Burn rehabilitation
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This document discusses various topics related to burn injuries and treatment: 1) It discusses the rule of 9 for estimating total body surface area (TBSA) burned, risks of compartment syndrome, the need for debridement and skin grafting, and calorie needs based on TBSA. 2) It notes increased risks for things like insulin resistance, bone loss, pneumonia, and poor wound healing for burns over 30% TBSA. 3) The document provides guidance on prevention and treatment of hypertrophic scarring and contractures, including various creams, massage, and range of motion exercises.
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Burn rehabilitation
Burns can severely impact patients and require extensive rehabilitation. Rehabilitation aims to rapidly close wounds, prevent complications like infection, and return patients to their pre-injury level of function. It begins immediately after injury with pain control, movement, splinting and positioning to prevent scarring, and management of issues like edema and inhalation injuries. Long term rehabilitation addresses physical, psychosocial and emotional challenges as patients adjust to their injuries and reintegrate into daily life.
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Skin grafts and skin flaps are surgical procedures used to repair skin defects and promote wound healing. In a skin graft, healthy skin is removed from a donor site and transplanted to a recipient site, but does not maintain its original blood supply. A skin flap retains part or all of its original blood supply after being moved from a donor to recipient site. Common donor sites include the thigh, arm, and buttocks. Skin grafts and flaps are used to treat burns, wounds, and reconstructive procedures. Care of the graft and donor site is needed to promote healing.
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Corticosteroids readily diffuse into cells and bind with glucocorticoid receptors to form complexes that interact with proteins and act as transcription factors, reducing inflammation. Intranasal corticosteroids become effective within 3 hours and are most effective for symptoms like itching and sneezing, while systemic corticosteroids are more effective for blockage and anosmia. Methylprednisolone and dexamethasone are preferred for intravenous use due to their minimal mineralocorticoid effects. Prednisone is converted to prednisolone in the liver, while dexamethasone has minimal mineralocorticoid effects.
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Cardiac rehabilitation
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Burn rehabilitation
- 3. Lund & Browder The rule of 9. Every one’s palm is equal to 1% ofTBSA.
- 4. 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
- 5. Daily calorie need: (25 kcal/kg) + (40kcal plusTBSA) Serum pre-albumin Dysphagia MoreTBSA More days with tracheostomy More days under ventilator
- 6. TBSA >30% Increase insulin resistance Reduce bone mineral density Reduce lean body mass catabolism Increase pneumonia Poor wound healing Beta-blockers(Propranolol) Anabolics (Oxandrolone) Exercise Passive(spilnting/positioning) Active ASAP
- 7. More trends toward hydrocollid,biosynthetic, antimicrobial dressings for superficial and partial-thickness wounds. Hydrotherapy increase G-negative infections such as Psudomonas.
- 9. To reduce intrinsic-minus deformity Functional position
- 10. Increase mortality in children/ elderly. Susceptible to ARDS/pneumonia/MOF Early tracheostomy Do not affect pulmonary outcome Increase oral hygiene level
- 11. Etiology Thermal injury/ electrical injury/ compression/ metabolic imbalance MoreTBSA & deeper burn Axonal lesion is more frequent than demyelinating injury Most common Median sensory neuropathy
- 13. 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.
- 15. Most common complication in burn injury Raised/ red/ painful/ pruritic/ contractile Does not cross injury line(in apposition with Keloid) Most susceptible group Adolescent/ darker skins/ inflammatory wounds with prolonged healing/ open wound more than 3 weeks TGF-β
- 16. Prevention is the best treatment. First line treatment Moisturizing creams Reduce mechanical insults Avoid heat and sunburn
- 17. Most common in shoulder/elbow/knee Massage/splint/stretch/proper positioning /ROM exercise will reduce contractures To reduce pruritus in scars Topical: Diphenhydramine/ Doxepin/Gabapentine Oral: Diphenhydramine/ Doxepin/Gabapentine/ Naltroxene Non-pharmacologic: Massage/TENS/ LASER
- 18. Functional Independence Measure<110
- 19. آقای43حدود سوختگی با ایساله30%این در تحتانی های اندام بیمار اپیرفیزیوت انجامجهت لطفا باشدو می یبستر بخشویزیت ار نمایید. Proper positioning Active ROM of all joints of lower limbs Stretch for hamstring and calf muscles TENS?