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Burns - Coggle Diagram
Burns
Physio principals
Day one, resistance and core program,
Slow stretches to improve collagen stretch, no more than 60 seconds due to pain
Do not accept poor posture as this can be adapted quickly
Number one challenge to mobility is sheer
Can use tilt table to get patients up and walking
Need to get patients moving early because of detrimental effects of bed rest
Loose muscle power 3-4% per day and 2-% per week with bed rest
Neuroplasticity
Resistance training and mirror therapy
Reduced pain with higher resistance training group, restores proprioceptive sensors
Tissue healing
Biotechnology
SSG
Recell
Escharotomy
Acute treatment Hospital
Medical management - Rules of nines for assessment of burns
Surgery
Physio for cardiorespiratory
Inhalaion injury challenge mortality
Oxygen is important in wound healing and regeneration of tissue. Increases mortality by 6.5x
Want to optimise early lung expansion
increase endurance and strength of Tx pine and upper limb accessory muscles.
Good history to prevent pulmonary oedema peaks and patchy atelectasis - we want to keep alveoli open and to reduce chance of infection. Lung drainage, Peep, PEP, flutter to remove debris and swelling to prevent long term issues
Factors effecting the zone of stasis.
PMHx, first aid, fluid restriction, oedema
Area of burn and depth of burn are two largest influences of severity and challenge to life.
Early PT management to reduce swelling and educate patient that movement will not cause further injuries.
Warm up movements and pain education
Infection control and fluid resuscitation
Mobility with pain relief
Develop pt self efficacy
Reduction in Itch with pregabalin
Subjective Reg Flags
Want to know their first aid, enclosed spaces, size of burn. fluid resus, depth of burn, location on body, agent, age, PMHx, nutrition
Burn depth = loss of dermin whoch supports the epidermis
Physio need acute and long term
MDT
Rehab
PLOF
ROM of skin and muscles - muscle change faster than skin
Improve physical scars but also scaring of the mind for better Quality of life.
Scar management - healing, itching, age in population, early movement.
Want to protect the patients cosmesis and identity.
Paed - not doing painful rehab, not doing rehab in their bed, try to return to education and support network, manage itch to concentrate
RTW
Nutrition support for healing
Burns Physio, chest physio, oedema and positioning, function, quality of movement, strength, ROM, endurance, splinting, IP and OPD - educator and motivator. We want to decrease threat of injury.
Psychosocial issues for paeds and their families
PLOF
ICF framework
Want to choose outcomes measures that align with the domain of ICF and AFL
Outcome measures
Upper limb and lower limb plus physical measures that are important to patient
use individualised recovery points for pt own recovery
Chronic disease
Texure, function and sensation of skin will change
Surgery - scar = long term wound healing
Good long term outcomes
Increase to scaring at 3-6 month post injury, After 21 days the chance of scaring rises
Decreased hypertropic scaring if you heal the burn woud in 10-14 days
Quality of scar associated with surgery
Acute/first aid - cool running water for 20 minutes for also for the first 3 hours
No ice as this vasoconstricts blood flow to injured area, can use cool wet towel and evaporative cooling. Never wrap in glad wrap if transfer takes over 2 hours = risk of infection
Population M>F throughout lifespan and decrease Aboriginal burns, mostly preventable.