1. BURNS AND ITS
PHYSIOTHERAPY MANAGEMENT
1
Dr. Hitiksha Bhalodia
(MPT in Women’s Health)
Assistant Professor , PIPT
Course Name: Physiotherapy in Medical and Surgical Condition
Course Code: 07101404
Course Objective: Select strategies for cure, care and prevention; adopt restorative and
rehabilitative measures for maximum possible functional independence of a patient at
home, work and in community. (CO2)
2. What is burns…?
⚫ It is a type of coagulative necrosis of tissue, caused
by thermal application transfer from source to body
or
⚫ Tissue injury caused by thermal, electrical or
chemical agents
2
3. Risk factors
⚫ Fire/combustion
□ Firefighter
□ Industrial workers
□ Occupant of burning structures
⚫ Chemical exposure
□ Industrial workers
⚫ Electrical exposure
□ Electrician
□ Electrical power distribution worker
3
6. 3. Electrical burn:
□ Skin injury’
□ Nerves, muscle and bone damage
4. Radiation burn
6
7. Effects:
● Burn injury causes destruction of tissue, usually the
skin from exposure to thermal extremes (either hot or
cold), electricity, chemical and radiation
⚫ The mucosa of the upper GI system (mouth,
esophagus, stomach) can be burned with ingestion of
chemicals
⚫ The respiratory system can be damaged if hot gases, smoke or toxic
chemical fumes are inhaled
⚫ Fat, muscle, bone and peripheral nerves can be affected in electrical
injuries or prolonged thermal or chemical exposure
⚫ Skin damage can result in altered ability to sense pain, touch and
temperature
7
9. 1. Depending upon depth of burn injury:
□ Previously used classification
First degree burn: only epidermis affected
Second degree burn: epidermis and dermal appendages
Third degree burn: epidermis and all dermis
Fourth degree burn: epidermis, dermis, and
subcutaneous tissues (fat, muscle, bone and peripheral
nerves)
9
10. Recent classification of burn depending
on depth of tissue injury
1. Epidermal burn
2. Superficial partial thickness burn
3. Deep partial thickness burn
4. Subdermal burn
10
12. Epidermal burn
⚫ Cell damage to epidermis
⚫ This depth of burns correlates to practice pattern 7B;
impaired integumentary integrity associated with
superficial skin involvement
e.g., sunburn
12
13. ⚫ Clinically skin appears red / erythematous
⚫ Painful, dry, red burns which blanch with pressure
⚫ No blister
⚫ Slight edema may apparent
⚫ Spontaneous healing (within 7 days) & no scar
13
14. Superficial partial-thickness burn
⚫ Damage occurs through the epidermis and into the
papillary layer of dermis (second-degree burn)
⚫ The epidermal layer destroyed completely
⚫ This depth of burn corresponds to APTA pattern 7C;
impaired integumentary integrity associated with
partial thickness skin involvement and scar formation
14
15. ⚫ Presence of intact blisters
⚫ Due to blister increased inflammatory response
⚫ Moist weeping or glistening surface when blisters
removed
⚫ Very painful
⚫ Sensitive to changes in temperature, exposure to air
currents, & light touch
⚫ Moderate edema, spontaneous healing, minimal
scarring & discoloration
⚫ Heal within 7-21 days
26
17. Deep partial thickness burn
⚫ Involves destruction of the epidermis and papillary dermis
with damage down into the reticular dermal layer
⚫ Impairment matches to APTA pattern 7C
⚫ Deep partial thickness burns appears as a mixed red or waxy
white color
17
18. ⚫ Blanching and brisk capillary refill
⚫ Broken blisters, wet surface
⚫ Their color may range from patchy, cheesy white to red and
they do not blanch with pressure
⚫ Sensitive to pressure but insensitive to light touch or soft
pinprick
⚫ Affected area is depressed
⚫ Healing with skin graft or flap or scarring
18
19. Full thickness burn
⚫ All epidermal and dermal layers are destroyed
along with subcutaneous fat layer
⚫ This burn depth consistent with practice pattern 7D;
i.e., impaired integumentary integrity associated
with full-thickness skin involvement and scar
formation
⚫ A full-thickness burn is characterized by a hard,
parchment-like Escher covering the area.
19
20. ⚫ Escher is devitalized tissue consisting of
designed coagulum of plasma & necrotic cells
⚫ Escher feels dry, leathery and rigid
⚫ the color of Escher can vary from black to deep
red to white ; latter indicates total ischemia of the
area
⚫ Hair follicles are completely destroyed
20
21. ⚫ A major problem arises from deep burns is the damage
to the peripheral vascular system
⚫ Large amount of fluid leak into the interstitial space □
increase pressure in extracellular space □ constriction
to deep circulation
⚫ Very slow healing following this type of burn
21
23. Subdermal burn
⚫ Involves complete destruction of all tissue from the
epidermis down to and through the subcutaneous
tissue
⚫ Occurs following prolonged contact with a heat source
⚫ This depth of the injury correlates with APTA practice
pattern 7E; Impaired integumentary integrity associated
with skin involvement extending into fascia, muscle or
bone and scar formation
⚫ Extensive surgical and therapeutic management is
necessary to return a patient to some degree of function
23
24. Electrical burn
⚫ S/S of an electric burn may vary according to the
type of current, intensity of the current and the area
of the body the electric current passes through
⚫ Electric current follows the course of least resistance
offered by various tissues. i.e., nerves, followed by
blood vessels offers least resistance; bones offers most
resistance.
⚫ Tissue damage results from tissue resistance to the
passage of the current or by direct electrical current
24
25. ⚫ Typically contact sites will exist where the patient
first came into contact with the electricity and a
second site where the patient was grounded
⚫ The affected skin appears yellow, ischemic and dry
⚫ Tissues along the pathway of the current may be
damaged owing to heat that developed as a result of
tissue resistance to current passage
⚫ Blood supply to surrounding tissues may be
altered and arteries undergo spasm
25
26. ⚫ There can be other consequences of electricity
passing through the body such as
□ Cardiac arrhythmias and acute renal failure secondary
to fluid and electrolyte imbalances and release of
myoglobin into blood
□ The most severe complication following
electrical current damage is acute spinal cord
damage or vertebral fracture
□ Ventricular fibrillation and respiratory arrest
26
27. Burn wound Zones
⚫ Three zones:
1. Zone of coagulation
2. Zone of stasis
3. Zone of hyperemia
27
28. Zone of coagulation
⚫ In the zone of coagulation cells are
irreversibly damaged & skin death occurs
⚫ This area is equivalent to a full-thickness burn &
will require a skin graft to heal
⚫ Here, because of lack of viable tissue & the amount of
Escher, the risk of infection increased
⚫ This potential complication emphasizes the need for
careful monitoring, use of antibiotics & the
treatment of a burned pt. in specialized burn center
28
29. Zone of stasis
⚫ It contains injured cells that may die within 24 to
48 hrs. without diligent treatment
⚫ Here, in this zone; Infection, Drying & inadequate
perfusion of the wound □ conversion of potentially
salvageable tissue to completely necrotic tissue &
enlargement of the zone of coagulation
⚫ Splints or compression bandages, if applied too
tightly, can compromise this area
29
30. Zone of Hyperemia
⚫ Finally in this zone, there is minimal cell damage
⚫ Tissue should recover within several days with no
lasting effects
30
31. Extent of Burned Area
⚫ A major consideration when determining the
severity of a burn is the extent of body surface
involved
⚫ % of Total body surface area(TBSA) burned;
calculated by Rule of nines
31
36. ⚫ The rule of nines divides the body surface into areas of
9% or multiples of 9% of TBSA
⚫ Modified:- according to continuum of age
accommodate for growth of different body segments
36
37. Total Burn Surface Area (TBSA): the greater the total burn
surface area the poorer the prognosis
Percentage chance of Survival =[100 – (Age in years + percentage
TBSA)]
37
41. Burn Patient Severity
Factors to Consider:
● Burn Depth classification
● Body surface area burned
● Age: adult v/s pediatric
● Preexisting medical conditions
● Associated trauma
- Blast injury
- Fall injury
- Airway compromise
- Child abuse
41
42. ● Patient Age:
Less than 2 or greater than 55 have increased
incidence of complication
● Burn Configuration:
- Circumferential burns can cause total occlusion
of circulation to an area due to edema
- Restrict ventilation if encircle the chest
- Burns on joint area can cause disability due to
scar formation
42
43. Critical Burn
Criteria
⚫ 30 > 10% BSA
⚫ 20 > 30% BSA
> 20% pediatric
⚫ Burns with respiratory injury
⚫ Hands, face, feet or genitalia
⚫ Burns complicated by other trauma
⚫ Underlying health problems
⚫ Electrical & deep chemical burns
43
46. Complications of Burn
injury
⚫ Depending on the extent of burn injury, the
depth of the burn & the type of burn, there may
be secondary systemic complications
⚫ In addition the health, age, & psychological status
of a patient who is burned will affect these
complications
46
47. 1. Infection
⚫ Infection is conjunction with organ system failure, is a
leading cause of mortality from burns
⚫ Some virulent strains of Pseudomonas aeruginosa &
Staphylococcus aureus are resistant to antibiotics &
have been responsible for epidemic infections in burn
centers
⚫ Systemic antibiotics are used to treat both burn
and general system infections once they have
been documented
47
48. 2. Pulmonary complications
⚫ Inhalation injury: pt who has been burned in closed
space
⚫ Signs of an inhalation injury include facial burns,
singed nasal hairs, harsh cough, hoarsness, abnormal
breath sounds, respiratory distress, & carbonaceous
sputum & hypoxemia
⚫ The incidence of pulmonary complications is
extremely high after severe burns, & death due to
pneumonia
48
49. ⚫ The primary complications associated with this
injury are carbon monoxide poisoning, tracheal
damage, upper airway obstruction, pulmonary
oedema, and pneumonia.
⚫ Lung damage from inhaling noxious gases and smoke
may be lethal
49
50. 3. Metabolic Complications
⚫ Metabolic rates may increase up to 50% in a 25%
TBSA burn and much more as the burn size increases
⚫ The consequences of the increased metabolic and
catabolic activity following a burn are:-
- A rapid decrease in body weight
- Negative nitrogen balance and
- A decrease in energy stores that are vital the
healing process.
50
51. ⚫ Following increased metabolic activity there will be
increase of 1.80F to 2.60F (10C to 20C) in core
temperature that seems to be due to a resetting of the
hypothalamic temperature centers in the brain
⚫ As a part of pt.'s altered metabolism, protein from
muscle tissue is preferentially used as a source of
energy muscle atrophy
51
52. 4. Cardiovascular complications
⚫ Hemodynamic changes result from a shift in fluid to the
interstitium, which subsequently reduces the plasma &
intervascular fluid volume in a burnt pt.
⚫ This shift of fluid to the interstitium can result in
significant edema
⚫ Decrease cardiac output
● Hematological changes: alterations in platelet
concentration & function, clotting factors & white blood
cell components, RBC dysfunction & decrease hemoglobin
& hematocrit
52
53. Heterotopic Ossification
⚫ Pts. With more than 20% TBSA burn highly susceptible
⚫ Usually occurs in areas of full-thickness injury or sites that
remains unhealed for prolonged period
⚫ Symptoms: decrease ROM, point specific pain, generalized
pain
53
55. Pathological Scars
⚫ Burn scar occur in area of deep partial-thickness burn
□ where healing is with skin grafting
⚫ If maturing tissue demonstrates a greater rate of
collagen production than degradation, a scar become
raised and thick □ hypertrophic scar
55
57. Psychological changes
⚫ Fear/ anxiety
⚫ Denial
⚫ Depression
⚫ Guilt
⚫ Grief & mourning
⚫ Loss of will to live
⚫ Apathy
⚫ Necrophilous orientation
⚫ anger
57
58. Management
Medical management of burns
● Initial treatment:
Goals: -
□ to address critical life-threatening problems & stabilize the
pt. through procedures designed to:
- Establish & maintain an airway
- prevent cyanosis, shock & hemorrhage
- establish baseline data on pt.; extent & depth of burn
injury
- Prevent or reduce fluid losses
- clean the pt. & wounds
- Examine injuries
- Prevent pulmonary & cardiac complications
58
59. ⚫ Transport pt. to burn center from the site of
accident
● Assessment : demographic details, history,
calculation of TBSA
⚫ Fluid volume replacement therapy
⚫ Wound cleansing
⚫ Debridement
⚫ analgesics
59
60. Wound Care:
⚫ Remove Escher along with sharp debridement
⚫ Apply topical medications either with open
technique or closed technique
60
61. Surgical Management of burn wound
Primary Excision:
- Surgical removal of Escher
- With excision removal of peripheral layers of
Escher until vascular, viable tissue is exposed as the
site for skin graft placement
- Burn wound is closed with a skin graft at time
of primary excision
Grafts used are: autograft, allograft or xenograft
□ Now a days skin substitutes are used for coverage of
an excised wound
61
62. Skin grafting
⚫ Done under anesthesia
⚫ Skin used for a graft usually is removed with a
dermatome
⚫ It can either split-thickness skin graft (epidermis with
variable amount of dermis) or full-thickness skin graft
(full epidermis and dermis)
Correction of scar contracture
62
63. The Z-plasty servesto lengthen a scar
by interposing normal tissue in the line of the
scar.
63
64. Physical Therapy Management
● PT interventions are directed towards:-
□ Prevention of scar & contracture
□ Preservation of normal ROM
□ Prevention or minimization of hypertrophic scar formation
and cosmetic deformity
□ Maintenance or improvement in muscular strength
□ Improvement in cardiovascular endurance
□ Return to pre-burn function and performance of activities of
daily living
64
65. ASSESSMENT
⚫ Demographic details:
⚫ Review of medical records
⚫ History
⚫ Observation
⚫ Palpation
⚫ Examination
□ Initial examination for the depth of burn
□ Percentage of burn (TBSA) & percentage chance of
survival
65
72. ⚫ ICF: Condition
□ Body structures and function
□ Activities
□ Function
Contextual factors: personal and environmental
facilitators and barriers
72
73. Anticipated Goals and
Expected outcomes (In
general)
⚫ Risk of infection and complications is reduced
⚫ Wound and soft tissue healing is enhanced.
⚫ Risk of secondary impairments is reduced.
⚫ Maximal range of motion is achieved.
⚫ Pre injury level of cardiovascular endurance is restored.
⚫ Good to normal strength is achieved.
73
74. ⚫ Independent ambulation is achieved.
⚫ Independent function in ADL and IADL is increased.
⚫ Scar formation is minimized.
⚫ Patient, family, and caregivers’ understanding of
expectations and goals and outcomes is
increased.
⚫ Aerobic capacity is increased.
⚫ Self-management of symptoms is improved
74
75. Positioning And Splinting
⚫ Positioning begin on the day of admission
⚫ Concept: positioning burned areas in place and maintain
the body part in the opposite plane and direction to
which it will potentially contract
● Goals: - To minimize edema
- To prevent tissue destruction
- maintain soft tissues in elongated state
- preserve function
75
79. ● Splinting given to provide anti-deformity positions
● Indications:- Prevention of contracture
- Maintenance of ROM
- Reduction of developing contracture
- Protection of jt. or tendon
- Reduce pain
79
80. ⚫ Splinting usually worn at night following skin grafting
⚫ Static or dynamic splint can be used
□ Dynamic splint apply low load, prolonged stress
that can be adjusted to pt.'s tolerance
80
84. Therapeutic Exercises
● Active and passive exercises:
□ Can be initiate from the day of admission
□ Before starting exercise look for the complications
and vital stability and consciousness/alertness
□ Perform AROM of all extremities and trunk
including unburned areas
□ Avoid ROM exercise of injured area in case of recent
skin grafting & allow the graft to adhere
84
85. Dosages:
□ AROM should be done twice daily
□ For sedated pts. PROM can be initiated and given thrice/day
□ Repetitions and degree of movement depends on
pt. tolerance and limit of stretch
85
86. Contraindications:
86
⚫ Active or Passive range of motion exercises should not
be carried out if there is suspected damage to any
tendons
e.g., flexion of PIP should be avoided at all to prevent
extensor tendon rupture
⚫ Range of motion exercises are also
contraindicated post skin grafting as a period of
3-5 days immobilisation is required to enable
graft healing
87. Practical considerations while mobilizing burn patient
⚫ Be aware of dressing clinic/daily dressing changes.
Mobilisation should coincide with this as it is important
to monitor the wound during AROM frequently.
⚫ Timing of pain relief. This should be timed appropriately
to ensure maximal benefit during treatment sessions.
⚫ Observe the patient carrying out the AROM and PROM
exercises prior to beginning treatment. Also observe the
patient taking on/off splints.
87
88. ⚫ Always monitor for post exercise pain and wound
breakdown.
⚫ Avoid blanching for long period as you may
compromise vascularity.
⚫ The patient may present with a reduced capacity for
exercise secondary to increased metabolic rate,
altered thermoregulation and increased nutritional
demands.
⚫ Postural hypotension may be present due to prolonged
bed rest and low haemoglobin
88
89. Ambulation
⚫ It should be initiated at the earliest appropriate time
⚫ If LEs are skin grafted ambulation may be discontinued
until it is safe to resume
⚫ Wrap elastic bandages after skin grafting while
ambulation
(supports new graft and promote venous return)
⚫ If orthostatic hypotension is there use tilt table to make
pt. standing gradually
89
90. “The rewards of a successful POC are
tremendous when a patient who has suffered a
life-threatening burn is able to walk out of the
hospital and return to productive community
90
involvement.”
91. Resistive and conditioning exercises
⚫ Pts. With major burns may lose body weight and lean
muscle mass can decrease rapidly
⚫ Exercise consist of isometric, isokinetic, isotonic or using
other resistive training devices can be started at rehabilitation
stage
⚫ General principles of exercise training and strength
improvement should be followed, but they may need to
be modified on the basis of a patient’s condition and
stage of wound healing
91
92. ⚫ Initially Isometrics used to maintain muscle properties
& with that help to prevent further muscle atrophy
⚫ In progression use weights and resistive equipments to
improve muscle strength
⚫ Regular and accurate monitoring of vitals
(including PR,RR, BP, SPO2, RPE) before, during
and after exercises.
92
93. Scar Management
Pressure Garment Therapy (PGT)
⚫ Following wound closure, a skin graft or healed burn wound is
vascular, flat and soft.
⚫ To achieve this following 3-6 months, dramatic changes may
occur – the newly healed areas may become raised and firm
⚫ If wound healing takes longer than 10 to 14 days or skin
grated, pressure usually is indicated
⚫ Pressure has been used successfully to hasten scar
maturation and minimize hypertrophic scar formation
93
94. ⚫
Pressure may exert control over hypertrophic scarring by;
- Pressure decreases blood flow
- Local hypoxia of hypervascular scars
- Reduction in collagen deposition
All three together causes:
o Decreases scar thickness
o Decreases scar redness
o Decreases swelling
o Reduces itch
o Protects new skin/grafts
o Maintains contours
⚫ The earlier the scar tissue is exposed to pressure, the better
result
94
95. Method of application:
For LE – fig. of eight pattern
For UE – spiral wraps
For trunk – circular wrap
Hand and toes – self-adherent bandages
95
97. Practical recommendations and safety considerations
⚫ Pressure exerted around 15 – 40 mmHg
⚫ Time : Worn up to 23 hrs./day
⚫ Worn as soon as wound closure has been obtained
(Post grafting after 10-14 days it is recommended and
it should be worn up to one year or until scar
maturation)
97
98. Possible complications/ confounding factors for
use of PGT
□ Lack of a scientific evidence to established optimum pressure
□ Non-Compliance ( due to comfort, movement, appearance)
□ Heat and perspiration
□ Swelling of extremities caused by inhibited venous return
□ Skin breakdown
□ Web space discomfort
□ Inconvenience
□ Personal hygiene difficulties possibility of infection
□ Allergies to material
98
99. Silicone Gel:
Sheets of silicone polymer gel may be applied directly over an
actively maturing scar.
⚫ Complication: local rash, rarely skin breakdown
99
100. Mechanism: unknown but possible mechanisms are as follow
□ Hydration: decreases capillary activity and collagen production, through
inhibition of proliferation of fibroblasts
□ Rise in temperature increases collagenase activity and scar
breakdown
□ polarized electric fields creates negative charge within silicone causes
polarization of scar tissue, resulting in involution of scar
□ Presence of silicone oil
□ Oxygen tension inhibit hypoxia signal
□ Increase in mast cell helps in remodeling of tissue
100
102. Massage:
Mechanisms on which Scar massage works:
- Prevent adherence
- Reduce redness
- Reduce elevation of scat tissue
- Relieve pruritus
- Maintain/restore moisture
102
103. Scar Massage Techniques:
⚫ Deep friction massage□ to loosen scar adhesions
⚫ Finger and thumb kneading □ mobilize the scar and surrounding
tissue
⚫ Effleurage □ to increase circulation
⚫ Skin rolling □ restore mobility to tissue interfaces
⚫ Wringing □ stretches scar and promote collagenous remodeling
⚫ Retrograde massage to aid venous return, increase lymphatic drainage,
mobilize fluid
114 □ Massage techniques can be used in conjunction with ROM exs
104. Guidelines for massage during 3 stages of healing:
1. Inflammatory phase: helps to decrease oedema and
increase blood supply
1. Proliferative phase: applies gentle stress to the
healing scar; to ensure correct alignment of
collagen tissues
1. Remodeling phase: massage should be progressed to
include prolonged stretching to minimize adhesions;
that aids in scar tissue breakdown
115
105. Practical considerations and safety:
□ Clean hands essential
□ Use non irritating lubricant
□ Modify practice according to pt. stage of healing and pain
levels
Contraindications:
- Compromised integrity of epidermis
- Acute infection
- Bleeding
- Graft failure
- Intolerable discomfort
116
106. Camouflage Make-up
⚫ Used for scars of face, neck and hands
⚫ Mostly used when a person has either
hyperpigmentation or hypopigmentation
⚫ It can also be used before scar maturation; so if pt.
wants to go out in public
⚫ The cosmetics are opaque, color-correct burn scars
and are available in multiple shades to accommodate
various skin colors
⚫ They also are waterproof and worn during all activities
106
107. The Role of Physiotherapist in rehabilitation
of the chronic Burn patient
⚫ Scar management is initiated in the sub-acute
phase, but it may need to be continued long term,
as many patient suffer from continuing limitation
of ROM
⚫ Healing process may continue for up to two years, or
more, as scar tissue remodels and matures
⚫ Patient may require functional retraining and
integration back into the community and
activities
107
108. Aerobic and Resistance Training Post Burn
Rationale for training:
□ Low cardiovascular endurance
□ Lower aerobic capacity measured by VO2 max and time to fatigue at one year
post burn compare to age matched healthy control (adults and children > 15%
TBSA)
□ Muscular strength and lean body mass has been found to be significantly less
in pts. Suffering from burns of 30% TBSA
□ Reduced lean body mass, endurance and strength has been associated with
limited standing/walking tolerance
□ Reduced upper limb function and lower health related QOL and ability to
participate in activities
108
109. Aerobic capacity and muscular strength is diminished by
the following factors:
⚫ Prolonged bed rest necessary in the early recovery process
109
⚫ Hyper metabolism; which may lead to:
- Exhaustion
- Protein catabolism
- Loss of lean body mass
⚫ Impaired thermoregulation
⚫ Inhalation injuries and compromised respiratory function
⚫ Fatigue
⚫ Pain
⚫ Psychological factors
110. Aerobic training recommendations for practice:
Frequency: 3 days/week; (3-5 days/week)
Intensity: moderate to high intensity i.e.,
65%% 85% of MHR
Type: Interval, continuous; using treadmill, walking,
running exercises
Time: 20-40 minutes/session
6-12 week programme
110
111. Resistance training recommendations for practice:
Frequency: 3 times/week
(break of more than 48 hrs. must be given between bouts of
resistance training as;
□resistance exs. Causes microtrauma to muscles already in
compromised state
□ resistance exs. In burned pts. stimulates protein synthesis)
Intensity/Type/time: 1 set of 50-60% of 3 RM at 1st week
70-75% of 3 RM for next 2-6 weeks
(4-10 reps)
80-85% of 3 RM for 7-12 weeks (2-6
reps)
111
112. Mixed and functional strengthening
112
□ Given for specific targeting muscle groups for desired
functional goal
□ Progression made by aiding resistive devices and finally
using free weight training
□ Initiate with 50-60% of 1 RM for 10-15 reps and than
progress further as per pt.’s need over 12 weeks
113. ● Safety considerations for strength and aerobic training:
□ Post burn 6 months to 2 years time given before initiation
of programmes or
□ In case of 40% TBSA it can be started after;
95% healed wounds/scars
ambulatory
psychological status
□ Ensure patient is taking Optimal nutrition and other medications
□ Monitoring of HR, BP, SPO2 & RPE before during and after
124 exercises
114. Psychological Aspects of Burn patient
125
⚫ Depression and post traumatic stress disorder are most
common disorders following burn
⚫ Pain and cosmetic appearance of individual
Treatment
- Psychotherapy
- CBT
- Medications (SSRI)
- Social skills training and community intervention
- Vocational rehabilitation
115. Ultrasound Therapy after skin grafting
127
UST can be given on alternate day started from 14th day to
21st day after skin grafting
Dosage: 1MHz, 0.5-0.8 W/cm2, for 5 min
□ (EFFECTIVENESS OF PHYSIOTHERAPY AFTER
SKIN GRAFTING- Indian journal of physiotherapy &
occupational therapy, dec-16)
116. First Aid in burns
DO’s
128
⚫ Stop the burning process by removing clothing and jewelry
⚫ In electrical burns, put the main switch off as quick as possible
and use wooden chair to push victim away from electricity
⚫ Extinguish flames by pouring plain water; if water is not available
by applying a blanket & removing the blanket as soon the flames
are put off
⚫ In chemical burns, remove or dilute the chemical agent by
irrigating large amount of water
⚫ Use cool running water to reduce the temperature of the burn
⚫ Take care of fractures and probable injuries during transportation.
• Ensure A,B, C before transportation to higher center
117. Don’ts
129
⚫ Don’t start first aid before ensuring your own safety
⚫ Don’t apply ice it may damage the injured tissues
⚫ Avoid prolonged cooling with water it may
causes hypothermia
⚫ Don.t apply any ointments
⚫ Don’t open blisters with pin, needle until topical
antimicrobials can be applied
