Burns Flashcards
Burns Severity
Superficial–>Epidermis–>Erythema (redness)
Partial thickness–>
Epidermis & Upper part of dermis–>
Blistering (may heal without a scar)
Full thickness–>
Epidermis & entire dermis–>
- Vary from waxy white/ leathery gray/ charred and black
- dry and inelastic
- does not blanch with pressure
Necrosis (heal with scar)
Subdermal
Epidermis+dermis+subcutaneous tissue
–>Extensibe surgical and therapeutic Mx needed to return the patient to some degree of function
Zones of Burns
Zone of coagulation:
Max damage
Irreversible tissue loss
Zone of stasis
-decreased tissue perfusion
-main focus when treating burn injury
Zone of hyperemia
- invariably recover unless severe sepsis
Rule of Nine
Adult:
Head: 9%
Anterior trunk: 18%
Posterior trunk: 18%
One arm: 9%
One leg: 18%
Groin: 1%
Child (under 12 yo):
Head: 18%
Anterior trunk: 18%
Posterior trunk: 18%
One arm: 9%
One leg: 14%/13.5%
Groin: 1%
Effects of Burns on Cardiovascular system
- Increase capillary permeabliltiy–>loss of fluid out of vessel–>interstitial edema+hypovolemia
Peripheral vasoconstriction–>Sympathetic nervous system–>redirect blood to essential organs
Hypotension & dec. organ perfusion
Myocardial depression and heart failure
Effects of Burns on respiratory system
- Pulmonary edema–>by inhalation injuries
Due to increase capillary permeablility - Bronchoconstriction, ARDS
Effects of Burns on Metabolic system
- Hypothermia
- Increase of metabolic activity–>rapid weight loss
Effects of Burns on MSK/renal system
MSK:
-susceptible to developing heterotopic ossification
Renal:
Kidney failure due to…
Loss of fluid–>poor perfusion
Inc myoglobin (muscle injury from burn)–>processed by kidneys
Sign of inhalation injury
- Singed eyebrows/nasal hairs/burnt face
- Black oral/nasal discharge
- Swollen lips
- Hoarse voice
- Abnormal oxygenation
- History of being enclosed in closed room
Process
* 24-48 hours: pulmonary edema
* 48 hours +: alveolitis, pneumonia, ARDS
Exercise Consideration
Skin graft:
- movement is CI (passive & active)
- surgeon decide when to start gentle ROM
patient needs to push through pain to maintain/improve ROM
- exercise after painkiller
Type of exercise:
- AROM first–>AAROM/PROM if can’t go full ROM
- High reps, serveral times a day
- elevation+AROM helps with edema
Exercise education tips
- Use pressure garment
- exercise after painkiller
Dry skin
- not open wound–>hydrate the skin
- cream for moisture–>prevent cracking/tearing
Massage
- before exercising–>increase tissue flexibility
Water:
- Hydration during exercise
Exercise enviornment:
- Avoid exercising in the heat/under the sun
Burn Positioning
Anterior neck:
Contracture: Flexion
Position: Extension+neutral rotation
Shoulder and axilla
Contracture: ADD, IR
Position: Flex, ABD, ER (airplane splint)
Elbow
Contracture: Flexion and pronation
Position: Extension and supination
Hand
Contracture: Claw hand
Position: PIP/DIP Ext, MCP Flex, Wrist Ext, Thumb Abd
Safe position of the hand:
- Wrist 30
- MCP 70
- DIP/PIP 0
Hip and groin
Contracture: Flex, Add
Position: Neutral/Slight Ext+Slight Abd
Knee
Contracture: Flex
Position: Ext
Ankle
Contracture: PlantarFlex
Position: Neutral
Donar sites
- Autograft: same person body
- Allogenic: different person
- Xenogenic: different species
Manage Heat sensitivity while exercising
- Avoid exercising in the heat and exposure to sun (e.g. exercise in air-conditioned room)
- Protection from the sun is key if exercising outdoors
- Cover up with a hat, long sleeves and use sunscreen
- Start slow and build up to longer duration when exercising outside
