TOPIC:- BURN

Presented by:-

Name:-Anny Kumary
Session:- 2019-23
Roll no:- 190010025647
Registration no:- BPT19042187/2019

Department of Physiotherapy
Vinoba Bhave University, Hazaribag.
 ACKNOWLEDGEMENT

I would like to express my sincere gratitude to "Professor Yashvir Jaggi",

the director of physiotherapy Department, Vinoba Bhave University,
Hazaribag, Jharkhand for giving me an opportunity to work on this project.
Also I would like to express my special thanks to my project guide " Dr.
Rahul Kumar" for giving me this project work.
I convey my sincere thanks to "Dr. Meraj Nabi Siddiqui" " Dr.Ambika
Gupta" And "Dr Sanjeev Kumar" for their guidance and valuable
suggestions.
I can also very thankful to all my faculty member of Department of
Physiotherapy for their sincere guidance in completing this project,
without this help and proper guidance this project might not have been
completed.
 CERTIFICATE
This is to certify that Miss ANNY KUMARY of Roll no:-
190010025647 ,Registration no.- BPT19042187/2019, session:- 2019-23, of
Department of Physiotherapy, Vinoba Bhave University, Hazaribagh,
Jharkhand has completed the evidence based project on the

TOPIC:- BURN

PROJECT GUIDE DIRECTOR

NAME:- Dr Rahul Kumar NAME:- Professor Yashvir Jaggi

SIGNATURE:- SIGNATURE:-
 INDEX
Definition and types of Burn
Effects of Burn
Classification of Burn
Assessment
Management
Physiotherapy management
Conclusion
References
 BURN
Definition:-
Burn is a type of coagulative necrosis of tissue, caused by thermal application
transfer from source to body.
Burn is the tissue injury caused by thermal, electrical, or chemical agents.

Types of Burn Injuries:-

1. Thermal Injury
2. Chemical Injury
3. Electrical Burn
4. Radiation Burn
Effects of burn:-
 Burn injury causes destruction of tissue, usually the skin, from exposure
to thermal extremes(either hot or cold), electricity, chemicals and/or
radiation.
 The mucosa of the upper GI system (mouth, esophagus, stomach) can
be burned with ingestion of chemicals.
 The respiratory system can be damaged if hot gases, smoke or toxic
chemical fumes are inhaled.
 Fat, muscles, bone and peripheral nerves can be affected in electrical
injuries or prolonged thermal or chemical exposure.
 Skin damages can result in altered ability to sense pain, touch,
temperature.
Classification of Burns:-
 Based on depth of burn
1. Superficial - involvement of only the epidermis
2. Superficial partial thickness- involvement on epidermis and dermis
excluding all the dermal appendages.
3. Deep Partial thickness- involvement of epidermis and most of the dermis
4. Full thickness- involvement of epidermis and all of the dermis.
 Based on extent of burn
1. First degree burn- Involves the epidermis; characterized by reddness;
tenderness and pain; increased warmth; edema may occur but no
blistering; burn blanches under pressure; usually heal in 7 days.
2. Second degree burn:- Damage extends through epidermis and involves the
dermis; not enough to interfere with regeneration of epithelium; moist,
shiny appearance; salmon pink to red colour; painful; may or may not have
blisters; usually heal in 7-21days.
3. Third degree burn:- Both epidermis and dermis are destroyed with burning
into subcutaneous fat; thick, dry appearance; pearly grey or charred black
colour; painless because nerve endings are destroyed; maybe minor
bleeding; cannot heal and require grafting.
 ASSESSMENT
 Demographic data (patients age <2 or >55)
 Review of medical records (preexisting medical condition)
 History
 Observation
 Palpation
 Examination
 Associated trauma (blast injury, fall injury, airway compromise, child abuse)
 Assessment of range of motion
 Assessment of tightness/ contracture
 Assessment of functional mobility
 Gait assessment
 FIM
Assessment of burn depth
 Superficial
• Bleeding in pin prick- brisk
• Sensation- painful
• Appearance- red, glistening
• Blanching to pressure- present
 Superficial dermal
• Bleeding on pin prick:- Brisk
• Sensation:- painful
• Appearance:- dry, whiter
• Blanching to pressure:- present
 Deep dermal
• Bleeding on pin prick:- delayed
• Sensation:- Dull
• Appearance:- cherry red
• Blanching to pressure:- No
 Full thickness
• Bleeding on pin prick:- none
• Sensation:- none
• Appearance:- dry, white, leathery
• Blanching to pressure:- No
Burn configuration
 Circumferential burns can cause total occlusion of circulation to an area due
to edema.
 Restrict ventilation if encircle the chest.
 Burns on joint area can cause disability due to scar formation.

Burn wound zones

 Zone of coagulation- cells are irreversibly damaged and skin death occurs.
 Zone of stasis- It contains injured cells that may die within 24 to 48 hrs.
 Zone of hyperemia- In this zone, there is minimal cell damage

Parkland formula for burns resuscitation

Total fluid requirement in 24 hrs= 4mL ( total body surface area%) X body
weight( in kgs)
Extent of burnt area
• % of Total body surface area (TBSA) burned:- calculated by "Rule of Nine".
• The "Rule of Nine" divides the body surface into areas of 9% or multiples of 9%
of TBSA.
• The greater the TBSA, the poorer the prognosis.
• Percentage chance of survival:-
[100 - (age in years + percentage TBSA)]
Burn criteria
 Severe burn criteria
1. 3° > 10% body surface area
2. 2° > 30% body surface area
3. Burns with respiratory injury
4. Hands, face, feet and genitalia
5. Burns complicated by other trauma
6. Underlying health problems
7. Electrical and deep chemical burns
 Moderate burn criteria
1. 3° = 2-10% body surface area
2. 2° = 15-30% body surface area
3. Excluding hands, face, genitalia
4. Without complicating factors
 Minor burn criteria
1. 3° < 2% body surface area
Skin assessment Scar assessment
 Appearance  Pigmentation of scar
0= Normal
 Temperature
1= Hypopigmentation
 Moisture/ Dryness 2= Hyperpigmentation
 Texture  Height of scar
 Colour 0= Normal
1= <2mm
 Size 2= <5mm
 Pulses 3= >5mm
 Sensations
 MANAGEMENT
Medical management
 Establish and maintain an airway
 Prevent cyanosis, shock, and hemorrhage
 Prevent or reduce fluid losses
 Clean the patient and wounds
 Fluid volume replacement therapy
 Analgesics
 Topical medications
Surgical management
 Surgical removal of Escher
 Skin grafting
 Correction of scar contracture
 PHYSIOTHERAPY MANAGEMENT

Goals of physiotherapy
 Prevention of scar and contracture
 Preservation of normal range of motion( ROM)
 Maintenance and improvement in muscular strength
 Improvement in cardiovascular endurance
 Reduction of risk of infections and complications
 Enhancing wound and soft tissue healing
 Reduction of risk of secondary impairments
 Return to pre-burn function and performance of activities of daily living
POSITIONING AND SPLINTING
Positioning
• Begins on day of admission
• Positioning burned areas in place and maintain the body part in the opposite
plane and direction to which it will potentially contract.
• To minimize edema
• To preserve function
Splinting
• Given to provide anti-inflammatory positions
• Prevention of contracture
• Maintenance of Range of Motion(ROM)
• Protection of joint and tendon
• Reduce pain
• Static or dynamic splint can be used.
THERAPEUTIC EXERCISES
 Active and passive exercises
• Starting from day of admission.
• Perform AROM of all the extremities and trunk including unburnt areas.
• Avoid ROM exercises of injured areas in case of recent skin grafting.
• AROM should be done twice daily.
• For sedated patients, PROM can be initiated and given thrice/day.
 Resistive and consitioning exercises
• Exercises consist of isometrics, isotonic, isokinetic Or using other resistive
training devices
• In progression, use weights and resistive equipments to improve muscle
strength
• Regular and accurate monitoring of vitals before, during and after exercises.
AEROBIC AND RESISTANCE TRAINING
Aerobic training
 Frequency:- 3days/week
 Intensity:- moderate to high intensity (65%-85%of MHR)
 Type:- interval, continuous; using treadmill, walking, running exercises
 Time:- 20-40 mins/session
Resistance Training
 Frequency:- 3 times/week (break of more than 48 hours must be given
between bouts of resistance training)

## Post burn 6 months to 2 years time given before initiation of training or In

cases of 40% TBSA, training started after 95% healed wound/scars.
AMBULATION
 It should be initiated at the earliest appropriate time.
 If LE's are skin grafted, ambulation maybe discontinued.
 Wrap elastic bandages after skin grafting while ambulation.
 If orthostatic hypotension is present, use tilt table to make patient stand
gradually.

SCAR MANAGEMENT
 Pressure garment therapy
• Method of application
For lower extremity:- figure of eight pattern
For upper extremity:- spiral wraps
For trunk:- circular wrap
Head and toes:- self-adherent bandages
• Pressure exerted around 15-40 mmHg
• Worn upto 23 hours/day
• Worn as soon as wound closure has been obtained.
• Post grafting after 10-14 days it is recommended and it should be worn upto
1 year or until scar maturation.
 Silicon gel
• Sheets of silicone polymer gel maybe applied directly over an actively
maturing scar
 Massage
• Deep friction massage
• Finger and thumb kneading
• Effluerage
• Skin rolling
• Wringing
• Retrograde massage
• Massage techniques can be used along with ROM exercises.
 CONCLUSION
I would like to conclude this project on the Topic:- Burn.
This project was very benificial and highlighted the topic Burn, with its
types, effects, classification and assessment. Through this project, I learnt
about the physiotherapy interventions that can be included in post burn
patients rehabilitation to restore the previous functional level.
 REFERENCES

• https://www.slideshare.net/slideshow/burns-its-ph
ysiotherapy-managementpptx/267152331
• https://www.slideshare.net/shreelakshmit/physioth
erapy-in-burns