Burn rehab

--burns are number one case of accidental death in children < 2 yrs, majority of which are due to abuse
--number 2 in children under 4

--systemic response to burns: loss of fluid, hyperventilation, inhalation injury, increase followed by increase in cardiac output, multi-organ system failure
--electrical burns cause more severe injury to deeper tissue (muscle and bone)

--newer burn categorization:
• Superficial partial thickness: epidermis and upper part of dermis injured
• Deep partial thickness: epidermis and large upper portion of dermis
• Full thickness: all layers destroyed

--Rule of 9’s (% body surface area burned):
• Head: 9%
• Each UE: 9%
• Each LE: 18%
• Anterior trunk: 18%
• Posterior trunk: 18%
• Perineum: 1%

--Worse prognosis associated with age (very young or very old), great BSA burned, depth of burn, and associated injuries

--Contractures: occur in first 1.5 years
*need 25 mm of pressure to counteract contraction of scars
--Position patient in extension and abduction
--Splinting can be used with ROM
--Compression garments are used to decrease hypertrophic scarring, worn 23 hours per day
--Silastic gel can reduce hypertrophic scarring in the absence of pressure
--Local steroids may reduce hypotrophic scarring

--Body is in highly catabolic state and may need 2000-2200 cal/day and 15gm nitrogen per sq meter of BSA

--Peripheral neuropathy present in 15-20% of burn patients with BSA of 20% or greater
--Osteophytes may occur near elbow and olecranon or coracoid process
--HO common --> most common at elbow
--Subluxation can be seen in MCP and MTP joints, prevent with splinting