Wounds and burns

Question 1

Health history question?

Answer 1

When did the injury happen?
● Cleared by MD?
● Modality
● Did it blister or did the skin stay intact?
● How long was the exposure to heat?

Question 2

Contraindications?

Answer 2

1. Avoid increase risk of infection hand wash, glove, no oil, mask)
2. Avoid direct contact w burns that produce blisters
3. Be careful w the use of temperature on skin healing from burn
4. Avoid drag and torquing, on or toward the injury in early stage
5. Active resisted exercise in acute in large area or present respiratory or heart problems.

Question 3

Treatment goals?

Answer 3

I. Acute and early subacute:
1. Reduce SNS firing to promote relaxation, reduce pain
2. Reduce edema on the affected areas to reduce scar tissue development
3. Encourage any activity to go back to ADL
II. Late subacute and chronic:
1. Promote relaxation to decrease pain perception and improve client compliance
2. Reduce edema to increase tissue health
3. Prevent restrictions and promote elasticity of scar tissue, prevent hypertrophic and hypersensitive scar tissue
4. Decrease pain after cross-fibre friction

Question 4

Treatment protocol?

Answer 4

I. Acute and early subacute:
1. Slow diaphragmatic breathing
2. Massage unaffected areas
3. Elevate, Lymphatic drain proximally up to injury site, ”Squeezing to distal”
4. Pain free movement affected w/o reinjury and unaffected joints, active, active assisted, passive
5a. Suture: normal stress and movement after 1 week
b. Skin grafting: passive and active movement within 5-10 days
II. Late subacute and chronic:
1. Slow diaphragmatic breathing + All techniques within the clt pain tolerance
2. Swedish proximal to injury
3. Immature scar: Gentle bowing, picking up
Mature scar: deep C-bowing, S-bowing, skin rolling, cross-fibre friction
4. Cold hydro (careful )

Question 5

Cold hydro?

Answer 5

Treatment:
1. Ask for consent to undrape
2. Undrape and get visual on it
3. CBAN explanation
4. Cold treatment consent
5. Pillow support
6. Clean towel
7. Cold pad
8. Check pain scale + CBAN
9. Massage unaffected side
10. Ask if they feel numb, REMOVE
11. If they don’t feel numb, REMOVE after 5 minutes
HOMECARE:
1. Modality (ice pack/frozen towel/ shower ect
2. Temp (0-12 cold/13-18 cool)
3. Where to apply it (body part)
4. How long to apply it for
5. Frequency (How many times a day)
6. For how long (days/weeks)
7. Precautions + CBAN
8. CI’s

Question 6

Home care?

Answer 6

Diaphragmatic breathing, self massage to the scar, apply heat before stretch, strengthen, encourage activities of daily living, cool and cold hydro after activities in early stage, heat before and cool afterwards in late subacute and chronic.