Burn-Injured Client
see pics, be familiar
Deformities:
Post Burn Injury
Mouth Deformities: Microsomia→ contraction of oral commissure
Mouth Splinting Options