Understanding Burns and Their Treatments

Burn Definition

• A burn is damage to skin tissues, usually caused by excessive heat.
• Heat is the most frequent cause of burn injuries.
• Burns can also be caused by chemicals, electricity, the sun's rays, or extreme cold.
• Burns commonly affect the skin, but other body parts, like airways and lungs, can also be damaged.

Types of Burns

• Superficial burn: Affects only the surface of the skin.
• Partial thickness burn: Damages deeper skin layers but doesn't reach the whole skin depth.
• Full thickness burn: Damages the entire skin depth, visibly dry appearance.

Other Burn Sites

• Burns to the face, eyebrows, or nasal hair can suggest airway damage.
• Black deposits in the mouth or sputum indicate potential airway/lung burns.
• Immediate medical attention is crucial for these burn types.

Rehabilitation after Burn Injury

• Treatment begins on the day of admission.
• The goal is to prevent swelling (oedema) and contractures.
• Positioning and splinting help maintain correct body positions.
• Active exercises and ambulation are often performed.
• Pain control includes analgesics like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
• Other methods like transcutaneous electrical nerve stimulation (TENS) may help.
• Inhalational injuries require specialized treatments that focus on removing lung secretions and preventing complications like pneumonia.

Inhalational Injury

• Upper airways are vulnerable to thermal or chemical injuries, causing edema.
• Lower airway involvement, like from steam, is less common than upper airway injuries.
• Inhalation of water-soluble substances can also cause injury.

Ranging and Anti-deformity Positioning

• Passive ranging and anti-deformity positioning can prevent contractures in injured patients.
• The therapist must consider factors like patient's wounds, extremity status, pain level, and airway security.
• Pre-treatment medication can improve patient comfort and effectiveness.
• Positioning is important to prevent shortened tendons, ligaments, and capsules, thus reducing swelling in extremities and face.

Other Considerations

• Splinting programs help prevent neck and joint contractures.
• Positioning the neck in a neutral and extended position is important to prevent neck contractures, especially during ventilator use.
• Elbow, shoulder, and other joint contractures can be prevented using splints.
• Positioning is crucial in minimizing contractures of the hips and knees, particularly in young children. Prone positioning (stomach down) can be helpful.

Knee Drop Plank

• Ankle deformities can develop even in the absence of direct burn injury to the ankles.
• Prevention is possible with neutral positioning and daily exercises.

Splint Usage

• Improperly designed splints can cause pressure injuries, particularly on the metatarsal heads or calcaneus.
• Regular inspections of splints for proper fit and pressure points are essential.
• Nursing staff monitoring reduces the risk of skin injury due to splints.

Oedema Management

• Oedema removal is vital, and the lymphatic system is responsible for effectively removing fluid.
• Oedema in burn areas can promote deeper burn progression.
• Edema reduction facilitates rehabilitation efforts by minimizing joint stiffness.
• Treatments include compression (e.g., Coban, edema gloves), rhythmic movements, elevating affected areas, and maximizing lymphatic function.