OPTA 222(Burns)
Rule of Nines
assesses the percentage of burn and is used
to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9
Depth of Burn: Superficial
(first degree) - sunburn
a. epidermis
Depth of Burn: Partial
(second degree) - blistering
a. Superficial partial (superficial dermis)
b. Deep partial (deep dermis)
Depth of Burn: Full Thickness
(third degree) - black/dead tissue
a. Subcutaneous tissue
b. Muscle, tendon, bone (sometimes referred to as 4th degree)
Burn Care: Acute
Rehab for positioning; helping with edema and ROM
Burn Care: Surgical/ Postoperative
Rehab for scar management and wound care
Burn Care: Rehabilitation
Rehab for psychosocial issues, Cosmesis (cosmedics – ex: wigs, prosthesis, clothing), Preventing scarring and disfigurement, Return of function (working on ROM to prevent contractures)
Positioning why is it important?
- Prevent edema
- Prevent contractures
- Maintain ROM
- promote proper wound healing
- relieve pressure
- protect new skin grafts
Medical Care
-Intravenous Hydration
-Escharotomy( removal of dead tissue)
-Wound Care
-Skin Grafting
Skin Grafting
- Autograft - take skin from self vs donor
- Synthetic coverings are an option.
- They mesh skin to make it larger to expand donor skin to cover a larger area and
to allow for fluid drainage
What do you think medical management would have to be post skin graft?
- wound care - edema management
- overall health - immunosupressng drugs of donor skin
Contactures
-Contractures are shortening of tendons, ligaments, muscles, soft tissue, blood vessels and nerves. Can be permanent.
-A significant function of the rehab team is to prevent contractures. Contractures develop during healing because: Wound is in a flexed position,Contraction is part of the normal wound healing process
-How do you prevent contractures? Positioning and ROM
Scar Formation
Hypertrophic scarring is a raised collagenous bundle like scar that is often discolored
Scar management
-Scars can continue to mature for 1-2 years
-Pigment can be different, scars can be raised etc.
-For hypertrophic scarring: Massage and pressure garments can assist in decreasing visibility of scar
Pressure Garments
Collagen in the skin is shaped like a grid, but when damaged, heals like a squiggly, messy grid. Pressure garments apply pressure for a long period of time to help re-organize the collagen to arrange more neatly and more like normal.
what social difficulties would a burn patient have
-Confidence
-Answering questions regarding their injuries
-How to respond to staring
-How to respond when people ask what happened