Burn Management

Question 1

High Risk Populations

Answer 1

Elderly 
Young children 
Physically disabled 
Mentally ill 
Workers in hazardous conditions

Question 2

Skin Functions

Answer 2

Protective cover
regulates body temp
shields deep structures from injuries
protects nerve endings

Question 3

Skin Anatomy : Epidermus

Answer 3

Regenerates

Question 4

Skin Anatomy: Dermis

Answer 4

Nerve Damage and Sensory loss occurs

Does not regenerate: requires graphing

Question 5

Classification of Burns is determined by

Answer 5

Type of burn
Depth of burn
TBSA= total body surface are involved in burn

Question 6

Thermal Burn

Answer 6

Flames, steam, metal, frost bite

Question 7

Chemical Burn

Answer 7

Acids: Usually work/industrial

Splash burns

Question 8

Electrical Burn

Answer 8

Currents (usually the worst type of burns)

Question 9

Radiation Burn

Answer 9

Sun burn, cancer survivors

Question 10

Friction Burn

Answer 10

Vehical accidents: impact w/ gravel

Question 11

Burn Depth: Superfical Partial Thickness

Answer 11

Damage to the epidermis and upper layer of dermis
Intact blisters and pain (pain indicates nerve endings are intact)
Heal w/in 7-21 days w/ minimal to no scaring

Question 12

Burn Depth: Deep Partial Thickness

Answer 12

Injury to epidermis and severe damage to dermis
Blotchy & whitish
+ pressure sense
- light touch
3-5 weeks healing; often grafted
Once skin is grafted & haled sensory return is very limited

Question 13

Burn Depth: Full Thickness

Answer 13

Usually smaller patches of area
Both epidermis and dermis are destroyed
May damage subcutaneous fat, muscle & bone tissue
Wounds are white and waxy
- sensation d/t destruction of dermal nerve endings
Require surgical care grafting or amputation

Question 14

Medical Issues Related to Burns

Answer 14

Infection
Pulmonary complications (CO2 intake: house fires)
Metabolic COmplications: burns result in an increased need for calories: pts. have rapid weight loss: calories (protein) help promote healing and regulate body temp.
Cardiac/Circulatory complications: large demands are placed on vital organs. Pt. has increased swelling & fluid build up.
Heterotophic Ossification: pt. lay done tissue on tendons (sensative to ROM)
Neuropathy

Question 15

Medical Management : Escharotomy

Answer 15

Surgical procedure done to circumfuernatal burns to releave compression. They make an incision to provide space for fluid to build up

Addition medical management: wound care

Question 16

Medical Management: Septic Shock

Answer 16

Toxins are released into the body: bactira is in the blood stream resulting into a drastic drop in BP, increased confusion & agitation, increase in temp.

Question 17

Medical Management: Excision

Answer 17

Removal of dead tissue

Question 18

Drugs

Answer 18

Narcotics: morphine: used to calm & quiet pt. also avoid the pt. from using their caloric intake.
Analgesics: tylenol: inflimation
Antacids: stress ulcers
Antibiotics: Oral & topical: ant itch medication

Question 19

Graft Types: Autograft

Answer 19

From pt; permanent

Question 20

Graft Types: Homograft (allograft)

Answer 20

Skin donor; temporary (stapled)

Question 21

Graft Types: Xenograft (heterograft)

Answer 21

Pigskin; temporary

Question 22

Graft Types: Bilayer skin substitiute

Answer 22

Permanent skin substitute

Question 23

Graft Type: Sheet Graft

Answer 23

Full Thickness 
Scar massage (passive & active) 
Focus on mobility & ROM on dorsal side to avoid claw deformity

Question 24

Graft type: Mesh graft

Answer 24

Perforated to increase surface area

Question 25

Key to healing grafts

Answer 25

Do not move any area that is freshly grafted. | They should be imobolized (7-10) days

Question 26

Hypertrophic Scars

Answer 26

Increase in the following: vacularity, fibroblasts, myofibroblast, interstitial fluid, collagen Jobst Garments (compression garments) used to prevent scaring. Prevent webbing (i.e. axilla, neck, flexion contractors, elbow, knees) Issues w/ Jobst: compliance: provide the pt. w/ peer support & before & after pictures

Question 27

Burn Eval: acute Phase

Answer 27

``` Edema Functional A/PROM (pumping) Strength (bed mobility) Sensation: pressure, localization Self care skills: low level A w/ dressing, glicerin swabs, urinal use ```

Question 28

Burn Tx : Acute Phase

Answer 28

Prevent loss of jt./ skin mobility Prevent loss of strength/endurance Control edema (positioning vs manual manipulation) Self-care skills Education of pt./family - ON EVERYTHING (Jobst, splinting) education should be repeated frequently Psychosocial support (body image)

Question 29

Burn Splint : PAN Splint

Answer 29

Not a resting hand splint Prevents claw deformity Applyed w/ curlex wrapping vs straps Wrist: flexion, MP: Flexion, IP: Extension Boutiner deformities also occur along w/ extensor tendon ruptures

Question 30

Hand ROM

Answer 30

Wrist flexion = finger extnesion and vice versa | Prevents stress on joints

Question 31

Post Surgical - Operative Phase : Eval

Answer 31

Functional A/PROM (goniometry, keep exact records of ROM) Strength: Dyno/Pinch, 9 hole peg (very standardized) Self care: address the need for adaptive equipment (large handled devices, button hooks) Sensation: dependent on wounds: 2point descrimination, localization (look at safety) Mental status: coping and depression Motivation

Question 32

Post Surgical - Operative Phase : Tx

Answer 32

Positioning Splinting: moves from static to dynamic Exercises: increase strength, fine & gross motor exercises, adapt as they heal Self-care : increased refinment & adaptive strategies Cognitive stim: (d/t smoke inhalation) adaptive strategies Psychosocial adjustment

Question 33

Rehab Phase : Eval

Answer 33

``` Increased persions A/PRROM (still standardized) Strength Sensation: sems winstein Coordination: build of 9 hole peg ADL's: move from self care to IADL's & Driving skills ```

Question 34

Rehab Phase: Tx

Answer 34

Focus: Maximizing Functional Abilities Positioning: still prevention contractors (sleep positioning) Splinting Sensory Reeducation: Compensation, visual awarness (safety) Exercise: more active vs passive ADL's: still push towards IADL's Work-related skills Scar control: SPF, hats, cover ups, used year round Pt./family education

Question 35

Dynamic Burn Splint: MP's are in

Answer 35

Flexion

Question 36

Follow UP: Out pt OT or Burn Clinic

Answer 36

``` Life Long Ongoing reconstructive/plastic surgeries Exercise Scar control Splinting Positioning Work-Related Skills ```

Question 37

Psychosocial Issues

Answer 37

``` Fear isolation guilt frustration loss grief body image disturbance ```