- Elderly patients.
- Burns affecting face, mouth and inhalation burns.
- Immobile patients.
- A history of a chronic respiratory condition.
- Pre–and post–operatively.
- Patients with full–thickness burns on the chest–breathing exercises to keep the eschar mobile.
This is necessary for both in and out patients. In–patients may be in a special ward, intensive care unit or a regional burns unit. The last is best because the patient receives highly specialist attention. The physiotherapist together with other team member must recognize the devastating effect a bad case of burning can have on the family. It is important to recognize moods of guilt, depression, anger, bewilderment and bitterness which can arise in the patient and family. The cause of the accident clearly has a bearing on these moods. The physiotherapist has to gauge what is the appropriate reaction–sympathy, cajoling, encouragement or optimism whilst achieving the aims of treatment. Given the long–stay nature of the recovery period, staff and patients develop a special relationship which must remain professional for the emotional well–being of all concerned. Respiratory Care Clearing secretions is achieved by shaking, clapping, postural drainage, coughing and suction. If it is very uncomfortable for the patient to have hand pressure on a chest burn, then a piece of foam may be used under the hands. Tipping is contraindicated if there is facial edema but the patient may lie supine or on either side. A ventilated patient usually requires suction and humidification. A little treatment, often, is the general theme. Steam inhalations may be necessary for the non–ventilated patient especially when there has been inhalation of smoke or fumes. Breathing (expansion) exercises are also important to maintain ventilation of all lung areas. The physiotherapist must not be afraid to treat with the vigor required to achieve the aims even when the chest skin is burnt. Intensive respiratory care is required in the following situations: