burns - embrace discomfort

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  • 1. BURNSThe statement that the position of comfort is the position most likely tolead into contractures is applicable toevery burn patient who has sustained a serious injury Dona Anderson OT 5117 Spring 2012

2. Epidemiology/Incidence Fire and burn deaths Admission Cause of Injury 44% fire/flameper year: 4,500 33% scald Hospitalizations for 9% contact (conduction)burn injury: 45,000 4% electrical Survival rate: 96.1% 3% chemicaldue to medical 7% otheradvances in burn care Place of occurrence Gender: 68% home 70% male 10% work 30% female 7% roadways 15% other (American Burn Association, 2011) 3. Burn are 100% preventable Know, practice, and promote safety precautions toprevent burns. Smoke alarms have had greatest impact in decreasingfire deaths in the US. Check the batteries annually. A cigarette left unattended can burn as long as 20-40minutes. Check the temperature of your hot water heater setting. 4. Skin Largest organ of the body About 20 square feet; 6pounds Composed of epidermis,dermis and subcutaneoustissue layers FUNCTION OF SKIN: Body image and self-identity Sensory: Tactile, Pain,& Temperature Provides thermalregulation An environmentalbarrier: Protects against fluid loss 5. Layers of the SkinEpidermis - 0.05mm 1.5mm 4-5 layers Top layer is tight packed dead keratinocytes Thick skin on palms of hands and soles of feet Melanocytes produce melanin pigment Langerhans cells process microbial antigens Is capable of regenerative healing without scarring Skin turns over every 2-4 weeksDermis Collagen elastic fibers Mechanoreceptors Sense of touch, heat, hair follicles, sweat glands, sebaceous glands, apocrine glands, lymphatic vessels, blood vesselsHypodermis Loose connective tissue Insulates, cushions, and protects inner organs mostly adipose tissue 6. Types of Burns Definition: An injury to the skin and sometime muscleand bone tissue as a result of: Thermal 3 major causes (85-90% of burn-related injury)Scalding hot water scalds ( 66% of all visits to burn centers) Flame direct or indirect Contact with hot surfaces and liquid stovetop, grease, bathtub Electricity: Electric home cords, power tools, lightning Key characteristic is an exit wound Chemicals: acid burns are more superficial while alkaline burns burrowmore deeply into tissues: gasoline, household cleaners,garden products Radiation 7. Burn Classificationaccording to depth of injury(Pedretti Table 42-1, p. 1060) Superficial Thickness(1st degree) Superficial-Partial Thickness (2nd degree) Deep-Partial Thickness(deep 2nddegree) Full Thickness (3rd degree) Subdermal( 4th degree) (Pedretti, Pendleton, & Schultz- Krohn, 2006) 8. Superficial Thickness (1st degree) Epidermis only No blistering Dry, red, slightly swollen Blanches to pressure Painful to touch Heals spontaneously Healing time is 3-7 days No scarring 9. Superficial-Partial Thickness (2nd degree) Entire epidermis andupper level dermis islost Intact blisters Moist, weeping Blanches to pressure Hypersensitive totouch Heals rapidly andspontaneously in 1-2weeks due to goodblood supply Scarring isuncommon 10. Deep-Partial Thickness (deep 2nddegree) Epidermis and severe damageto dermis No blisters Blotchy whitish, wet or waxy Some loss of sensation soless painful Susceptible to infection Healing is sluggish (greaterthan 2 weeks, 4-6 weeks) High risk of hypertrophicscarring and contractures Could benefit from skingrafting 11. Full Thickness and Subdural(3rd -4th degree) Complete loss of epidermis anddermis, even subcutaneous fat,muscles, bone White and waxy to charred black Insensate no pain (completedestruction of nerve endings,skin appendages, apocrineglands) Markedly decrease in blood flow Susceptible to infections High risk of hypertrophic scarringand contractures Pruritis (itching) is a commoncomplication during rehabilitation Must do surgical intervention:escharotomy, skin grafts, or 12. Electrical burns - subdural Thermal burns where the person becomesthe electrical pathway Child chewing on cord Lightning work and leisure activities Key characteristic is an entry AND exitwound Muscle damage adjacent to bone ismost vulnerable deep tissue necrosis Retrieved from 13. Risk Factors andSecondary complications Healing delayed in veryyoung children and elderly Hx of smoking, diabetes,chronic illness Sensory loss Neuropathy Temperature regulation Heterotopic ossification Amputation Psychiatric issues Body disfigurement Loss of loved ones at timeof injury http://www.burntherapist.com/BurnArticles.htmhttp://www.youtube.com/watch?v=wR_SeUbBKd0&feature=related 14. Rule of Ninesfor estimating TBSA of burn (adults) TBSA: Total burn surfacearea Rule of Nines: Determines level of burnacuity Is a standardizedprotocol Used to calculatenutritional and fluidrequirements Transfer to Burn Centerdue to size ( >15%TBSA) (palm = 1%) In patients with severeburns over more than40% of TBSA), 75% of all (Church, Elsayed, Reid, Winston, & Lindsay, 2006)deaths are currently 15. Train the Brain: Snow World Snow world: Neuro-distraction lessens needfor pharmacologicalintervention to relieve pain patients are more alertand able to participate in ADLsandrehabilitationSnow World is an interactive virtualreality technology being used at burncenters around the nation. Goggles areheld aloft by mechanical crane in frontof patients facehttp://www.youtube.com/watch?v=jNIqyyypoj 16. OT Role Principle of non-maleficence is sorely tested: PROMis painful Positioning and splinting early in rehabilitation process Edema management Continuing and prolonged stretching of contractures tomaintain functional ROM, movement, and appearance Desensitization training itching (burn-related pruritis) orhypersensitivity Continuing aerobic exercise to improve cardiopulmonarystatus Patient education on protection and prevention of furtherinjury protect area from exposure to extremes of heat,cold, and sun Psychosocial coping strategies for PTSD, anxiety,depression Liberal use of appropriate narcotics for pain controldecreases patients attention and active participation in 17. References American Burn Association. Burn Incidence Fact Sheet2011. http://www.ameriburn.org/resources_factsheet.php Church, D., Elsayed, S., Reid, O., Winston, B., & Lindsay,R. (2006). Burn wound infections. Clinical MicrobiologyReviews, 19(2), 403-434. doi: 10.1128. CMR.19.2.403-434.2006http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1471990/ Cox, R.D. ( ). Chemical burns in emergency medicinedifferential diagnoses. Medscape Reference.http://emedicine.medscape.com/article/769336-differential OSHA Construction eTool, US Deparment of Labor.http://www.osha.gov/SLTC/etools/construction/electrical_incidents/burns.htmlPedretti, L. W., Pendleton, H. M. H., & Schultz-Krohn, W.(2006). Pedrettis occupational therapy: Practice skills forphysical dysfunction. St. Louis, Mo: Mosby/Elsevier. 18. Additional Resourceshttp://www.ameriburn.org/resources_factsheet.phphttp://www.youtube.com/watch?v=JsHPx2E5gaQ&feature=relatedhttp://www.youtube.com/watch?v=52Ge08n04dM&feature=relatedhttp://www.burnsurgery.org/Modules/initial/part_two/sec5.htm