prevalence
Approximately 1 million people per year seek treatment for burns
Approximately 45,000 require hospitalization
94% survival rate after admission to hospital
causes of burns
Fire/flame 42%
scalding 31%
contact burn 9%
electrical burn 4%
chemical burn 3%
other 11%
thermal/contact burn
Caused by flame, scalding or contact with hot object/material
chemical burn
Caused by strong acid or alkali substances; Continue to burn until substance is removed
electrical burn
Thermal burn that follows path of least resistance- results in internal damage that cannot be seen on the surface
depth of burn
superficial
superficial dermal
deep dermal
full thinkness
superficial
appearance: erythma, brisk cap refill
sensation: painful
superficial dermal
appearence: moist, reddened with blisters, brisk cap refill
sensation: painful
deep dermal
appearence: white slough, reddened and mottled,sluggish or absent cap refill
sensation: dull
full thickness
appearence: dry, chapped, whitish, absent cap refill
sensation: painless
Rule of nines (for adults)
arm: 9 each
trunk: 18 front 18 back
head and neck: 9
rule of nines for kids
varies on size
extent of burn: palm method
for children
critical period
first 72 hours
Prevention of Burn Shock; Management of Fluid loss
IV Fluids
Pain medication
Antibiotics
Secure airway breathing
Collect baseline health data
Possible escharotomies
Position to prevent contractures
Support Family
acute period
several weeks
Closure and Healing of Wounds
Surgery to remove necrotic tissue
Autografting
Prevention of infection
Prevention of scarring
PT/OT/ST
Splinting
Range of motion as allowed
Engagement in daily activities as able
Spiritual support to patient and
recovery and rehab
Reintegration into home and community
PT/OT/ST
Scar management
Reconstructive surgery
Counseling services
Role of OT early stages
Positioning to reduce edema and contractures
Range of motion in non-grafted joints
Splinting to promote functional positioning and reduce contractures during immobile period
skin grafting
graft taken from healthy skins
skin meshed to cover a large wound
placement of meshed skin graft ovedr open wounds
auto graft (own skin) vs cadaver graft
role of OT: post skin graft
Immediately after grafting, extremities are generally elevated to prevent edema and placed in a functional position to minimize contractures. The body part is left in that position until the first dressing change, which varies according to physician proto
flap
#NAME?
local flap
May take nearby tissue and stretch It over a small burn area and suture in place
pedicled flap
May transfer skin while still attached to the original blood supply
-lift skin from another part of the body and place burned area under the flap until the flap has in tact vascular supply from burned area
free flap
May physically detach the flap from original blood supply and the reattach to vessels at the recipient site
OTs want to prevent
contracture
scarring
Hypertrophic scarring -
Scar tissue is not pliable,
Excessive fibrosis (exact mechanism not known)
Scarred areas are delicate and burn easily
Scarred areas are dry and need unscented moisturizer
Scars can be reduced with pressure
Silicone products such as
Role of OT: Return to occupations
Dependent upon the degree of scar and healing needed.
Difficult for individuals with burns of face or hands - difficult to cover
Psychosocial support needed