Week 3 Burn Pathophysiology PT Considerations

Question 1

what are some rehab requirements for burn centers

Answer 1

comprehensive program within 24 hours of admission, with one full time burn PT and OT, that gets minimum daily therapy session. burn care 7x/week, with competency based therapy. Therapists train at a minimum every 2 years.

Question 2

what are some burn center referrals

Answer 2

full thickness burns 
specialized areas like the face, ears, eyes, hands, feet, 
circumferential burns 
chemical burns
electrical burns 
significant fractures 
inhalation or airway burns 
kids under 1 years old

Question 3

who makes up the team

Answer 3

physicians, students, NP, nurses, PT, OT, ST, social worker, chaplain, pharmacologist, dietician, respiratory therapy and recreational therapist.

Question 4

what are some burns and some complex skin conditions

Answer 4

electrical injuries, scald, flame, flash, contact burns
steven johnson syndrome, TENS
necrotizing fasciitis, gangrene, frostbite

Question 5

what is the most common type of burn

Answer 5

flame

Question 6

seconds most common burn

Answer 6

scald

Question 7

can you have a combo of burns

Answer 7

yes like scald and contact if it is a very thick liquid that will stick to the skin

Question 8

how are we going to treat a burn size that is less than 10-20% TBSA

Answer 8

pain control, bandages, therapy like stretching, exercise, and mobility.

Question 9

how do you treat someone with more than 10-20% TBSA burns

Answer 9

airway, breathing and circulation 
pain control 
fluid resuscitation 
bandages and dressings 
therapy

Question 10

what are the differences in treatment of full and partial thickness burns

Answer 10

full: therapy, surgical interventions, therapy
partial: therapy

Question 11

what is the order of tissue, starting from most superficial and going to deepest

Answer 11

superficial: epidermis 
dermis 
subcutaneous tissue 
fat
fascia
muscle 
bone

Question 12

do you get pain and sensations with full thickness burns

Answer 12

no, recuasse you are burning the nerve endings, so you get no pain

Question 13

how long does it take a superficial wound to heal

Answer 13

1-7 days

Question 14

how long does it take for a partial thickness to heal

Answer 14

7 days - 1 month

deeper: 2-6 weeks, heals by scarring.

Question 15

how long does it take for a full thickness burn to heal

Answer 15

can’t heal without surgery.

Question 16

what happens during the inflammation phase

Answer 16

increased blood flow, vasodilation, increased capillary permeability.
immune response
edema, exudate production
pain

Question 17

what happens during the proliferation phase

Answer 17

angiogenesis, collagen production, red, vascular tissue appears in the wound, epithelialization vs scar tissue formation, skin, scar contraction.

Question 18

what happens during the maturation phase

Answer 18

collagen remodeling and scarring
capillary regression
scar flattens, softens, pales, itching subsides.

Question 19

what is the rule of 9s with adult bodies

Answer 19

head and each arm are 9%
each leg and the trunk are 18% (front and back)
the groin is 1%

Question 20

what is the rule of 9s for a Childs body

Answer 20

head and trunk 18%
arms 9%
groin 1%
legs 14%

Question 21

a patients palm accounts for what % of the body

Answer 21

1 %

Question 22

what can a burn diagram show us

Answer 22

depth of the burns and locations on the body

Question 23

TF: burns are usually uniform depth

Answer 23

false, they vary with depth size

Question 24

what is the zone of coagulation

Answer 24

center part, and the deepest part with dead vessels

Question 25

what is the zone of stasis

Answer 25

center

Question 26

what is the zone of hyperemia

Answer 26

increased swelling and blood flow around the wound

Question 27

a partial thickness burn in what zone can covert to a full thickness burn

Answer 27

zone of stasis

Question 28

what factors can contribute to a partial thickness becoming a full thickness

Answer 28

infection edema poor resuscitation of fluid hypotension

Question 29

how can we do activity and edema management

Answer 29

early AROM ace wrap dependent limbs positioning and elevation muscle pumps

Question 30

what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for superficial

Answer 30

appearance: pink, red, wet blanching: present sensation: intact and painful healing time: less than 3 days risk of scarring/contracture: very low

Question 31

what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for superficial partial thickness

Answer 31

appearance: pink, red, edema blanching: present sensation: intact healing time: 3-7 days risk of scarring/contracture: low

Question 32

what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for deep partial

Answer 32

appearance: white, waxy, mottled, blochy. blanching: diminished sensation: limited light touch and pressure intact healing time: 2-6 weeks risk of scarring/contracture: moderate to high, may need skin graft

Question 33

what is the appearance, blanching, sensation, healing time and risk of scarring and contracture for full thickness

Answer 33

appearance: white, waxy, leathery, bright red, dark eschar blanching: absent sensation: absent, often painless healing time: surgical intervention risk of scarring/contracture: scarring with grafting only way to heal.

Question 34

what are some issues with electrical burns

Answer 34

they go very deep, and can travel very quickly. full thickness, sometimes down to the bone.can have a lot of necrotic tissues, and usually has an exit wound

Question 35

what kinds of things are you observing with a wound

Answer 35

location, tissues present, exudate, odor, edges, condition and color of peri-wound, inflammation and infection, edema and pain

Question 36

what are some pieces of a hands on wound exam

Answer 36

palpate the wound bed size and depth photograph it test sensation, blanching, and vascular integrity.

Question 37

what is compartment syndrome

Answer 37

when distal circulation is compromised because of increased internal pressure. you get a tourniquet effect, with a loss of tissue elasticity.

Question 38

in what kind of burns do you get compartment syndrome

Answer 38

circumferential full thickness, and even partial or mixed thickness that causes an increase in pressure because of inflammation and edema.

Question 39

what are the symptoms of compartment syndrome

Answer 39

severe edema, pain out of proportion tingling and numbness absent and diminished peripheral pulses

Question 40

what techniques are crucial for alleviating and avoiding compartment syndrome

Answer 40

edema management with slings, leg elevators and pillow, all while monitoring pulses.

Question 41

what is the medical management of burn related compartment syndrome

Answer 41

escharotomy. this is when they make an incision into the dermal layer to release the tension, usually through the burn tissue.

Question 42

what do you do for treatment is an escharotomy or fasciotomy is planned

Answer 42

defer PT until it is complete.

Question 43

after the escharotomy, what do we do

Answer 43

may have some bleeding, but we make sure there is dressing, compression (WITH RESTORED PULSES), no weight bearing restrictions, but may get pain.