Conditions - Burn Flashcards
5 Common Causes
- Scalds from steam, hot bath water, tipped-over coffee cups, hot foods, cooking fluids, etc.
- Contact with flames or hot objects (from the stove, fireplace, curling iron, etc.)
- Chemical burns (from swallowing things, like drain cleaner or watch batteries, or spilling chemicals, such as bleach, onto the skin)
- Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets, etc.)
- Overexposure to the sun
stats about scald burns
- US-scald burns-the most common causes of burns in children.
- Approximately 22,600 scald burns injuries are treated in emergency rooms each year. 22% of those are burned patients are children 5 years old or younger.
- Burns –second leading cause of children’s death.
- Most scald burns in children occur when hot food or liquids are spill either in the kitchen or areas where food is served.
- Hot tap water could cause the most severe burns (third-degree burns) because of the high temperature and because of the high body area that it could cover
- It takes 1 second for 156°F (69°C) liquid to cause a third-degree burn, 5 seconds at 140°F (°C), and 15 seconds at 135°F (56°C) .
- Hot foods like coffee, chocolate, or tea are usually served at 160°F
Types of burns
First-Degree Burn Superficial burns
- The mildest of the three and are limited to the top layer of skin
- Signs and symptoms: These burns produce redness, pain, and minor swelling. The skin is dry without blisters.
- Healing time: Healing time is about 3 to 6 days; the superficial skin layer over the burn may peel off in 1 or 2 days.
2nd degree burns, Partial thickness Burns
- More serious that involve the epidermis and dermis
- Signs and symptoms: Burns appear raised, blistered, reddened, moist, and they blanch to the touch
- Healing time: Varies depending on the severity of the burn. The deeper the second-degree burn, the slower the healing. It can take up to 3 weeks or more.
- Superficial burns heal by re-epithelialization and usually do not scar if healed within 2 weeks
3rd Degree burns, or full-thickness burns
- Most serious type of burn that involves all layers of the skin and underlying tissue
- Signs and symptoms: Surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain or the area may feel numb at first because of nerve damage.
- Healing time: Deep second- and third-degree burns will likely need to be treated with skin grafts. They heal by scar deposition, contraction and limited re-epithelialization.
Rule of Nines
4 associated injuries
- Airway
- May lead to massive edema or airway obstruction
- Risk increases with massive burns, burns to head and mouth
- Breathing
- Hypoxia from flame injuries
- CO poisoning
- Smoke inhalation injury to lungs
- Burn Shock (within first 24 hrs)
- Compartment Syndromes
- Limbs, Abdominal, and Chest
Medical treatment
- Medical Treatment varies according to the severity of a burn
- Factors that classify the severity:
- The cause of the burn
- The depth of the burn
- The percentage of total body surface area affected (TBSA)
- The location of the burn
- The age of the patient
3 stages in the burn-injury recovery process
- Stage 1 - The acute-care stage
- Stage 2 - The surgical and postoperative stage
- Stage 3 - The rehabilitation stage
Stage 1 - accute care
Medical Focus:
Replacement of body fluids, stabilization of the patient, and care of burn wounds
Daily wound debridement and dressing changes needed
OT Intervention:
Prevent loss of joint mobility, strength, and endurance
Self-care activities
Education of the child and family regarding the rehabilitation process
stage 2: surgical and preoperative
Medical Focus:
Surgical removal of burned tissue, skin grafts, and postoperative recovery
Immobilization of the affected area through positioning or splints is required for approx. 3-7 days after surgery
Serial splint placement may be used to gradually increase ROM
_OT Interventio_n:
Provide adapted devices to assist with ADL’s or other activities
Stage 3: Rehabilitation
Medical Focus:
-Wound healing
-Pt is susceptible to scarring and contracture formation during this period
-Scarring interferes with the pt’s functional
recovery
- Hypertrophic- scares are thick, inflexible, and red
- Can impair joint mobility if they cross a joint- due to tightening of the skin
-Elastic wraps (Jobst garments)
- Tailor made to conform to child’s body-constant pressure
- Jobst garments, elastomer inserts, and facial masks are applied 24 hrs a day for 6-24 mths to obtain optimal results
OT Intervention:
_Occupational Leve_l
- Enable child to return to prior level of independence in school and community
- Return child to developmentally appropriate levels of play and daily living skills
- Support child’s social participation
Client Factors
-Assist in prevention of deformity, contracture, and hypertrophic scarring
-Maintain full active ROM and strength
Example OT intervention
OT Intervention
Initial stage, consultation for positioning and splinting while Katie was in the ICU.
Positioning to keep bilateral axilla areas open, with stockinette used as sling over bed frame
Bilateral resting hand splints and lower extremity foot drop splinting
Once stable, a ROM program was instituted
Multiple revisions of her splints as swelling decreased and grafts became more stable
Once grafts were stable, pressure garments were measured and obtained
Family was taught the beginnings of her stretching program
Adaptive utensils were used for
eating and writing/coloring
Universal cuff then built-up handles so that they do not need to use their fingers.
Purposful activity vs Rote exercise article
Purposeful Activity:
Playing a game that the child enjoys doing
Play activity promoted ROM
Rote Exercises:
Repeating ROM exercises corresponding to the ROM goal
Items measured:
# of repetitions of therapeutic exercise completed
# and type of overt distress behaviors displayed
Scores on self-report scales of pain intensity and fun
Findings:
ROM embedded in play activities may be the most effective use of therapy time early in the rehab process because the child may experience less pain intensity, perform more repetitions, and enjoy the activity more
Later in the rehab process, rote exercise may be equally effective and take less time (average 1-2 min vs. 7-8 min for play
