Burns

Question 1

Burns Severity

Answer 1

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

Question 2

Zones of Burns

Answer 2

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

Question 3

Rule of Nine

Answer 3

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%

Question 4

Effects of Burns on Cardiovascular system

Answer 4

• 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

Question 5

Effects of Burns on respiratory system

Answer 5

• Pulmonary edema–>by inhalation injuries
  Due to increase capillary permeablility
• Bronchoconstriction, ARDS

Question 6

Effects of Burns on Metabolic system

Answer 6

• Hypothermia
• Increase of metabolic activity–>rapid weight loss

Question 7

Effects of Burns on MSK/renal system

Answer 7

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

Question 8

Sign of inhalation injury

Answer 8

• 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

Question 9

Exercise Consideration

Answer 9

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

Question 10

Exercise education tips

Answer 10

• 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

Question 11

Burn Positioning

Answer 11

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

Question 12

Donar sites

Answer 12

• Autograft: same person body
• Allogenic: different person
• Xenogenic: different species

Question 13

Manage Heat sensitivity while exercising

Answer 13

• 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