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include:
Cardiovascular:
Cardiac
arrest
(ventricular fibrillation for electric current
or systole for lightning), arrhythmia (usually
sinus tachycardia or nonspecific
DEFINITION OF TERMS
Types of Burns
Thermal Burns
Thermal burns are the result of conduction
or convection, as
in contact with a hot object, liquid,
chemical, flame, or
steam. In order of frequency, the common
types of thermal
burns are scalds, flame burns, flash burns,
and contact burns
Electrical Burns
An electrical burn is caused by exposure to
a low- or highvoltage current and results in
varied degrees of visible cutaneous tissue
destruction at the contact points, as well as
less visible but massive damage of
subcutaneous tissue, muscle, nerve, and
bone. Tissue necrosis of these deeper
structures occurs from the high heat
intensity of the current and the electrical
disruption of cell membranes. Tissue
damage occurs along the path of the
current, with smaller distal areas of the
body damaged most severely. This pattern
of tissue damage accounts for the high
incidence of amputation associated with
electrical injury. The severity of an
electrical burn depends primarily on the
duration of contact with the source, the
voltage of the source, the type and
pathway current, and the amperage and
resistance through the body tissues.
Electrical burns are characterized by deep
entrance and exit wounds and arc wounds.
The entrance wound is usually an obvious
necrotic and depressed area, whereas the
exit wound varies in presentation. The exit
wound can be a single wound or multiple
wounds located where the patient was
grounded during injury. An arc wound is
caused by the passage of current directly
between joints in close opposition. For
example, if the elbow is fully flexed and an
electrical current passes through the arm,
burns may be located at the volar aspect of
the wrist, antecubital space, and axilla.
Gastrointestinal:
Cramps,
nausea,
vomiting, diarrhea, and bowel ischemia
Hematologic: Pancytopenia (decreased
number of red blood cells, white blood
cells, and platelets), granulocytopenia
(decreased number of granular leukocytes),
thrombocytopenia (decreased number of
platelets), and hemorrhage
Vascular: Endothelium destruction
classification of burn
Superficial Partial-Thickness Burn
Epidermal Burn
An epidermal burn, as the name implies,
causes cell damage only to the epidermis
(Fig. 24.2). This depth of burns correlates to
practice
pattern
7B,
Impaired
Integumentary Integrity Associated with
Superficial Skin Involvement, in the Guide
to Physical Therapist Practice. The classic
sunburn is the best example of an
epidermal burn. Clinically, the skin appears
red or erythematous.The erythema is a
result of epidermal damage and dermal
irritation, but there is no injury to the
dermal tissue. There is diffusion of
inflammatory mediators from sites of
epidermal
damage
and
release
of
vasoactive substances from mast cells. The
surface of an epidermal burn is dry. Blisters
will be absent, but slight edema may be
apparent. After an epidermal burn, there is
usually a delay in the development of pain,
at which point the area becomes tender to
the touch. Following epidermal damage,
the injured epidermal layers will peel off or
desquamate in 3 to 4 days. Epidermal
healing is spontaneous; that is, the skin will
heal by itself, and no scar tissue will form.
ischemia
of
the
area.
Frequently,
thrombosis of superficial blood vessels is
apparent and no blanching of the tissue is
observed. The deep red color of the tissue
results from hemoglobin fixation liberated
from destroyed red blood cells.
Hair follicles are completely
destroyed, so body hairs pull out easily. All
nerve endings in the dermal tissue are
destroyed so the wound will be insensate
(without feeling); however, a patient still
may experience a significant amount of
pain because adjacent areas of partialthickness burn usually surround a fullthickness injury.
II. EPIDEMIOLOGY
Biological Barriers
Langerhans cells, macrophages, and
DNA
Langerhans cells in epidermis present
antigens to lymphocytes
Fair-skinned
people
have
more
pheomelanin and dark skinned people have
more eumelanin
Environmental Factors
UV light increases enzymatic activity in
the melanosomes and leads to increased
melanin production.
A tan is achieved because the amount of
melanin has increased as well as the
darkness of the melanin. (Eumelanin
provides protection from UV exposure while
pheomelanin
tends to break down with too much UV
exposure)
The melanin provides protection from the
UV radiation but prolonged exposure may
cause skin cancer.
Carotene (carot = carrot)
yellow-orange pigment
precursor for Vitamin A which is used to
make pigments needed for vision
found in stratum corneum and fatty areas
of dermis and hypodermis layer
Hemoglobin
Oxygen-carrying pigment in red blood cells
Skin Markings
- skin is marked by many lines, creases
and ridges
friction ridges: markings on fingertips
characteristic of primates
allow us to manipulate objects more easily
- fingerprints are friction ridge skin
impressions
flexion lines: on flexor surfaces of digits,
palms, wrists, elbows etc skin is tightly
bound to deep fascia
at these points
freckles: flat melanized patches vary
with heredity or exposure to sun
moles: elevated patch of melanized skin,
of the with hair mostly harmless, beauty
marks
Derivatives of skin - during embryonic
development thousands of small groups of
epidermal cells from
stratum basale push down into dermis to
form hair follicles and glands
Skin receptors:
Your skin and deeper tissues contain
millions of sensory receptors.
Most of your touch receptors sit close to
your skin's surface.
Light touch
Meissner's corpuscles are enclosed in
Irreversible
tissue
loss
due
coagulation of constituent proteins.
to
Zone of Stasis:
Characterised by decreased tissue
perfusion
Potential to rescue the tissue in this zone
Problems
such
as
prolonged
hypotension, infection or oedema can
convert this area into one of complete
tissue loss
Zone of Hyperaemia:
The tissue here will invariably recover
unless there is severe sepsis or prolonged
hypoperfusion.
The depth of the wound develops over
time: The
burn
process
peaks
at
approximately three days. Progression is
3D- zone of coagulation both increases in
depth and width (Ever et al 2010).
IV. ETIOLOGY
V. PATHOPHYSIOLOGY/MECHANISM OF INJURY/PATHOLOGY
Pathophysiology of Burns Skin and
body tissue destruction occurs from
the absorption of heat energy and
results in tissue coagulation. This
coagulation is depicted in zones
(Figure 12-2). The zone of coagulation,
located in the center of the burn, is the
area of greatest damage and contains
nonviable tissue referred to as eschar.
Although eschar covers the surface
and may appear to take the place of
skin, it does not have any of the
characteristics or functions of normal
skin. Instead, eschar is constrictive,
attracts microorganisms, houses toxins
that may circulate throughout the
body, and prevents progression
through the normal phases of
healing.3 The zone of stasis, which
surrounds the zone of coagulation,
contains marginally viable tissue
which can easily be further
damaged from processes such as
hypoperfusion, edema, or infection.
Proper wound care can minimize
this conversion and preserve the
integrity of the viable tissue in this
zone. The zone of hyperemia, the
outermost area, is the least
damaged and heals rapidly unless
additional tissue injury occurs.7-9
The depth of a burn can be
described as superficial, moderate
partial thickness, deep partial
thickness, or full thickness (Figure
12-3). Each type has its own
appearance, sensation, healing time, and
level of pain, as described in Table 12-2.
First-degree burns have no significant
structural damage and therefore no zone of
stasis
or
coagulation.
Differentiation
between moderate and deep seconddegree burns can be made based on the
presence of the zones of coagulation,
stasis, and hyperemia in the deeper burns
while moderate second-degree burns will
only have zones of stasis and hyperemia.
Third-degree burns contain a significant
and easily identifiable zone of coagulation
as well.
Impairment
Face
Facial
disfigurement
(contractures of eyelids,
nose, mouth, ears, and
adjacent facial skin)
Inability to close eyes
Loss of facial expression
Teeth malalignment
Drooling and inability to
close lips
Lower lip eversion
Loss of normal cervical
spine range of motion
Limited visual fields
Difficulties with anesthesia,
due to decreased neck
range of motion
Protraction of shoulders
Kyphosis
Functional scoliosis
Decreased
respiratory
Neck
Trunk
function
Breast entrapment
Perineal banding
Axilla
Hands
Arms
legs
and
Foot
ankle
and
Cardiovascular:
Cardiac
arrest
(ventricular fibrillation for electric current
or asystolic for lightning), arrhythmia
(usually sinus tachycardia or nonspecific
ST changes) secondary to alterations in
electrical conductivity of the heart,
myocardial contusion or infarction, or
heart wall or papillary muscle rupture
Neurologic: Headache, seizure, brief loss
of consciousness or coma, peripheral
nerve injury (resulting from ischemia),
spinal cord paralysis (from demyelination),
herniated nucleus pulposus, or decreased
attention and concentration
Orthopedic: Dislocations or fractures
secondary to sustained
muscular contraction or from a fall during
the burn injury
Appearance
Healing
Pain
3-5
days
by Tenderness to
epithelialization
tOuch or
Skin appears intact painful
5 days to 3 wks by
epithelialization
Pigmentation
changes
are likely
Very painful
3 wks to mas by
Very painful
granulation tissue
formation and
epithelialization
Scar
formation
likely
Not
able
regenerate
to No pain, perhaps
an ache
Systemic effects
Once the burn covers more than 30% of
TBSA, the injury has a systemic effect due
to
Molecular structural alterations
o Release of toxic metabolites
o
Release
of
antigen
and
immunomodulatory agents
Histamine,
Serotonin,
Bradykinin,
Nitric oxide, etc.
Causes systemic shock, cardiovascular,
respiratory
and
renal
failure,
immunosuppression
and
hypermetabolism.
(Evers et al 2010)
Cardiovascular Changes
Myocardial depression
o Myocardial contractility decreased
Oedema formation
o Capillary permeability is increased
o leads to loss of intravascular proteins
and fluids to the interstitial compartment
Hypovolemia
o Secondary to oedema and rapid fluid
loss from surface of wound
Peripheral
and
splanchnic
vasoconstriction occurs
o May cause renal failure
These changes may lead to systemic
hypotension
and
end
organ
hypoperfusion.
(Evers et al, 2010)
Respiratory Changes
Inflammatory
mediators
cause
bronchoconstriction
and
pulmonary
oedema
severely burnt adults acute respiratory
distress syndrome (ARDS) can occur
Exacerbated in the case of inhalation
injury (Evers et al 2010)
Metabolic Changes
Hypermetabolism begins approximately
five days post burn
o Metabolic state is initially suppressed by
the effects of acute shock
o Can persist for up to two years post
injury
Inflammatory,
milieu cause
hormonal
and
cytokine
Increased
oxygen
and
glucose
consumption
Increased CO2 and minute ventilation
Increased heart rate for up to 2 years
post burn
(Jeschke et al 2007; Grisbrook et al 2012a;
Hurt et al 2000)
This hyper metabolic state leads to energy
substrate release from protein and fat
stores Protein catabolism
Loss of lean muscle mass and wasting
Potentially fatal if structure and function
of organs are compromised
(Jeschke et al 2007; Hurt et al 2000)
In adults with burns of 25% TBSA,
metabolic rate ranges from 118-210%
that of predicted values. At 40% TBSA, the
resting metabolic rate in a thermoneutral
environment is
o 180% at acute admission
o 150% at full healing
o 140% post 6 months
o 120% at 9 months
o 110% at 10 months
(Jeschke et al 2007; Herndon and Tomkins
2004)
Gastrointestinal Changes
Impaired gastrointestinal motility
Impaired digestion and absorption
Increased intragastric pH
Feeding difficulties exacerbate effects of
hyper metabolism (Evers et al 2010)
Immunological Changes
(Hettiaratchy and Dziewulski 2004)
Immune deficiency occurs despite the
activation of the immune system. High
risk of infection, particularly while wounds
are open.
VII.
sulivan
Presenting Complaint
Inhalation injury
There should be a high index of suspicion
if the patient was injured in an enclosed
space and / or
commence immediately
Conservative
or
operative
treatment
o Surgical managementremoval
of eschar, transplantation of skin
grafts, flap
Early postoperative physical therapy
Functional rehabilitation
Secondary and tertiary corrections if
necessary
Objective Assessment
Inspection and Palpation
To assist with treatment planning,
pertinent data that can be gathered from
the direct observation of a patient or
palpation include the following:
Level of consciousness
Presence of agitation, pain, and stress
Location of the burn or graft, including
the proximity of the burn to a joint
Presence and location of dressings,
splints, or pressure garments
Presence of lines, tubes, or other
equipment
Presence and location of edema
Posture
Position of head, trunk, and extremities
Heart rate and blood pressure,
respiratory rate and pattern, and oxygen
saturation
Pain Intensity Assessment
Observational
behavioural
pain
assessment scales should be used to
Measure pain in children aged 0 to 4 years
e.g. The FLACC scale
British
Burn
Oedema Assessment
Overview
An acute burn injury creates inflammation
and swelling. After wound healing is
complete, scar tissue maturation and
contraction may lead to sub-acute and
chronic states of oedema formation. With
time, oedema fluid changes in its
composition and creates greater stiffness
and resistance to movement within the
tissues. This is particularly notable when
surgical reconstruction is required and if
the burn is circumferential around limbs or
other structures. See table 4 for clinical
stages of oedema.
(ANZBA 2007; British Burn Association
2005; Eisenmann-Klein 2010)
Mobility Assessment
The assessment and treatment of mobility
can be separated into two aspects - the
limbs & trunk, and general functional
mobility
(e.g.
transferring
and
ambulation). A physiotherapist must also
response
to
Neurological status
Pain
Concomitant
bearing status
injuries/weight-
MANAGEMENTS
of
- Adverse reaction
and total body water volume further impact
upon effectiveness an analgesia.
- Nausea
aspiration
and
increased
risk
of
Impaired
communication
memory
Pharmacological
Pain
Sleep Normalisation:
disrupted sleep occurs in up to 50% of burn
patients and links have been established
between poor sleep quality and pain
severity, as well as pain and prolonged
experiences
of
sleep
disturbance.
Normalisation of the 24hour day, with a
bedtime routine, within the limits of the
hospital environment is aimed for to
promote sleep, with the use of analgesics
and night sedation.
Skin Grafts
A skin graft is the transportation of skin
from one area of the body to another.
(Glassey 2004)
A graft is an area of
skin that is separated from its own blood
supply and requires a highly vascular
recipient bed in order for it to be successful.
Prior to grafting, the process of wound
debridement must take place. Wound
debridement involves removing necrotic
tissue, foreign debris, and reducing the
bacterial load on the wound surface
(Cardinal et al 2009).This is believed to
encourage better healing. The following are
the methods available for grafting onto a
debrided wound to obtain closure:
Autograft (split skin graft) (own
skin)
Allograft (donor skin)
Heterograft or xenografts (animal
skin)
Cultured skin
Artificial skin
(Glassey 2004)
Meshed vs. Sheet Grafts
Sheet grafts are those which are not altered
once they have been taken from the donor
site.
and synthetic or
biological. A very
clear
and
concise
Capillary
in-growth
(Glassey 2004)
and
Skin Flaps
The difference between a skin graft and a
skin flap is that a skin flap contains its
own vasculature and therefore can be used
to take over a wound bed that is avascular.
A skin graft does not have this ability
(Glassey 2004). When speaking about grafts
and flaps in the research, skin flaps is often
incorporated into the term skin grafts.
Tissues which a skin graft will not take over
include and which a skin flap will include:
Bone without periosteum
Relocation of Flaps
The third way in which flaps are
Tendon without paratenon
classified is by their method of relocation.
Flaps are defined as either local or distant
Cartilage without perichondrium
depending on the distance between the
(Glassey 2004)
donor and recipient sites (Glassey 2004).
Categorisation of Skin Flaps
Based on three factors:
1. Vascularity
2. Anatomical composition
3. Method of relocation (Glassey 2004)
Vascularity
Flaps can be classified as either
random pattern flaps or axial flaps
depending on their vascularity. Random
pattern flaps are not raised on any
particular major blood vessel, but instead
are raised on smaller branches of
these blood vessels known as the
subdermal plexus. These flaps
are limited in size to ensure distal
parts do not become ischemic
(Glassey 2004). Examples of
these flaps include Z-plasty, V-Y
advancement flap, rotation flap
and transposition flap. Axial
flaps, on the other hand, are
Local Flaps:
Rotation or transpositional flaps are
tissue that is lifted and manipulated to
cover the local defect, maintaining their
connection with the body. Therefore, they
are never fully excised.
Advancement flaps are those in
which the tissue is moved directly forward
to cover the defect, e.g. V-Y flaps used to
cover finger-tip injuries
(Glassey 2004).
Distant Flaps:
of
loss
Early functional
(Kamolz et al 2009)
of
functional
rehabilitation
1mmobilisation
post
skin
reconstruction
surgery
Oedema increasing for up to 36 hours post
injury
Stopping movement and function of the
Hypermetabolic response, peaking at five body parts involved should be enforced
after skin reconstruction for a burn has
days post injury
taken place. When a body part must be
Early synthesis and remodelling of collagen immobilised, it should be splinted or
positioned in an anti-deformity position for
Aims
the minimum length of time possible
Reduce risk of complications
(Edgar and Brereton 2004; ANZBA 2007)
o Reduce oedema, particularly where
it poses a risk for
The following is a table drawn up using
impinging
on
peripheral current literature on the recommended
circulation or airways
immobilisation times for the various skin
grafts:
Predisposition to contractures
The times frames for mobilisation post Prevent deformities/loss of range
surgery outlined in this booklet are merely a
guide taken from an analysis of current
Protect/promote healing
literature and are NOT a replacement for the
specific time frames directed by the
Common treatment techniques
operating surgeon or consultant (ANZBA
Immobilisation
2007).
o Bed rest
For a physiotherapist the most important
o Splinting
concepts to grasp are:
Positioning
What is the minimum timeframe of
Immobilisation
immobilisation post-surgery
What structures MUST be immobilised
Rationale for Immobilisation
Special considerations for movement,
function and ambulation dependent on
Positioning in the Acute Stage
*Modify according to burn area, patient
pain and medical status.*
Rigid or soft
Donor sites and the structures repaired or
excised during surgery.
Dorsal or Volar
Deformity Prevention
Static Splinting
The most common deformity associated A serial static splint is a device with no
with burns is the claw deformity. It
involves extension of the MCP joints,
flexion of the PIP joints, adduction of the
thumb and flexion of the wrist (Kamolz
2009). This position is also referred to as
the intrinsic minus position.
Position of Safe Immobilisation
The position of safe immobilisation of the
burned hand is essentially the opposite of
the above claw deformity position. This
position involves: 20-30 wrist extension, 8090 degrees flexion MCP joints, full extension
PIP and DIP joints and palmar abduction of
the thumb
(Boscheinen-Morrin 2004).
Splinting
Physiological rationale for splinting (Kwan
2002)
Scar tissue is visco-elastic. It will elongate
steadily within a certain range. When this
stretching force is released, there is an
immediate decrease in the tissue tension
but a delay in the retractions of the tissue to
a shorter length. These stress relaxation
properties of visco elastic scar tissue means
it can accommodate to stretching force
overtime. Dynamic and static splinting
provide this prolonged low stretching force.
Categories of Splints
Static or Dynamic
Supportive or Corrective
Splinting Precautions
Management
of
Oedema
Elevation
Elevation of the hand above heart level is
the most simple and effective ways to
prevent and decrease oedema (Kamolz
2009).
these
evidence
Passive ROM
Passive ROM exercises in the acute stage
are contraindicated as applying passive
Limit effects of scar contraction/prolonged stretching forces may result in future
to
the
burned
structures
positioning on range of motion and function damage
(Boscheinen-Morrin 2004). Applying these
Address effects of prolonged bed rest
passive manoeuvres in the acute stage will
result in increased oedema, haemorrhage
Common modalities
and fibrosis of the burned tissues (Cooper
Mobilisation- both mobility and specific 2007).
joint mobilisation
The biomechanical principle of creep when
Scar management adjuncts
passive stretching. A slow sustained stretch
o
Pressure
garments,
silicone, is more tolerable for patient and more
massage
effective for producing lengthening (Kwan
Continuation of oedema/ positioning 2002).
management where necessary
Passive joint mobilisations can begin
during the scar maturation phase once the
Mobilisation
The advantages of general mobilisation for a scar tissue has adequate tensile strength to
burns patient to counteract the effects of tolerate friction caused by mobilisation
prolonged bed rest are no different to that techniques
(Boscheinen-Morrin and Connolly
of a surgical or medical patient. Burns
2001).
patients should be mobilised as early as
possible to avoid deconditioning and
possible
respiratory
complications Frequency, Duration Recommendations
associated
with
prolonged
bed
rest Physiotherapy intervention should be twice
(Esselman 2007).
daily with patients prescribed frequent
active exercises in between sessions.
As outlined in the above introduction, due to
the ethical issues surrounding withdrawal or For the sedated patient gentle passive
modification of treatment the evidence range of motion exercises should be done 3
surround the optimal duration, frequency times a day once indicated (Boscheinenand methods of physiotherapy interventions Morrin and Connolly 2001).
in the treatment of burn patients is unclear.
Dependent on the severity of the burn
Despite this lack of clarify surrounding these
active and very gentle passive range of
issues it is clear that both active and
motion exercises for the hand and fingers
passive mobilisation plays a key role
are begun from day one of injury.
throughout the stages of burn recovery.
Below
is
a
summary
of
the
Contraindications
recommendations
from
the
currently
literature on passive and active mobilisation Active or Passive range of motion
exercises should not be carried out if there
of burns.
is suspected damage to extensor tendons
(common occurrence with deep dermal and
Active ROM
full thickness burns). Flexion of the PIP joints
Depending on the need for immobilisation
should be avoided at all costs to prevent
gentle active ROM exercises is the preferred
extensor tendon rupture. The hand should
treatment during the acute stage of injury
be splinted in the position of safe
Aims
Optimise scar appearance
rater
reliability
has
not been
on/off splints.
assessed for burn scars to date
(Durani et al 2009).
Always monitor for post exercise pain and
Validity: When compared with POSAS
wound breakdown.
scale, validity was evident
Avoid blanching for long period as you may
(Durani et al 2009)
compromise vascularity.
Sensitivity: Most Scar OCM rely on
categorical/ordinal data with few levels
The patient may present with a reduced
which provides limited sensitivity and can
capacity for exercise secondary to increased
only
identify
considerable
differences
metabolic rate, altered thermoregulation
between scars
and increased nutritional demands.
(Fearmonti et al 2010).
Postural hypotension may be present due
to prolonged bed rest and low haemoglobin. Patient and Observer Scar Assessment
Scale (POSAS)
(ANZBA 2007)
Use: Measures pigmentation, vascularity,
thickness, relief, pliability and surface area.
Scar Management
Abnormal scarring is the most common Also includes assessment of patient pain,
complication of burn injuries, with the itching, colour, stiffness, thickness and
estimated prevalence of > 70% of those relief. The only scale to measure subjective
who suffer burn injuries (Anzarut et al, aspects of pain and pruritus (severe itching)
(Fearmonti et al 2010).
2009). Not only do hypertrophic scars cause
Reliability:
Good
internal
consistency and
psychosocial
difficulties
through
their
reliability
cosmetic appearance, they may also be
(Durani et al 2009)
painful, pruritic, and they may limit range of
Validity:
Good
concurrent
validity
motion where they occur on or near a joint
(Durani
et al 2009)
(Morien et al 2009; Polotto 2011).
Sensitivity:
Like
the
VBSS/VSS
above,
Hypertrophic scars require a continuum of
limited
sensitivity
due
to
categorical/ordinal
dedicated and specialised treatment from
the acute stage to many years post data
(Fearmonti et al 2010)
treatment
(Procter, 2010, ANZBA 2007).
1)
Hydration
effect:
decreased
scar
hydration results in mast cell stabilization
and
a
subsequent
decrease
in
neurovascularisation
and
extracellular
matrix production. However this hypothesis
is in contrast with a mechanism of action of
silicone, in which an increase of mast cells
causes scar maturation.
to
comfort,
(Willis et al 2011)
Aerobic capacity as measured by VO2 peak
and time to fatigue has been found to be
lower in adults and children of >15% TBSA
at one year post burn, compared to age
matched healthy controls
(Willis et al 2011; McEntine et al 2006)
(Grisbrook et al 2012b).
to
age
( Grisbrook et al 2012b; Suman and Austin et al, 2003 studied 3 adults with >
Herndon 2007; Suman et al 2001; Przkora et 60% TBSA, 3 with between 30-40 TBSA and
al 2007) 2 unburned patients post 1 hr cycling at 35
degrees and 60% humidity
o Suman et al, 2001, found an increase of None showed significant intolerance for
15% in resting energy expenditure in heat as measured by heart rate and core
children with burns of >40% TBSA who were temperature, measured rectally
not treated with resistance and aerobic
exercise, while the REE of those who No significant difference in whole body
participated in the intervention remained sweat rate
stable.
Overcompensation by healthy skin in the
o Suggested that exercise may have
burned patients.
sympathetic nervous system attenuating
effects
Suggested physical history was a factor in
determining
patients
ability
to
A balance of resistance and aerobic thermoregulate. Therefore adaptations may
exercise may cause a decrease in SNS occur through training.
activity, decreasing catabolic effects.
o Exercise is required to integrate dietary However, studies involving heat loads of 40
amino acids into lean muscle mass degrees have found a significant inability to
(Herndon and Tomkins 2004)
maintain adequate thermoregulation. Due to
the small study numbers of the above, and
**Thermoregulation
the controversy surrounding the efficacy of
Human skin produces sweat to dissipate measuring core temperature accurately, it is
heat in response to thermal stress (McEntine advised that patients are closely monitored
et al 2006). A proper sweat response initially during aerobic exercise for signs of
requires functional integrity of the
heat intolerance.
Sweat glands
***Inhalation injury and pulmonary
Skin circulation
insufficiency
Neural control of the skin (McEntine et al
Long
term
pulmonary
function
is
2006)
compromised in some patients post severe
Full thickness burns damage the dermal burn
appendages including sweat glands. These Lasts several years
are not replaced by grafting. There is also a
Documented in both children and adults
decreased density of sweat glands in the
(Grisbrook et al 2012a)
donor site post grafting
(Esselman et al 2007). Caused by
However, McEntine et al 2006 found that in
o Smoke inhalation
15 children with an average of 55% TBSA
o Direct thermal damage to airways
there was
No
significant
difference
in
core
o Pulmonary oedema
temperature, measured tympanically, pre or
post 20 minutes of treadmill exercise at
o Respiratory tract infection
REFERENCES