Rehabilitation after burn injuryBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7461.343 (Published 05 August 2004) Cite this as: BMJ 2004;329:343
- Dale Edgar,
- Megan Brereton
Prevention of scarring should be the aim of burn management. For every member of the burn team, rehabilitation must start from the time of injury. Having a substantial burn injury is frightening, particularly as patients will not know what to expect and will be in pain. Consistent and often repetitive education is a vital part of patient care. Oedema management, respiratory management, positioning, and engaging patients in functional activities and movement must start immediately. Patients need to be encouraged to work to their abilities and accept responsibility for their own management. Functional outcome is compromised if patients do not regularly engage in movement.
In order to achieve desired outcomes and movement habits, ensuring adequate pain control is important. The aim of analgesic drugs should be to develop a good baseline pain control to allow functional movement and activities of daily living to occur at any time during the day. The use of combined analgesics such as paracetamol, non-steroidal anti-inflammatory drugs, tramadol, and slow release narcotics reduces the need for increasing doses of narcotics for breakthrough pain. Codeine should be avoided if possible because of its negative effects on gut motility. Other pain control methods that may be helpful include transcutaneous electrical nerve stimulation (TENS).
Aggressive, prophylactic chest treatment should start on suspicion of an inhalational injury. If there is a history of burn in a closed space or the patient has a reduced level of consciousness then frequent, short treatments should begin on admission. Treatment should be aimed at removing lung secretions (oedema), normalising breathing mechanics, and preventing complications such as pneumonia.