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
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
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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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