burn rehabilitation
TRANSCRIPT
Burn Rehabilitation
Braddom Chapter 58
Alireza PishgahiDecember 2012
Burn Wound Subtypes
TBSA
Lund & Browder
The rule of 9.
Every one’s palm is equal to 1% of TBSA.
Acute Surgical Procedures Avoid compartment syndrome Wounds have to remain open after escharotomy. Extremities should be elevated and in neutral position for 24
hrs before ROM exercise.
Debridement & autologus skin grafting
Reduce infection Increase survival
Nutrition in Burns
Daily calorie need: (25 kcal/kg) + (40kcal plus TBSA)
Serum pre-albumin
Dysphagia More TBSA More days with tracheostomy More days under ventilator
Catabolism
TBSA >30%Increase insulin resistanceReduce bone mineral densityReduce lean body mass
catabolism Increase pneumoniaPoor wound healing
Beta-blockers(Propranolol)
Anabolics (Oxandrolone)
ExercisePassive(spilnting/
positioning)Active ASAP
Dressing & Hydrotherapy More trends toward
hydrocollid,biosynthetic, antimicrobial dressings for superficial and partial-thickness wounds.
Hydrotherapy increase G-negative infections such as Psudomonas.
Positioning
Splinting
To reduce intrinsic-minus deformity
Functional position
Complications- inhalation injury
Increase mortality in children/ elderly.
Susceptible to ARDS/pneumonia/MOF
Early tracheostomyDo not affect pulmonary outcomeIncrease oral hygiene level
Complications- inhalation injury
EtiologyThermal injury/ electrical injury/ compression/ metabolic
imbalance
More TBSA & deeper burnAxonal lesion is more frequent than demyelinating injury
Most commonMedian sensory neuropathy
Complications- inhalation injury
Complications- Hypertropic Ossification
TBSA>30% Most common site is below elbow
Best treatment or prevention is not yet clear.
Bisphophonat agents(Etidronate)Recurrence is common even after surgery and postoperative
passive mobilization.
Complications- Hypertropic Ossification
Complications- Hypertrophic Scarring
Most common complication in burn injury
Raised/ red/ painful/ pruritic/ contractileDoes not cross injury line(in apposition with Keloid)
Most susceptible groupAdolescent/ darker skins/ inflammatory wounds with
prolonged healing/ open wound more than 3 weeks
TGF-β
Complications- Hypertrophic Scarring
Prevention is the best treatment.
First line treatmentMoisturizing creamsReduce mechanical insultsAvoid heat and sunburn
Complications- Contractures
Most common in shoulder/elbow/knee
Massage/splint/stretch/proper positioning /ROM exercise will reduce contractures
To reduce pruritus in scarsTopical: Diphenhydramine/ Doxepin/ GabapentineOral: Diphenhydramine/ Doxepin/ Gabapentine/ NaltroxeneNon-pharmacologic: Massage/ TENS/ LASER
Inpatient Rehabilitation
Functional Independence Measure<110
مشاوره بخش سوختگی مردان
% اندام های تحتانی 30 ساله ایW با سوختگی حدود 43آقای در این بخش بستری می باشدو لطفا جهت انجام
فیزیوتراپی بیمار را ویزیت نمایید.Proper positioningActive ROM of all joints of lower limbsStretch for hamstring and calf muscles
TENS?Massage?