Case Study - Burns in Disasters and Conflicts: Difference between revisions
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== Title == | == Title == | ||
Face, Neck, Trunk and Arm Burns following a cooking fire in a Temporary Camp post Earthquake <ref>Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. Handicap International: London, UK. 2020.</ref> | |||
== Abstract == | == Abstract == | ||
Mrs T is a 35-year-old female who presented to a healthcare facility four hours post burns to the face, neck, trunk and arms after a cooking fire in a temporary camp post earthquake that destroyed her house. Mrs T was breathing spontaneously showed signs of superficial burn around the nose and mouth, which may be indicative of toxic smoke inhalation and suggest need for oxygen therapy. Required escharotomy to the chest and upper arms. | |||
== Key Words == | == Key Words == | ||
Burns, Fire, Earthquake, Disasters, | |||
== Patient Characteristics == | == Patient Characteristics == | ||
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[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Physioplus Content]] | [[Category:Physioplus Content]] | ||
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. | === Background === | ||
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. | |||
== Examination Findings == | |||
=== 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. | ||
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Medical Management – there is a need for oxygen: link with medical team | Medical Management – there is a need for oxygen: link with medical team | ||
B: Breathing | === 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 | |||
Evidence of burns to her chest and upper back | |||
Signs of superficial burn round nose and mouth (may be indicative of toxic smoke inhalation) | Signs of superficial burn round nose and mouth (may be indicative of toxic smoke inhalation) | ||
C: Circulation | === C: Circulation === | ||
Patient is not haemorrhaging from anywhere | Patient is not haemorrhaging from anywhere | ||
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 | Hands are cold with poor capillary return in fingers - 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 | Medical team to insert cannulas and start fluid therapy and carry out escharotomy to both arms and chest | ||
D: Disability | === 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 | |||
There appears to be no 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 | ||
E: Exposure | === E: Exposure === | ||
Patient needs to be kept warm to prevent hypothermia | Patient needs to be kept warm to prevent hypothermia | ||
F: Fluid Resuscitation | === F: Fluid Resuscitation === | ||
Crucial in Acute Burns Management: Medical team to lead on this | |||
Important to monitor [[Urine|Urine Output]], [[Pulse rate|Pulse]], [[Blood Pressure|BP]] and [[Capillary Refill Test|Capillary Refill]] | |||
Continue to assess her airway and swelling due to oedema | |||
Ensure pain management is covered, to include pre-change of dressings (COD’s)/ | === Pain Management === | ||
Ensure [[Pain-Modulation|pain management]] is covered, to include pre-change of dressings (COD’s) / Therapy [[Analgesic Medication and Exercise|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 | |||
== Rehabilitation == | |||
== Concerns == | |||
[[Edema Assessment|Oedema]] | |||
Oedema | |||
Respiratory | Respiratory | ||
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Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and mobilise to encourage normal function) | Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and mobilise to encourage normal function) | ||
=== Treatment === | |||
Nurse Mrs T sitting up due to [[Inhalation Injury|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 [[Vibration|vibrations]] and [[percussion]] should be left for five days if possible, and if necessary, done over Gamgee (absorbent cotton between gauze) dressings/pads | |||
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). | Elevate her arms gently and keep them abducted and extended at rest, as safely appropriate. (see treatment Table). | ||
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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 ==== | ||
Encourage Activity from day one. | |||
Encourage | |||
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. | 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. | ||
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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. | 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 | ==== Long-term ==== | ||
Expected management and outcome | |||
Assess stage of scar maturation and patient’s acceptance of altered body image and function. | Assess stage of scar maturation and patient’s acceptance of altered body image and function. | ||
== References == | == References == | ||
<references /> | <references /> |
Revision as of 00:28, 5 March 2022
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Title[edit | edit source]
Face, Neck, Trunk and Arm Burns following a cooking fire in a Temporary Camp post Earthquake [1]
Abstract[edit | edit source]
Mrs T is a 35-year-old female who presented to a healthcare facility four hours post burns to the face, neck, trunk and arms after a cooking fire in a temporary camp post earthquake that destroyed her house. Mrs T was breathing spontaneously showed signs of superficial burn around the nose and mouth, which may be indicative of toxic smoke inhalation and suggest need for oxygen therapy. Required escharotomy to the chest and upper arms.
Key Words [edit | edit source]
Burns, Fire, Earthquake, Disasters,
Patient Characteristics[edit | edit source]
Background[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.
Examination Findings[edit | edit source]
A: Airway and C-spine Control[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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 - 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[edit | edit source]
Mrs T is conscious and talking when spoken to V on the AVPU Scale
Examination of her pupils are equal and responsive to light
There appears to be no neurological concerns
Patient able to sit up independently, so you do not need to log roll her
E: Exposure[edit | edit source]
Patient needs to be kept warm to prevent hypothermia
F: Fluid Resuscitation[edit | edit source]
Crucial in Acute Burns Management: Medical team to lead on this
Important to monitor Urine Output, Pulse, BP and Capillary Refill
Continue to assess her airway and swelling due to oedema
Pain Management[edit | edit source]
Ensure pain management is covered, to include pre-change of dressings (COD’s) / Therapy Analgesia
Wound Care[edit | edit source]
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
Rehabilitation[edit | edit source]
Concerns[edit | edit source]
Respiratory
Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and mobilise to encourage normal function)
Treatment[edit | edit source]
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[edit | edit source]
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[edit | edit source]
Expected management and outcome
Assess stage of scar maturation and patient’s acceptance of altered body image and function.
References [edit | edit source]
- ↑ Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. Handicap International: London, UK. 2020.