Burns and pain Flashcards
(30 cards)
burn classifications
1st degree: superficial
2nd degree: partial thickness (superficial and deep)
3rd degree: full thickness
4th degree: subdermal
superficial burn
- epidermis
- ex) sunburn, brief contact with hot liquid
- pain: mild discomfort
- peeling, dry, redness (erythema)
- no blisters
- healing: < 1 week
- scar risk: none
partial thickness burn - superficial
- epidermis + 1/3 dermis
- ex) contact with hot metal (curling iron)
- red, wet, blisters
- pain: significant
- healing: <2 weeks
- scar risk: low
partial thickness burn - deep
- epidermis + 2/3 dermis + hair follicles + sweat glands
- ex) flames, exposure to intense heat
- red AND white (poor blood flow)
- pain: the most severe
- healing: >2 weeks
- scar risk: high
full thickness burn
- epidermis + dermis + hair follicles + sweat glands + nerve endings
- ex) chemical, extreme heat
- pale, dry, does not blanche (turn white with pressure)
- pain: none; nerve damage so no sensation
peripheral pain - healing: months
- scar risk: very high
** surgical intervention required **
subdermal burn
- full thickness + underlying tissue (muscle, tendon, fat exposure)
- ex) electrical burn, house fires
- charring, *peripheral nerve damage
- pain: none; nerve damage so no sensation
- healing: months
- scar risk: very high
** surgical intervention required **
posible amputation
phases of burn recovery from medical management perspective
- emergent (survival)
- fluid resuscitation, compartment syndrome
- respiratory management
- temperature and infection control - acute phase (until wound closure)
- non surgical: cleaning therapies, dressing changes, heals on own
- surgical: cut & cover - grafts
types of grafts
xenograft: processed pig skin
allograft: cadaver skin
autograft: person’s own skin
full thickness vs split thickness
meshed vs sheet
rule of 9s
- to assess the extent and severity of the burn
- body percentage; surface area
head: 9
each arm: 9
each leg: 18
trunk/back: 36
groin: 1
OT eval other to include
- occupational profile, ROM (72 hrs post op), joint mobility, strength, sensation, edema (all when wounds are healed)
ROM contraindications
- avoid active flexion with a dorsal hand burn to prevent rupture
- can do PROM of digits
sensation contraindications - electric burns
do a gross sensation screening to assess peripheral nerve damage
edema contraindications
no volometer with an open wound; use a circumferential assessment
OT intervention with burns
- prevent deformity, contractures
- address edema
- positioning and splinting
positioning
- start day 1
- comfort = contracture -> no flexion or adduction (this is naturally what we want to do)
(think of titanic person or da vinci man)
neck: neutral, slight ext
axilla: shoulder abducted to 90 and ER
elbow: extended, forearm neutral
hips: neutral ext, slight abd
knees: ext, slight flex with anterior burn
ankles: neutral or dorsiflexed to prevent foot drop
UE safe position in splint
INSTRINSIC PLUS
dorsal burn –> volar splint
wrist: 15-30 deg ext
MCPs: 50-70 deg flex
IPs: full ext
thumb: abducted
s/p graft
- immobilization and protection
- initiate movement: gentle AROM (or AA or P if can’t tolerate)
what to look out for when starting movement
- heterotopic ossification: bone formation in soft tissue –> do daily AROM in pain free range
- soft tissue contracture –> serial casting or dynamic splint to stretch
things to do in sessions
- skin conditioning: lubricate, massage, stretch, use lotion
- pain management: meds 30 min before, relaxation, visual imagery
- temporary compression: worn at all times except bathing cleaning and dressing changes
hypertrophic scar
- most common with deep second and third degree burns
- appears 6-8 weeks after wound closure
- 1-2 years to mature
- compression garments should be worn 24 hours/day
types of pain
- acute (short)
- chronic (long)
- myofascial (muscles, tendons, or fascia)
- fibromyalgia (musculoskeletal pain and fatigue disorder, tenderness of muscles and tissues
- low back pain (most common work related injury, lumbar, from poor posture and body mechanics)
pain assessment
- determine location
- evaluate intensity on a scale
- onset and duration
- description
- functional assessment
pain scales that commonly address function
- McGill Pain Questionnaire
- Pain Disability Index
- Functional Interference Estimate
OT intervention for pain
- modalities
- proper positioning/postural techniques
- splinting
- gentle ROm
- relaxation
- using proper body mechanics in ADLs and at work
- modify activities
- ADL training
- alternative exercise programs
