Week 3 Burn Pathophysiology PT Considerations Flashcards
what are some rehab requirements for burn centers
comprehensive program within 24 hours of admission, with one full time burn PT and OT, that gets minimum daily therapy session. burn care 7x/week, with competency based therapy. Therapists train at a minimum every 2 years.
what are some burn center referrals
full thickness burns specialized areas like the face, ears, eyes, hands, feet, circumferential burns chemical burns electrical burns significant fractures inhalation or airway burns kids under 1 years old
who makes up the team
physicians, students, NP, nurses, PT, OT, ST, social worker, chaplain, pharmacologist, dietician, respiratory therapy and recreational therapist.
what are some burns and some complex skin conditions
electrical injuries, scald, flame, flash, contact burns
steven johnson syndrome, TENS
necrotizing fasciitis, gangrene, frostbite
what is the most common type of burn
flame
seconds most common burn
scald
can you have a combo of burns
yes like scald and contact if it is a very thick liquid that will stick to the skin
how are we going to treat a burn size that is less than 10-20% TBSA
pain control, bandages, therapy like stretching, exercise, and mobility.
how do you treat someone with more than 10-20% TBSA burns
airway, breathing and circulation pain control fluid resuscitation bandages and dressings therapy
what are the differences in treatment of full and partial thickness burns
full: therapy, surgical interventions, therapy
partial: therapy
what is the order of tissue, starting from most superficial and going to deepest
superficial: epidermis dermis subcutaneous tissue fat fascia muscle bone
do you get pain and sensations with full thickness burns
no, recuasse you are burning the nerve endings, so you get no pain
how long does it take a superficial wound to heal
1-7 days
how long does it take for a partial thickness to heal
7 days - 1 month
deeper: 2-6 weeks, heals by scarring.
how long does it take for a full thickness burn to heal
can’t heal without surgery.
what happens during the inflammation phase
increased blood flow, vasodilation, increased capillary permeability.
immune response
edema, exudate production
pain
what happens during the proliferation phase
angiogenesis, collagen production, red, vascular tissue appears in the wound, epithelialization vs scar tissue formation, skin, scar contraction.
what happens during the maturation phase
collagen remodeling and scarring
capillary regression
scar flattens, softens, pales, itching subsides.
what is the rule of 9s with adult bodies
head and each arm are 9%
each leg and the trunk are 18% (front and back)
the groin is 1%
what is the rule of 9s for a Childs body
head and trunk 18%
arms 9%
groin 1%
legs 14%
a patients palm accounts for what % of the body
1 %
what can a burn diagram show us
depth of the burns and locations on the body
TF: burns are usually uniform depth
false, they vary with depth size
what is the zone of coagulation
center part, and the deepest part with dead vessels
what is the zone of stasis
center
what is the zone of hyperemia
increased swelling and blood flow around the wound
a partial thickness burn in what zone can covert to a full thickness burn
zone of stasis
what factors can contribute to a partial thickness becoming a full thickness
infection
edema
poor resuscitation of fluid
hypotension
how can we do activity and edema management
early AROM
ace wrap dependent limbs
positioning and elevation
muscle pumps
what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for superficial
appearance: pink, red, wet
blanching: present
sensation: intact and painful
healing time: less than 3 days
risk of scarring/contracture: very low
what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for superficial partial thickness
appearance: pink, red, edema
blanching: present
sensation: intact
healing time: 3-7 days
risk of scarring/contracture: low
what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for deep partial
appearance: white, waxy, mottled, blochy.
blanching: diminished
sensation: limited light touch and pressure intact
healing time: 2-6 weeks
risk of scarring/contracture: moderate to high, may need skin graft
what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for full thickness
appearance: white, waxy, leathery, bright red, dark eschar
blanching: absent
sensation: absent, often painless
healing time: surgical intervention
risk of scarring/contracture: scarring with grafting only way to heal.
what are some issues with electrical burns
they go very deep, and can travel very quickly. full thickness, sometimes down to the bone.can have a lot of necrotic tissues, and usually has an exit wound
what kinds of things are you observing with a wound
location, tissues present, exudate, odor, edges, condition and color of peri-wound, inflammation and infection, edema and pain
what are some pieces of a hands on wound exam
palpate the wound bed
size and depth
photograph it
test sensation, blanching, and vascular integrity.
what is compartment syndrome
when distal circulation is compromised because of increased internal pressure. you get a tourniquet effect, with a loss of tissue elasticity.
in what kind of burns do you get compartment syndrome
circumferential full thickness, and even partial or mixed thickness that causes an increase in pressure because of inflammation and edema.
what are the symptoms of compartment syndrome
severe edema,
pain out of proportion
tingling and numbness
absent and diminished peripheral pulses
what techniques are crucial for alleviating and avoiding compartment syndrome
edema management with slings, leg elevators and pillow, all while monitoring pulses.
what is the medical management of burn related compartment syndrome
escharotomy. this is when they make an incision into the dermal layer to release the tension, usually through the burn tissue.
what do you do for treatment is an escharotomy or fasciotomy is planned
defer PT until it is complete.
after the escharotomy, what do we do
may have some bleeding, but we make sure there is dressing, compression (WITH RESTORED PULSES), no weight bearing restrictions, but may get pain.
