Burns

Question 1

Describe the importance of skin for the human body

Answer 1

• Skin has 3 layers: epidermis, dermis, subcutaneous tissue
• Protects against infection
• Prevents loss of body fluid
• Controls body temperature
• Functions as excretory organ
• Produces vitamin D

Question 2

What is the common cause of a burns injury?

Answer 2

• Fire/flame, scald, contact, electrical, chemical and other factors
• Majority of burns occur in the home

Question 3

Describe the depth of the burn

Answer 3

• How deep the skin layers a burn extends and duration of contact
• Influence survival rates, healing times, treatment, scar formation

Question 4

What is a partial thickness burn?

Answer 4

• Destroys epidermal layer, extends down the dermal layer of skin
• Characterised by clear blisters, weeping, wet skin
• Burn will blanch, painful when touched
• Heal within 2 weeks

Question 5

What is a full thickness burn?

Answer 5

• Destroys entire epidermal/dermal layer, extends down subcutaneous layer
• Wound is charred black, cherry red, pearly white

Question 6

What is a deep full thickness burn?

Answer 6

• Destroy all skin layers, extend into muscle/tendon/bone
• Charred or mummified appearance
• Results in partial or total loss of function
• Severe damage to underlying structures

Question 7

What are symptoms of burns?

Answer 7

Inhalation Injury
-Burn shock (48-72 hours after injury)
Hypermetabolism
-Triggers significant prolonged stress response in body
-Release of hormones initiates and mediates hypermetabolic response
Infection
-Injury to barrier providing immunity response disrupts innate immune system and increases susceptibility to infection
Scars
-Form as wound closes
-Fibrous tissue that replaces normal tissue after injury

Question 8

Describe the diagnosis for burns

Answer 8

• Clinical examination of burns depth
• Accurately estimate total body surface area involved in burn area
• Depth and size guides medical management

Question 9

Describe the medical management for burns

Answer 9

Inhalation Injuries:
-Maintain adequate oxygenation with humidified oxygen mask to maintain oxygen saturation level
Fluid Resuscitation:
-Early, aggressive fluid resuscitation required to stabilise patient
Nutritional Support

Question 10

What is the influence of burns on ones occupational performance?

Answer 10

• Decreased joint mobility and joint function, passive and active ROM to joints; impacted due to formation of scars and contractures
• Muscle power/endurance impacted; experience long periods of immobilisation and limited from scar formation
• Traumatic/catastrophic nature of burns, suffer PTSD, depression

Question 11

What are the layers of the skin when referring to burns?

Answer 11

• Superficial
• Mid dermal
• Deep dermal
• Full thickness

Question 12

Describe the pathophysiology of burns

Answer 12

HEAT

• Dilation blood vessels, increase capillary permeability
• Odema, fluid loss from burn
• Decreased urine output & circulating blood volume

Question 13

What are some acute problems with burns?

Answer 13

• Respiratory and metabolic effects
• Odema
• Pain
• Limited ROM
• Limited exercise tolerance
• Physiological effect of inactivity/dependence
• Decreased immune response, scar formation

Question 14

What should the OT apply when managing scars?

Answer 14

1) Pressure
2) Friction massage
3) Contact media

Question 15

What are some problems burns patients experience when returning to occupations?

Answer 15

Problems with heat
-Heat intolerance
-Sunburn protection
-Fears: cooking, lighting appliances
Problems with Fatigue
-Increased metabolic load, decreased fitness
-Stress, mood swings, decreased motivation
-Sleep disturbance
Community Re-entry
-Confidence: facial scaring
Skin
-Fragility (friction), sensitivity, itching 
-Skin tolerance