Burns – Section 3

DR A VD MERWE
Pathophysiology of burns

Damage to/
Thermal
destruction of
energy
cells
Pathophysiology of burns
Degree of damage = duration + intensity of exposure

Pathophysiology:
◦ Increased capillary permeability
◦ Destruction of red blood cells
◦ Decreased kidney function
◦ Pulmonary changes
◦ Coagulation problems
Pathophysiology of burns
Local effects
◦ Local inflammatory response
◦ Vascular damage and vessel leakage
◦ Fire, scalds and contact injuries –
cellular damage
◦ Chemical and electrical injuries –
injury to cell membranes and
transfer of heat
Systemic effects
◦ Destruction of red blood cells
◦ Suppression of cellular immunity
◦ Myocardial depression
◦ Hypermetabolic reaction
◦ Renal damage
◦ Pulmonary hypertension and edema
◦ Fat and muscle catabolism
◦ Etc.
Pathophysiology of burns
SIRS (Systemic Inflammatory Response Syndrome)
◦ Definition:
◦ Systemic inflammatory process commonly caused by tissue damage related to the burn itself.
◦ Sepsis:
◦ SIRS in the presence of infection; life-threatening organ dysfunction caused by a dysregulated
host response to infection
◦ Signs + symptoms:
◦ Increased body temperature
◦ Increased HR
◦ Increased respiratory rate
◦ Leucocyte count increased
Pathophysiological stress response
Pathophysiology of burns
Phases of wound healing
Pathophysiology of burns
Pathophysiology of burns
Extrinsic factors affecting wound healing: Intrinsic factors affecting wound healing:
◦ Mechanical stress ◦ Health-status
◦ Debris ◦ Age
◦ Temperature ◦ Body build
◦ Laceration of the skin ◦ Nutritional status
◦ Infection
◦ Chemical stress
◦ Medications
◦ Alcohol abuse
◦ Smoking
Pathophysiology of burns
?? Implications of different stages of wound healing for physiotherapists?

When no additional treatments/

surgeries have been done
Phase of healing Stage Time frame Description
Homeostasis Acute Within hours of Immobilisation and positioning, head
injury elevation, elevate affected limbs
Inflammation 1 – 5 days post Maintain ROM, promote healing, protect,
injury prevent deformities: Gentle active ROM;
Careful of passive ROM as passive
stretches may result in damage; head
elevation, elevate affected limbs

Proliferation Sub-acute 4 – 21 days post Maintain&regain ROM: Active ROM,

injury therapeutic exercise, passive mobilisations
during scar maturation phase, splinting,
strengthening, Fx activites

Remodelling Chronic/longterm 21 days – 1 year Regain ROM, functional training,

post injury strengthening, scar management,
stretching, reconstructive surgery
 Example 1
Injury:
• 3 days ago

Intervention thus far:

• Dressing done
• Wounds cleaned in ward
• Pain medication

PT intervention examples?
Note your intensity of your intervention as well
 Example 1
Injury:
• 3 days ago

Intervention thus far:

• Dressing done
Stage of healing?
• Wounds cleaned in ward • Inflammatory (acute) Limited by pain; no
stretching
• Pain medication Interventions?
• Gentle active ROM- neck, knees, ankles, wrists
• Careful of passive ROM- neck, ankles, knees, wrists
PT intervention examples? • Head elevation- elevate HOB
• Elevate affected legs- sit with legs on a bench prop up with enough cushions;
hands
 Example 2
Injury:
• 3 weeks ago

Intervention thus far:

• Dressing done
• Non-surgical debridement
• Pain medication

PT intervention examples?
 Example 2
Injury:
• 3 weeks ago

Intervention thus far:

• Dressing done
Stage of healing?
• Non-surgical debridement • Proliferation (sub-acute) Pushed into end
range&further
• Pain medication Interventions?
Active ROM/ therapeutic exercise/ Fx activities- trunk and shoulder activities
[reaching, picking-up things, pulley, dressing UL]; Walking, stairs, cycling
PT intervention examples? Passive mobilisations (only if indicated, rather active with an end range hold)
Strengthening- biceps, lats, shoulder