April 2010 Archives

April 27, 2010

Frostbite (Cold Induced Injury) Part II

Treatment of frostbite:

  • Seek medical attention.
  • Move the person to a warmer area; remove any constricting jewelry or clothing as well as wet clothing.
  • Cover the person with warm blankets.
  • Immerse the affected area in warm water (never use hot water) with temperature between 104 to 108 degrees, for 20-30 minutes. During the warming process burning pain and swelling may occur but it is important to continue warming.
  • Apply dry, sterile dressing to the affected area; remember to separate affected fingers and toes by putting the dressings between frostbitten fingers or toes to keep them separated.
  • Move the affected area as little as possible.
  • Refreezing of the affected area can cause more severe damage, therefore keeping the affected area warm is important.
  • Treatment should be continued by a medical professional as needed.
Things not to be done:
  • Don't use direct dry heat to warm the affected area such as radiator or hair dryer as these areas are numb and can burn easily.
  • Don't use hot water as it may burn the affected area.
  • Don't rub or massage the affect area as this may cause more damage.
  • Don't disturb blisters that are present.
  • Don't smoke or drink alcohol during the process of recovery as smoking and alcohol can interfere with the blood circulation.
Prevention:
  • Avoid going out in extreme cold or windy weather.
  • In situations where you have to work or go out for long periods of time in very cold weather, wear protective clothing. This includes many layered dry, wind proof garments, gloves, a scarf, a hat and 2 pairs of socks. Cotton clothing is better than wool. Avoid tight clothing and boots as these may cause poor circulation.
  • Stop smoking and drinking alcohol if you expect to be exposed to cold weather for a long period of time as this may interfere with the blood circulation.
  • If you are caught in a severe snow storm, try to find shelter as early as possible, also it is important to increase physical activity in order to maintain body warmth especially in the hands and feet.
  • People with risk factors (see above) that can contribute to frostbite should take precaution and avoid extreme cold weathers such as those with diabetes.

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.

April 26, 2010

Frostbite (Cold Induced Injury) Part I

Frostbite is a tissue injury induced by exposure to cold. Frost bite happens when a person is exposed to extreme cold leading to damage of the skin and the underlying tissue. Any part of the body may be affected by frostbite but it usually occurs in the nose, ears, fingers and toes.

When the temperature reaches zero or below, the blood vessels located close to the skin start to constrict to decrease the blood flowing throw them which in turn will lead to decrease heat loss and preserve core body temperature (see regulation of body temperature). When the skin and the underlying tissues are exposed to prolonged cold or extreme cold, the flow of blood to the affected areas will be greatly reduced leading to damage to these areas which may be permanent leading to tissue death and amputation in severe cases.

The risk of frostbite increases in the following:


  • Persons who use medications that decrease the blood flow to the skin such as beta-blockers.

  • Persons with peripheral vascular disease which decrease the blood flow to the affected tissue.

  • People with peripheral neuropathy which decreases the ability to feel injuries.

  • Smoking and diabetes.

  • High velocity wind which increases the rate of heat loss from the skin.

  • Persons who are not well dressed for extremely cold temperature.


Signs and symptoms:

  • Each individual may experience symptoms differently; the signs and symptoms depend on the severity

  • Pins and needles sensation followed by mild numbness.

  • Redness and pain in the affected skin area.

  • Firm or waxy skin which is white and completely numb (a sign that tissues have started to freeze).

  • Skin blisters.

  • Very severe frost bite may cause gangrene (blackened, dead tissue) and damage to the deep structures such as muscles and nerves.


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.

April 21, 2010

Psychological Consequences of Burns: Long Term Rehabilitation

During this phase the patient is discharged from the hospital and starts to reenter and reintegrate into life and society. Interacting with family members, friends and the rest of the community may be difficult at first. The patient may be used to the hospital environment, leaving the hospital; they will have the fear of being rejected by the community because of their change in appearance or abilities. Other issues that face the patient during this stage are dealing with returning to work, changing their image and resuming sexual activities. Patients may develop anxiety and depression as a result of these issues.

Going through rehabilitation, exercises, dressing changes, pressure garment use, amputations, scarring and itching may all have an effect on the patient emotionally and physically.

Treatment provided in this stage begins before discharge by explaining and preparing the patient and family for the difficulties anticipated after discharge. Outpatient counseling, social skill training and support groups play a role in recovery. Family and friends' support and the patient's willingness to engage himself/ herself in society play an important role in recovery.

People are creative and can devise ways of achieving their goals when they receive the encouragement and support needed. Some patients may need more time than others to achieve their goals but every survivor can do it. Progress step by step with optimism and the right attitude, anyone can definitely get through anything.

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.

April 20, 2010

Psychological Consequences of Burns: Acute Stage

Acute stage:

This stage of recovery follows the resuscitative stage. In this stage the patient begins the healing process both physically and emotionally. Patients in this stage are still going through the painful procedures and treatments. They will start to be aware of the impact of the injury and how their injuries have changed their lives. Some have lost loved ones; some may have lost everything they have worked for.

Patients in this stage may experience sleep disturbance due to many factors: being in a hospital environmental with factors such as lights, staff awakening the patient for medication and to check vital signs. Anxiety and depression plays a major role in sleep disturbance. Nightmares, agitation and pain may also affect sleep. Acute stress disorder which occurs in the first month and post traumatic stress disorder which occurs after the first month manifest during this stage.

Psychological issues (pre-burn) such as depression may have an adverse effect on the outcome of the patient. These patients may stay in the hospital for a longer time and may have more severe psychological consequences after the injury.

Anxiety and depression counseling may be helpful to reassure the patient that after a trauma like this, it's not uncommon to experience these symptoms and that they may disappear on their own with time. Sometimes medication may be needed in addition to counseling.

Drugs, in the form of Opiates, may be used to treat pain. They can be either long acting or short acting. Long acting opiates are used for pain caused by the burn injury while short acting opiates are used for pain due to procedures performed such as wound care.

Non drug methods include hypnosis and cognitive behavioral therapy. A new technique called virtual reality can be helpful in burn patients, these patients often experience excruciating sensations of pain, and this will distract the attention of the patient from the painful procedures as a person can only focus on one stimulus at a 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.

April 19, 2010

Psychological Consequences of Burns

One of the most traumatic experiences that a person can go through both physically and psychologically is suffering a burn injury. Psychological consequences of burns don't only affect the patient who suffered the burn trauma, but can affect the people who are close to him/her. Psychiatric symptoms and needs depend on the stage of recovery. There are three stages of recovery which are:


  • Resuscitative stage (critical care stage).

  • Acute stage.

  • Long term rehabilitation.


The Resuscitative stage (critical stage):

After a burn injury, some patient will need to be admitted to the hospital and depending on the severity of their injury some will be admitted to the intensive care unit of the hospital. In this scary environment with all the tubes and instruments attached to the patient, the painful procedures that the patient is going through, separation from friends and family, limited outside communication, struggling for survival and other factors such as the high doses of medications used in the treatment, infections, metabolic conditions and others may contribute to the patient's symptoms. The patient may experience psychological issues such as extreme drowsiness, confusion, disorientation and delirium. The patient may start to misinterpret his/her surrounding when there is an altered state of consciousness, like misidentifying friends, hear things that are not really there, etc.

Members of the team taking care of the patient will work with the patient's family members to do whatever they can to enhance recovery. The patient is encouraged to deal with this unusual situation in the intensive care unit with whatever means possible such as denial. Family members play an important role in the recovery, although it is hard and distressing for them to see a loved one in this condition and going through all of this, they should always be calm and give hope to the patient as this will help in the recovery.

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.

April 16, 2010

New York Hospital Burn center:

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

The William Randolph Hearst Burn Center at New York- Presbyterian Hospital/Weill Cornell Medical Center has an excellent reputation not only in New York but worldwide. It is the largest Burn Center in the busiest in the state with sophisticated technology and treatment methods. The burn center team is highly specialized and qualified to provide all the services needed for the patient and his/her family.

April 16, 2010

Westchester County Medical Center

Grasslands Reservation
Valhalla, NY 10595-1689 United States
914-493-7000

The Trauma and Burn Center in Westchester County is the only burn center between New York City in Eastern New York and the Canadian border. It responds to emergencies around the clock and consists of the adult trauma center; the pediatric trauma center and the burn enter. The specialized team in the center offers the best services and survival chances with their dedication and expertise. They provide care for every aspect of injury. This center treats and save hundreds of burn victims and provides them with hope. This center as well as treating patients with burns, treats people with a wide variety of wounds and injuries as the center is also the home to the regional advanced wound therapy and hyperbaric center.

April 15, 2010

Mid- Atlantic Burn Camp

Summer Camp

The camp serves approximately 90 child and adolescent burn survivors' ages 8 to 17 from the Mid-Atlantic Region and beyond. Applications for the summer camp are mailed in April and the camp is held the third week in August each year at Camp Horizons in the Blue Ridge Mountains of Virginia. The camp offers a variety of activities and an experienced staff will be available to help the campers with their needs.

Winter camp:

This is held every February in the Pocono Mountains of Pennsylvania at a ski resort. Campers receive skiing lessons and participate in a variety of indoor and outdoor recreational activities over 4 days. During this camp the focus is on, planning for the future and setting goals. Survivors who participate in the camp must be between the ages of 15 and 17.
For more detail see the website.

April 15, 2010

Carbon Monoxide (CO) Poisoning

Carbon monoxide is a colorless, odorless, tasteless gas. It is also flammable and is quite toxic to humans and other oxygen-breathing organisms. Carbon monoxide poisoning happens when enough carbon monoxide is inhaled.

CO is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal, burning wood, and gas ranges and heating systems.

Breathing carbon monoxide fumes decreases the blood's ability to carry oxygen. Low levels of oxygen can lead to cell death, including cells in the vital organs such as the brain and heart.

Symptoms:

Symptoms vary from person to person. Those at high risk include young children, the elderly, persons with lung or heart disease, people at high altitudes, and smokers. Symptoms may include:

  • Headache.
  • Nausea, vomiting (often seen in children).
  • Dizziness.
  • Fatigue.
More severe symptoms may include:
  • Confusion, drowsiness.
  • Rapid breathing or pulse rate.
  • Vision problems.
  • Chest pain.
  • Convulsions, seizures.
  • Loss of consciousness.
  • Cardiac arrest.
  • Respiratory failure.
  • Death.
Carbon monoxide can be harmful to the fetus.

Treatment:

  • Immediately leave the area and get fresh air, immediately remove the victim from the site of exposure.
  • Call for medical help.
  • If the victim is unconscious, start CPR.
  • Depending on the severity of the poisoning, 100% oxygen may be given as soon as it is available.
  • Hospitalization may be needed and further treatment will be given depending on the condition of the victim.
  • In severe cases hyperbaric oxygen therapy may be used.

Prevention:

  • Install a carbon monoxide detector on each floor of your home.
  • Check the battery once per year.
  • Inspect and properly maintain heating system, chimneys and appliances.
  • Use non electrical space heaters only in well ventilated areas.
  • Don't use gas oven or stove to heat your house.
  • Don't burn charcoal inside your home, garage, or tent or camper.
  • Don't leave cars running inside the garage.
  • If you are using a kerosene heater indoors, make sure there is good ventilation.

Prognosis:

Carbon monoxide poisoning can cause death. For those who survive, recovery is slow. Prognosis depends on the amount and length of exposure to the carbon monoxide.

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.

April 14, 2010

Chlorine Poisoning And Chlorine Burns (part II)

Treatment:

  • Seek medical help immediately.
  • If the chemical exposure was on the skin or the eyes, cleansing of the skin or eyes with large amounts of water for at least 15 minutes. If the exposure on the skin results in chemical burn see chemical burns part I, II.
  • If the patient swallowed the chemical substance immediately give the person water or milk, unless told not to by a medical care provider. Don't give water or milk if the patient is vomiting, having convulsions, or other symptoms that make it hard for the patient to swallow. Don't make the patient throw up unless told to do so by a physician.
  • If the chemical is inhaled move the patient immediately away from that area to an area where there is fresh air.
Prevention:

Certain protective measures can be followed to prevent exposure to toxic levels of chlorine.

  • Protective masks and good ventilation for those working with the chemical will help avoid inhalation while working with the chemical.
  • Face shield and eye protection with breathing protection will help protect the eyes.
  • Protective clothing and insulating gloves will help protect the skin.
  • Proper handling of the chlorine containing substance.
  • Keeping all bleaching materials out of the reach of children in well secured containers.

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.

April 13, 2010

Chlorine Poisoning And Chlorine Burns (part I)

Chlorine is a chemical compound that is found in a liquid and a gaseous form. The liquid is colorless to amber colored and the gas is greenish-yellow in color.

Chlorine is used in water purification because it prevents bacteria from growing. It is found in swimming pool water. Chlorine is used as a disinfecting agent in mild cleaners and some bleach products. It is also used in industrial products such as industrial plastic production and other industrial and consumer products.

Chlorine poisoning occurs when a person swallows it or inhales it. Chlorine reacts with water inside and outside the body to form acids which are extremely poisonous.

Symptoms:

The symptoms will depend on the part of the body affected.

  • Respiratory: may include cough, sore throat, a choking sensation, breathing difficulty, upper airway irritation and burns to mucous membranes and lungs, pulmonary edema (fluid filling the lung), inflammation of the sinuses and lungs, and lung infection.
  • Blood: change in the acidity of the blood.
  • Eyes: watering of the eyes, pain and burning sensation in the eyes, redness, burns, loss of vision.
  • Skin: when the skin comes in contact with chlorine it may lead to, irritation, pain, redness, burning sensation, frost bite, skin burns (see chemical burns part I, II).
  • Heart and blood vessels: collapse, possible arrhythmias (abnormal conduction), decrease in blood pressure.
  • Gastrointestinal: nausea and vomiting, severe abdominal pain, burns to the food pipe, vomiting blood or blood in the stool.
  • Nervous system: headache, dizziness, decrease consciousness level, coma.
  • Kidney: it may lead to kidney damage.
  • Liver: it may lead to liver damage.

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.

April 12, 2010

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy is a non invasive mode of medical treatment in which the patient is entirely enclosed in a pressure chamber filled with oxygen at a pressure greater than one atmosphere.

It is a painless procedure that can be carried out in either in a monoplace chamber where only one patient is in the chamber, or a multiplace chamber where the patient along with someone else are inside the chamber. The chamber is pressurized with 100% pure oxygen.

Topical hyperbaric oxygen therapy technique includes delivering 100% oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure through special devices. The patients may be trained and can use these devices at home.

There are many conditions that may benefit from hyperbaric oxygen therapy such as sores and gangrene that will not heal or that are related to diabetes, decompression sickness, osteomyelitis, severe anemia and others. Healing wounds and burn victims can benefit from this treatment with its effect on body tissues and wound healing.

In severe thermal burns tissue damage will happen leading to hypoxia (insufficient supply of oxygen) and tissue death. Tissue damage may progress due to the failure of the surrounding tissue to supply borderline cells with oxygen and nutrients necessary to sustain viability. Hypoxia will prevent normal wound healing. HBOT will accelerate wound healing by providing the oxygen needed to stimulate and support wound healing.

Burned patients have increased susceptibility to infection due to the loss of skin which acts as a barrier to bacterial invasion. HBOT can be useful in treating some of these infections. It can act by enhancing leukocyte and macrophage activity, potentiating the effects of antibiotics and act directly on anaerobic bacteria.

Hyperbaric oxygen therapy is also used in the treatment of smoke inhalation. Carbon monoxide has a high affinity to hemoglobin and when it is inhaled it will bind to hemoglobin forming a compound called carboxyhemoglobin (COHb), this will lead to hypoxia and decrease oxygen delivery to tissues. Hyperbaric oxygen decreases the half life of carboxyhemoglobin and fasten the disassociation of carbon monoxide from hemoglobin making hemoglobin available for oxygen.

Side effects may include:

  • Ear and sinus barotraumas.
  • Myopia.
  • Aggravation of congestive heart failure.
  • Oxygen seizures.
  • Pulmonary barotraumas
.

The Hyperbaric oxygen therapy course will vary depending on the condition, severity and the response of the patient to therapy.

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.

April 8, 2010

Airway Suction, Bronchodilators, Chest Physiotherapy

Airway Suction:

Smoke inhalation injuries may lead to edema (swelling) of the lining of the airway, this may lead to the accumulation of secretions in the airways, these secretions need to be cleared as they may increase the risk of infection and increase the risk that these secretions may be aspirated leading to inflammation of the lungs and pneumonia.

Nasotracheal suctioning is done by inserting a suction catheter through the nasal passages and pharynx into the trachea in order aspirate these secretions.

Bronchodilators:

They are drugs that may be useful in smoke inhalation injuries; these drugs cause bronchial smooth muscle relaxation leading to dilatation and an increase in the diameter of the airways which in turn will improve respiration.

Chest physiotherapy:

It is one of the methods used in the treatment of smoke inhalation injury to aid in the removal of secretions from the bronchial tree; it is gravity assisted bronchial drainage. There are multiple positions in which the patient can be placed for postural drainage.

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.

April 7, 2010

Pennsylvania Burn Camps


Pennsylvania Professional Firefighters Association Camp:

Pennsylvania

The PPFFA camp provides a place where burn survivors can unite with each other, share their stories, play and have fun in a caring and safe environment. It's opened to burn survivors between the age of 6 and 17.

For mor information see the website

Email: DSchmidt@ppffa.org

West Penn Hospital summer Burn Camp:

Pennsylvania

This camp is one of the programs of the West Penn Hospital Burn Trauma Center. This camp is held each June for children ages 7-17 who have been patients in West Penn's Burn Center. This camp will provide an environment for children who were burned to have fun and be carefree for a week. This supportive environment will also help these children in raising their self-esteem knowing that there are others who have gone through the same thing. This camp also provides therapeutic services to the campers.

For more information see the Website.

Email: slewis3@wpahs.org

April 2, 2010

The Burn Team (part II)

  • Speech and language therapists and pathologists: they help the patient with swallowing issues, they can help with vocal cord issues, and communication needs (if the patient can't speak) and they can help teach the patient with a tracheotomy how to speak.
  • Respiratory therapist: they manage and administer oxygen, breathing treatments and other respiratory needs. If the patient's injury is severe; the patient might need breathing assistance with the aid of mechanical ventilator (see mechanical ventilator part I, II).
  • Dietitian: the dietitian develops a nutrition plan for the patient to promote wound healing and minimize weight loss, (see nutrition and burn).
  • Psychologist or psychiatrist: their duty is to provide counseling and support to patients with psychiatric issues or psychological distress as a result of the burn injury.
  • Social workers: they offer help with practical concerns, benefits, financial and social issues, supportive counseling in the hospital and planning of discharge from the hospital. They also help identify helpful services in the community.
  • Child life specialists: they help children and their families. Their goal is to maintain a child's development, emotional wellbeing, and the ability to cope with the illness, procedures, dressing changes and the stress associated with wound care. It is done through play, self expression and other forms of age appropriate therapy.
  • Pharmacist: they dispense and monitor the medication given to the patient and provide any information needed about their use and their side effects.
  • Case managers and discharge planners: they help with funding the services and equipments of the patient. They make sure that there is a smooth transition from the hospital to a home or to a rehabilitation center.
  • Ward clerk: involved in organizing the admission and discharge papers and direct phone calls to the patient.
  • Chaplains: they can help with the religious and spiritual needs of the patient and the family.
  • Translators: can be provided if needed by the patient or the family.
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.
April 1, 2010

The Burn Team (part I)

Taking care of a burned patient in a hospital requires a team effort. This team is called the burn team which is a group of people with different specialties who work together to help the patient and his/her family.
The members of the burn team with some variation from one hospital to another include:


  • The patient: you are the key member of the burn team, when you are admitted you may meet different members of the team. Each team member plays an important role in your recovery. As your condition improves, you will become more independent and will help set goals for your care. Make sure to ask the team about any concern that you have. Communication and understanding are very important.

  • Family: your family is an important member of the team. They should not hesitate to ask the team about any question or voice any concern they might have. Family plays an important role in providing the encouragement and emotional support that the patient needs. They will be taught how to deal with and handle situations they might face in the burn center or at home.

  • Burn surgeons and other specialty surgeons: a burn surgeon is a surgeon who is specialized and trained in burn care, wound care, skin grafting and plastic surgery. The burn surgeon who is monitoring wounds, healing, and signs of infection is the team leader who gets help from the other specialists and staff as needed. There are other specialty surgeons who may also be involved in the team such as plastic surgeons, orthopedic surgeons, ophthalmic surgeons, vascular surgeons and others.

  • Trauma intensive care doctors: these physicians are specially trained to care for the needs of critically ill adults. They work with the burn surgeons and other specialties.

  • Pediatric intensive care doctors: they are specially trained to care for the needs of critically ill pediatric patients. They work with the burn surgeon and other specialties.

  • Medical physicians: depending upon the injury, other physicians may be consulted to help the team with the care needed for the patient, these physicians may include: internists, ophthalmologists, nephrologists, cardiologists and other specialties.

  • Nurses: the nurse will be with you for the longest period of time each day; the nurse is skilled in burn care. Patient and family cooperation will help facilitate the nurse when caring for the patient. Nursing staff may include: registered nurses, licensed practical nurses, clinical nurse educators, nurse assistants and others. The staff is usually directed by a burn center nurse manager.

  • Physical therapists: they are involved in exercises to help improve joint movement, strengthen muscles and improve general function. Physical therapy is important to prevent contracture and restricted movement. The physical therapist will work with you on an exercise program. He/she may develop a home exercise program as well as follow up with the patient after discharge.

  • Occupational therapists: they are involved in evaluating and assessing the functional abilities and what equipment is required by the patient. They make splints to help prevent and/or reduce contractures, among other responsibilities are teaching the patient how to accomplish activities of daily living and to provide a program for splinting and exercises.

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.