March 2010 Archives

March 26, 2010

Burn Centers in Connecticut

Hartford Hospital
PO Box 5037
Hartford, CT 06102-5037 United States
860-545-5555


Bridgeport Hospital Burn Center
267 Grant St.
Bridgeport, CT 06610-2870 United States
203 384-3728

March 26, 2010

Burn Centers in New Jersey

St. Barnabas Medical Center -- Burn Center
101 Old Short Hills Rd.
Livingston, NJ 07039 United States
973 533-5920


Hackensack University Medical Center
30 Prospect Ave.
Hackensack, NJ 07601-1991 United States
201-996-2000


March 26, 2010

Burn Centers in Pennsylvania

Western Pennsylvania Hospital -- Burn Trauma Center
4800 Friendship Ave.
Pittsburgh, PA 15224-1722 United States
412-578-5274


Mercy Hospital of Pittsburgh
1400 Locust St.
Pittsburgh, PA 15219 United States
412-232-8111


St. Christopher's Hospital for Children -- Pediatric Burn Center
Erie Ave. at Front St.
Philadelphia, PA 19134 United States
215-427-5000


Crozer-Chester Medical Center -- Nathan Speare Regional Burn Treatment Ctr.
One Medical Center Blvd.
Upland, PA 19013 United States
610-447-2800


Temple University Hospital -- Temple Burn Center
Broad & Ontario Streets
Philadelphia, PA 19140 United States
215-707-2876


Lehigh Valley Hospital Burn Center
PO Box 689
Allentown, PA 18105-1556 United States
610-402-8734


St. Agnes Medical Center
1900 S. Broad St.
Philadelphia, PA 19145-2304 United States
215-339-4100


March 26, 2010

Burn Centers In New York

New York Hospital Burn Center
525 E. 68th St.
New York, NY 10021-4873 United States
212-746-5317


University Hospital Burn Center
State University of New York at Stony Brook
Stony Brook, NY 11794-0001 United States
516-444-2270


SUNY Health Science Center -- Burn Unit
750 E. Adams St.
Syracuse, NY 13210-2306 United States
315-464-6083


Jacobi Medical Center -- Burn Unit
Pelham Parkway South & Eastchester Rd.
Bronx, NY 10461 United States
718-918-6606


St. Joseph's Hospital
555 E. Market St.
Elmira, NY 14901-3256 United States
607-733-6541

Strong Memorial Hospital -- University of Rochester School of Medicine
601 Elmwood Ave.
Rochester, NY 14642-0001 United States
716-275-2100


Erie County Medical Center -- Burn Treatment Center
462 Grider St.
Buffalo, NY 14215-3098 United States
716-898-5231


Nassau County Medical Center -- Burn Center
2201 Hempstead Turnpike
East Meadow, NY 11554-5400 United States
516-572-3207


Westchester County Medical Center
Grasslands Reservation
Valhalla, NY 10595-1689 United States
914-493-7000


March 22, 2010

Temperature Regulation In Burned Patients

The skin plays an important role in body temperature regulation, see regulation of body temperature. In deep second degree and in third degree burns, the sweat glands will be destroyed and will not be replaced by new ones as the skin heals. These patients will often have difficulty in humid and hot situations (because of the destruction of sweat glands which play a role in regulating the body temperature).

These patients have to be careful and avoid certain exercise, activities or working conditions that might lead to heat stroke (heat stroke is an abnormally increased body temperature with accompanying physical and neurological symptoms). They are susceptible to heat stroke because the sweat glands are destroyed.

People with Partial thickness skin grafts may not fully recover sweat glands; this may cause problems with temperature regulation as well.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 19, 2010

Preventing And Dealing With Scars (part II)

Treatment of skin scars:


  • Steroid injection: this is done by injecting steroid into the scar itself. This may help flatten and soften the appearance of a keloid or hypertrophic scar.

  • Cryotherapy: it involves freezing the scar with a medication.

  • Compression garments: this type of treatment is often used when the scar covers a large area. It is only effective on fresh or recent scars.

  • Silicone sheeting and gel: this method involves using silicone sheets and gel which may improve the scar appearance and may decrease itching by keeping the skin hydrated.

  • Dermabrasion: this method involves the removal of the surface of the skin with a special device; it is useful in raised scars.

  • Surgery: it involves removing the scar with an incision then placing stitches to help close the wound. Sometimes skin graft is used in this method to help close the wound; this may be used with other methods such as silicone gel use. Tissue expansion may be used which involve a surgical procedure that increases the amount of existing tissue which will be available for reconstructive purposes. There is a high recurrence rate after keloid excision surgery.

  • Laser surgery: this method involves the use of different lasers depending on the underlying cause of scar, it may be used to smooth the scar, remove abnormal color of a scar, or flatten a scar, this method is often done with other methods like steroid injection.

  • Radiotherapy: this method involves the use of low dose superficial radiotherapy, used to prevent the recurrence of severe keloid and hypertrophic scars.

  • Treatment of scars can be challenging and may involve the use of more than one method.

  • You can minimize the scar tissue by following the instructions given to you by your physician, this may involve wearing your compression garments if they were prescribed for you for 23 hours a day, do your exercise and pressure massage.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 18, 2010

Preventing And Dealing With Scars (part I)

Scars are areas of fibrous tissue that replace normal skin or other tissues after an injury. Scar formation is a natural part of the healing process.

Scars can happen as a result of an infection, surgery, injuries such as burns or inflammation of tissue. They may cause functional and psychological problems for patients.

There are three types of scar: Hypertrophic scar, keloid scar, and contracture scar.
Factors that influence the formation of a scar in a burned area are:


  • The size and depth of the wound (a deeper and larger the wound is, will result in a more significant scar).

  • Location of the injury: (certain locations in the body are susceptible to form scars such as the deltoid region of the upper arm, the upper back, the sternum, the earlobes and the back of the neck.

  • Age, hereditary, and ethnicity factors: scars are more common in young people. People with darker skin are more susceptible to form scars. Some people have inherited tendency to form scarring more than others.

Skin scars happen when the second deep layer of the skin (dermis) is damaged. It is hard to tell how much the patient will scar after a burn injury. Most second and third degree burns part I, II will cause some degree of scaring and the worse the damage is, the worse the scar will be.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 17, 2010

Wound Infection

Skin plays an important role in protecting the body against infection; see skin and infection. When there is a burn the risk of infection increases depending on the degree of the burn, location of the burn and the general condition of the patient.

Risk factors for developing an infection in a burn wound may include:

  • Improper wound care.

  • Extremes of age because of lower immunity.

  • Associated diseases like diabetes.

  • Full thickness burns.

  • Burns that involve more than 30% of the total body surface area (TBSA).

  • Burns in the perineum.

Infection is the most common complication of burns and is the major cause of death in burn victims, it can happen in the hospital or at home; it can be local (at the site of the burn)or systemic (spreading of infection to other areas in the body which may lead to septicemia and organ failure). It is important to contact your doctor immediately when you observe any of the signs and/or symptoms of infection.

Signs and symptoms of infection may include:


  1. Increased redness in or around the wound.

  2. Increased swelling in or around the wound.

  3. Increased or persistent pain.

  4. Increased drainage from the wound.

  5. Change in the color of the drainage (green discharge or pus).

  6. Foul smell from the wound.

  7. Heavy bleeding soaking the bandage.

  8. Chills or fever (usually greater than 101.5 degrees F).

  9. Persistent vomiting or diarrhea.

Burn wound infection prevention:

  • Keep the burned area clean.

  • Look for any signs or symptoms of infection during dressing change.

  • Follow a strict sterile protocol during wound dressing change (see home wound care).

  • It's important in infants to observe any change in the appearance of wound or change in activity level (not playful, fails to hold eye contact, lethargic) children can't express what they feel. Contact the doctor immediately if you observe any sign or symptom of infection.

  • Topical antibiotic ointments may be prescribed as a prophylactic (preventive) measure in burned patients.

  • Infection delays wound healing, encourages scarring (as a result of collagen deposition in reaction to the infection) and may result in bacteremia and organ failure (systemic infection).

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 16, 2010

Burn Wound Care at Home

Wound care at home is an important factor in the continuation of wound healing. A patient may come home with unhealed areas that still require wound care.
Dressing change and bathing:


  1. It is important to wash the hands with soap and water before and after dressing changes.

  2. Put surgical gloves on both hands.

  3. If dressing change is painful, pain medications might be needed (consult with your doctor), pain medications if needed have to be taken 30 minutes before changing the dressings to give them time to work.

  4. Dressing change may be done during bathing (ask your doctor if you can shower or bathe).

  5. Remove the old dressings carefully. Taking care not to disturb scabs on healing process.

  6. Look for any signs and symptoms of infection.

  7. Use lukewarm water, wash the wound gently with soap and water, use mild non deodorant soap (such as Dove), if you have used creams or ointments, make sure that you have removed all of it by using a clean white wash cloth (avoid using any cloth that contain dyes as it may be irritating to the skin).

  8. Dry the skin, apply creams, ointments, if they were given to you (consult your doctor for the type of creams and ointments).

  9. Cover the wound with a clean, dry dressing (consult your doctor for the type of dressing)


When Bathing a Child:

  1. Make sure that the hot water tank temperature is set below 120 degree F so that very hot water cannot be turned on accidentally.

  2. Make sure that the area where bathing is taking place (shower or tub) is clean.

  3. Fill the tub BEFORE placing child in the water, make sure the water is not too hot.

  4. Have a specific clean area where you will always perform the dressing change, make sure you have all the supplies needed for dressing change and have a place where you store them.

  5. Always look for signs and symptoms of infection especially in children as they may not be able to express what they feel.

  6. Contact your doctor immediately if there are any signs and symptoms of infection.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 15, 2010

Post Hospital Burn Care

Following a burn injury, some patients will be admitted to the hospital for a period of time and then discharged home. When the patient returns home, he/she will require an adjustment period not only for him/her but also for the whole family.

Consideration after discharge:

Pain:

Most patients with burns have pain from the burned area unless the burn is deep and the nerve endings are burned. Even in these burns, pain may be felt from surrounding injured tissues. The amount of the pain can vary depending on the severity and location of burn. The pain may interfere with the daily activities. Dressing changes and wound care may also be painful.

Some patients may experience permanent disfigurement or permanent disability which may lead to emotional distress.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 12, 2010

Mechanical Ventilator (part II)

Medications are often used when the patient is intubated in the form of sedative and analgesic drugs to reduce the anxiety and stress associated with the intubation as well as helping the patient with tolerating the constant irritation of the endotracheal tube. The patient is also given prophylaxis against Deep Vein Thrombosis Part I, II. When the patient is intubated this will affect the ability of the patient to talk or speak.

There is another form of mechanical ventilator which is the oldest form in which a negative pressure is used instead of a positive pressure to create a vacuum which forces air into the lung.

Ventilators are used to support and help people who can't breathe adequately.

Some patients need to stay on mechanical ventilators for a short period of time others may need to use it for a longer time. Some may need it for the rest of their lives. In such cases the machine can be used outside the hospital in the form of a portable machine. When the patient sufficiently recovers from the cause that led him/her to be on a ventilator, he/she will be weaned gradually. Once the patient can successfully breathe on his/her own, the ventilator will be stopped.

Complications of mechanical ventilation: they may include

  • Infection (pneumonia): patients on ventilators with a breathing tube in the airway have an increased risk of having pneumonia called ventilator associated pneumonia. This happens at least 48 hours after intubation. It is a serious and a common complication that is treated with antibiotics.
  • Infection of the sinuses (sinusitis).
  • Pnemothorax: it is a condition were air leaks out of the lungs into the space between the lungs and the chest wall.
  • Gastrointestinal complications: may include distension, stress related hemorrhage which can be prevented with using medications that decrease the acid secretion of the stomach.
  • Damage to the vocal cords.
  • Deep Venous Thrombosis Part I, II.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 11, 2010

Mechanical Ventilator (part I)

Burns can affect different parts of the body in different ways. Some patients will not be able to breathe on their own and may need the help of a breathing machine (mechanical ventilator).

Mechanical ventilator: can be defined as a device that is designed to help the patient to breathe simply by moving air into and out of the lungs.

Mechanical ventilators may be used in diseases, conditions, or factors that interfere with or impair breathing such as:

  • Burn injuries: some burn patients may need to be hooked to a mechanical ventilator depending on the cause and the severities of injury eg, in some smoke inhalation injuries.
  • Infections eg, pneumonia.
  • Lung diseases eg chronic obstructive pulmonary diseases.
  • Conditions that affect the nerves or muscles involved in breathing such as injury to the upper part of spinal cord, polio.
  • Damage to the brain's respiratory center, stroke, coma.

A mechanical ventilator may be used during surgery when general anesthesia is needed.

The mechanical ventilator system is composed of a machine (ventilator) that pushes air or mixture of other gases such as air and oxygen under a positive pressure to the lungs, the air may be delivered through:

  • A nasal or a face mask.
  • An endotracheal tube: a tube placed in the wind pipe (trachea) through the nose or mouth, this is used for patients who need the ventilator for a shorter period of time.
  • A trach tube: which is a tube inserted directly into the trachea through an opening created in the trachea by a surgical procedure called a tracheostomy; this is used when the patient needs the ventilator for a longer period of time.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
March 5, 2010

Chemical Burns (part II)

Management:

First aid should be administered as soon as a chemical burn has occurred.


  1. Remove the cause of the chemical burn.

  2. For liquid chemicals, remove any clothing or other items that the chemicals may have spilled on. Wash thoroughly any chemicals off the skin under running water for 15-30 minutes.

  3. For dry chemicals, wash the area with a large amount of water to flush the chemical from the skin; don't use small amounts of water as they may activate the chemicals. If there is no water then brush the dry chemical with a clean cloth.

  4. Loosely cover the burn with a dry, sterile bandage.

  5. If the chemical gets into the eyes, the eyes should be flushed with water immediately, continue flushing the eyes with running water and get medical help immediately, if there are contact lenses try to remove them.

  6. If the chemical substance is swallowed or inhaled, seek medical attention immediately.

  7. Minor chemical burns will generally heal without further treatment. However if there is a second or a third degree part I, part II burn or if there is an overall body reaction, then get medical help immediately.

  8. Don't do the following: a) Apply any household remedy to a chemical burn. b) Break blisters or remove dead skin from a chemical burn.

  9. Call your doctor and/ or proceed to the nearest ER.

Prevention:

  1. Wear protective clothing: goggles, gloves, and clothing.

  2. Store all chemicals out of reach of children, in tamper proof containers.

  3. Don't mix different products that contain toxic chemicals because they can give off toxic fumes.

  4. Avoid using potentially toxic substances in the kitchen or around food.

  5. Don't ever store household products and chemicals in food or drink containers.

  6. Only use chemicals that give off fumes in well ventilated area. Store chemicals safely immediately after use.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 4, 2010

Chemical Burns (part I)

Chemical burns of the skin are burns that happen when strong acids or strong bases (alkalies) come in contact with the skin. Chemical burns follow the standard burn classification (first part I, II, second and third degree part I, II), most chemical burns occur on the face, eyes, arms and legs.

Clinical features:

The exact clinical features of a chemical burn depends on the type of chemical substance involved, it's concentration, it's physical form, duration of contact, site of contact, whether or not the skin is intact and if the substance is swallowed or inhaled. Symptoms may include:


  1. Redness, irritation, or burning at the contact site.

  2. Pain or numbness at the contact site.

  3. Acidic chemicals cause a black dead skin because they denature proteins.

  4. Alkali chemicals cause deep tissue injury to the skin because they denature proteins and cause saponification (hydrolysis) of fats.

  5. If the chemical substance comes in contact with the eye it may lead to vision changes or complete loss of sight.

  6. If the chemical substance is swallowed or inhaled this may lead to vomiting, headache, cough or shortness of breath, faintness, weakness, dizziness, muscle twitching, seizures, irregular heartbeats or cardiac arrest.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 3, 2010

Electrical Burns (part II)

Treatment:


  1. If it is possible shut of the electrical current from its source.

  2. Call for medical help.

  3. If the current can't be turned off, use a non conducting object such as a wooden broom, rug, and chair to push the victim away from the source of the current. Don't use anything that conducts current like wet or metal objects and if possible stand on a dry and non-conducting object.

  4. Once the victim is free from the source of electricity; check his or her airway, breathing and pulses, if the victim isn't breathing and is not responsive, it may be necessary to perform cardiopulmonary resuscitation.

  5. If the victim has any signs of shock eg, pale, lay the victim down with the feet raised and cover the victim with a blanket to maintain body heat. Avoid moving the victim's head or neck if there is suspicion of spinal cord injury.

  6. If the victim has an exit wound, cover it with a clean, sterile bandage.

  7. All patients with electrical burns should be taken to the hospital for further evaluation as there may be concealed internal injuries.


Things to be avoided:

  1. Don't attempt to rescue a victim near active high-voltage lines.

  2. Don't apply any butter, ointments, ice, or adhesive bandages to the burn.

  3. If the victim has burns, don't break blisters or remove dead skin as this may lead to more damage and increase the risk of infection.

  4. Don't touch the victim with your bare hands while the person is still in contact with the source of electricity.

  5. Don't move any victim of electrical injury unless there is immediate danger such as fire because the victim may have internal injuries.


Prevention:

  1. Use child safety plugs in all electrical outlets.

  2. Don't use electrical equipments near running water or when wet.

  3. Keep electrical cords out of reach of children and don't let children suck or chew on them.

  4. Teach children the danger of electricity.

  5. Avoid electrical hazards by following manufactures safety instructions when using electrical appliances.

  6. Always turn off circuit breakers before making any repairs to wiring.

  7. Never touch electrical appliances while touching faucets or cold water pipes.


The human body conducts electricity. When the electrical current passes through body tissues it generates heat due to the resistance applied by the tissues, this heat may cause burns and extensive damage to internal organs.

Muscle contraction may happen when the external current is conducted by the nerves to the muscles; this contraction is involuntary and may lead the person to be frozen for a while. If the skeletal muscle contraction is severe, it may lead to bone fractures.

Electrical current may cause the heart to beat irregularly or it may cause it to stop beating.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 2, 2010

Electrical Burns (part I)

Electrical burns are burns that happen when a person is directly exposed to an electrical current, they can cause extensive damage to internal organs.

Potential causes:


  1. Children poking metal object like a knife in an electrical outlet, sucking, chewing, or biting an electrical cord.

  2. Accidental contact with exposed parts of electrical appliances.

  3. Occupational related exposure eg, electric arcs from high voltage power lines.

  4. Failing to shut the power supply before making home repairs.

  5. Lightning.

  6. Dropping a plugged-in appliance into water.


Symptoms may include:

  1. Skin burns.

  2. Numbness or tingling.

  3. Headache.

  4. Impaired swallowing, vision or hearing.

  5. Muscle contraction and pain.

  6. Bone fractures.

  7. Altered level of consciousness.

  8. Seizures.

  9. Respiratory failure.

  10. Heart arrhythmias and cardiac arrest.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

March 1, 2010

Contractures

A contracture scar can be defined as tightening of the skin overlying the affected area. This type of scar may affect the adjacent muscles, tendons and nerves leading to limitation in the ability to move.


A contracture is a serious complication; it happens when the normal elastic connective tissue is replaced with inelastic fibrous tissue. The fibrous tissue is resistant to stretching. Depending on where the contracture scar is located, the patient may have difficulty performing normal daily activities. This may occur because the contracture can inhibit movement. For example, if the contractures restrict range of motion of a joint.

Treatment of contractures:

  • Exercises: they help to stretch the scar area and keep the muscles and joints of the burned limb flexible. It is important to follow the instructions and do the exercises given to you by your doctor, physical therapist, or occupational therapist.
  • Pressure aids: like Ace wraps, custom made compression garments.
  • Surgical treatment: if the non surgical methods fail to treat the contracture surgery may be an option, this may include:
  1. Skin graft or skin flap procedure: this involves removing the scar tissue and then covering the area with a skin graft or a skin flap which is similar to a graft but has its own blood supply.
  2. Z-plasty: it involves using a Z-shaped incision. This type of procedure is used to revise a scar.
  3. Tissue expansion: this procedure involves a process that increases the amount of existing tissue which will be available for reconstructive purposes.
. This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.