Physical Therapy: Burn Injuries
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Questions and Answers

What should you do if the person is still in contact with the electrical current?

  • Turn off the source of electricity if possible (correct)
  • Call for medical assistance immediately
  • Touch the person to try to rescue them
  • Move the person away from the electrical current

    • What percentage of TBSA is considered suitable for outpatient management?

  • Less than 15%
  • Less than 10% (correct)
  • Less than 20%
  • Less than 5%

    • What should be done to blisters in 1st and 2nd degree burns?

  • Burst them immediately
  • Leave them intact (correct)
  • Cover them with gauze
  • Apply antibiotic ointment

    • Why should a urinary catheter be inserted in burn patients?

    <p>To monitor urine output</p> Signup and view all the answers

    What should you do if the wires are jumping and sparking?

    <p>Move away from the source of electricity</p> Signup and view all the answers

    When should you move a person with an electrical injury?

    <p>Only if the person is in immediate danger</p> Signup and view all the answers

    What is the estimated annual number of people seeking medical treatment for burns worldwide?

    <p>6 million</p> Signup and view all the answers

    Where do most burn injuries occur?

    <p>In the home</p> Signup and view all the answers

    What is the ranking of fire and burn injuries as a cause of death in children between 1-4 years?

    <p>Second leading cause of death</p> Signup and view all the answers

    What is the proportion of resting cardiac output received by the skin?

    <p>One-third</p> Signup and view all the answers

    What is the age group in which fire and burn injuries are the third leading cause of death?

    <p>Children under 19 years</p> Signup and view all the answers

    What is the weight of the skin in the average person?

    <p>4-5 kg</p> Signup and view all the answers

    What is the function of the basement membrane in the epidermis?

    <p>To separate the epidermis from the dermis</p> Signup and view all the answers

    What percentage of the dermal thickness is made up of reticular dermis?

    <p>80%</p> Signup and view all the answers

    What is the function of fascia in the subcutaneous tissue?

    <p>To separate and surround structures</p> Signup and view all the answers

    What is the thickness of the epidermis in the palms of the hands and the soles of the feet?

    <p>0.6 mm</p> Signup and view all the answers

    What is the function of the papillary dermis?

    <p>To form fingerprints</p> Signup and view all the answers

    What is the function of adipose tissue in the subcutaneous tissue?

    <p>To store fat and provide energy, cushioning, and insulation</p> Signup and view all the answers

    What is the primary factor in determining whether a burn is major or minor?

    <p>Percentage of total body surface area burned (TBSA)</p> Signup and view all the answers

    What is the formula to calculate the amount of fluid needed for patient resuscitation?

    <p>(2 or 4) ml x kg bodyweight x % TBSA + 2000 ml saline</p> Signup and view all the answers

    What is the disadvantage of the rule of nines method?

    <p>It consistently overestimates the size of a burn injury</p> Signup and view all the answers

    Which method is preferred for small burn areas?

    <p>Palmar method</p> Signup and view all the answers

    What is the relationship between the percentage of body surface area burned and the number of anticipated contractures to develop?

    <p>There is a direct relationship</p> Signup and view all the answers

    Which method is more suitable for children under 16 years of age?

    <p>Lund &amp; Browder chart</p> Signup and view all the answers

    What is the principle used in the volumetric measurement method?

    <p>The principle of water displacement discovered by Archimedes</p> Signup and view all the answers

    What is the advantage of the girth measurement method?

    <p>It is simple, efficient and clinically useful</p> Signup and view all the answers

    What is the characteristic of Grade 3+ pitting edema?

    <p>A 6 mm depression that may last more than 1 minute</p> Signup and view all the answers

    What is the limitation of the volumetric measurement method?

    <p>It is time-consuming and requires specialized equipment</p> Signup and view all the answers

    How is edema classified?

    <p>Based on the type of edema (pitting or non-pitting)</p> Signup and view all the answers

    What is the advantage of palpation in assessing edema?

    <p>It helps to determine the type of edema (pitting or non-pitting)</p> Signup and view all the answers

    What is the consequence of the loss of fat padding from the subcutaneous tissue?

    <p>Development of pressure ulcers</p> Signup and view all the answers

    What is the difference in the effects of acidic and alkaline burns on the skin?

    <p>Alkaline burns cause liquefaction necrosis, while acidic burns cause coagulation necrosis</p> Signup and view all the answers

    What is the additional complication that can arise from inhalation of fumes created by chemical spills?

    <p>Pulmonary dysfunction</p> Signup and view all the answers

    What is the effect of aging on collagen content in the skin?

    <p>Collagen content decreases by 1% per year</p> Signup and view all the answers

    What is the result of the combination of changes in skin structure and function with aging?

    <p>Thin, dry, and inelastic skin</p> Signup and view all the answers

    What is the type of injury that can occur due to minor friction or shearing forces?

    <p>Skin tear</p> Signup and view all the answers

    Which of the following is a sign of hypovolemic shock in a burn patient?

    <p>Pulse is weak, rapid, systolic BP</p> Signup and view all the answers

    What is the primary purpose of the burn severity index (BSI) in burn management?

    <p>To predict the mortality rate of burned patients</p> Signup and view all the answers

    What is the main focus of the neurological and psychological factors assessment in burn management?

    <p>To identify any neuromuscular or skeletal deficits</p> Signup and view all the answers

    What is the significance of a urinary output of < 20 mL/hr in a burn patient?

    <p>It is a sign of hypovolemic shock</p> Signup and view all the answers

    What is the purpose of evaluating the patient's demographic data and history in burn management?

    <p>To plan an effective treatment strategy</p> Signup and view all the answers

    What is the significance of a hematocrit of 35 in a burn patient?

    <p>It is a sign of hypovolemic shock</p> Signup and view all the answers

    What is the primary method used to measure the volume of edema in a patient?

    <p>Volumetric measurement method</p> Signup and view all the answers

    What is the recommended position for the head in cases of facial or inhalation injury?

    <p>Elevate the head above the level of the heart</p> Signup and view all the answers

    What is the depression depth of Grade 2+ pitting edema?

    <p>4 mm</p> Signup and view all the answers

    What is the purpose of using a neck conformer?

    <p>To avoid hyperextension of the neck</p> Signup and view all the answers

    What is the disadvantage of the volumetric measurement method?

    <p>It is time-taking and requires specialized equipment</p> Signup and view all the answers

    What is the recommended position for the shoulder in sidelying?

    <p>Shoulder abduction at 90 degrees</p> Signup and view all the answers

    What is the characteristic of Grade 1+ pitting edema?

    <p>Mild depression that disappears rapidly</p> Signup and view all the answers

    What is the purpose of using a pillow or splint in sidelying?

    <p>To maintain elbow and forearm flexion</p> Signup and view all the answers

    What is the purpose of palpation in assessing edema?

    <p>To determine the type of edema</p> Signup and view all the answers

    What is the recommended position for the wrist in sidelying?

    <p>Wrist extension at 30 degrees</p> Signup and view all the answers

    What is the advantage of the girth measurement method?

    <p>It is simple, efficient, and clinically useful</p> Signup and view all the answers

    What is the purpose of using a clavicle or shoulder strap?

    <p>To support the clavicle and shoulder</p> Signup and view all the answers

    What is the primary nutritional requirement for burn patients?

    <p>High protein and high calories</p> Signup and view all the answers

    What is the consequence of inadequate nutrition in burn patients?

    <p>Negatively impacted immune response, wound healing, and survival</p> Signup and view all the answers

    When can a burn patient be fed using the most appropriate route?

    <p>When bowel sounds return in about 48–72 hours post-burn</p> Signup and view all the answers

    What is the relationship between the size of the burn and the patient's metabolic rate?

    <p>The metabolic rate increases in proportion to the size of the burn</p> Signup and view all the answers

    What nutrients are essential for burn patients besides protein and calories?

    <p>Fat in the form of lipids, vitamins, and trace minerals</p> Signup and view all the answers

    Study Notes

    Anatomy and Function of Integumentary System

    • Skin is the largest organ and first line of defense, weighing over 4-5 kg in the average person.
    • Receives roughly one-third of resting cardiac output.
    • Thinnest skin is located on eyelids and eardrums, while thickest skin is on palms and soles of feet.

    Incidence of Burn Injuries

    • An estimated 6 million people seek medical treatment for burns annually worldwide.
    • One-third of burn victims are children, with fire and burn injuries being the second leading cause of death in children between 1-4 years and third leading cause of death in children under 19 years.
    • Most burn injuries occur in the home, primarily in kitchens and bathrooms.

    Skin Anatomy

    • Epidermis: avascular outer layer, 0.06-0.6 mm thick, consisting of 5 stratums with three appendages (hair, glands, and nails) within the dermis.
    • Dermis: inner layer, 2-4 mm thick, highly vascular with two layers (papillary and reticular dermis) containing blood vessels, oil glands, sweat glands, hair follicles, fat tissue, nerves, and connective tissue.
    • Subcutaneous tissue (Hypodermis): supports skin, consisting of adipose tissue and fascia, storing fat for energy, cushioning, and insulation.

    First Aid for Burn Injuries

    • Chemical burns: flush with cool running water for 20 minutes, remove contaminated clothes, and call for medical assistance.
    • Electrical burns: don't touch the injured person if still in contact with the electrical current, turn off the source if possible, and call for medical assistance.

    Outpatient Management

    • For 1st and 2nd degree burns less than 10% TBSA: blisters should be left intact and dressed with silver sulfadiazine cream, with daily dressing changes.

    Initial Emergency (Hospital) Procedures

    • Fluid infusion must be started immediately, with NGT insertion to prevent vomiting and aspiration, and urinary catheter to measure urine output.
    • Weight should be taken daily.

    Extent of Burn (TBSA or BBSA)

    • Rule of Nine: divides the integument into areas roughly equivalent to 9% of TBSA, but consistently overestimates the size of a burn injury.
    • Lund & Browder chart: considers variations in body surface area distribution with age, more suitable for children under 16 years old.
    • Palmar method: uses the area of the palmar surface of the patient's hand to determine burn size, preferred for small burn areas.

    Edema and Limb Circumference

    • Edema grading: Grade 0+: no pitting edema, Grade 1+: mild pitting edema, Grade 2+: moderate pitting edema, Grade 3+: moderately severe pitting edema, Grade 4+: severe pitting edema.
    • Measurement methods: water displacement method, girth measurement, and ring method.
    • Fat loss from subcutaneous tissue causes prominence of bony protuberances in thorax, scapula, trochanters, and knees.
    • Loss of fat padding contributes to development of pressure ulcers.
    • Collagen and elastin shrink and degenerate, with collagen content decreasing by 1% per year throughout adult life.
    • Skin becomes thin, dry, and inelastic, making it susceptible to skin tears.

    Burn Injury

    • Coagulation destruction of skin or body parts due to thermal, chemical, electrical, irradiation, or atomic causes.
    • Etiology of burn injuries includes:
      • Thermal burns
      • Chemical burns (acidic and alkaline)
      • Electrical burns
      • Irradiation burns
      • Atomic burns

    Chemical Burns

    • Acidic burns: occur when acidic chemicals come into contact with skin, causing coagulation necrosis and limiting tissue damage.
    • Alkaline burns: occur when alkaline chemicals denature skin proteins, causing liquefaction necrosis and deeper tissue damage.
    • Alkaline burns tend to be more severe than acidic burns.

    Electrical Burns

    • Occur when electricity flows through the body, causing resistance and systemic effects.
    • Signs and symptoms of hypovolemic shock include:
      • Restlessness and anxiety
      • Pale, cold, and clammy skin
      • Temperature below 37°C
      • Weak and rapid pulse
      • Systolic blood pressure
      • Urinary output < 20 mL/hr
      • Urine specific gravity > 1.025
      • Thirst
      • Hematocrit 35
      • Blood urea nitrogen (BUN)

    Burn Management and Evaluation

    • Evaluation is a continuing process of collecting and organizing relevant information to plan and implement effective treatment.
    • Components of evaluation include:
      • Patient demographic data and history
      • Burn severity index (BSI)
      • Edema and limb circumference
      • Sensory assessment
      • Muscle strength assessment
      • Joint range of motion (ROM) assessment
      • Flexibility assessment
      • Mobility and ambulation assessment
      • Endurance assessment
      • Functional activities assessment
      • Neurological and psychological factors assessment

    Burn Severity Index (BSI)

    • The Abbreviated Burn Severity Index (ABSI) is a five-variable scale to assess burn severity.
    • Variables associated with increased mortality rate in burned patients.

    Edema and Limb Circumference

    • Edema can be assessed by:
      • Observation and comparison to the unaffected limb
      • Palpation to determine type of edema (pitting or non-pitting)
      • Measurement using water displacement, girth measurement, or ring method
    • Edema grading:
      • Grade 0+: No pitting edema
      • Grade 1+: Mild pitting edema
      • Grade 2+: Moderate pitting edema
      • Grade 3+: Moderately severe pitting edema
      • Grade 4+: Severe pitting edema

    Volumetric Measurement Method

    • Gold standard tool for measuring edema
    • Utilizes the principle of water displacement discovered by Archimedes
    • Disadvantages include:
      • Time-consuming setup
      • Difficulty in moving the equipment
      • Requires specialized equipment
      • Messy and unsuitable for certain patient populations

    Nutrition in Burn Recovery

    • Patients require a diet high in calories and protein to counteract hypermetabolic response and support growth of healthy tissue.
    • Burn patients require fat in the form of lipids, vitamins, and trace minerals.
    • Inadequate nutrition can negatively impact immune response, wound healing, metabolic function, and survival.

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    Burn Management 2022 PDF

    Description

    This lecture covers the anatomy of the integumentary system, functions, and types of burn injuries, as well as proper first aid, evaluation, and rehabilitation for burned patients. Learn about burn injuries and their treatment.

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