Physical, therapy, surgery and burns (Ricardo Fernandez)

PHYSICAL THERAPY AND BURN CARE IN MSF FIELD HOSPITALS

RICARDO FERNANDEZ FLYING PHYSIO E-DESK

PHYSICAL THERAPY ROL IN MSF BURN CARE

Burn care: Haiti, Jordan, Gaza, Syria, Yemen.

General Profile: • acute and secondary phase • 23%TBSA average • Deep partial thickness or full thickness burns • Caused mostly by flame 67% (Syria) or liquid 56% (Haiti) • Located: face 31%, hands 59% ,perineum 17%).

• Age average is extremely low THIS PROFILE IN PRECARIOUS CONTEXTS IS GENERATING SEVERE (17,2 years), • Skin grafting at least once FUNCTIONAL SEQUELAE.

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TREATMENT PHASES AND DOMAINS Acute: • OT: assessment, mobilizations, splinting.

Close rellationship with surgeon • IPD: bed positionning and complication prevenction, breath, independency, pain management.. Close rellationship with anaesthetic and nurse team Secondary: • OPD: ambulatory sequelae prevenction/treatment, compressive garnements. Close rellationship with ER doctor.

Prevenction, quality care, education..

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TREATMENT PHASES AND DOMAINS The PT in burn care starts from the day of the injury

Retract

WITHOUT COMPRESSIO WITH COMPRESSION

Burn Injury SECONDARY PHASE ACUTE PHASE Reconstructive phase Maturation phase 3 MONTHS

24 MONTHS

STANDARDs OF CARE IN THE FIELD Objectives: Prevention or treatment of major functional complications: • retractions • coalescence • hypertrophic scars MAXIMUM AUTONOMY/INDEPENDENCY OUTCOME Principles 1. Maximal Cutaneous Capacity (MCC) 2. Complementarity Mobilisation/immobilisation 3. Early and prolongued compression • Pain control • Asepsis

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COMPLICATION PREVENCTION TREATMENT TECHNIQUES DRESSING COALESCENCE (FUSION)

Bad dressing: mobility/joints not respected

PLASTIC SURGERY IN NEED! Good dressing « segments separated »

TREATMENT TECHNIQUES COMPLICATION PREVENCTION POSITIONNING/POSTURAL INSTALLATION

PLASTIC SURGERY IN NEED!

TREATMENT TECHNIQUES COMPLICATION SPLINTING/MOBILIZATIONS PREVENCTION Complementarity inmobilization/mobilization

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TREATMENT TECHNIQUES COMPLICATION PREVENCTION PRESSURE GARNEMENTS

• Material • Staff technical knoledge • Patient collaboration independency • Msf protocols

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MULTIDISCIPLINARY INTEGRATION PHYSIO EMERGENCY DOCTOR First assessment Fonctional prognosis Follow up complementarity

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ANESTHETIC Positionning choice and timming PATIENT SURGEON Debridement+mobi lization Skin grafting+ inmobilization, positioning, splinting,…

Prior dressing in ipd Complementarity: caloric intake Painkillers DLA exercises

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SKIN BIOMECHANICS

M

CUTANEOUS CHAINS RELATED TO MOVEMENT "La composante cutanée dans les mouvements segmentaires : 4 variations sur un thème de Schöber Incidences sur la rééducation" J P Girbon, F Braye KINESITHERAPIE LA REVUE 2006 EIAS

34cm

SKIN BIOMECHANICS CUTANEOUS CHAINS RELATED TO MOVEMENT

34,6cm

SKIN BIOMECHANICS CUTANEOUS CHAINS RELATED TO MOVEMENT

30째

35,4cm

SKIN BIOMECHANICS CUTANEOUS CHAINS RELATED TO MOVEMENT 60째

36,8cm

SKIN BIOMECHANICS 90째

CUTANEOUS CHAINS RELATED TO MOVEMENT

39,6cm

SKIN BIOMECHANICS 150째

CUTANEOUS CHAINS RELATED TO MOVEMENT

43,2 cm

MCC SPOT DEPLACEMENT 9,2CM

180°

44 43 42 40 cm

38,9

39,6

38 36,8 36 34

34

34,6

35,4

32 30 am plitude d'élévation du bras

THERAPY PLANNING

Mobile spot

Fix spot

CUTANEOUS CREDIT DEPLACEMENT OF MOBILE SPOT

PROTOCOLS ACUTE Phase I Non surgery Surgery days days/Skin graft Positioning Bed installation Splinting : - Static - dinamic Manual Autopostures Mobilization passive active Pressure techniques Rigid Soft Strenghing isometric dynamic Breathe therapy Wound/scar Dressing Massage adherences Lymphatic drainage Sensitive Hydratation Functional DLA endurance Functional devices Ocupational Gait

Phase II

SECONDARY POST-OPERATIVE AMBULATORY Phase I Phase II Epidermic Good closed independency wound level

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MERCI!!

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ricardo.fernandez@paris.msf.org

THANKS!!

Contact: ricardo.fdez.schez@gmail.com

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