NPTE - Burns

Superficial Burns

Layers involved: epidermis only

Appearance: red, dry, blanchable

Sensation: painful

Healing: 3-7d, no scar

Superficial Partial Thickness Burns

Layers involved: epidermis + upper dermis

Appearance: blisters, moist, red

Sensation: very painful

Healing: 7-21d, minimal scarring

Deep Partial Thickness Burns

Layers involved: epidermis + deep dermis

Appearance: mottled red/white, less moist

Sensation: diminished

Healing: 3-6wks, may scar

Full Thickness Burns

Layers involved: entire dermis (and may involve subcutaneous fat)

Appearance: leathery, white/charred, dry

Sensation: insensate

Healing: requires grafting

Subdermal Burns

Layers involved: extends into mm, tendon, bone

Appearance: charred, deep destruction

Sensation: insensate

Healing: requires extensive surgery

Estimating Burn Areas - Rule of 9s

Head and neck - 9%

Each arm - 9% (4/5% front, 4.5% back)

Each leg - 18% (9% front, 9% back)

anterior trunk - 18%

posterior trunk - 18%

perineum/genitalia - 1%

Inflammatory Healing Phase

0-3d

hemostasis, immune response

protect healing area, prevent infection

Proliferative Healing Phase

3d-3wks

granulation, epithelialization

scar management, ROM, begin mobility

Remodeling Healing Phase

3wks-2yrs

collagen remodeling, scar maturation

maximize ftn, prevent contracture

Burn complications

infection (leading cause of death in burn pts)

contractures (esp over joints)

hypertrophic/keloid scars

dehydration and shock (esp early on)

pulmonary complications from inhalation injury

neuropathy (esp from electrical burns)

compartment syndrome

Burn red flags

burns crossing a joing —> high risk for contracture

electrical burn —> risk of internal damage, arrhythmias

Positioning and Splinting

prevent contractures —> use anti-deformity positions

protect graft sites —> immobilize initially, then progressive ROM

support healing tissues —> use splints and positioning devices

Anti-deformity position examples

neck: extension (no pillows!)

shoulder: abduction, ER

elbow: ext, supination

hand: intrinsic plus position (MCP flexed, IP extended)

hip: extension, abduction

knee: extension

ankle: neutral

ROM and mobility

Begin gentle AROM as soon as safe

PROM if AROM limited

Encourage early functional mobility (bed mobility, sitting, transfers)

Scar management

compression garments (15-35mmHg) worn 23hrs/d for 12-18mo

silicone sheets, massage, desensitization techniques

avoid aggressive friction early on

Wound care considerations

debridement: enzymatic/sharp debridement as needed

hydrotherapy: used for softening tissue; avoid soaking

topical antimicrobials: silver sulfadiazine common (watch WBC drop)

grafting: autograft = from self (preferred)

Boards tips Pt 1

Blisters = partial thickness

no pain = full thickness/deeper

The rule of 9 differs for children - legs are proportionally smaller, and the head is larger

Hypertrophic scarring and keloid occur during the remodeling phase

after grafting, immobilize for 3-5d, then begin gentle motion per protocol

Boards tips pt 2

burns across ant neck = risk of flexion contracture —> position in extension

ped burns are calculated differently due to body proportion

graft site = immobilize; donor site = treat like superficial partial-thickness burn

use compression garments to manage hypertrophic scars

electrical burns —> always assess cardiac and renal systems

positioning > PROM > strengthening in early rehab stages

Outcome measures

Vancouver Scar Scale: rates scar thickness, pliability, height

Borg RPE: monitors exertion during mobility

FIM: overall ftnal ability in ADLs