El terapista ocupacional Michael Serghiou explicará la importancia de iniciar rehabilitación temprana en el paciente quemado, prácticas recomendadas y ferulaje funcional. Michael tiene más de 25 años de experiencia en el manejo de quemaduras y se ha especializado en el área de rehabilitación. Trabajó por más de 15 años en el Hospital Shriners de Galveston Texas y actualmente se desempeña como Especialista de Cuidado Clínico en la organización BMS. Es miembro del comité de rehabilitación de la Asociación Americana de Quemaduras (ABA) y el representante regional de Norteamérica para la Sociedad Internacional de Lesiones por Quemaduras (ISBI).
start with you being the translator. Now, can you hear me? Grazia? Okay, it's just lag. Okay? Let me stop the video. Stop the video. If you cannot hear me, can you come on, please? Yes, I will be here. Okay. Okay. Way have to go ahead and start. Otherwise we're gonna run out of time and for the Sehgal. For those who are online, we should go ahead. Yeah. Yes, I agree. Okay. So hello, everyone. Uh, maybe we can go. Go ahead with you, baby. Okay. Hello, everyone thinks is Michael Sergiu. For those of you I don't know, I am on occupational therapist in the United States. And I have been practicing in Bern rehabilitation for about 30 years. Okay? My sister present and started saying OK soon. Therapist. Compassion. I Yeah, Ohio Armada. Brentano's, uh, specific mental models. It is a pleasure having you online today. We are about to embark on a series, of course. Is one sort by Physicians for Peace. A deal with burn rehabilitation. Uh, certainly Luzzatto who stays akin is, uh, Unidos, and it's totally confidential. Obama's comments are gonna Syriatel conferencia. Uh, is that Michael specific? Um in temporal apart rehabilitation. Tora Lassana Kone came out as she, as most of you know, Physicians for Peace is a non governmental organization based in the United States that helps spread burned rehabilitation, teach about burn rehabilitation around the world commenced A sovereign medical Spalla passes in organizations in animal Lou Pro Que una programas is You are, uh, in Trina e a memento Casio l A Party. Kimura Soleimani Kimura's passing came up The mission off Issues for Peace speaks about teaching one and healing many meaning that we can teach you. And in turn, you can teach and help others in your respective countries. Camo sovereign logo Medical past s in Sana A You know, it's an amateur. Yes. Okay. Seol upon scenario, stay so acerca pass. No solamente tratar a mask. A similar scenario looks Jabarin deal. So starting today, we're gonna be discussing a Siri's off topics in Bern rehabilitation. Uh, and today we're gonna start with a little bit of anatomy off the scheme and then moving into positioning off the burn patients early on when they arrive in the burn intensive care unit. So melissa continent Bama's ornamented toilet particulate astonished when a party grandee local a villain. Barrio Stamos. Uh oh. In Morocco Central, a party rehabilitation tempranillo specimens in position. A mental person came up. Future topics that we are interested in discussing with everyone, including evaluation, reassessment of the burn patients a Muchas otras Thomas and a placenta Kamala Kamala Vennochi Nonstop arena. You know, just a revelation. Uh, um Analysis Revelation Del paciente Kamal Glinting orthotics and casting Laporta Fabulous. If laferla the cereals Car management Manny Holiday Sick actresses exercise strength and endurance Her sister's para Consider Fortaleza in Marin Demento first for ethics, prostate icos Activities of daily living age Appropriate activities for Children and, uh, returning to work for adults Uh, people activity eyes for employees who goes para ninos the peninsula's for that. You mean a former the su trabajo activities skills Are you in a tra? Well, we will cover topics on patient and family education to help the patient once they return home with the continuation of rehabilitation patrol Estamos important says you car pass entry a la familia inactive subpoenas una paciente regreso a casa. We'll cover a variety of home treatment programs. Programas peralta Tommy in total passing Takamado in casa. Well, uh, have a session on a community integration for those patients who are returning back to the community. How we, as burned rehabilitation specialists can help them return back to their communities. Patrol is the most important. Vasella, Integration The placenta. Kamala Dala. Ammonia Common assault Rose. The camo professional Isela salute. Giuliana. Passengers came out when Ah, Judah or prayer. Is this activity I spiral of Integra integration Laconia and for Children. Specifically how we can help Children return back to their schools and be functional again. Oh, you meant parallel. Parallel, ninos. Uh, momentum said adieu. Darla's accessory integrity Nuevo in school ratios and Susan Escuelas. And then finally, a topic that I believe is very much needed everywhere in the world when it comes to burn, rehabilitation is research. Yeah, I mean, a lot more important. Continuing cannot para nunca is part of the investigation l a party rehabilitation passing kema. And I know, I know some of you in Central America have already begun working on research projects, uh, with with one of my great colleagues, Ingrid Parry from the United States. So I think with English leadership, uh, in the topic of research, we can accomplish alone a lot together in the future, you say Tomenko Embarrassed by Assistant Central America who says it's 10% of their investigation? Photochemical lega in Great Perry e, a coma leader, said, With a causes more buenas in a party investigation, the the rally that passing the camera so rehabilitation is a very, very important part off the burn team. And um, yes, the large burns today survive. Rehabilitation becomes very important. Okay, so most are an intolerable It'll soon a party vita the whole process. So the the paciente came out trata mental paciente came out uh, Merida Telescopes Charbonneau and Sando Los Pacientes Kitchen in Kamakura Smoke grandes and Christina's already calves Maximus on camera, Christmas Grand Central Station. So compare in and component of it'll rehabilitation becomes very, very critical because it relates directly to function and functional outcomes. And we therapists have a great, very critical role to play in this respect. Oh, a little essay will be in Punta Cruzi. I e Okay. Uh, now a party functional deacon. Laura's with functionality. Bastian s a component critical. So the goal of rehabilitation is to help patients achieve their maximum potential in physical function, cosmetic appearance and teach them how to compensate for any permanent lost they may have sustained during their injuries. Come on, Put America's own Ella's metas Katrina. Rita Parson Takamado is a general pacientes Al Capone Alcanzar sumas Maxima potential in the party. Functional physical and mental Pariente in cosmetic and a forensics Terna. Yeah, Tommy Parajuli our list, uh, compensate Low compared illah la functionally a camper deal. So the short term goals for rehabilitation is to preserve range of motion and functional mobility. And that's what we're gonna be talking about today. What are we gonna do? Short term to preserve range of motion on? We're gonna be discussing positioning specifically today. Okay, so this, uh, lamented Tremmel various off patios, various metas, the metas, a sort of place. So you're looking on the Tatar audience. The presentation is tratar de preserve our l rango the movimiento paciente l. A mobility, a functional passing Dykema. Our long term goals include achieving good function, cosmetic and psychological outcomes in burning rehabilitation. The guerrillas, the last metas a largo plazo. I mean, alcanzar uh buenas ueno resultados in party cosmetic A and party functional in party physical damage. So for all of us here today. Online therapies. We have the same goal. Therapies around the world have the same goals. When it come to read the rehabilitative process along the continuum of care, we all go about different ways of achieving the same goals. And that's okay as long as we all have the same goal. Remind Thio achieved good functional and cosmetic and psychological outcome. Okay, so this Oh, I mean the tallest therapist. A replication Alfredo del Mondo toast anymore. Last minimal metas in a process of general facility Khumalo a ravioli Tarzi in tall process. So the Keynesian Castalia Hospital, CNN marble A former can star Sokoto. That's what I own a uniform. A different areas. Yes, Davian. So we're gonna start very briefly about some skin anatomy and talk about classifications of burns. This maybe just a little review for everybody. Because all of you online, I'm sure familiar with this. But because we want to start from the very beginning and of course, is along the continuum of care. We shouldn't skip this part. It's been a part important to commence Sokolova sick. Oh, I meant in Tendo Stays focused on Akiko Nicholas Jacko nose into It's a party, but my parents important to come in circle a part of Africa Cola Party anatomical brassica, but apparent in the system of Holland. So as we're talking about burns and burns rehabilitation, have this that 23 slides. I'm going to show you in mind it zvehr review for all of us. But it's good to have this in mind as we're talking about positioning and later splitting and so on. So look away. A lot of key argument is bicycle locks again. Stresses light Bana present total a party and artemia que tenemos detonating Point out now is common sense. Holiday party rehabilitation. So what you see here, if you can see my mouse hovering, it's the normal scheme. The normal skin includes the epidermis that Hermes and subcutaneous tissues come on board member Ella part in the movie in their mouth is lapel normal? No. Take epidermis in in areas in L. A. Patella armies lto, kestas, patani. So in the epidermis, basically, what we see is is the outermost layer of the skin, and it's a vascular. There's no blood supply to the determined okay, part Ella permits argument. Is Larry a mass, uh, mass external. The lapel? Yes. Like vista Vascular is our So it's a vascular. Yeah, eso. So in the dermis, the section you see here is the section that contains the hair follicles, the nerves, the blood vessels That is, you know, the most important part. I would say off the skin. Here, the dermal layer. Okay, Michael, did you say that the epidermis is vascular Arises or is not Is a vascular non vascular? Okay, Saravanan, total apart. L A permit. Tall seven. No tolls. Que no esta school Ariza logo. Second tunnel apart. L a there means kept on the Statoil apart. Ellos fully close s total apart. Ellos Navio? Yes, that'll apart. Vascular infection. So if somebody sustained sustained burn injury, um, it depends on how how severe that injury is. And that's how that's how we classify burns. So I'm gonna attempt to show you here a little, uh, kind of a table that describes the various classifications of burning injury. And again, this is a review for everybody. You just have to cover it very quick. Okay. Francisco Moco Surroundings to yellow. Salmonella. Former C classifications. Generalmente Lasky, Madura. Your comment penned the 19 c ill apart from the island. Madura, It Oh, Estonia lost a Lohse and perky Sierra. Most travelers is that Allah and on the stela classifications Jonah Kimmel. So for the first degree burn, it's a superficial burn, and it effects only the epidermis. Perella una que madura superficially primo grado solamente is the envelope rely Pierre Me. So excuse me. The the skin appears red, but there are no blisters. Intiselera LaPierre's Panero, huh? I don't know. I am Pooja's. The skin is dry. Lapels start cecka and sensation wise. We feel like mild to moderate pain. L A party says the Lord. Persistent Santo poco or no, Delores is material. This type of injury will heal about 5 to 7 days. Tamara. Interesting created. Yes, Pakistani. And, uh, there will be no scarring. Um, after the injury heals, where runaways Una voce sanest idea. No, but the heart sick a tree. So basically an example of a first degree burn or a superficial burn. It's a sunburn. Does the sooner he s stories When a camera poor soul? No. So, basically, that's the picture you see here. Yeah, it's very important to know that people need to avoid getting sunburn time after time, year after year after year, because they running the risk of getting skin cancer later in their lives When it's important to kill a intercept. Uh, Marcy Tempo console, a annual Rosanna Rosanna where he need are canceling appear then moving down toe the superficial partial thickness burns known as second degrees superficial burns ltp Kamakura Segundo grado que superficial party I the from the, uh So if you if you remember the slide, the previous slides with the skin. Um, yeah, the injury here extends from the epidermis into the superficial dermal layer. Okay, so tip. Okay. Madura sister record in La Figura Ontario Holographic Ontario 60 New polka massage. Laperriere. Miss Impastato, Carla Party. Superficial. The ladder, Mr Mia. I could example of a superficial second degree burns, blisters, Vannevar, A kick Just a crayon and just going to sit deep. The model that the grout, this type of burns, um, moist and elastic. Eso eso humor assisted people. The madura sits on Elastica. They're they're painful initially because the superficial nerve endings now are exposed to the air. Uh, creating kind of a painful injury. It's McComas oloroso. Especialmente yeah. Termination interviews Assistant expressed as he s o k nera. Manzullo is, uh, thes wounds. Or this injury will heal between one and three weeks, and it will not most likely have scarring. Hello. I'm in San Andreas una address semanas e pelo gina. Another handsy countries now moving down a little deeper into the dermis. We are faced with the deep partial thickness burns or second degree deep burns. Uh, let's let's category, uh, the propaganda. So these these burns appear like yellow a wide on Have some richness in them also. So this is the people cameras present colorist a Maria's Blanco's corn algunas areas Rojas. And they're fairly dry and less elastic. Uh huh. Some Boston second is on menus. Elastica, these thes injuries would take over three weeks. Most likely Thio Thio Hell, And there will most likely developed scarring is the tip. Okay. Madura banner present our point points on our when Tamara poco mas trees semana. Since an R e m present was supposedly Kennedy, women represent is the Chris ASEAN contractor. So sometimes the deep partial thickness burns are excised and grafted. Justice Kennedy, I meant the people. The Kimura's brokering is the exhibition. Okay, so you said Eve, Uh, let's get excision, Excision and skin grafting come grasses my Puerto Ricans grafting in a recording this memento in her to the, uh, the exhibition like system The last trip. A really surrounding Heurtaux. So this partial thickness burns are very important to remember later on, as with discussion, discussing scar management and specifically pressure therapy, can you repeat again? I'm sorry, Michael, uh, later on, when we discussed the topics of scar management, it's very important to remember that the partial thickness burns at the terms that may require grafting. Okay, because they will scar. OK, this thing this is Mike. Okay. Candace Thomas, Orlando Money Holistic actresses look Obama's record, that is in Tip o K. Madura is Obama's start necessity and stay. Um, it's the same in the exhibition because thank you. Yeah, because pressure pressure therapy when we discuss in future sessions begins most likely with deep second degree burns and then 3rd and 4th degree burns. Cuando somos Orlando, they present therapy present manager Allison Tresses, Bama's star, Orlando People, they Maduro's Kisanga, Segundo Grado parcel profundo, or the Report. A graph so now moving down to third degree burns off full thickness burns or a almost parallels camera, Dr Segro or the total Perfumania. These are the burns that extend through the entire term. Me So the entire epidermis enter Miss a destroyed Tom says Elis. Arcadia. Esta type cameras don't 60 and traveled a total of the army. This this burns appear white or brown. They are leathery and non elastic. Is that people like a maharajah Present a new color. Blanco Marone e like consistency. Accommodate s the waiter, right? Right. They There may be some from post vessels. Some kind of burned vessels. Um, exposed there. Um and that can be visualized when bed constant vessels Gracia the blood vessels. Um so So basically, the whole the whole determines is destroyed. All the blood vessels are destroyed. No. Bastos and Guinness billion grasses. So the third degree burns initially are non painful because all the nervous nerve endings are destroyed. However, surrounding areas are very painful. Okay, we're nerves and destroyed. Okay, The second handed advantages. Too steep. The camera editor said No, no, no, I don't lot parking, Ayatollah Nervous and Dok miles. No, I don't Laursen embargo in las areas al grade or the second Madura Ihsan Tumultuous law. These this type of burns, the full thing that burns will require Interesting move. The total manera 64 cameras, banana career, a Hurtis And and these are the burns that most likely will create contractors later on if they're not care for probably. Este tipo came out as well as Henry and contract tourist especialmente you know, Sequi and no money an appropriate meant. Now the fourth degree burns at the burns that not only destroyed that we see that the epidermis and dermis is destroyed, but also the subcutaneous tissues all the way to the bone and muscle and destroyed. Uh, but let's get a quarter gram 2016 Dennis Elemental appear armies, Allied armies Chemokine passes through it O crescendo. Lt. Hero soup Cattaneo J. Ganga's Assad must close. It weighs this to the burns that require amputation. It's the salty body cameras, correct, creating a put on potassium. So it's very important to have these kind of table in mind. Aziz, we move on in burning rehabilitation because this has a lot to do with how you're gonna evaluate the burn patient, how you're gonna treat them later on. As we discussed the evaluation and treatment of the patient is more important nearest Atallah and maintain a passing Takamado for Basel. Honest Atala uh, evaluate Horrell passing Takamado Ikaria Tratamiento Press pass in Tacoma. So the total body surface area of the body, if you can imagine, is 100%. So you support any Medina el presente? The Komano said the CME for siento So we divide the body in percentage percent of nine is called the Rules off nine in order to calculate the percentage of burn so they like the Oracle Color Keeper. Santa Area The Post Akima Syphilis locates Jamela Regulus New EV's case, the cuerpo in por ciento so the legs are 18%. So let's bareness Song gives you two por ciento for an adult. The chest, uh, is 18% and the back is also 18%. So that 36% it's just put on a tele party lpci. The minutes from the city of porcine Les Paul de Soto presentable Totalitarian sales. Each arm is 9% Kala kala, Brazos presento. The head is 9%. Lock away says no import siento, and the genital area is 1%. L. A ellaria genital is gonna percent now that there is a difference from an adult to a child in terms of the total boarded surface area. And if you if you can immediately notice that the head off, a child and a baby it's about double the size of an adult's head in terms of their relation to the body. So the the head off a child is 18% front and back, versus 9% of the adult come up with a member. Was loss percentages para DVDs El Cuerpo minnows on different. It's become a member for Santa Cecilia. A visa for the track is majority a photo, and it's the Castle Zelda percent. Oh, this is a the legs, unless than 18% for the child there. About 13.5 14%. But let's fairness common to embarrass him. Pocho Meno Scale Spn Adona Turkistan Principato Cinco Qatar supports siento cap in. So it's very important again as we discuss future, the future in therapy to to have a total surface area burned in mind. The percent of burn a more important, a delinquent in a moment to come inside programa a person, a camera so real quick now again For the sake of review, I wanna cover couple definitions, but we're cool. Part definition solamente para para que toasting Almost in cuentas that definition honest. So s car is the burn tissue Everything that is burned and debt becomes what we call Escarre like Cara Lo que ella particles Takemasa. If the rockets Takamado Since Takamado is muerto esta muerto, Sam's car s corado me is an incision. Who? The s car to relieve pressure. Let's catatonia finances young k s a lo largo the lackey Madura Locate Isaiah Zapata Liberal. Uh, tension. So, uh, Escarra Thomas have done when we're faced with circumferential burns Henry mentally catatonia Si Cuando assistant in front Tando aqui Madura sickened Lindsay Alice Now fascia Otomi It's an excision not only to the escort, but all the way down toe pasha to relieve pressure Uh, Lafosse Otomi anthem Venison insisted on peninsula meta largo de la que madura nova Stella Fassa para olivera Attention! So this is a picture of an S Kuroda me done to relieve the pressure in the hand is the tuna employees catatonia And this is an example of cash Otomi deeper cut to relieve pressure All the way down to fat, um, to relieve pressure, the estate, suna, hemp, DeFazio, Tamia and only say, Asseo nine system as profound A as that gorilla party grasa. But I live in our attention. So one other aspect of what very, very important to what we do in therapy is a Dema. It's something that comes into play as soon as the injury occurred. Oh, tell us, because that's important says l Arema Ketamine. What? Can you repeat that? Michael, I'm sorry. Uh, oedema is president. Once the burn injury occurs, elements present a novice or you're a lackey. Madura. The deeper the burn, the more severe Dema will be. EntreMed's profound a camera or a so I demise the natural response of the body to compensate with the injury. E m. I s gonna expressed unnatural del cuerpo Alegria action on a key Madura. So in addition, when a patient comes to the burn you need we are pumped them with a lot of fluids that contributes with Hema also, uh, universal Passen Jega Hospital. Yeah, Residential hospital hinted at Monticello. Trata commute fluid does e uniform and fluid stamina and Alabama. So as the patients lose fluid, we try to pump fluid due to maintain their, uh, profusion levels. But in order coming from the mountain Ella los niveles prophecy In the past, e came up at the end of fluid owes seven, uh, in the past few years. So so the goal of fluid resuscitation. The pumping of fluid is to establish profusion off the vital organs, especially the brain and kidneys. And, uh, principal okoto the Mountaineer or the data fluid those are passing. Tiki Mile is a A cell perfusion the loss organ of the Talis. Especialmente they'll Serero L arena. So the patient, depending on the severity of the injury, they lose fluids and we pump into fluids to maintain satisfactory profusion. In today's America Opportunity Fluid. Lucas Mboya is a commune la la la la Matthew Use little for McKillop perfusion, continuances organized. So so oedema is very important. We have to have in mind oedema in positioning the burn patient. This is a more important issue. Okay, most in in in Quetta, especialmente quando most pensando in a position of mental pass in Tacoma. So real quick. There's a lot of wound care that takes place in the burn center initially and that we were therapies have to be very aware of the wound care that is done because that determines how we treat the patient. So there are more important medicine money. Whole idea. Yeah, look at the most detonating point home assistance in the money whole idea. But there's a form of paralysis tratamiento Tommy. So there's some topical dressings that the nurses we use every day in their practice to address the patients. Don't says Jonas's Khorasani, uh, low sergeant stop because Susannah in Alaska, Madura zealous areas remember the word excision we mentioned earlier? We excise that that tissue thio achieve good bleeding before we put the fresh skin on top Tow. Cover the wounds. The skin graft in terms is required in criminal causes important, like secession. Kittel a party Kistane Necrotic Costa Allegra una una went off comma the electro the lucky Sarasa A continuation. But the different ways that, uh, the surgeons in the burn center would excise the skin. They do it in layers or they take the whole thickness of the skin. Uh, toe achieve good bleeding so they can put the skin graft on top off healthy bleeding. Okay, E various form a gazelle. Oi! I'm gonna see Johannes Kilowatts import for Capas Kevan Kitano la Pierre Necrotic for capas Ultra Low Allison Kitano told Jonah like question is part of the heart when a comma only choke is the combustion vascular recession, but a really hurt. So then they're different dressing standing in the burn unit and I'm gonna move very quickly on this stuff. But there's some synthetic dressings that applied to the to the injury that allow us to move the patients relatively quickly. And I I value steeples the, um qura, CNN or the Gaza. So the materialistic solution, But, uh is the money represent the Muslim losing cuenta carassava coma podemos tratar lows in the party. Larry Cashion. So an example of these dressings the bio brain. So this one is just a helpless assisted by your brain. A Xena graft. It's ah, it's a graph that comes from another species. It's a temporary graft. So a Xena graft can be a graft that is taken from a P. Yeah. Okay. Stay here because I am a cena graph. Can no seagrass city new numbers specific. Oh, but l people in here. Tokyo, Vienna, The ultra space you know, manna and the castle. The zero The home A graft is a graph that comes from our same species from another human from from a cadaver eso we use fresh or frozen at a very skin to temporarily cover the burn wounds. L oma graft. So lost losing herto Scalvini they Romano the Tosa. Romano Prodi said them Carrabba when frescoes like the ice use hollow in a party tomorrow. Now autograph is basically what we are mostly used to photograph is taken from one part of our body and placed on another part of our body. Our autograph the, uh the Edo uh, Vienna, The paciente toma. Uh, come on. Antenna Partizan para Penelas or L A party? Uh, Tacoma. So there are three kinds off autographs. One of them is a mess. Craft. It's a it's a piece of skin that is taken and meshed and expands is the tip O is Elie herto mode Imada Grace uh Bonelli Nombres Exacto Spiro estate Herto Metallica is Zach Atari's Exactly look at expanding easy proponents d'zurilla party kema That's good. Then there is ah, split thickness skin that is taken as one piece as a ship off skin to cover a whole area. That this piece of skin is not expanded its the same piece that you take and you applied to another part of the body. I owe trust people the hair, toes and on the lapel knows expanded. Kamala Akira Antipolo, Maya, You know, Casey Tomorrow mismo Lamido Casesa column emojis upon in particular. And then there is another type of graph that is called the full thickness graft. This is a a smaller in general piece of skin that is taken, uh, in its full thickness. So this this piece of skin has the epidermis and the entire thermal layer and subcutaneous tissue with it. It's a very, very thick craft. It's the people in hurtle. Crystalline Dorita is funny herto the profundity, a total they sell. Xhaka Ellen herto total men taken epidermis. Dermis, he included apart lt he Asuka, Tanya Tanya. So then there is another technique to cover the burn wound, and that's the culture skin. It's a piece of skin, usually a square inch of skin, that it's a full thickness skin. It has the epidermis and the dermal layers, the subcutaneous tissue, the fact all layers of the skin that is taken into the laboratory and out off that wherein we can have a culture skin Um, about three weeks to cover about a square foot or more of the patient uh, particularly says, hey, momentum in support support tomar para. So speaking of the p a the profundity attack inclusion like Peter Miss ladder missile a party. The use of Catania Look as in the DRC on laboratory procure local Steven Uh huh yes Poco mas grandes Wang Karuna Cinema Zambia The Lucky model There are other techniques off skin grafting like the Integra, another skin substitutes that are partially synthetic, partially autologous skin grabs that are are applied and they're more permanent, uh, types of skin gra a trust people the substitute pl caramel integra, some some partisan testicles, a party, no synthetic per ketamine servant Aracama Herta's. But so Nas Caymus. So it's very important to know all these that I just described all the different kinds of grafting techniques because later on, when we start talking about exercise and mobility is very important to know which graph was done, the patient, which will determine how fast we mobilize patient and how aggressively we mobilize patient it's more important to stay calm. Oh, uh, therapist Stepan Exactamente keep people in here to focus on passing. Came out for Esa manera uh, tratamiento specifically participation. Vanessa Uh, Mosiello Conchita. Aggressive comments. Uh, well, you need to loosen your thesis and passing. They came out stop and deeply in here to conciliate. So another thing we need to have the mind is the donor side. The donor side is the side where skin is taken, autographed is take and to be placed to another on another part of the body. That's the donor side. Other particles the in Quintal, Apartado, Nantel City, Tornante, The way Sakala lapel Santa Paris really hurt. So for the donor sides, once they stopped bleeding, we can start exercise right away. We can get the patients up and way. So there's no need to mobilize the patients because skin was taken from one part of the body to be placed in another Carol apart on a loan Inc. Okay, I esperar escape Paris Agrarian. It's a momento opportunity momento. Pacific Western movie. Lisa sees acetone, Lieutenant esperar enemas. Let me take a party. The camera. So evaluation is something that we're gonna talk about in the future session. But that's the very first thing we're gonna do when it burn. Patient comes to the unique uh, Estella, most important city in Syria. A 10% Tom pronto entry Alaniya. So we have to evaluate the patient in order to determine what kind of positioning and we're gonna apply early on in the intensive care unit. So now it's Oglala Sioux. Paciente stays put and determine our call Islam position. Position. I mean, talking positivity. Net bologna, queer sentence use. So now we're gonna talk about positioning off the burn patient, and I know everything to this point was just a little review. But we have to have everything in mind in terms off the classification of burn. Uh, the type of skin grafting that was done. I thought of evaluation needs to take place, and then everything leads to positioning off the burner patient. That's one of the first interventions we're gonna do in the burn center. In turn, says on L. A s most quantities mirror. Uh, most momento. Come on. A patient care. Uh, they here to receive e o quality opera from the island Madura jaundiced oppositional aqui, madura, Tosto value that, uh, determine our quality whole position. Um, interesting position. So positioning of the burnt patient is very, very important in orderto achieve good functional outcomes After completion of rehabilitation, low post position aumento is vital in passing Takamado por que eso no value data named Horace resultados An evil functional Laporta rehabilitation. You should begin immediately when the burn, um patient comes to the burn center and continue until the patient leaves the burn unit l position aumento comments that inmediatamente pronto l percent ingress. Elliptical investigator asientos as the help Help ascent the Salgado Hospital It can continue later on at home also if we are if the patient is fighting constructions Oh yeah, I mean eso continuous Siskel paciente MPs Almost contraction Positioning should be designed for the specific individual patient position aumento a specific alert paracas percent. So it's a custom made frequent plan for a patient. So this is a specific Opara capacity in all those persons. Valentina, tell me more. Tell me more. Plan the opposition. It must be designed in a way that helps to decrease oedema a position Amita circa little form a casual a serial arema Maintain join alignment Mountaineer LA's joint. Um Mm. Let's articulation. A articulations in elimination maintains tissues delegated Montana lost hills along aisles prevent contracture formation. Vanilla farmer in the contract Tura maintain range of motion. Martin L l rango momento promote wound healing. Promo work is chaos And assume the idea. Relief pressure areas am a circular spiritless Dallas area The Christian It's the, uh, the start the foreman on and protect joints exposed sentence and new grafs. Yeah, I see me in my office. I could put the hotel apart. L a state known in total apart loc herto, uh, when we position the burn patient, we have to have in mind the total body surface area burn. And remember the rules of nine. We discuss when a condo in a position and Pacific Kimaiyo 17 in cuenta lo siento. Yes, Ellaria Quanta area. The specific model where purposes came out. Uh, ma, we have to have in mind the depth of the burn. And remember we discussed today the classifications burns 1st, 2nd, 3rd, 4th degree burns, The maintenance centenarian Quintal A profound ideology. Madura record A demo premieres the window to see Eric photograph. We have to have in mind when we do our evaluation? If the patient has any other injuries other than the burn injury, do they have smoke inhalation? Do they have broken bones? Do they have exposed tendency? Otra cosa Que se den cuenta know Solomon Telecom. Maduro, You know See, I argue. Notre Tipo, the areas company employees always Rato's Okay, A in a lot of, um Oh, okay. Tinga. Andonis its been expressed toe. We have to be very careful when we position that burnt positions so that we prevent pressure ulcers. Commentator There not also in positional passing. Prevent all Sierra prevent nerve lesions scenarios. Sometimes when we overstretched the patients to position him in one position, we damage nerves and cause more harm than good. Uh, this is conduct Thomas. So reposition Merrill paciente system Assassin less you Nando Lunar Geo Locate samosas Disco Sandelin mature Daniel, we have to be careful not toe decrease the range of motion instead of increasing it. Other co secretary mosquito netting 20 You know I am, uh this Minuit rango the monumental Paciente Lagarde Elementary. We have to be very aware off the anatomy and kinesiology of a joint so we can position the joints appropriately the meeting camera camo style last articulation, honesty position at the for my equal. So I'm going to describe to you from head to toe how to position the burn patients. And I'm sure every every one of you has You have your own ways of doing it. And I can remember, as long as our goal is the same, it doesn't matter how you do it. There's so many different ways of doing it as long as we do it correctly. And, um, we, um, way strive to achieve as long as we strive to achieve good functional outcome. Okay, it does Look a little booth. Okay, so let's get supposedly a formal definition. Different. Uh, l a pretty was toasting and remote radio. No Mito therapy system and memo PTO bodies for Monticello. Vastly. Car como cumulus if you needed me. So So for a big, massive burn, we have thio elevate the bed as they you need, Like you see in this picture? No, just the head of the bed. But the whole bed has to be elevated as a unit. Uh, cameras some we extends us. Look, Tanaka series level Dhlakama, and I'm gonna sit securely Barto, come open, Berenice. Tha missed a margin. Sister Live Angela Party Superior Della Com These helps relieve oedema from the head. The head has to be positioned above the level of the heart in this angle. Okay, so Judah is a liberal focal Ledezma Bardella visa Like a Latina princess Imma the area Khorasani says Derrick Thomas level This position will help relieve it him by mobilizing fluids. It s a sitting position a Julia Olivera don't polka ledezma, but more movie and lick yous. The work Ah, the reason we elevate the whole bed is to prevent contracture at the hips. If a patient again has a massive burn injury, look at the most famous Elizondo Telecom Tambien is every contract duras in Los Angeles, Kyra especialmente position a mature extent because if the if the patient's burns extend to the torso and lower extremities, if we only elevate the head of the bed when the patient gets up to walk, they wanna be they're gonna be walking bend over, uh, in the car. So, like immature is extensive. It waste are included. Gondola. Spearman's look serious s tratar de tar on the passenger just promote very far are no tangles. Perna Zola's, you know, coming. So if you don't have electric feds like you see in this picture here to achieve that position, then you can use, like, little wooden blocks to elevate the bed like you see in this picture Sisters and Sunni on a tenant Camas, Kitson Electrical Uh, udar opposition are horrible percent. Look, Buenos Aires block is the malaria and on the level Akama, whose understood blocks off the patient is positioned in the neutral position. No rotation and approximately 10 to 15 degrees extension. Michael, can you repeat that? I just miss you for a couple of seconds, and I couldn't. The neck needs to be positioned in the midline position with 10 to 15 degrees extension. Okay, handle your aura. It is a position appropriate apple is in in and, yes, akin figure out of the extension. No rotation should be allowed to the next. So again, no rotation neutral position. And we should not have any pillows for the patient to restaurant in the burn center. Tomsula position the starting position. Know? Try no estar uh, Booth. Sometimes if the patients and neck tries to rotate on one side, we can fabricate like strapping mechanism like you see here, Thio prevent the rotation off the neck, toe one side, and I'm gonna casos Sips represented, uh, allows okay, association Which basis? Scree Artistic people come, uh, Banda's que, uh, position track, but no permitted capacity. Moira Sasana. So to achieve this position, sometimes we will put, uh, pillows or sheets or towels behind. The patients are scapula, so it allows the neck to drop into extensions. Uh, but a terrorist position Looking mature businesses just nuisance on savanna sand Rojas or almallah or to a, uh, Panella parties cupola. But you are, um, Antonetti's position. Sometimes the ears off the patients are affected. So to protect the ears, we can fabricate out of splitting material here. Cops, uh, that encapsulate the ear to prevent the cartilage from getting more injured. And I will knows casos a pretty hair loss or a holiday present. Uh, thank you, Miles. Okay, Amos, a choice. Utilize our Elmina material. Accused Thomas, but zealous. Fabulous. But I said it's the people Arita, Mentos and on the palm of school. Uh, lottery. Huh? Thomas Cape was by an asshole. Speak. These are like simple splitting techniques you can do initially in the burn unit. And again, as I mentioned, we're gonna discuss splitting later on in future sessions in detail, E I mean, uh, the most fabulous initially brassicas key points, solonius, like we have sentence zero, pero party fabulous. Leboyer mention are in ultra system asylum. The moving down to the shoulder. The shoulder is positioned in about 90 degree abduction with about 10 to 20 decreed forward elevations. But I lost Ambrose like that. I can you move 11 bath, please. My Yeah, for the shoulder. The position is 90 degree abduction. Okay, in Texas, but position a mental Assam roses in no, no, integral. They abduction with about 15 to 20 degrees. Horizontal abduction and slide external rotation. So basically 15 to 20 degrees elevation off the shoulder con una on elevation. The skins have integrate. Does the elevation the laundry? So the this position, the forward elevation prevents stress on the break Your plexus and aesthetic position case tampoco CIA Atlanta Locavore Evita is precision. In which area? Michael In story. The breaking plexus. It's a It's a complex off nerves. Eso we don't stretch the nerves off the break. It plexus when we have the forward elevation. Okay, no seconds. It'll break. Club placers Lassana understand Toll of Navio Serious status quo. Condo is the place over a perfect. Yeah. Uh that was a good way. Okay, so So that Zatz Very important. Gracia, do you want to comment on this position? Maybe a little better in Spanish when a critical look and Michael knows. Study siendo excuse important Mantener la Uh, the long Prospero's empirical booth downtown. Keep Ermita ls possible place or a calculator? Liver Baruchel Paciente Novaya Journalist Randall Place. I think that's good. Yeah, yeah. If you want, I can help. I think the signal is is good now? Yeah. Okay, so let's Z sometimes if we don't have a way off securing, uh, the shoulders in the position, we can use these little clumps that we find that we can find in the hardware store on. We can use foam so make into troughs to lay the shoulders in there. Much basis in contra most, uh, tomato. Osama bin dorkiness. Imagine podemos estas camo, princess, Because compra in Eritrea, but, uh, the elbow should prevent Titan missing the capsule for a position, a position, a position. Notre Pero Singha Serena Hyperextension Uncle logo Ducale Although several Okay, very good. Now, very, very important is the wrist in the hand. So position there ist in the hand off the burn patients. The position resembles the intrinsic plan position. Okay. Being important is also Lamonica Alemanno and France's position so true. Totally samosa Yarmolenko's position Intrinsic applause. So starting with the wrist, the risk is positioned into extension about 10 to maybe 30 degrees Extension if oedema allows for that position to be achieved if Kadima doesn't allow for that position than less extension or maybe neutral for hundreds, etcetera complete the trade. Use a 10 to 15 in a show about 10 to 15. You can go home or if there's no a team. Um but that's good. OK, introduce dickensa Ross Perot, when you commented, loathe grass. Yeah, if if there is a deep mine places going neutral. See, I moved for Emma and those are important. Lorca. Lamonica, sir. Position and a position Delta, because if there isn't, um, a president in the wrist area there. We don't want to stress the medial and all north nerve, but yeah, and all the nerves go through the canal there. So we wanna be careful not to put too much pressure there and damage the nerve Agent booth? No most The Messiah. Extensive lamenting position. No property, no cameras, Compressions or interview. Mariana interview. Bitter like you know more than you. And it's for a parcel. Can handle a nervous Excellent, then moving to the metacarpal Phil Angio joints. So these are the M. C. P. At a carpool. Filante adjoins this joint's U P position in the maximum extension. That demon louse. Yeah, Wanda, particularly a Planica is not particularly a position, as in a flex young Maxima permit. Let them the position here. Deflection position at the m C. P joint allows for the collateral ligaments at this level. Toby Stretched. Who's the man test? Opposition elements. A articulation metacarpal colony can aumentaron permit Lonely lamento Collaterals is thing extended. Those casinos Trigana Buturo, Ukraine The formulas. It's very, very important to have your collateral ligaments in the hand, uh, stretched because if they shorten, then you're gonna lose the function of the hand later on. In rehabilitation, it's more important moment. Loathe America extended in extensive testing. Jack s a ligament to second trying for a man. The proximal and distal inter financial joins opposition into extension, which allows the collateral ligaments at this level or develop late ligaments to be extended stress. They were manera articulation. Inter fanatic. Approximately this callous. So maintaining complete extension, particularly aumento literally the last. Another sign nothing and problematic artemisinin. The thumb is positioning a combination off Palmer and radio extension, abduction Polgar position A radial. So that is very, very important to differentiate from this intensive plus position to the position with position the recent hand when we have neurological problem. Okay. More important tomorrow when a specific jacking melamine McKay cinema lamanna Cuando monotony problem. And, uh, you know Una was, um opposition Intrinsic Applause specific, Um, in the parliament, uh, for tomorrow. So if you can see my heart, this is a functional position. This is a bad burn position. You can see the stretch here between the thinner and have within our eminences. We don't want the hand to be like that because we're gonna have a contracture. Uh, Alberta premier when opposition functional, irregular. A former home control or 93 doors reflection, which is basically the neutral position. You see, here so could happen. Dependable centering in your Petrova Hemos l Tokyo It's a podium. Opposition union Ultra opposition Benavente Grouse. Yes. Come on, Esther. Colorado lto Paciente. So defenders and throwing the central have a Sicilian opposition. Notre ornamental. Derogatory. So we achieved this with splints or we achieved this with foam like you're still here. Uh, depending on what you have in your unit and again, we're going to discuss more in depth about splitting later on. Dependent on this testing soothe conform off block is the former galore and position the materialistic A media. Uh, this is what you see here is a device made up off PVC pie and netting that helps with the entire lower extremity. It's almost like a hammock. It's a suspension device. Got ya. Helps bring with position into the lower extremity and air into the wound from underneath Eso The wounds can heal faster and the skin grafts can be protected. Study positive. Vennochi's tho Competency. Marga, you're a Montana total extreme in an inferior in wana position Come upon a scene in Paris Perata maintaining people that will permit kill I re entry tambien our been, uh, evolutionary patient con respectful as well. It's very easy to to construct, and we can discuss this in future sessions. When we talked about splitting and different devices of PVC Onda, we can show you exact dimensions on how to make this is more, more fast. The constraint. Your broken cientos opportunities can run on for the most things continue poco com zeppetella, particularly with several different percent. Sometimes we have to position the patient in the prone position when surgery takes place on the back. So we have to make sure that the feet off the patient a position appropriately to prevent pressure on the toes and the hills. Quantum froth is important being Montana tithe. Ultra problem across in Alberta Position in position. I'm not sure if any of you are using mechanical traction, but traction can be used in the burn center to position the patient appropriately. You say what you said A. Elizondo tracks mechanic Perrone, Alguno, Centro, Cecil Lisa Para Position are those patients So sometimes the therapist, uh, can move the patients extremities while the patient is in infraction by adding or taking away ways so they can allow for flexion extension within the traction. So they can do exercise while the patient is infractions. Cuando tenenoff contraction Minister Papandreou is our cto Kitano Law spaces? Yes. When Laurent poquito man and nearly really hard A moment of passion. So now sometimes we have to design some special best for the patients if the patients are gonna be in prone for example, after surgery, we use a lot of phone in therapy to cut through mattresses allow to being and bringing machines from underneath the bed so the patients can breathe while their position Prohm Cuando I much better necessary. 00 no stress Propios called Tron eso court are foam. Oh, Depending Look Necessity Paciente Coma stamina and homogeneous barrack request our position on Dillaman era l acqua. So we use foam. We use gel cushions on different other materials to prevent areas where like for example, the forehead where pressure source can happen from the patient positioning Prohm or the area off the pelvis looking If the patient is positioning in from for a long time A starting position, bro. No tourism. A different material Come a phone or Kahin a hell jacket starting position A froth. So in therapy we can modify a lot of beds using cushions. I'm sorry. Foam. Different density foam jails on. We can help position the burnt patient. It takes a lot of work manual work from the therapies, But sometimes it's necessary to position patients with severe constructors appropriately, like you see here a contract a, uh, A position, Uh, con different. Testy. Put the Kahin isjust confirmed the different history. Different peoples jacket, including Montana trabajo necesario para a star camo knowing a contract or, uh, mus island. Sometimes later. When the patient is ready to leave the burn unit to go home. If they have a little constructors you can design, uh, positioning devices like you see here that the patients can take home to apply on top of their bed will help stretch when they're asleep. Conduct a scientist. Honest? Uh, casa A, who knows? Material is a key position. Are solo like a, uh, you know, by a mere who's taken a position? A So this, uh, I showed you some pictures that are unusual. And the point I wanna stress here is that when we practice positioning of the burn patient, we have to have in mind What is the goal? Well, What is a percent of burn? What is the depth of burn? What are we trying to achieve? Quando Quando photos, Photos Community in quantum position A military pero menace important. Recordar over container cm pregnant uh, finale local cream Allegra Getem for food. And like Madura Paciente it is Look at the Scott Trust Caramelo alertness it takes. Remember, at the very beginning, we talked about we all have the same goal, but we have achieved in different ways It takes a lot of imagination from the burn therapy, uh, with pero that can summon different manera uh a uh So with that, we conclude today's session on positioning off the burn patients Asai mentioned before there many more sessions to come. Uh, look a total continue. Uh, a paciente concert will take us. I would like Thio. Thank all of you for attending today. Also big. Thank you Thio Grazia Bruni from Honduras for for helping us with translation Also Indiana Gamma and Leslie Little from Physicians for Peace. For you. In a way, I would like to open the session for questions. If we have some time, you see a robbery. All right, Michael, we've had a couple of questions. I received one from Dina Martinez. I'm not sure if baby can help us Thio. Give her an opportunity to ask the question. Yeah. Yes, sure. Gina, uh, support for for 11. Telemann. Ito, this is on the corner for keynote. Yorkie contain hombre e. I mean, okay as he material. Yeah, Dana momento a Latina. Well, I will be calling to pry intact with dragon ties. Uh, inmediatamente posts. Aurora. Uh, I was in here. Uh, Puerto que momento. Uh, kpm person here in Kuala common standards, lasagna is part of a lost pacientes. Cassani tells differently. Clear does Yeah. Okay. I'm sorry. Sorry. E can't see Michael, but I'm here, Okay, Okay. She wants to know what's the consider about a considerable amount of time to move a patient with an autograph According to what you know. Well, hello. In a very good question, I There there. There is not a good answer to this question because there's so many variables that would affect how fast you will mobilize much A gene, uh, s e a e que mas cosas ghetto considers it probable movimiento. So just just in general, uh, we we would like to mobilize as fast as we can. Now it depends. It depends where the graph is located. It's not. If it's not located on a joint, you can move as early as one or two days after grafting. If it's only join, you may wanna wait, wait or begin moving with the mobilization of the specific part cream era cattle. CS Soon in Health took a noise. Stein on articulation podria most MPs Romolo and Tempranillo Muhammadiyah. This place like a location in here, if a rosy is this plays CSM one article you said after being on a joint. Michael, I'm sorry ifit's If it's, for example, if the knee the knee joint is grafted, you can make a feral A for the knee joint and continue start walking in a day or two. She is in articulation. Della Rodion Tina Putting him close podria Sarona Feral apparent MPs are India uh, India in Pescara, Alberto, Colorado. The mobilization of the actual join you should come about three days. LA Mobilization. Articulation problem. Original Cast hemp. Separate area. Proximamente tradition again if the If the graph crosses the joint about three days because I'm about 48 hours the graph and asked Moses, It takes what would say on dure Able to start moving jackets for the quarantine chores. Page A in here to see anastomosis Sekiya separate common referring issues and Jakadrien comments are, um, over the treaties. Of course. All these depends on how large the graft is. And it depends also on the physician protocol. The physicians in your burn unit what do they believe? You know, way startup is have to take their orders. Uh, they're they're America. Tanaka trabajar bardelas ordinance chaos. Then in the Quanta Tiempo, easily inheritors will inherit a my grand always running her topic King Thank you. Gracias. Okay. They never see I mus Preguntas for a key. Liliana is the million Arango. No, we have connected productive processes to Pregunta. Celia Nastase used us. Yeah, Leanna a protest in my A, uh, really had come on a car. E tina. Is any ambrose? 30 Doris e para parasail quinto Camilla. So? So the question is, um, And in the graph that Gina just asked when If it's in the lower extremities, how long would it take to start walking or standing up a patient again? It's the same answer Thank you for the question, Liliana. The the answer here is that is the graft crossing a joint? If the graft is crossing a joint, then you can immobilize the joint and start walking without mobile. I without moving the ankle joint, for example, of the need he's the graph doesn't doesn't cross the joint. You can start walking right away as long as you have good protection. As faras um is wrapping just wrapping the extremity. Well, um, for good, uh, circulation. Uh, request a request. A Syria wall Olukolade most Regina El primer dia Barbara Solarcity selling herto noise. And then articulation is the Empress Cuando seven dot kuna in the last Inca marta est avian Suharto is seen Oh, CSM in articulation grand into success very upon Aruna Parola. But I mobilize al articulation commensurate Parallel paciente immobility Sandia SportsCenter certain so you can start moving. If the graph doesn't cross, join right away the next day. If the graft crosses a joint, immobilize it with a splint and start moving Maybe a day one or two. There's some people who move one day. There's some people who move day, too. Uh, still selling Heurtaux esta a man selling her to style known articulation grand Laura equal. Always Bonnaroo. Federal MPs are, um, over the you know does address E in the, you know, esta and articulation grand. You know, standing articulation, Booth, You don't really want to mobilize the grafted joint If the draft choices crosses the joint for about 48 hours minimum, we let the graph on us the most graph to take No secure a mobile is R l in herto for quarantine. Ochoa orders This was developed puesto as Takada's process, so the anastomosis. But when it comes to amputating toe walking with drafting, we have to make sure that we use elastic wraps from distal to proximal toe is wrap the leg all the way up to the thigh to help with circulation. Sometimes we double is rap to have good, good distal to proximal kind of pressure is important. A paciente CME Pretinha Most when Brenda Hale elastico centralist and a proximal que avaya hasta la caldera in Macau casino. So Trapani most doubly Benda Hey, Elastico. Very good question e, are you part of the personal mask? A Linda, Dr Linda Guerrero's just a 10 in one commentary. Okay, come Party control Loathe espacio para que no comment Toe Vista. Hola, Professor Aura. Linda? Yeah, Linda. Nice places Kuchar basically in Anniston Momento Linda by Okay, okay. Ultra persona kickstart and being in Delano Zapanta Vista is a doctor. Norberto Navarette. Norberto knows a sister party though I was controversy s, um, contact our nosy that couple days All a doctor. Okay. Alberta s I a channel? Hola. When I start this, uh, can you start splitting as soon as the patient has, like, the initial burn? Can you splint like in the acute phase? Day one? Absolutely. As soon as the bird patient comes in, which you're not gonna graft, uh, go ahead and starts planting. Remember, if the burns are deep, second degree burns or deeper, you're looking at the patient developing constructors later on, so starts planting right away. If you're dealing with the deeper burns, you know? You know you know, wanna said when a record paciente important inmediatamente polana parola record and you see a lot more Uh, the condor. A profound, uh, wanna normal contractors intensive process is important process so resistant front and also explained immediately after grafting tambien displays the release are telling herto is important. Federally Sorry, Mary Ottoman. And when we later on, when we talk about splitting, we can discuss How long? How often When do you put the splints on? When do you take them off off? When do you exercise the only wear? McKnight All depends on what the doctors have done and how deep the burns are. And what are the contract? I'll forces my son and taekwondo most so very last Perilous but most large tambien sovereign Tolosa parameters are your day at school Musical oak and Qantas appointing Komazec Eaten, uh, Lisa dependent. Uh, Leslie and Bibiana once that question. Thank you for your interest. Kevin. Look good too. So the the look America, a former party booth medical parla passes Thomas like the Donatella Confidential como esta una vez and miss. And don't say planets continue our Callister Stamos can Thomas. Uh, Leslie, I can I can offer my email for whoever. Um, has any questions they have. They need to address with me. If that's okay with you. Please release my email and I'll be glad to help any therapies who has questions. And we can collaborate on working together. Sure, No problem. We will share that. Miguelito, we have many other questions. I'm not sure if you want to take at least a couple of them or Okay, go. Jess. Any uh Yesenia Sister Cora. Panelist. A junta? Yeah, all Like Yesenia Yesenia. No sense coaches. Allah, Panama. Yesenia, you're gonna die. Well, she was. I don't know if you want to go ahead and ask. But she she wanted to know like after they have a graft. For how long do you are we supposed to keep a splint on a patient again? That depends on the protocol of the burn you need. Usually what I'm used to is that we keep the splints on for three days and then we evaluate the patient again. Ah, if the patient needs the spleens because they're contracted contracting if the spleens air off, we may have to work through the day. Take them only off. Take them off only when they exercise. If they are not contracting, they can keep the splints off during the day and only wear them at night. But we can discuss the different scenarios later on. When we talked about splitting also okay. When a camo zoning Herto, uh, Michael s go up in there. They're pacientes Yeah. Cecil paciente Cuando se the material apparel started star saloon. A contractor in one sense. LaFerla Samantha near Toronto. Uh, tabla forlan, osteoporosis Cuando sell Akita paciente no esta haciendo contracts or oh, never attraction. And princess a harsh hollow. Also nocturnal Presto Stamos, uh, s area with a rock and a famous. Okay, uh, Carolina Camillo una Pregunta Carolina sisters for, uh, that nobody Aquinas passed through that Carolina Camilla Carolina society. Okay, Catalina Carolina Mhm no oneda tiene una Pregunta oneda Aravinda law on a that'll open air in Kibera Kenya's pass Pregunta it. Okay, maybe they're not there. Oneda. Yeah, again we can we can offer, uh, those people. My I am my email address, which is, uh, m a s at silent dot com. And people can write me and ask the question so they can send it to you. And we can, uh, try. They need a, uh when I started stealing a michael. Uh, the sun. Uh, okay. Uh, it's the, uh, uh in northern. Has a child off. Well, thoroughly in the quick go Latina. Well, it's gonna position he a Michael A you so Hello, Michael. Um, we wanted to know, Like in case that you had a lateral burn. How would you Michael? Sergio, Position of patient with a lateral lateral burn. Uh, how do you define lateral like on the side? Like a history. Allow. Listen, history allows and a part of a patient, uh, people look a time, uh, way have, like, patients that are burned, some part of their back and their lateral like their arm on their side. So so, yeah, again, you have to kind of stretch the part of the body that is affected to prevent contracture. So you still have Thio put him on their side. Maybe, but the neck you need thio maybe have, ah, a way to stretch the neck So they're not contracted in this position again. You put them on their side, they're known affected site and try to stretch them, like for the for the shoulder. You can have a skyhook or something to hold above their head so the arm on the side will be stretched. I hope I'm answering. The question correctly is important. It's important. Marine cuenta kill pacientes de sterile and Tom momento sentences in your caso Sarona camera. Lateral love Andrea with the lock and not in relation Nuevo tratar de sterile Brazos over a long grow your where your environment and the rusted out of Pakistan A software can a second Nothing I wanna contract. Oh, no sexist contest and Dolores la Pregunta. The principle is to stretch the part of the body that is burned. So if it's the lateral side, try to stretch the lateral side as the arresting, uh, put him in a position off anti contracture position, Little principio position a una position anti contract Tura, Jose Segura Testimonies Randall a party guest, Alesana and and it's not I really appreciate the question from Nicaragua because this is not a very, very easy way to do it. And this is where you use a lot of your imagination and again having the goal in mind is to position the patient in the anti contraction position Uh, Nicaragua Jacket noise algo fasting. Uh, positional paciente and opposition Kanaya. And a contract or uh okay, look. Okay. Perfect. 10 golden instrumental cars. Caritas Graziella Boy, I sit in Espanol Carolina Camillo Sopron, Tando s C. That spread Tenere Paciente position on low Kakheti. Emperor recommendable mobilized our articulation. Okay, once we have positioned the patient Um how long between each mobilization like how long would you wait? Between exercise? I would exercise the patient as much as I can during the day hours on. I would just arrest them at night. If they're awake during the day, I will push for patients to do their activities of daily living like I would take him out of the position and walk to the bathroom or walk on exercise, sit in a chair versus just staying in bed all day long. So the more exercise you do, the better off You are in intimacy since your release. Amos Me, Horvat Paciente in Picasso's paciente status Puerto Telia. Dhlakama said your area is the natural position. Rarely. Sando Toe also had a very area for him. Flow LeBron Torsella commas and Tarsem Singh Associate title Benaki Convenience Salvano Like there s complacent Estella Mazza TiVo in hard rock releasing the majority that facilities if they're awake and if they can move, they need to be out of bed as much as possible. System DiSpirito Supporting mover Getting star Pharrell Akama Mayor Tiempo possible. And the faster you start exercising, the better off you are in Kandahar. Cesium pronostica will present. Gracias. Tenemos una Pregunta. Michael, are you okay with a couple of questions? I am still okay. No problem. Okay, so, Clara, Clara, pass the Clara sister site A responsive A Pregunta. Mhm. Not there, Clara. Tardy Holiness. Booth like that's gonna think when we went out to you. A respected location. Michael Delasin. Herto mm institution low Siraha nose. Plastic. Also Maastricht. Oh, and recommend that can grant her parole. Inheritor Paciente, suspend a sutera. Pia? No solamente Lassana on the esta actually in her toe. You know Caymus s use those trees ideas and ideas in the skull. Passion knows. Mobilize a no central life asked a Cajun revision killing her project photos so phenomenally in division ocr Phenomenally Kanazawa Michael the lecherous cooler except Sandra Sandra appear to system Fritos. No normal. Uh, ni siquiera extremely eyes can think Amos Durant s a stress this Locanda Georgia on ready saddling here to, um visto sewa Dhiren Shia Loretta Momma's, uh, travel a therapy for map with my sims. Most intense. Right? So where I work doctors are very strict with their protocols on exercise when grafted. So three days post op after the graft has been set, they will not let a smoove patients, even if it's a non burn area. So patients are completely They're not supposed to be moved for three days and after they have checked their, um after they have checked and they see that it has been, it's attached and they can start with a little bit more aggressive therapy. So three days before that, they can't motivations, and that's that's perfectly fine. I can everything, as I mentioned before, it depends on the physicians protocol. What's what they're doing over there is correct. It's their protocol. I don't think the patient, uh, if you wait three days, they're gonna lose a lot. Um, um, there is no a right or wrong way off doing this. Some people like to mobilize early. Some people like to mobilize later if they are achieving good functional outcomes. That's okay. That's perfectly fine looking contested Michael esque toes and Latina Super cold. No significa que protocol local. Elissa, in medical travel has protocol. Okeanos like wow, So tres dias differential. No trade via the normal is amassing mutually Forenza. Pero Castillo sorta stand up to me and the mobilize. And despite some windows with history in, uh, nowadays they're a new research studies that are being done, uh, to show if there is really a difference when you get the patients up and mobilize them right away after skin grafting or after a massive injuries. So we'll know more about this. And if it makes a big difference one day, two days, three days, five days when these research, um, comes out, you know when the evidence comes out. But now what they're doing is correct for them and that is perfectly OK. Our next momento substantially Sando varias investigaciones sobre CIA unit difference Eassey symbolism Paciente who started ordering herto Petrolia west. You know, tomorrow resultado pero Cuando Yasin CNN result The student studios have Ramon Poquito huh Problem Mementos and protocol Okura, listen in the center is like Well, e no i problemas at the normal request in Barcelona studio Good question time with one. So Pamela eczema Pregunta is securing. Yeah, that Obama's apostle Korea Michael para que cualquier otra Rwanda is still oppose Assad directamente area in Michael is pregnant. Tando Kamala Grandma's position are Issa's Manos de ninos, the treasonous and position functional. Our sister Lucia A Fabulous is deficiency E. Difficile after Los por El Venda. Excellent question. If I understood correctly, go ahead. How does position? Um, well, it was a functional position for hands between one and three. My baby? Yeah, with that, if it's so hard to get them using a splint and get a splint in place, you can make a very, very small Splain. But it's very, very difficult. I agree with you for a for a very small hand. It's very difficult to achieve this good position. Onda. Sometimes it's okay toe to split them straight to prevent this contracture. It's okay to screen them in a straight position, like in a platform or a sandwich, just a small firm of plastic on the bottom with foam and a foam and some of plastic on top and bandage together in a straight position like this. It's okay because those small joints are there. Be elastic, the very plastic they will do. Okay, uh, if you take the splints off and exercise and then immobilize them straight if you cannot spline them in this project, Uh, when, uh, Chiquita Perot stock Wardak is based on physical paciente stamp Kenya's much a basis look, uh, Jack alone in your CNN articulations was Santa Elastic Casino Savannah Daniel Position Are losing on opposition Knelt Director Is this still a manual release on a federal Amassed So many people? One sandwich on the step Andrea L. A Plaster material Maria Pop funk and Regula Man erect in Bogota Spagnuolo Prospera in that low Correct and says Pamela Peeke minutos on an elastic because no Savannah Where? Kompromat Eos a Santa Communal. Very good. Yes. Good question. Much more Very difficult. Process their process Stanton Fizzy like when I must Preguntas. Pero yo korakia most Michael grasses for their nose toe. Really? Males remain bazaar must Rwanda's pork Oreo Gracia Magicians Gracias. Uh uh, Smooth. Uh, the commas, uh, like the Bahamas esta conferencia Universal mess Ban access the value Stamos no solamente una certa rehabilitation on a coma On the reality Is your mom a certain value? Stamos Candace tratando Dante Liano. I speak in, uh tenga Mozilla Proxima Chiana seven parties semanas conducting a missile Tema Laffita Let's start demos in beyond Oh, la Invitation practice of Albany history. Allah, Proxima Telecom, Forenza and Indiana. Please, please tell everybody who is online or Grazia Uh, everybody who is online today has something to contribute. Tau all this. So we want everybody to stay together and we start collaborating and exchanging ideas on how to do this. E o e some personal Some of person is capable Country were a movie star. A creative person associated posthumous, active in quantum. Okay, so we are in the majority. He has not. Michael noticed a country with a serious yes Maranello cmp for far more important. Michael. Muchas gracias. More interest Santa machismo. Gracias. Excellent. Espero Kato's a an approach shadow is totally conferencia aecom Ojul is content in part of Semana September serenity and no, no, no invitation para confidential approx moments. Yeah, a e o a
