Only epidermis damaged
red, swollen, tender
heals in a few days
“1st Degree”
Superficial Burn
Epidermis and Upper Dermis are damaged.
Swelling, redness, blistering, pain. Heals in 10 days - epithelial cells still present, minimal scarring.
“2nd Degree”
Superficial Partial Thickness Burn
Damage to epidermis & dermis (reticular layer)
Blood vessels, hair follicles and sweat glands. Red SEVERE EDEMA, heals in 3-5 weeks.
*also previously “2nd Degree”
Deep Partial-Thickness Burn
also previously “2nd Degree”
- Destroys all skin layers down to subcutaneous fat
- Eschar, leathery
- Nerve endings destroyed (no pain)
- Damage to lymphatic (minor edema visible)
- Regeneration not possible
- REQUIRES skin-grafting
- heals in several months
“3rd Degree”
Full-Thickness Burn
Burns that destroy subcutaneous fat, muscle and/or bone, often due to flame/electric shock
Requires surgery, skin-grafting, possible amputation. Can be lethal.
Subdermal Burn
What difference is there in utilizing the Lund-Browder Classification vs the Rule of 9s with children burn patients?
A child under one year has 9 % taken from the
lower extremities and added to the head region.
Each year of life, 1 % is distributed back to the
lower extremities until age 9 when the head
region is considered to be the same as an adult.
What is the #1 leading cause of death in burn patients that is associated with organ failure?
Infection
Scars from burns have what primary effects on a patient?
Loss of joint and muscle mobility
Loss of function
Cosmetic
What are the Cardiovascular Complications of burns?
- Dehydration
- Electro imbalances
- Circulatory shock
Metabolic Complications of Burns.
Hyperthermia
Atrophy: protein and muscle loss
Respiratory Complications of Burns
- smoke (noxious chemical inhalation)
- pneumonia: significant cause of death
- pulmonary edema
- Lung/trachea damage (O2 capacity decreases in RBC)
Metabolic Complications of Burns
- decreased core temp by 1.8-2.6 degrees
- decreased weight
- atrophy / weakness
Initial Burn Treatment Goals
- adequate nutrition and calories
- prevent infection
- warmth
- debridement, topical medications
- dressings
- skin-grafts
What is the anti-contracture position for burns on the back of the hand?
- wrist: 30-40 degrees in extension
- MCPs: 60-70 degrees flexion
- IP joints in extension
- mid-palmer: radial abduction
Physical Therapy Goals for Burns
- promote healing
- prevent deformity
- maintain function
- maintain or improve cardiopulm status
Indications for Pressure Garments on a burn patient.
- hypertrophic/keloid scars
- burns taking more than 14 days to heal
What rationale is there behind applying Pressure Garments?
- tissue remodeling
- re-organization of collagen
- minimize edema
