General information:

Name: E.B
Age: 26 y/o
Sex: Male
Address: Pasay City
Civil status: Single
Handedness: R
Weight: 72 kg
Height: 5’8
BMI: 24.9 (Normal)
Occupation: LPG Gas cylinder refiller
Religion: Roman Catholic
Nationality: Filipino
Referring unit: PGH (Burn Center)
Referring MD: Dr. O.S
Rehab MD: Dr. Y.T
Date of consultation: October 11,2023
Date of referral: October 11,2023
Date of IE: Oct. 18, 2023
Type of pt.: In pt
Informant/Reliability: pt/ Good
Dx: Superficial Partial thickness burn 61% TBSA

S>
C/C: pt ℅ constant burning pain on ant trunk, R and L arms, and
R limb (VRS 6/10) and inability to move the affected
extremities such supine to sitting, sit to stand, reaching objects,
and doing his ADLs such as eating, grooming and bathing.
Pt goal: Pt wants to do ADL such as dressing, toileting, taking
bath, and to be discharged from the hospital.

HPI:
~ 1 wk PTIE, pt was rushed at Philippine General Hospital
and was manage at Burn Unit with an with an injury of
thermal burn following cooking gas cylinder explosion at
work . Pt was conscious and physical examination showed
superficial deep burn over ant trunk, R and L upper arm, R
and L arm, R and L hand, R thigh and R leg. Pt was
wearing a pair of shorts at that time. His body was covered
with blisters and red cherry in color as he was taken to the
hospital pt was resuscitated with intravenous fluid (ringer’s
lactate). Pt also received medication (see under Drug Hx).
Pt wound was clean and irrigated using the dilute savlon
and normal saline. Initially, pt use sufratulle gauze and 10%
povidone iodine soaked gauze for the closed wound
dressing but after 48 hrs it was change to exsalt T7 silver
dressing (contains silver oxysalts) was left in situ and was
to be changed after 1 except those places where it has
become adherent to the wound. Urine output was
monitored hourly and secondary wound dressing was
changed whenever there is strike-through. All calories were
delivered to the pt through an oral route.

~ 2 days PTIE, pt still experienced difficulty in performing

ADLs such as self care, eating, grooming, dressing upper
and lower body and max difficulty in doing IADLs such as
toileting, transfers, sit to stand; pt was prescribed by silver
sulfadiazine cream and apply gauze (VRS: 8/10 - 6/10). Pt
also experience pain aggravated by movement of R arm
limb and fingers when exposed to hot temperature and air
current and inc. pain when someone touches the burn area
(VRS 8/10-9/10). To relieve pain at night, pt sleep lying on
 his back while hand elevated on a pillow & took Ibuprofen
400 mg (see Drug Hx) for pain relief and inflammation
(VRS: 8/10 - 5/10), pain still continues.
~ 1 day PTIE, pt was seen by rehab. Dr. Y.T. who examined
him and was referred to PT.

At present pt ℅: pt ℅ constant throbbing pain (VRS 8/10) and

difficulty moving around.
Ancillary Procedures:

Procedure Date Taken Findings

Chest Radiograph Oct. 11,2023 (+) Fluid accumulation
Bronchoscopy Oct. 11. 2023 (-) Arrhythmia
(-) Inhalation Injury

Laboratory result::

Procedure Normal Values Results

CBC
WBC (x10 3.8-10.4 12.5
3
/microL)

RBC (x10 3.8-5.0 2.5

6
/microL)

Platelet (x10 153-361 345

3
/microL)

Hematocrit (%) 40%-52% (men) 37%

36%-47% (women)

Hemoglobin (g/dL) 13-17 g/dL (men 10

12-15 g/dL (women)
BUN (mg/dL) 6-24 23
Creatinine (mg/dL) 0. -1.3 1
Troponin i (ng/L) 0 - 0.04 0.04
Total serum CK 50–400 390
(U/l)
Serum troponin T < 14 20
(ng/l)
Serum creatinine 60–100 115
(µmol/l)
Serum urea (mmol/l) 3.2–8.1 8.5
Serum AST (U/l) 15–45 30
Serum ALT (U/l) 10–70 80
Amylase (U/L) 40 - 140 150
RBS mg/dl <99 80
WBC differential
Neutrophils (per mm 2500-8000 9000
3
)
Lymphocytes (per 1000-4000 5000
mm
3
)

Monocytes per mm 100-700 820

3)

Basophil (per mm 25-100 150

3)

Eosinophil 50-500 550

Electrolytes
Potassium (mmol/L) 3.7 - 5.1 7.5
Sodium (mmol/L) 135 - 145 135
Magnesium 1.7 - 2.2 2.0
(mmol/L)
Chloride (mmol/L) 97 - 105 99

Urinalysis |
pH 4.5- 8.0 7.0
Color Pale yellow Pale yellow
Specific gravity 1.001- 1.030 1.025
Nitrite Negative Negative
DRUG HX:
Drug Date Taken Dosage Indication Side Effects
Intravenous Oct. 11, 2023 130-154 mmol/l Maintaining Chest pain
fluids (Ringer’s hydration in Abnormal heart
lactate) hospitalized rate
patients unable Decreased blood
to keep fluids pressure
down
Ibuprofen Oct. 11,2023 400 mg (every 6 Decrease pain
hrs) and
inflammation
Silver Oct 11, 2023 6g daily prevent and treat rash; hives;
sulfadiazine wound infections itching; red,
swollen, blister
Salbutamol Oct. 11,2023 4 mg (3-4 times Inhalation injury headache
a day)
Propranolol Oct 11, 2023 (40 mg daily) Modulation of Vomiting,
hypermetabolis Nausea
m
Tetanus Oct 11, 2023 0.5 mL Anti Tetanus Nausea
Prophylaxis

FMHx

Maternal Paternal
Hypertension (-) (-)
DM (-) (-)
Cardiopulmonary Dse (-) (-)
OA (-) (-)
RA (-) (-)

PMHx
(+) Injuries / Accident (Ankle sprain 2019)
(-) Hospitalization
(-) DM
(-) Allergies
(-) Trauma
(-) Surgery

PSEHx
● Sedentary lifestyle
● Non smoker
● Non alcoholic
● Diet - vegetables, fruits, meat
● Hobbies - Watching TV, playing basketball
Home situation
● Lives in a bungalow house c parents and a dog
● 2 bedrooms and 1 bathroom
● Main door ↔ gate: ~20 steps
● Main door ↔ living room: ~ 10 steps
● Main door ↔ kitchen: ~15 steps
● Main door ↔ bathroom: ~18 steps
● Main door ↔ bedrooom: 15 steps
● Floor type: Ceramic tiles
● Doorknob type: Round type
● Bed type: Firm mattress

Work situation
● Working hours: 8 hrs a day
● Works from 8am to 5pm
● Work environment: Fill LPG Gas cylinders
● Mode of transportation: Motor for approx. 1 hr to (work to
house)

O>
VS:
 Before During After
BP 110/70 mmHg 120/70 mmHg 110/75 mmHg
Temperature 36.8 °C 36.9°C 36.8°C
PR 75 bpm 80 bpm 78 bpm
RR 14 cpm 16 cpm 15 cpm
SpO2 98% 98% 95%
Findings: Pt’s VS is WNL.
Significance: for baseline purposes and precautionary
measurements

OI:
● Mesomorph
● Alert, Coherent
● In apparent distress
● (+) Swelling
● (+) Redness on wound site
● (+) Pressure dressing on R and L arm, ant trunk, R limb
● (+) Intact blisters R and L arm, ant trunk, R limb
● (+) Glistening surface on opened blisters on R upper and
lower arm, L lower arm, R leg
● (+) Postural deviation (see postural analysis)
● (+) Gait deviation (See gait analysis)
● (-) Deformities on B UE and LE
● (-) Hypetrophic contraction
● (-) Keloid

Palpation:
● Hyperthermic on B UE and R LE
● Normotonic on B UE and R LE
● ( + ) Grade 2 tenderness on R and L lower arm and hand, R
thigh and leg
● ( + ) LOM on R and L forearm and arm, ant trunk, R thigh
and leg (see ROM)
● ( + ) Muscle spasm on R and L Shoulder flexor, extension
 and abduction, R knee flexor and extension
● ( + ) Stage 0 edema on R and L lower arm and hand, R
thigh and leg
● ( - ) Nodule on B UE and R LE
● ( - ) Crepitus on B UE and R LE

ROM: all major jts on B UE and LE are WNL except for the ff:

Motion AROM Difference PROM Difference N Value End feel

R Shoulder 90° 100° 0-180 Empty
Flexion
L Shoulder 90° 100° 0-180 Empty
Flexion
R Shoulder 90° 100° 0-60 Empty
Extension
L Shoulder 90° 100° 0-60 Empty
Extension
R Elbow 20° 125° 0-150 Empty
Flexion
L Elbow 20° 125° 0-150 Empty
Flexion
R wrist 10° 35° 0-70 Empty
Extension
L wrist 10° 35° 0-70 Empty
extension
R Knee 0-10
Extension
R Knee 0-135
Flexion
R ankle 0-50
Plantarflexi
on
R ankle 0-20
Dorsiflexio
n
Findings:
Significance:

MMT: All major mm on B UE and LE are WNL except for the

ff:

Muscle Group Grade

R Shoulder Flexor 3/5
R Shoulder Extensor 3/5
R Shoulder Abductor 3/5
R Elbow Flexor 3/5
R Elbow Extensor 3/5
R Forearm Supinator 3/5
R Forearm Pronator 3/5
R Wrist Flexor 3/5
R Wrist Extensor 3/5
R Wrist Radial Deviator 3/5
R Wrist Ulnar Deviator 3/5

Findings: Pt shows mm weakness on R and L arm, ant trunk, R

limb
Significance: PT Mx should include strengthening exercises.

NEUROLOGIC EVALUATION
Sensory Assessment:

SUPERFICIA STD USED R UE L UE L LE R LE

L
SENSATION
Light Touch Cotton ball 5/5 5/5 5/5 5/5 trials
 trials trials trials
Pain Tip of neuro 5/5 5/5 5/5 5/5 trials
hammer trials trials trials
Temperature Two test tube 5/5 5/5 5/5 5/5 trials
(warm/cold) trials trials trials
Deep Pressure Therapist 5/5 5/5 5/5 5/5 trials
fingertip trials trials trials
Findings: Pt has 100% superficial sensation on R UE and R LE.
Significance: For modality precautions

Deep Sensation

DEEP STD USED R UE L UE L LE R LE

SENSATION
Proprioception Extremity is 5/5 trials 5/5 trials 5/5 trials 5/5 trials
moved and
held in a static
position by PT
Vibration PT moved the 5/5 trials 5/5 trials 5/5 trials 5/5 trials
extremity
passively
Kinesthesia Tuning fork 5/5 trials 5/5 trials 5/5 trials 5/5 trials
Findings: Pt has 100% intact in deep sensation on both UE and
LE
Significance: for precautionary measures during intervention

ANTHROPOMETRIC MEASUREMENT:
Limb Girth Measurement

Landmark R L Difference
2 cm Below Lateral 28 cm 29 cm 1 cm
Epicondyle
4 cm Below Lateral Epicondyle 28 cm 29 cm 1 cm
6 cm Below Lateral Epicondyle 26 cm 27 cm 1 cm
2 cm Above Lateral 33 cm 34 cm 1 cm
Epicondyle
4 cm above Lateral Epicondyle 34 cm 35 cm 1 cm
6 cm above Lateral Epicondyle 36 cm 38 cm cm
2 cm Below apex of 35 cm 36 cm 1 cm
patella
4 cm Below apex of patella 38 cm 40 cm 2 cm
Findings: All measurements are WNL
Significance: To check for edema

Chest Expansion

Landmark Resting Maximum Difference

Expiration
Axila 104 cm 106.3 2.2 cm
Xiphoid Process 103 105 2 cm
Lower Costals 103 105 2 cm
Significance:All measurements are WNL
Findings:for baseline purposes and precautionary measurements

PULMONARY Ax
Auscultation

Lobe Segments Findings

(L) ®
Upper Lobe Apical (N) Resonance (N) Resonance
Anterior (N) Resonance (N) Resonance
Posterior (N) Resonance (N) Resonance
Middle Lobe/Lingula (N) Resonance (N) Resonance
Lower Lobe Apical (N) Resonance (N) Resonance
Anterior (N) Resonance (N) Resonance
Posterior (N) Resonance (N) Resonance
Postero-inferior (N) Resonance (N) Resonance
Findings: Pt has a normal breath sounds
Significance: to rule out pulmonary affectation (Laterality
include inspiration and expiration - normal clear
Postural Ax: Pt was assessed in standing position

AP VIEW Landmark ® LATERAL VIEW (L) LATERAL VIEW

Midline Head/Neck Neutral Neutral
Protracted Scapula Leveled Leveled
Rounded Shoulder Rounded Round
® and (L) slightly Elbow Slightly flexed Slightly flexed
flexed
® and (L) slightly Wrist and Hand Neutral Neutral
flexed
Neutral Thoracic Neutral Neutral
Neutral Lumbar Neutral Neutral
Leveled Pelvis Midline Midline
Leveled Hips Aligned Aligned
Slightly flexed Knees Slightly flexed Slightly flexed
Leveled Ankles Aligned Aligned
Neutral Foot Neutral Neutral
Findings: Pt presents postural deviation at the R UE, having
rounded shoulders, protracted scapula,elbow, wrist & hand, and
knee slightly flexed d/t burn. V

Significance: PT mx must include stretching and proper

positioning.

Gait Analysis:
Gait was not assessed
Findings: Pt wound shows that regeneration stage.
Significance: for wound care mx and precautionary
measurement.

Functional Ax:
Self-care Activities Grade
Eating 3
Grooming 3
Bathing 4
Dressing - UE 4
Dressing - LE 4
Toileting 5
Sphincter Control 3
Bladder 7
Bowel 7
Transfers
Bed, chair, wheelchair 5
Tub, shower 5
Locomotion 7
Walk/Wheelchair 5
Stairs 5
Communication 7
Comprehension 7
Expression
Social Cognition 7
Social Interaction 7
Problem Solving 7
Memory 7
FIM Levels: Grade 7: Complete independence Grade 6:
Modified independence (device) Grade 5: Supervision Grade 4:
Minimal Assistance Grade 3: Moderate Assistance Grade 2:
Maximal Assistance Grade 1: Total Assistance

Findings: Pt score is 106 which mostly needs minimal

assistance esp during self care activities d/t having burned in his
(R) arm and forearm.

Significance: Pt Education to include exercises for UE and LE to

inc the level of independence in ADL’s

Psychological Ax

A>
PT Impression: E.B. young man MDDx c superficial deep burn
on R and L arm, ant chest, R and L limb c and manifested
difficulty with ADL, LOM, mm weakness, contracture, dec.
superficial sensation on the affected sites leading to the
difficulty to do the following: Self care such as dressing,
toileting, eating, and driving motor c a total FIM score of 106
which indicates pt needs mod assistance. PT mx will focus on
regaining ROM, mm strengthening, contracture prevention,
prevent respiratory complications and functional activities.

REHAB POTENTIAL: Pt has a good prognosis d/t the

following reasons

Favorable Non-Favorable
● (-) Infection ● (+) Burning pain
● (-) Necrosis ● (+) Open and close wounds
● (-) Hypertrophic Scarring ● Irreversible scarring
● Edema ● TBSA of 63%
● Physically fit ● Body Image
● Received early intervention
● No internal organ affectation
● Pt’s age
● No psychological problem
● Scar formation

PROBLEM LIST:
Burning pain on R UE (forearm, wrist) and R LE (thigh) pain
scale of 6

1.) Pt has low FIM level - specific (e.g., assistance 7-2) Edema
on (R) forearm
3.) LOM on (R) UE towards all planes of motion
4.) Mm weakness d/t prolonged immobilization in R and L arm,
ant trunk, R limb
5.) Increased dependence on all aspects of ADL with moderate
to maximal assistance especially to feeding, grooming, and
bathing.
7.) Postural Deviation
8.) Pt has poor quality of sleep

LTG: In 3 wks, pt will exhibit an increase in doing ADLs and

preparatory for out-pt treatment.

STG:
In 5 days PT session 2x/day pt will be able to:
1. Pt will demonstrate increase in FIM score
2. Pt will demonstrate increase in ROM on all affected joints
by 5-10 degree increments
3. Pt will demonstrate low-intensity isometric contractions
performed against little to no resistance.
4. Pt will manifest proper posture and stretching

P>
PT Mx
Ward Exercise
1.) Bed Positioning/ Bed Mobility Exercises
2.) Splinting of (R) UE towards forearm supination, full elbow
extension and shoulder abduction to 90°
3.) PROMES to AAROMES of (R) UE towards all planes of
motion x 10 reps x 3 sets
4.) Squeeze Ball Exercise c minimal resistance x 7SH x 10 reps
x 3 sets(Progress to moderate/maximal resistance if pain is not
elicited)
5.) Gentle Passive Stretching towards all planes of motion
within pain free range x 15 secs hold x 5 sets

Pt Education:
1. Always maintain shoulder in an abducted position, slightly
flexed and externally rotated
2. Maintain elbow into extension & supination
3. Maintain hand into intrinsic plus position with thumb
 abducted with increased web space
4. Utilize small movement if possible
5. Maintain affected limb elevated or slightly higher level
than the heart
6. Dry and avoid wetting the bandage and keep the bandaged
area clean
7. When removing dressing make sure to submerge it in water
to ensure ease of removal
8. Take time to rest
9. Prevent deformed positions and staying in one position for
too long
10. Elevate the R and L forearm and hand, and R leg at all
times, especially while sleeping to prevent edema
11. Educate pt. on how to posture the body properly and use
good mechanics to avoid deformities while healing
12. Use of sunscreen

PT-In-Charge:
Najeeva Jumangit, SPT