Case Study - Burns in Disasters and Conflicts: Difference between revisions
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== Patient Characteristics == | == Patient Characteristics == | ||
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | |||
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | [[Category:Rehabilitation]] | ||
[[Category:Rehabilitation]] | |||
[[Category:Projects]] | [[Category:Projects]] | ||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Physioplus Content]] | [[Category:Physioplus Content]] | ||
Mrs T is a 35-year-old lady who was cooking over a fire in a temporary camp following an earthquake that destroyed her house. The fire was put out with a bucket of cold water and she presented to your facility four hours later. | |||
There is no history or additional trauma and you do not suspect C-spine injury, so she does not require neck collar/sandbags and tape. | |||
There is no history or additional trauma and | |||
you do not suspect C-spine injury, so she does | |||
not require neck collar/sandbags and tape. | |||
A: Airway and C-spine control | A: Airway and C-spine control | ||
Is patient maintaining airway? Yes, Mrs T is maintaining her airway. | Is patient maintaining airway? Yes, Mrs T is maintaining her airway. | ||
swelling and/or inhalation injury. Sit patient up | However, there are burns to face and neck, so we are concerned that the airway may be at risk due to swelling and/or inhalation injury. Sit patient up | ||
Medical | Medical Management – there is a need for oxygen: link with medical team | ||
B: Breathing | B: Breathing | ||
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Spontaneously breathing with normal breath sounds throughout | Spontaneously breathing with normal breath sounds throughout | ||
RR of 16BPM, breathing is a little shallow. | RR of 16BPM, breathing is a little shallow. | ||
Evidence of burns to her chest and upper back – burns appear deep, so patient may require escharotomy – link with medical team | |||
inhalation) | Signs of superficial burn round nose and mouth (may be indicative of toxic smoke inhalation) | ||
C: Circulation | C: Circulation | ||
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Pulse is 110, BP 100/70: likely to be dehydrated, but not in shock | Pulse is 110, BP 100/70: likely to be dehydrated, but not in shock | ||
Hands are cold with poor capillary return in fingers – the burns on the upper arm are | Hands are cold with poor capillary return in fingers – the burns on the upper arm are deep and circumferential | ||
deep and circumferential | |||
both arms and chest | Medical team to insert cannulas and start fluid therapy and carry out escharotomy to both arms and chest | ||
D: Disability | D: Disability | ||
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Mrs T is conscious and talking when spoken to (V on the AVPU Scale) | Mrs T is conscious and talking when spoken to (V on the AVPU Scale) | ||
Examination of her pupils are equal and responsive to light, and there appears to be no | Examination of her pupils are equal and responsive to light, and there appears to be no neurological concerns | ||
neurological concerns | |||
Patient able to sit up independently, so you do not need to log roll her | Patient able to sit up independently, so you do not need to log roll her | ||
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Patient needs to be kept warm to prevent hypothermia | Patient needs to be kept warm to prevent hypothermia | ||
F: Fluid | F: Fluid Resuscitation | ||
Crucial in acute burns management: medical team to lead on this (important to monitor | Crucial in acute burns management: medical team to lead on this (important to monitor urine output, pulse, BP and capillary refill and continue to assess her airway and swelling due to oedema) | ||
urine output, pulse, BP and capillary refill and continue to assess her airway and swelling | |||
due to oedema) | |||
Pain management | Pain management | ||
Ensure pain management is covered, to include pre-change of dressings (COD’s)/therapy | Ensure pain management is covered, to include pre-change of dressings (COD’s)/therapy analgesia | ||
analgesia | |||
Wound care | Wound care | ||
Discuss the plan for Mrs T’s wound care – therapy ties in well to COD’s and is a chance | Discuss the plan for Mrs T’s wound care – therapy ties in well to COD’s and is a chance to check on wound healing/assess for complications | ||
to check on wound healing/assess for complications | |||
From assessment, rehabilitation concerns | From assessment, rehabilitation concerns | ||
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Respiratory | Respiratory | ||
Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and | Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and mobilise to encourage normal function) | ||
mobilise to encourage normal function) | |||
Rehabilitation treatment | Rehabilitation treatment | ||
Nurse Mrs T sitting up due to inhalation injury risk – add breathing exercises and, if | Nurse Mrs T sitting up due to inhalation injury risk – add breathing exercises and, if required, chest physiotherapy (as with any other condition). Keeping the patient well-hydrated is important, so that secretions don’t dry up | ||
required, chest physiotherapy (as with any other condition). Keeping the patient well- | |||
NB, post-SSG to the chest area vibrations and percussion should be left for five days if possible, and if necessary, done over Gamgee (absorbent cotton between gauze) dressings/pads | |||
Elevate her arms gently and keep them abducted and extended at rest, as safely appropriate. (see treatment Table). | |||
Keep monitoring fingers to check on her circulation | |||
Splint neck and axilla and, if needed, mouth (see Table) | Splint neck and axilla and, if needed, mouth (see Table) | ||
Teach ROM and stretching (avoiding overstretch) exercises (see Table for area specific | Teach ROM and stretching (avoiding overstretch) exercises (see Table for area specific information) | ||
information) | |||
Assess and advise on mobilisation | Assess and advise on mobilisation | ||
Ensure patient is feeding with her own participation as safely able, and monitor pain | Ensure patient is feeding with her own participation as safely able, and monitor pain levels | ||
Document everything clearly and COMMUNICATE everything clearly to patient and her family | |||
Document everything clearly and COMMUNICATE everything clearly to patient and her | |||
family | |||
Short-term | Short-term | ||
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Encourage activity from day one. | Encourage activity from day one. | ||
Aim is to prevent contracture and maximise return to function – initial movements can | Aim is to prevent contracture and maximise return to function – initial movements can be limited if patient has had to undergo any skin grafts, but once surgeon allows it, movement must be encouraged. | ||
be limited if patient has had to undergo any skin grafts, but once surgeon allows it, | |||
movement must be encouraged. | |||
as contours of the face, neck and trunk. | Outcome assessment to include measurement of active and passive ROM and also chin-to-sternal notch measurement and commenting on mouth opening (limited/full), as well as contours of the face, neck and trunk. | ||
Long-term expected management and outcome | Long-term expected management and outcome | ||
Revision as of 23:33, 4 March 2022
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Abstract[edit | edit source]
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Patient Characteristics[edit | edit source]
Mrs T is a 35-year-old lady who was cooking over a fire in a temporary camp following an earthquake that destroyed her house. The fire was put out with a bucket of cold water and she presented to your facility four hours later.
There is no history or additional trauma and you do not suspect C-spine injury, so she does not require neck collar/sandbags and tape.
A: Airway and C-spine control
Is patient maintaining airway? Yes, Mrs T is maintaining her airway.
However, there are burns to face and neck, so we are concerned that the airway may be at risk due to swelling and/or inhalation injury. Sit patient up
Medical Management – there is a need for oxygen: link with medical team
B: Breathing
Spontaneously breathing with normal breath sounds throughout
RR of 16BPM, breathing is a little shallow.
Evidence of burns to her chest and upper back – burns appear deep, so patient may require escharotomy – link with medical team
Signs of superficial burn round nose and mouth (may be indicative of toxic smoke inhalation)
C: Circulation
Patient is not haemorrhaging from anywhere
Pulse is 110, BP 100/70: likely to be dehydrated, but not in shock
Hands are cold with poor capillary return in fingers – the burns on the upper arm are deep and circumferential
Medical team to insert cannulas and start fluid therapy and carry out escharotomy to both arms and chest
D: Disability
Mrs T is conscious and talking when spoken to (V on the AVPU Scale)
Examination of her pupils are equal and responsive to light, and there appears to be no neurological concerns
Patient able to sit up independently, so you do not need to log roll her
E: Exposure
Patient needs to be kept warm to prevent hypothermia
F: Fluid Resuscitation
Crucial in acute burns management: medical team to lead on this (important to monitor urine output, pulse, BP and capillary refill and continue to assess her airway and swelling due to oedema)
Pain management
Ensure pain management is covered, to include pre-change of dressings (COD’s)/therapy analgesia
Wound care
Discuss the plan for Mrs T’s wound care – therapy ties in well to COD’s and is a chance to check on wound healing/assess for complications
From assessment, rehabilitation concerns
Oedema
Respiratory
Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and mobilise to encourage normal function)
Rehabilitation treatment
Nurse Mrs T sitting up due to inhalation injury risk – add breathing exercises and, if required, chest physiotherapy (as with any other condition). Keeping the patient well-hydrated is important, so that secretions don’t dry up
NB, post-SSG to the chest area vibrations and percussion should be left for five days if possible, and if necessary, done over Gamgee (absorbent cotton between gauze) dressings/pads
Elevate her arms gently and keep them abducted and extended at rest, as safely appropriate. (see treatment Table).
Keep monitoring fingers to check on her circulation
Splint neck and axilla and, if needed, mouth (see Table)
Teach ROM and stretching (avoiding overstretch) exercises (see Table for area specific information)
Assess and advise on mobilisation
Ensure patient is feeding with her own participation as safely able, and monitor pain levels
Document everything clearly and COMMUNICATE everything clearly to patient and her family
Short-term
Encourage activity from day one.
Aim is to prevent contracture and maximise return to function – initial movements can be limited if patient has had to undergo any skin grafts, but once surgeon allows it, movement must be encouraged.
Outcome assessment to include measurement of active and passive ROM and also chin-to-sternal notch measurement and commenting on mouth opening (limited/full), as well as contours of the face, neck and trunk.
Long-term expected management and outcome
Assess stage of scar maturation and patient’s acceptance of altered body image and function.
Examination Findings[edit | edit source]
References [edit | edit source]
