A 6-year-old male is admitted to the burn intensive care unit (ICU) after sustaining 40% total body surface area (TBSA) burns to bilateral lower extremities, buttocks, genitals, lower abdomen, and lower back. The patient was playing around a campfire with his older siblings when he tried jumping over the campfire and he caught his pants on fire. In a panic, the patient began to run away. The patient's family was eventually able to catch the child and put the fire out. Upon arrival at the hospital, it was determined that the patient developed compartment syndrome in both legs and was emergently taken to the operating room (OR), where escharotomies were performed on both lower extremities. The patient returned from the OR intubated and sedated. The physical therapist will evaluate the patient less than 12 hours post-admission. The patient will be returning to the OR in the afternoon for surgical excision of the burns as well as possible grafting. After this surgery, the patient will be extubated.
What are the examination priorities?
Based on his health condition, what do you anticipate will be contributors to activity limitations?
What are the most appropriate physical therapy interventions?
What are possible complications interfering with physical therapy?
- AUTOGRAFT: Skin that is taken from an unburned area of the patient and transplanted to cover an injured area of the same patient
- ESCHAROTOMY: Incision through burn eschar (rigid barrier of dead tissue) used to relieve the pressure inside a limb, digit, or the trunk to restore circulation to potentially viable tissue
- FASCIOTOMY: Incision made through the fascia to relieve the pressure inside a limb, or within the trunk
- GRANULATION TISSUE: Vascularized tissue comprised of fibroblasts and inflammatory cells that forms in healing wounds; appears as red, moist tissue
Describe the classification of burn injuries.
Understand burn wound physiology, including systems affected and the phases of wound healing.
Understand the major impairments associated with a severe burn.
Describe the appropriate plan of care for each phase of wound healing.
PT considerations during management of the child with a severe burn injury:
- General physical therapy plan of care/goals: Prevent loss of range of motion (ROM) or contracture; achieve pre-injury level of strength and cardiovascular endurance; maximize functional independence with mobility and gait
- Physical therapy interventions: ROM and stretching; tendon gliding; splinting and positioning; aerobic and resistance exercise; mobility training; gait training; family education regarding exercise and mobility
- Precautions during physical therapy: Monitor vital signs; post-surgical limitations
- Complications interfering with physical therapy: Compartment syndrome; exposed tendons; heterotopic ossification
Advancement in the medical management of large burns including surgical techniques, wound care and dressings, and artificial skin has made a previously non-survivable injury one that is routinely survivable. However, burn injuries leave physical impairments that can ...