Week 3 Burn Pathophysiology Special Considerations

Question 1

what are some complications of major burns and the PT implications

Answer 1

systemic effects of major burns 
tendon exposures
heterotypic ossification 
amputations 
inhalation therapy
CO poisoning 
face and neck burns

Question 2

systemic effects of burn injuries happen when the burn is what % TBSA

Answer 2

over 15-30%

Question 3

what are some systemic effects

Answer 3

effects that are not seen for 2-3 days after the admission that cascade to all organs and systems.

Question 4

what is burn shock

Answer 4

combo of distributive, hypovolemic and cardiogenic shock.

Question 5

what are some cardiovascular systemic effects

Answer 5

tachycardia

hypotension (decreased CO)

Question 6

what are some hypermetabolic systemic effects

Answer 6

increased HR

increased nutritional needs because the body is in a state of catabolism

Question 7

what are some pulmonary effects

Answer 7

lung inflammation and edema, and can lead to acute respiratory distress syndrome

Question 8

what are some immune system problems

Answer 8

compromise due to absence of that skin barrier and the inflammation that occurs

Question 9

do you get inhalation injuries fro hot air or poisons/chemicals

Answer 9

chemicals

Question 10

what can PT do for inhalation injuries

Answer 10

mobility, positioning, posture, breathing, airway clearance things.

Question 11

what is CO poisoning, and what happens to cardio things

Answer 11

carboxyhemoglobin COHb (0-5% normally)
HR and RR increase
you get arrhythmia and MI
BP decreases

Question 12

TF: with CO poisoning, you get a true elevated SpO2

Answer 12

false, it is falsely elevated

Question 13

what is delayed neuropsychiatric syndrome

Answer 13

cognitive/personality changes, Parkinsonism, and spontaneous resolution in 1 year. (thanks to CO poisoning)

Question 14

what is the risk of deep dorsal hand burns

Answer 14

risk of injury to extensor hood

Question 15

what do we want to avoid with deep dorsal hand burns

Answer 15

composite fist flexion until it is closed.

Question 16

what position do we want the hand in

Answer 16

MP flexion with IP extension

Question 17

what are some implications of an achilles tendon burn

Answer 17

tendon damage, needs splinting, and prolonged low load stretch

Question 18

what is heterotypic ossification

Answer 18

formation of bone in soft tissue around a joint, that happens with trauma, SCI, burns…

Question 19

in burn populations, where is the most common spot for HO

Answer 19

elbow

Question 20

what happens to ROM and end feel with HO

Answer 20

decreased, firm and hard end-feel

Question 21

with HO, what positions do you normally lose

Answer 21

forearm supination, then elbow flexion and extension

Question 22

TF: the pain is usually in proportion to the injury with HO

Answer 22

false, out of proportion

Question 23

TF: you always see HO on x-ray

Answer 23

false, not in early stages

Question 24

when is the average time of onset with HO from the injury

Answer 24

12 weeks

Question 25

how do PT’s manage HO

Answer 25

not aggressive ROM
start with patient AROM that they can tolerate.
do not push past end range
surgical intervention after 1-2 years.

Question 26

when might one have an amputation

Answer 26

electrical burn, frostbite, deep burns, infection

Question 27

what is crucial for limb salvage

Answer 27

strength and sensation assessment

Question 28

how do we manage the residual limb

Answer 28

wrapping, desensitization, HEP, positioning, splinting, ROM management and edema management.