Physiotherapy rehabilitation of burns with various forms of exercise, modalities, recent advances, splints. all the therapies described here are evidence based practices with references
Introduction
Burns
Clinically Relevant Anatomy Of Hand
Common Hand Problems In Burns
Surgical Management
Evidence based Physical Therapy Rehabilitation
Outcome Measures
Summary
References
Introduction
Burns
Clinically Relevant Anatomy Of Hand
Common Hand Problems In Burns
Surgical Management
Evidence based Physical Therapy Rehabilitation
Outcome Measures
Summary
References
contracture ppt for physiotherapy..
definition of contracture
types of contracture
why contracture occurs
therapy of contracture
YouTube link- https://youtu.be/JU1zyft7w9c
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
Mastectomy is the removal of the whole breast. There are five different types of mastectomy: "simple" or "total" mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy.
contracture ppt for physiotherapy..
definition of contracture
types of contracture
why contracture occurs
therapy of contracture
YouTube link- https://youtu.be/JU1zyft7w9c
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
Mastectomy is the removal of the whole breast. There are five different types of mastectomy: "simple" or "total" mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Journal Club : Article by Kim YS, Rhim H, Choi MJ, Lim HK, Choi D. High-intensity focused ultrasound therapy: an overview for radiologists. Korean journal of radiology. 2008 Aug 1;9(4):291-302.
A traditional manual therapy technique developed by John Upledger, involving bare hands and stretching the tension membrane so as to ease the tension within
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
Traction: a basic physiotherapy modality used for inducing space between the joints. this slideshow deals with various types of traction and its application to cervical, thoracic and lumbar spine.
the PPT Describes about various types of dysfunction in mechanical pattern as described by Janda's. it also describes about normal muscle slings prresent within the body and its compensation and decompensation patterns towards the adaptations of the body
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsRadhika Chintamani
This slide show describes about thoracic and rib cage in detail with its anatomy, kinetics and kinematics along with force couple. the slideshow also describes about the pathology and pathomechanics related to the topic
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
A very old school of manual therapy which comprises of two main principle centralization and peripheralization thought given by Robin McKenzie. The slideshow explain theoretical and practical part of both entire spine and extremities as well
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Massage of therapeutic form is beneficial in many conditions like stroke, flaccidity, muscle tightness, spasm etc.
it has many physiological effects along with many types for different conditions as well as different body areas.
it is another taping technique which inhibits or control the movement. it is helpful in postural correction and movement pattern correction as well. usually used clinically
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Contents
1. Definitions
2. Skin Anatomy
3. Classification of burn
4. Pathological changes: Local and Systemic
effects
5. Assessment of burns
6. Outcome measures
7. Treatment phases
3. Definitions and Epidemiology.
• A burn is an injury to the skin or other organic tissue primarily
caused by heat or due to radiation, radioactivity, electricity,
friction or contact with chemicals. (WHO, September 2016)
• Epidemiology:
A five year epidemiological study done by Goswami et al.
collected retrospective data of all the burn patients admitted to
the BCU in Tata Main Hospital, Jamshedpur, Jharkhand, India
from January 2009 to December 2013 were collected and were
analyzed. The number of admission from 2009-2013 were
variable, ranging from 326-436 and the overall male to female
ratio was 1:1.05, with most common etiology to be Flame burn
(65.16%).
HyperlinksIndianJBurns24141-1241573_032655.pdf
5. Classification of Burns 4
On the basis of skin
thickness
On the basis of
etiology
1. Superficial thickness
burn
2. Superficial Partial
thickness burn
3. Deep Partial
thickness burn
4. Full thickness burn
5. Subdermal burn
1. Thermal burn
2. Chemical burn
3. Electrical burn
4. Inhalation burn
5. Friction burn
6. Radiation burn
6. On the basis of skin thickness
CHARACTERS: 1. Surface thickness of burn 2. Color. 3.
Surface Appearance. 4. Pain. 5. Edema. 6. Healing. 7. Scarring
7. On the basis of etiology
Thermal Burn:
•Types of
mechanism:
Conduction and
radiation.
Thermal Burn:
•Types of
mechanism:
Conduction and
radiation.
Pathological mechanism is temperature-time relation.Pathological mechanism is temperature-time relation.
10. Chemical burns
Agent Common source Mechanism of action
Alkalis Lime
Potassium hydroxide
Sodium hydroxide
Cement
Household cleaners
Cell dehydration
Liquifaction necrosis.
Acids Industrial cleaners
Household rust removers
Oxidation
Hydrocarbons Industrial cleaners
Solvents and degreasing
agents
gasoline
Protoplasmic toxicity
Ref: Carrougher. G. J. Burn care and therapy. Mosby Inc.(1998).pg no:6
11. Electrical burns
Hyperlinks[Macedonian Journal of Medical Sciences] Electrical Injuries Etiology
Pathophysiology and Mechanism of Injury.pdf
Hyperlinks[Macedonian Journal of Medical Sciences] Electrical Injuries Etiology
Pathophysiology and Mechanism of Injury.pdf
Voltage Effect
1 mAmp Threshold of perception
5-10mAmp Maximum harmless
current
16-
20mAmp
Tetany of skeletal muscles
20-
50mAmp
Paralysis of respiratory
muscles (respiratory arrest)
100mAmp Threshold for ventricular
fibrillation
2-5Amp Asystolia
12. • Two types: Direct inhalation burns and indirect
burns.
• Direct burns: Enclosed space.
• Indirect Inhalation burns: concomitant to neck and
facial burns.
14. Radiation burns
Minimum radiation
required to cause burn is
greater than 25rads.
Radiations greater than 100
rads cause acute radiation
syndrome. (3types)
Ref: Kelleher D: Acute effects of radiation. In United States Navy/Royal
Navy workshop on nuclear warfare combat casualty care, US Navy, 1983,
US Govt Prnt Offc
Ref: Kelleher D: Acute effects of radiation. In United States Navy/Royal
Navy workshop on nuclear warfare combat casualty care, US Navy, 1983,
US Govt Prnt Offc
16. Skin exposed to high temperature
Breakdown of proteins of skin
Cell and tissue damage
Loss of barrier function of the skin
Massive fluid loss from water evaporation
Inability to control body’s temperature due to loss of body
heat occurring due to excessive evaporation
Loss of proteins, potassium and sodium
Pathology of burn injury (common pathology)Pathology of burn injury (common pathology)
17. Burn Injury
Increased fluid
leakage from
capillaries
Tissue edema
Loss of blood or
any fluid due to
imbalance
poor blood
visceral supply
Stomach ulcer and
renal failure
Increased level
of
catecholamine
Inflammatory
response
Hypermetabolic
state (causing
decrease in body
wt)
18. The local effect involves three burn zones:
www.vicburns.orgwww.vicburns.org
The depth of the wound develops over time: The burn process
peaks at approximately three days. Progression is 3D- zone of
coagulation both increases in depth and width.
The depth of the wound develops over time: The burn process
peaks at approximately three days. Progression is 3D- zone of
coagulation both increases in depth and width.
19. Pathological changesPathological changes
1.Local changes:
a.Severity of burn.
b.Three zones of burn
c.Vascular changes: due to circulatory disruption, third
spacing, fluid remobilization.
2. Systemic changes:
a)Shock: lasts for 12-24 hrs
b)Biochemical changes: electrolyte imbalance, blood urea.
c)Blood changes: increased breakdown of RBC’s.
d)Metabolic changes: The greater the TBSA, the greater the
risk and impact of hyper metabolism.
20. Evidence
Author
name
Title and year Parameters Conclusion
William DW.
Long. J.
Mason. A.D
Skreen. R.W
Pruitt. B.A
Catecholamines
Mediator of the
Hypermetabolic
Response to
Thermal Injury
[1974]
Energy Expenditure
Interaction with
Metabolic Rate, Body
and Skin Temperatures.
The injury stimulates the
hypothalamic reset of the
internal thermostat due to
which burn patient strive
to maintain a core body
temperature about 10
-20
greater than normal.
Goran M.
Peters EJ.
Herndon DN.
Wlofe. R. R.
Total energy
expenditure in
burned children
using the doubly
labeled water
technique.
[1990]
Resting energy
expenditure in burned
children
Total energy
expenditure in burned
children
REE is 1.2times greater
than that of normal
TEE 1.3 times greater
than that of normal
children
21. Stages of burns
Stage of Shock
Stage of Eschar
Stage of Healing and Reconstruction
Phases of burn
1.Emergent phase:24-48hrs.
2.Acute phase: 48hrs-wound closure.
3.Chronic phase: wound closure-functional ADL
regainment.
Phases of burn
1.Emergent phase:24-48hrs.
2.Acute phase: 48hrs-wound closure.
3.Chronic phase: wound closure-functional ADL
regainment.
22. Complications of healing in burn2Complications of healing in burn2
i. Pain: Background pain, pain due to anxiety,
Procedural, Break-through pain.
ii. Edema.
iii. Inflammatory Response.
iv. Compartment syndrome.
v. Hypertrophic scarring.
vi. Keloid.
vii.Toxic Epidermal Necrolysis.
viii.Reduced ROM.
ix. Impaired functional capacity.
x. Psychological problems.
23. Assessment2
Primary assessment
• Airway.
• Breathing.
• Circulation.
• Neurologic status.
Secondary assessment
• Type and Mechanism of
injury
• Severity and extent of
burn
• Depth of burn
26. Physiotherapy Assessment
• On observation: degree of burn, severity of burn, extent
of burn, edema,etc.
• Edema assessment: site, pitting, non-pitting.
• Burn wound area assessment: Laser dopler flowmetry,
clock method.
• On palpation: Area to be palpated burnt area with
sterile methods and the area beside it to assess for
assessment of perception of sensation.
• Range of motion assessment: after advised period of
immobilization.
27. Outcome measures 2
HyperlinksBURN SPECIFIC HEALTH SURVEY.doc
x
HyperlinksBSHS-B.pdf
Scar Outcome Measures:
HyperlinksBurn scar scales.pdf
28. • Evidence:
• When the BSHS – B is used in comparison
with the SF -36 health questionnaire, the
BSHS – B was seen to provide more useful
information with fear avoidance and post-
traumatic stress disorder in relation to
returning to work (McMahon 2008).
• HyperlinksBurn Centre Referral Criteria.docx
29. Hydrotherapy
for cleansing
30 minutes
Adequate
cleansing is
achieved by mild
soap.
Mechanical
debridement
Chemical
debridement
Surgical
debridement
Wet dressing,
Wet-to-dry
dressing,
Wet-to-moist
dressing.
Accuzyme,
Collagenase
Santyl,
Elase.
Tangential
excision.
Fascial
excision.
Cleansing 1
Debridement of
wound1
Treatment of burns:
I. Emergent Phase: 2
Treatment of burns:
I. Emergent Phase: 2
31. Formula name Recommended
solutions
Formula for
estimating fluid needs
EVANS 0.9% of NS +
Colloid solution
1ml/kg/%TBSA +
1ml/kg/%TBSA
Brooke Lactated Ringer’s
solution + Colloid
solution
1.5mlkg/%TBSA +
0.5ml/kg/%TBSA
Hypertonic saline Na+
250mEq/liter Volume to maintain
urine output at
30ml/hr
Modified Brooke Lactated ringer’s
solution
2ml/kg/%TBSA
Parkland Lactated Ringer’s
Solution
4ml/kg/%TBSA
Common fluid resuscitation used in emergent phase of burn
are: Adult burn resuscitation formula: Initial 24hr post injury
32. Formula
Name
Recommended
solutions
Formula for existing fluid needs
EVANS 0.9% NS +
5% Dextrose in water
50% of first 24hrrequiremnt +
2000ml
Brooke Lactated ringer’s
solution+
5% dextrose in water
50% to75% of first
24hrrequiremnt +2000ml
Hypertonic
saline
33% isotonic salt
solution
0.6ml/kg/%TBSA burn +
Replacement of insensible losses
Modified
Brooke
Colloid solution +
5% dextrose in water
0.3-0.5ml/kg/%TBSA +
Volume to maintain desired urine
output
Parkland 25% albumin +
5% dextrose
20-60% of calculated plasma vol
+
Volume to maintain desired urine
output
Second 24hrs post injury 2
33. Acute Phase
Aims:
• Protect/promote healing.
• If can not be managed with conservative treatment
then surgery specified.
• Reduce pain and edema.
• Reduce risk of complications by maintaining
immobilization.
• Optimize scar appearance.
• Decrease complications of scar /prolonged positioning
on range of motion and function.
• Prevent contractures
• Prevent deformities/loss of range
34. Type of
treatment
Dosage Duration Effects
Hyperlinks
Iontophoresis
and Low level
LASER1.pdf
Continuous
frequency
modulation=500
Hz.
10min Acceleration of
messenger RNA
transcription rate of
collagen gene,
Increased fibroblast
activity, increased
concentration of
inhibitory
neurotransmitters.
Hyperlinks
Dermapulse
Stimulator.pdf
0-5.6mA Increases TGFβ
Physical therapy intervention to promote healing in acute phase:Physical therapy intervention to promote healing in acute phase:
35. Hyperlinks
hyperbaric_
oxygen_ther
apy_for_the
rmal_burns.
pdf
100%
oxygen at 2
ATA
90 minutes
every 8 hours
for 24 hours,
then every 12
hours until
healed
mean healing
times were
significantly
shorter in patients
exposed to HBOT
and that fluid
requirements
were also smaller
in the HBOT
group
Hyperlinks
ECSWT.pdf
100
impulses/cm2
20 seconds/cm2
accelerated
epithelialization
37. Surgical Procedures Immobilization Time
Biological dressing <24hrs
Autografts 24-48hrs
STSG 3-5days
FTSG 5-7days
The following is the recommended immobilization times for
the various skin grafts
The following is the recommended immobilization times for
the various skin grafts
Ref: ANZBA 2007; Edgar and Brereton 2004
Rationale for immobilizationRationale for immobilization
38. I. Pain:
• Physiotherapy management: TENS, cognitive behavioral
therapy, music therapy, Virtual reality.
Modality Dosage Duration Effect
HyperlinksTENS ef
fective at reducing p
ain in patients with
severe burn injuries.
pdf
pulse width of
80-85msec,
rate of 75-
90pps
Reduction in pain after
a Traverse
(enzymatic
debridement)
procedure
HyperlinksVR in b
urns.pdf
Water friendly
VR
3min along
with physical
therapy
Reduction in
procedural pain and
pain related to anxiety
Hyperlinksmusic th
erapy in burns.pdf
MBI
MAR
MAE
Relaxation induced
pain relief
Cognitive
behavioural therapy
39. II. Healing:
Relaxation, Massage, ESCWT.
III. Edema:
Bradford SlingBradford Sling
Edema glove and digi sleeveEdema glove and digi sleeve
47. Range of motion:
a. Mobilisation- both mobility and specific joint
mobilisation:
Frequency:
- Twice daily, with 10 repetitions with frequent
active exercises between sessions.
- For sedated patients: gentle passive range of
motion exercises done thrice daily.
Ref: Hale. A, O’Donovan. R, Diskin. S, McEvoy. S,
Keohane,Gormley G. Physiotherapy in Burns, Plastics and
Reconstructive Surgery. 2013. pg no: 3-25, 37-67.
48. Chronic Phase
• Aims:
i. Early functional rehabilitation
ii. Attainment of activities of daily life
HyperlinksBurn_Exercise_Fact_Sheet_508.pdf
Circuit Training for Inpatient and outpatient aer
obic and resistance training.docx
49. Reference
1.Carrougher G.J. Burn Care AND Therapy. 1998: pg No.: 1-34,
133-166.
2.Hale. A, O’Donovan. R, Diskin. S, McEvoy. S,
Keohane,Gormley G. Physiotherapy in Burns, Plastics and
Reconstructive Surgery. 2013. pg no: 3-25, 37-67.
3.O’ Sullivan. Schmitz T. Physical Rehabilitation. JAYPEE
BROTHERS. 2007. ed(5th
):pg. no: 1091-1116
4.Goswami P., Singodia P, Sinha A, Tudu A. Five year‑
epidemiological study of burn patients admitted in burns care
unit, Tata Main Hospital, Jamshedpur, Jharkhand, India. Indian
Journal of Burns. 2016: 24: pg no:41-46.
5.Moritzz. A. R. Henrique. F. C. STUDIES OF THERMAL
INJURY II. THE RELATIVE IMPORTANCE OF TIME AND
SURFACE TEMPERATURE IN THE CAUSATION OF
CUTANEOUS BUBTNS. 1946: pg no.: 695-720.
50. 6. Gjorgje Dzhokic, Jasmina Jovchevska, Artan Dika. Electrical
Injuries: Etiology, Pathophysiology and Mechanism of Injury.
Macedonian Journal of Medical Sciences. 2008 Dec 15; 1(2):54-
58.
7. Kelleher D: Acute effects of radiation. In United States
Navy/Royal Navy workshop on nuclear warfare combat casualty
care, US Navy, 1983, US Govt Prnt Offc.
8.Rayan. J.L .Ionizing Radiation: The Good, the Bad, and the Ugly.
Journal of Investigative Dermatology (2012) 132, 985–993;
doi:10.1038/ jid.2011.411; published online 5 January 2012.
9.http://:www.vicburns.org
10.Goran M. Peters EJ. Herndon DN. Wlofe. R. R. Total energy
expenditure in burned children using the doubly labeled water
technique. The American Physiological Soceity.1990:pg no.:
E576-E585.
11.William DW. Long. J. Mason. A.D Skreen. R.W Pruitt. B.A.
51. 12. Belli. M, Fernandes C, Neves L, Mourão V, Barbieri R,
Esquisatto M, Amaral M, Santos G and Mendonça F. Application
of 670nm InGaP Laser and microcurrent favours the healing of
second degree burns in wistar rats. Laser Phys. 25 (2015).
13. Cianci P. Lee L. Shapiro R. William. C. Green B. Adjunctive
Hyperbaric Oxygen reduces the need for surgery in 40-80%
BURNS. Journal of Hyperbaric medicine. 1988. (3):pg. no: 97-
101.
14. Ghetti C. Music Therapy and Music-based Interventions for
Surgery, Medical Procedures and Examinations. Journal Medical
Music Therapy. 2014 (7). Pg no: 1-10.
15. Sharar S, Miller W, Soltani M, Hoffman H, Jensen M, Patterson
D. Applications of virtual reality for pain management in burn-
injured patient. NIH Public Access. (2008).pg no: 1-14
16. Osborne C. Is Transcutaneous Electrical Nerve Stimulation
(TENS) effective as a modality to reduce pain and pruritus in
patients with burn injuries. 2015.