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:
- 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.
Positioning, splinting and exercise are used for maintaining and gaining joint range.
Unfortunately for the patient, the position of comfort is the position of contractures (mostly flexion). Positions of necessity are, therefore, as follows.
Head and Neck
Elevation (over 900) of the limbs with the shoulder in abduction and slight flexion, elbows and wrists in extension, metacarpophalangeal joints in flexion, IP joints in extension and thumb in abduction.
Hips in extension and slight abduction, knees in extension and ankles in 900 dorsiflexion. Elevation is obtained by raising the end of the bed, not by placing pillows under the legs which would put the hips into flexion.