September 2010 Archives

September 30, 2010

Central Venous Line and Infections (part II)

According to an article in the New England Journal of Medicine in December 2006, there was a 66 percent reduction in central-line associated blood stream infections after 67 hospitals in Michigan implemented a checklist developed by Peter Pronovost, M.D, Ph.D. Health and Human Services Secretary Kathleen Sebelius called on all hospitals across America to use the checklist to reduce central-line infections in ICUs by 75 percent over the next three years, this check list includes:

  • Washing hands before and after examining a patient or inserting, replacing, accessing, repairing and dressing the catheter (line).
  • Disinfecting the skin of the patient before inserting the catheter and during dressing changes.
  • Maintaining aseptic technique by wearing a mask, cap, sterile gown, and a steril gloves when inserting the line.
  • Avoiding placing the catheter in the groin because the groin area is hard to keep clean. A subclavian site is preferred.
  • Removing unnecessary catheters.
Not all hospitals follow this list. If a family member or a friend has to be hospitalized in intensive care, take this list with you and ask whether the intensive care unit uses it, says Dr. Pronovost in Consumer Reports. He also believes that public accountability powerfully motivates hospitals to get their infection rates under control.

Under new laws 27 states are disclosing infection rates or will have to while five years ago only four states did reported hospital infection rates.

Reporting infection rates in hospitals and making them public help people decide which hospital is better and which hospital to go to, therefore it is important to search and see whether or not your hospital provides information about its infection rate. In case your hospital's infection control rate is not good and you don't have the option of changing it then you, your family member should make sure that the hospital staff taking care of you are following measures necessary to prevent infection including washing the hands, using gloves, and using disinfectants. If a central line is needed, make sure that the staff is following the Pronovost checklist. You also play a role in reducing the chance of infection by following all the instructions given to you by your healthcare providers.

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.

September 29, 2010

Central Venous Line and Infections (part I)

A central venous line (central line, central venous catheter) is a long, thin, soft plastic tube that is introduced through a small cut in the skin into a large vein in the neck (internal jugular vein), arm ( arm vein), chest (subclavian vein) or groin (femoral vein). It is used to administer fluids, blood products, nutrients and medications over an extended period of time.

A central venous line is often placed in patients who require care in the intensive care unit to provide nutrition, medication and fluids. Infection can be one of the complications associated with the use of a central venous catheter. Blood stream infection can happen when bacteria and/or fungi enter the blood stream. Other complications may include bleeding, pain, blockage, kinking or shifting of the catheter, air embolism and lung collapse.

As the central venous line is introduced through an opening in the skin, bacteria can grow in this line making the patient more susceptible for blood born infection. Infections associated with a central venous line can be very serious as the bacteria causing these infections can multiply and spread quickly to the entire blood stream causing septicemia which can be fatal.

A Consumer Reports analysis of newly released data revealed that central line infections account for 15 percent of all hospital infections but are responsible for at least 30 percent of the 99000 annual hospital-infection-related deaths according to the best estimates available. Hospitals that are following simple hygienic steps have virtually eliminated those infections but many others are failing to act. Research shows that putting the catheter in the subclavian vein is best for infection control.

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.

September 28, 2010

Scar Massage

As the burn wound heals a scar will form. A scar is a fibrous tissue that will replace the normal tissue that was damaged by the burn injury. Depending on the severity of the injury a hypertrophic scar may form.

Scar massage can be used in the treatment of a hypertrophic scar in combination with other modalities of treatment. Scar massage can be started once the burn scar is mature enough to tolerate sheering forces, it stretches the scar and breaks down the fibrous bands, and this allows the scar to be more elastic and stretchy. Scar massage can also help in cases of contracture scars.

Heat and lubricants may be used with scar massage to increase tissue flexibility. It is found that scar massage can decrease itching and is also used for pain desensitization. Scar massage will be performed by your therapist, it may be painful in the beginning but with time your scar will become better and you will be happier. You and/or your family will be taught how to perform scar massage. Scar massage is performed twice or more a day (3-5 times is preferred). You have to follow the instructions given to you by your therapist who will frequently assess the condition of the scar and the progress of treatment.

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.

September 27, 2010

The Effect of Burns on the Kidneys

One of the life threatening complications of severe burns is acute renal (kidney) failure (ARF). ARF is a sudden loss of the kidney's ability to excrete waste, concentrate urine and conserve electrolytes.

According to a study done in Helsinki burn Center between 1988 and 2001, the mortality of ICU patients with ARF was 44.1% where as patients without ARF was only 6.9%. It is shown that the severity of the burn, the presence of smoke inhalational injury and the age of the patient are among the factors that play a role in the incidence of ARF. According to Holm and colleagues (Acute Renal Failure in Severely Burned Patients), if ARF occurs within the first 5 days after the burn injury it's early ARF, decrease blood pressure due to inadequate fluid replacement and the presence of myoglobin (muscle protein) in urine due to the destruction of muscle tissue as a result of burn, are common causes. If ARF occurs after 5 days of injury, it is late ARF; sepsis (severe infection spreading through the blood stream) is the most common cause.

ARF is treated with dialysis. As burns associated with ARF will worsen the prognosis, early preventive measures taken to reduce this complication include proper fluid replacement, infection prevention, early wound debridement, and excision of dead tissue.

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.

September 24, 2010

Survivor Story

In April of 1984, Jerry White, lost his right leg in a landmine accident, he outlines in his book "I Will Not Be Broken" five steps to cope with disasters and achieve strength and hope.

  1. You have to face the facts: a person must accept the facts and the reality that this thing has happened and you can't change it no matter what, you can't set the clock back to the time before that incident. Sometimes suffering results from attachment to ideas and things more than the loss itself.
  2. Choosing to live: look at the future and say yes to it, look at your life and choose it to go in a positive way, don't surrender to what happened, let go of the resentment and look always forward and not backward.
  3. Reaching out: after the incident there may come times of isolation and loneliness, break these times by reaching out to friends, family and people who have been through similar circumstances, don't wait for someone to reach you, it's up to you to reach to someone.
  4. Get moving: take steps to move on with your life, step out of your house to generate motion, take responsibility for your actions, see what steps you can take to return back to your normal life.
  5. Giving back: sharing your experience, skills and talents with others to inspire them to do the same. Survivors are in a special position to help and encourage others to heel and fulfill their potential. With the right support all survivors can heal and thrive. Ralph Waldo Emerson said "It's one of the most beautiful compensations of life that no man can sincerely try to help another without helping himself."

September 23, 2010

Face Facts

From the book "I Will Not Be Broken" by Jerry White

Survivor X was setting into his new work as an aid worker in Rwanda. His team was held hostage and shot by insurgent. He was the only one who survived after losing three of his colleagues. In order to save his life, his leg had to be amputated above the knee. He says that looking at the mirror and seeing himself different from before was one of the hardest things for him. He had to learn to be ok with who he was. He had to face the fact that he lost his leg and take care of the things that needed to be done.

Losing a body part was his worst fear in life as he says and it became true, but it wasn't so bad. His next worst fear was to learn to walk again and it wasn't that bad either. He found that life wasn't that bad and he had the courage to laugh after facing his fears.

September 22, 2010

Camp Phoenix

445 E 69th St #319
New York, NY 10021, U.S.A.

The mission of Camp Phoenix is to help pediatric burn survivors and their siblings. In this camp the campers will share their experiences and stories and will have a network of support that can help one and other. It's a safe exciting and a memorable experience that will not soon be forgotten.

For more details see the link to the camp.

September 21, 2010

Iron Burns in Young Children

Contact burns are common in young children. young children have the curiosity to explore things, they can get iron burns. Common causes of burns include leaving a child unattended while leaving a hot cloth iron or hair iron to cool.

It is also possible for adult using a cloth iron or a hair iron to suffer a burn. It is of great importance to avoid distractions (phone calls, conversations, television) while using any type of iron. It is also recommended that the iron be unplugged when not in use.

The surface area burned is small but it may be of concern depending upon the severity (see second degree burns and third degree burns)

Preventive measures can be taken to decrease the incidence of iron burns in children, these include:

  1. Parents becoming more accident conscious.
  2. Unplugging the iron when it's not in use.
  3. Never leaving a hot iron with a child unattended.
  4. When the iron is left to cool, unplug it, store it in a safe place and keep the cord out of children's reach.
  5. When ironing, use an ironing board instead of the floor or using low tables.
  6. Store curling irons in a safe place and on surfaces that a child can't reach.
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.
September 3, 2010

My name is Dashanda and I am a burn survivor (Part Six)

At home the memories of the kitchen would haunt me every time I walked by the kitchen. For months I would lean to one side when I walked because it would hurt to walk straight. I was afraid of taking showers and I was also afraid of hot water. I didn't want to get burned again so I would always take a bath. My mother would have to put cream on my burns and wrap me back up. Every time I took a shower someone had to be in the bathroom, so that I would not fall and open my wounds. Eventually we moved out of the apartment where my accident occurred. I attended eight grade which was challenging. My peers would stare and point at my arm, I felt like they was laughing at me. After a while, they got to know me personally. I overcame the stares and the looks, it does not bother me anymore. I am now 17 and I recently graduated High School. I showed everyone that I can do whatever I set my mind to. My family used to tell me that I can out of my shell. I've come out of my shell by being more open minded about my situation, talking to people about my experience. Not trying to hide my skin but letting others know that I am human too. I made a list of things that make me feel shy, uncomfortable or withdrawn. I tell people who are curious about my burns, that I am proud of the young woman that I have become. I know that I am beautiful inside and out and that is all that matters to me. Knowing that I respect myself plus everyone else around me there is no stopping my will to strive for the best. Being burned is not just skin deep it affects your personality. Just learning to cope with it is the hardest part. Some move on and some don't. I moved on. I didn't want to be sad all the time or fell pity. There is still a life out there and I plan on living it. In fact, I start college in the fall.

September 2, 2010

My name is Dashanda and I am a burn survivor (Part Five)

When I got home I had to get use to being there. I needed my mother to change my bandages. I attended a barbeque with friends down stairs from my grandmother house. I didn't stay very long because my back was hurting me. My shirt was stuck to my back and I could not remove the shirt. Unfortunately I was re-admitted to the hospital. The second time being there was easier than the first time. Technically it was still stressful being back in a place I was trying so hard to avoid. The only thing that needed to heal was my back. So they put a certain type of patch that went around my whole body. The patch contained some kind of medicine. The nurse never told me that I would constantly feel sharp pain. When I was in the bed I couldn't move a certain way because of the pain. The second time in the hospital I stayed by myself. That didn't bother me because I needed some time to be alone to think about how my life would be. I would read books to keep my mind off the pain. Sometimes I thought about how being burned affected my family. When I came home I still had to attend weekly visit to the doctors, physical therapy and home school. That's when they gave me my JOBST suit. A JOBST suit is a custom pressure garment. I had to wear it 23 hours a day, only taking it off when I took a shower and putting moisture on my burns. The type of lotion I used was Lubriderm. I received summer school because I had to constantly be watched. That was hard because it was just the teacher and me. But luckily I passed through out all of the pain I endured. Seeing people just like me made me feel like I was not alone. My doctors recommended burn camp so that I could meet other patients like me. Connecticut Burn Camp was life changing. I never knew that so many children were burned. Even the camp counselor shared the same experience. That was the first time I wore a bathing suit in front of friends. No one judge us because we were all burned or scared. We always asked each other to share out stories. I plan on being a camp counselor when I turn eighteen. I want to give hope to other kids and let them know that they get through this tough time.

September 1, 2010

My name is Dashanda and I am a burn survivor (Part Four)

The surgery was for a skin graft where I had 3rd degree burns. In surgery the doctors used a metal medical object so that they could peel the skin off from a healthy part of my body. Then the graft would be placed on the part of my body that had 3rd degree burn. After the surgery I had to stay in bed for a whole week which was so uncomfortable. They would monitor the amount of food I ate every day to make sure that I was eating the proper amount. Going to the bathroom in the pail was horrible. Depending on others was hard, because I was 12 years old; I was a big girl and not a baby. I felt like an angle with one of her wings cut off, I could not fly. But I always held my head up. While in the hospital I attended therapy, which was very difficult for me. I had to move my right arm so that my joints would not be stuck. Trying to lift my arm over my head or reach for a certain object was challenging. I played games with the nurse but I would have to put my left one behind my back and play with my right hand. Because I part of therapy was to stretch my right that was burned arm. Playing with just my right hand was good exercise therapy. Each day I got one step close to recovery. Stretching my back to loosen up my muscles brought me to tears. I told myself that I would never stop pushing myself. When it was time for me to leave the hospital I was still kind of scared to go out into the real world. To prepare me for discharge the doctors set me up with a psychologist. I talked to her about everything. I worried that I would not be accepted in school. I felt like no one would like me because I was burned, I became depressed feeling guilty, thinking that it was my fault. The psychologist insisted that I tell my mother that I was glad it was me instead of her. The psychologist came to see me in the hospital. She knew how I felt about people starring at me. But I knew that everyone was going to look at me different. She prepared me and gave me more confidence about myself. A few days later I got to go home the burn unit thrown me a going home party. I was ready to go home and be with my family. I helped my mother pack all my belongings. I knew I could not be in the sun so my mother brought me a jump suit. I was starting a new chapter in my life as a burn survivor. I knew I was ready for the new challenges that awaited me.