Burn Rehabilitation PDF

Burn Rehabilitation Burn Definition A burn is damage to the skin’s tissues, usually caused by excessive heat. Heat is the most cause of burn injuries the Burns can also be caused by chemicals, electricity, the sun’s rays, or extreme cold. Burns usually affect the skin, but other important...

Burn Rehabilitation Burn Definition A burn is damage to the skin’s tissues, usually caused by excessive heat. Heat is the most cause of burn injuries the Burns can also be caused by chemicals, electricity, the sun’s rays, or extreme cold. Burns usually affect the skin, but other important areas of the body can also be injured. For example, the airways and lungs can be damaged as a result of inhaling hot fumes and gases Types of burn The severity of a burn depends on how deeply it has affected the tissue. There are three types of burn: Superficial burn This is a burn that only affects the surface of the skin. Partial thickness burn This is a deeper skin burn, but it does not affect the whole depth of the skin.  Full thickness burn The full depth of the skin is damaged and the skin appears dry. Other burn sites Burns to the face, singeing of eyebrows or nasal hair and black deposits in the mouth or sputum indicate that the airways may be burnt and immediate medical attention should be for this type.  The treatment is started the day after admission with positioning. The goal is to prevent oedema and contractures. It is often necessary to maintain the desired position by splinting. If the patient is in good condition active exercises and ambulation is performed. Rehabilitation after burn injury Pain control The use of combined analgesics such as paracetamol, non- steroidal anti-inflammatory drugs, Other pain control methods that may be helpful include transcutaneous electrical nerve stimulation (TENS). Inhalational injury chest treatment should start on suspicion of an inhalational injury. If there is a history of burn in a closed space or the patient has a reduced level of consciousness, short treatments should begin on admission. Treatment should be aimed at removing lung secretions (oedema), and preventing complications such as pneumonia. Inhalational injury 1) Upper airway Thermal / chemical injury leading to edema 2)Lower airway Thermal injury unlikely beyond major bronchi [ except steam ] Injury secondary to inhalation of water soluble substances. Ranging and antideformity positioning Passive ranging and antideformity positioning in the ill patient can prevent This is best done twice daily, with the therapist taking all joints through a full range of motion. The therapist must be sensitive to the patient's wounds, the status of extremity the state of pain and anxiety, the security of the patient's airway It is often useful to medicate patients before therapy sessions to increase their efficacy and decrease their discomfort. These procedures are important but cannot be effectively or humanely performed if they are associated with undue pain and anxiety. Ranging often can be timed to coincide with dressing changes and wound cleansing. Properly performed antideformity positioning minimizes shortening of tendons, collateral ligaments, and joint capsules and reduces extremity and facial edema. Predictable contractures occur in burn patients that can be prevented by a properly performed splinting program. Flexion deformities of the neck can be minimized with thermoplastic neck splints. In ill patients, positioning the neck in  slight extension is often all that can be done. It is also important not to allow ventilator tubing to pull the head such that a contracture develops. If proper care is not taken, a rotary contracture can develop, generally with the patient turned toward the ventilator Axillary adduction contractures can be prevented by positioning the shoulders widely abducted with axillary splints,. Elbow flexion contractures are minimized by statically splinting the elbow in extension. These splints can be alternated with flexion splints to facilitate retention of full range of motion. Flexion contractures of the hips and knees are particularly common in young children but can be prevented by careful ranging and positioning. It is important to prevent these even in infants, as these contractures can interfere with subsequent ambulation. Prone positioning, although poorly tolerated by some, can assist in minimizing hip flexion contractures, and knee immobilizers can minimize knee flexion contractures.  The ankle deformity, is a serious problem that can occur even if the ankles are not burned. However, they can be prevented with static positioning of the ankles in neutral and twice daily ranging. Splints designed for this purpose can cause pressure injury over the metatarsal heads or calcaneus if improperly designed. These injuries can be prevented using local padding to distribute pressure away from the metatarsal heads. At least twice daily inspection of all splints for evidence of poor fit or pressure injury is important. Improperly used splints can cause injury. Regular splint examination of the nursing staff minimizes splint-related skin injury. Oedema management Oedema removal should be encouraged from admission. The only body system that can actively remove excess fluid is the lymphatic system. Oedema collection in the zone of stasis of a burn may promote the progression of depth of a burn. Burned and grafted extremities commonly have lingering edema that can contribute to joint stiffness. Reduction of this edema facilitates rehabilitation efforts. Rehabilitation starts on the day of injury Compression—such as Coban, oedema gloves Movement—rhythmic, pumping Elevation or positioning of limbs for gravity assisted flow of oedema from them Maximisation of lymphatic function