Thermal Injuries Flashcards
Burn Causes include:
- thermal
- chemical
- electrical
- radiation
burns are ____ injuries
- multi-system
- especially if burn is greater than 25% TBSA
TBSA
total body surface area
thickness of burn determines_____
-extent of tissue damage
Hypertrophic scarring can result from_____
-partial- and full- thickness burns
Burn Classifications
- superficial partial thickness
- deep partial thickness
- full thickness
Sunburns are a type of ____
1st degree burn
Superficial Partial Thickness
- epidermis and dermal papillae (can involve some of basal cell layer)
- 2-3 weeks to heal (re-epithelialization)
- no scar
Superficial Partial Thickness S/Sx
- erythema
- wet
- shiny
- surface
- edema
- painful
Deep Partial Thickness
- significcant damage to dermis
- 3-4 weeks for healing with scar tissues (may hypertrophy and contract)
- may need skin graft
Deep Partial Thickness S/Sx
- erythema
- blisters
- white
- waxy
- pliable
- pain to deep pressure
- cold
- may be insensitive to light touch
Full Thickness
- epidermis and dermis destroyes
- possible subq also
- skin graft to heal
- scar may hypertrophy and contract
Full Thickness S/Sx
- brown/black, deep red, white
- dry surface
- edema
- painless
- insensate
Rule of Nines
- assessment of burn size
- arms/head=9% each
- Legs, ant/post trunk=18% each
- genitals=1%
Rules of Nines for Kids
- head=12%
- trunk ant/post=18%
- arms=9%
- Legs=16.5
- genitals=1%
Burn Impairments
- shift of body fluids to interstitial spaces
- loss of tissue
- loss elasticity
- scar hypertrophy
- scar contraction
Capillary walls during injury
- more permeable
- fluid flows out of vessels to interstitial space
- take in nutrients, WBC and oxygen to injured area
Burn Intervention
- Airway & Breathing
- Fluid Resuscitation
- Escharotomy
- Fasciotomy
- Nutrition
- Pain management
- wound management
Escharotomy
-release of scar tissue
Fasciotomy
-release of fascia
Burn Surgical Management
- skin graft
- muscle flap
Skin Graft
- full thickness burns require (unless very small)
- large area burns require graft (regardless of depth)
Graft Site
-location of burn that will be covered by homograft or autograft
Donor Site
-area that contributes the skin in autograft
Autograft
-from another part of same body
Allograft
-graft from same species (cadaver or other person)
Heterograft
- (zenograft)
- from another species (pigskin)
CEA
- Cultured Epithelial Autograft
- skin of pt grown in lab
Integra, Apligraf, dermagraft
-dermal replacements
Sheet Graft
- more cosmetically appealing
- requires larger donor site
- always used on face and hands
Meshed Graft
- can be expanded
- waffle-like appearance
Burn Rehab Focus
- positioning
- splinting
- ROM
- function/gait
- ADLs
- Scar Management
-START IMMEDIATELY!!! DAY ONE!!!
Scar Formation
- deep wounds heal with scar tissue
- fibrous tissue replaces normal tissue
- goal: minimize hypertrophic scars
Position of comfort is _____
the position of deformity
Position to prevent:
- contractures
- decubitus ulcers
- control edema
Indications Splinting
- prevent contractures
- protect exposed joints/tendons
- when ROM is decreasing
- 4-5 days post graft to immobilize graft area
Position for Burn pts
- Vitruvian Man
- (da Vinci)
Functional Potential of hand
(safe, intrinsic plus)
- slight wrist ext with ulnar deviation
- MCP at 90*
- IP at 0*
- Thumb IP 0*-some flexion
- Thumb opposition
ROM & Ex’s goals
- prevent contractures
- joint integrity
- maintain tendon gliding
- prevent adhesions
- reduce edema
Contractures can form in ____
1-3 DAYS
ROM most effective during____
bathing
ROM is usually ____
Painful
__/10 is highest amount of pain pt should have during therapy
4/10
ROM/Ex’s Precautions
- edema
- med equip
- IV’s
- tubes
- exposed joints/tendons
- Heterotopic ossification
- associated injuries
- escharotomy/fasciotomy
- new autograft sites
- unstable/fragile autograft sites
- neuropathies
- cellulitis
Heterotopic Ossificatoin
- accum of unstructured bone around joint
- sudden dramatic decrease in ROM
- specific joint pain
- only AROM until surgically removed
Prevention of HO
- at elbow, limit ex’s to AROM or gentle AAROM
- (not PROM)
Mobility Goals
- increase functional independence
- increase ROM, strength, endurance
- prevent DVTs
- improve pulmonary status
- prevent postural hypotension
Mobility Options
- bed mobility
- transfer training
- cardiac chair
- up to chair
- ambulation (limit use of AD)
Scar management
- ROM/Ex’s
- functional mobility
- compression therapy/garments
- scar massage
- modalities
Function of Compression Therapy
- control of hypertrophic scarring
- promotes healing
- assist w/ venous return
Indications for Compression therapy
- partial- or full-thickness burns
- can initiate with minimal open areas (still have bandages on)
- measure for custom garments after temporary compression has been used
Types of Temporary Compression Therapy
- ACE wraps
- compressogrip/tubigrip
- support hose
- foam neck collars
- coban
- isotoner gloves
custom compression garmets
- name brand
- must be measured for them (after graft healed)
- 25-30 mmHg pressure
Phases of PT Burn Management
- Emergent and resuscitation phase
- Acute phase
- rehabilitation phase
Inpatient Rehab follow up
- rehab unit
- outpatient
- home health
- vocational rehab
- work hardening
Burn Outpatient Assessment
- ROM (joint by joint)
- Scars
- Pressure Garment/splint
- ADL/Mobility
- Activity level (back to work/sports/hobbies/school)
- Psycholosocial Adjustments
- Complications (pruritis, sleeplessness)
Psychological Issues
- PTSD
- depression
- feelings of guilt
- anxiety
- re-integration back to society
Supportive Services
- family support groups
- burn survivor support group
- burn camp
- community activities & education
- the american burn association
- the phoenix society
- the world burn congress
PT during Emergent Phase
- control edema
- AAROM
- mobility
- positioning/splinting
- ADL/Transfers
PT during Acute Phase
- splinting/positioning
- AROM
- WB and Ambulation
- ADL
- graft and donor site management
- discharge planning
PT during Rehab Phase
- Skin care
- scar eval
- pressure garmets
- ROM (AROM, PROM)
- ADL
- Strength/endurance
- Therapeutic modalities
- school/work function
