July 2012 Archives

July 25, 2012

Factors Affecting The Healing of Burns

Burns are wounds. Wound healing is a complex process that can be affected by many factors. These factors may include:


  1. The age of the patient: elderly patients have delayed wound healing due to the fact that the blood supply is decreased to some parts of the skin with the presence of relative hypoxia (decreased oxygen). Very young and the elderly may not be able to mount an effective inflammatory response due to immature cells and less efficient physiological functioning respectively. See burns in geriatrics, Burns in pediatrics.

  2. Nutrition: nutrition plays an important factor in wound healing; patients who are malnourished have a decreased collagen formation. Wound healing requires protein synthesis therefore protein requirement increases in the presence of wound. Vitamins are also important for wound healing, vitamin C is important in collagen synthesis and in maintaining the immune function. Vitamin A is also important in promoting wound healing. zinc is important for wound healing as it's deficiency may impair wound healing, elderly are more liable for zinc deficiency due to poor intake and absorption. Zinc is important for many enzymes involved in the repair of tissue. Iron is important in collagen synthesis. Copper is also important as it's a co-factor for an enzyme called lysyl oxidase which is needed for cross linking of collagen molecules. See Nutrition and burns, Burns and fluid replacement.

  3. Infection: infection can affect wound healing and may lead to a delay or a non healing wound, infection has to be cleared before healing can take place. See Wound Infection, Burn wound care at home, Discharge home after a burn injury, Post hospital burn care.

  4. Presence of other illnesses: many illnesses can affect wound healing among which is diabetes. Diabetes affects the blood vessels leading to a change in the blood supply to the wound which in turn impair the delivery of oxygen and nutrients. Diabetes also affects the peripheral nerves leading to decreased sensation and a serious wound can result from a minor trauma. The wound of diabetic patients are more liable for infection. One of the other diseases that affect wound healing is malignancy in which the malignant cells grow very fast and nutrients are diverted from the wound side to the malignant cells. Loss of appetite and loss of weight in patients with malignancy also affect the healing of the wound. See Feet burns in diabetic patients.

  5. Medications: such as steroids which are anti-inflammatory that decreases inflammation and decreases the production of collagen, this will change the wound healing process and may delay wound healing.

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.

July 24, 2012

Third Degree Burns and Burn Recovery Beds

One of the complications of severe burns (second and third degree burns) is bed sores. Bed sores which are also called pressure ulcers, pressure sores and decubitus ulcers are injury to the body tissues resulting from the compression of these tissues between two hard surfaces such as the bed mattress and other body parts like bones.

Risk factors for bed sores:

  • Bedridden people such as those with severe burns and wheelchair bound people
  • People with chronic illnesses such as vascular diseases and diabetes
  • People who are paralyzed or who can't move certain body parts such as brain injury
  • Older age people with fragile skin
  • Mental disability from certain conditions like Alzheimer's disease
  • People with bowl or bladder incontinence
Burn recovery bed or burn bed is a special hospital bed that is designated for people who have suffered severe burns across large portions of their body. The main purpose of this bed is to distribute the patient's weight evenly to ensure body contact over the largest area possible.

Air chamber burn bed:

This is a type of weight distributing burn bed in which the mattress is formed of groups of inflatable air sacs that can be adjustable in each section to different air pressure and made of material permeable to water vapor. The air sacs are maintained in a partially deflated state so that the air pressure can freely distribute itself. This prevents the formation of bed sores and ensures that the patient's skin is kept dry in a comfortable and controlled warm air atmosphere. There is no friction against painful burn wounds as well as less turning the patient allowing for longer nursing periods of the patient.

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.


July 17, 2012

Severe Burns and Sleep Disturbance (part II)

Treatment of sleep disturbance associated with severe burns:

Treatment may not be easy, there are different types of treatment strategies. Your physician or the burn team may ask you questions regarding your sleep habits in the past and factors that affect your sleep. Factors that affect the treatment type are:

  • What caused the sleep disturbance.
  • What is the type of sleep disturbance.
  • What is the severity of sleep disturbance.
  • What is the recovery stage of the patient.
Treatment types:

A- Non pharmacological treatment: in this type of treatment no medications are used. This includes:

1- Keep a regular sleep schedule and a good sleep hygiene : This may include

  • Practicing to decrease naps during the daytime as they interfere with the pattern of sleep. If you must nap, do it in the early afternoon, at the same time daily and not lasting more than 30-60 minutes.
  • Setting a regular bedtime and wake up at the same time every day.
  • If you have been awake for 15 minutes and have difficulty in falling a sleep, try getting out of bed and doing something non stimulating such as listening to music or reading a book. Avoid screens of any type such as computer, I pad and TV as the brain is stimulated by the type of light they emit.
  • Cutting down on caffeine which is a stimulant that can be found in coffee, chocolate, etc. Food, drinks and medications that contain stimulants should be avoided in the late evening.
  • Alcohol can affect sleep quality, contact your treating physician and ask him if it is safe to drink alcohol. If you are on medications that make you drowsy, consuming alcohol can be dangerous.
  • Quitting smoking and other nicotine containing substances, if you can't then avoid them near bed time as nicotine is a stimulant and can disturb sleep in numerous ways.
  • Staying away from big meals close to bed time, at the same time don't go to sleep and you are hungry. A light snack before bed can promote sleep.
  • Exercising is helpful in relieving stress and sleeping troubles. You have to start exercising as soon as you get clearance from your treating physician
.

2- Relaxation techniques:

Relaxation techniques can be beneficial for sleep problems, practicing them before bed time can calm the mood, reduce tension and prepare for sleep. Relaxation techniques may include:

  • Deep breathing: it is done by closing your eyes and taking deep slow breath, making each breath even deeper than the last.
  • Progressive muscle relaxation: it is done by tensing all the muscles as tight as you can, then completely relaxing them. Start at your toes and work your way up to the top of your head.
  • Imagining training: Close your eyes and imagine a calming place or activity.
  • Yoga.
  • Hypnosis: it is an altered state of consciousness, artificially induced.
B- Pharmacological treatment (medications):

Medications can be used to treat sleep problems and make sleeping better, they may be used alone or with other non-pharmacological methods. It is important to follow your physician's orders and take the medications as described.

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.


July 11, 2012

Severe Burns and Sleep Disturbance (part I)

Severe burns such as second degree burns and third degree burns can affect any aspect of the patient's life, one of these aspects is sleep. Sleep disturbance can happen in any stage of burn injury but it's common immediately after the burn, in the healing process and in the recovery process. About half of the patients who are affected by severe burns suffer from sleep problems and the most common is insomnia. Insomnia can present as difficulty in falling asleep, staying asleep, waking up too early in the morning, nightmares and poor quality sleep.

Many causes can lead to sleep disturbance following a burn injury and some of which may have a long lasting effect even after the patient being discharged home.

These causes may include:

  1. Pain.
  2. Itching.
  3. Post traumatic stress disorder.
  4. Stress.
  5. Depression.
  6. Some drugs used in the treatment of the above conditions.
  7. Nightmares and memories of the burn accident.
  8. Breathing difficulty were the breathing passages are affected by the burn injury such as in smoke inhalation injury.
  9. Certain chemicals in the body that regulate sleep can be affected by the burn injury.
  10. Scar tissue can lead to contractures which can restrict movement and affect sleep.
Effect of sleep disturbance on the patient:

Sleep disturbance can have an adverse effect on the patient and the healing process.
It may:

  1. Cause the healing process to be slower.
  2. Worsen pain.
  3. Cause depression.
  4. Cause behavioral changes.
  5. Cause restlessness and energy lack.
  6. Cause concentration problems and increase accidents risk.
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.


July 10, 2012

Child Protective Services (CPS): New York

Is a governmental agency that investigates and responds to any case of potential child abuse or neglect. Its purpose is to ensure that children are safe and to prevent any further abuse or neglect by the parents or the legal caregivers. CPS also helps families to get the services needed to guarantee a safe and a healthy home. CPS protects children from physical abuse, sexual abuse and neglect by the parents or the legal caregivers.

A suspected case of child abuse or neglect must be reported. Anyone can report a case of child abuse or neglect but professions who have regular contact with children like hospital personnel, teachers, social workers, and police are required to report suspected cases of child abuse or neglect by New York state law. The person who reports a case doesn't need to have any evidence of child abuse or neglect. A suspicion to a reasonable degree based on behaviors, observation and other information is enough to make a report. The 24 hour New York State Central Register number is 1-800-342-3720. When calling the person will be asked specific information and the report will be accepted if the information provided meets the legal criteria for child abuse or neglect. Depending on the county that the family lives in, the report will be given to the CPS in that area.

The CPS will assign a caseworker to meet the family and assess the situation to determine if there is child abuse or neglect and the steps required to deal with it if there is a case.

Among the rights they have, parents have the right to:

  1. Be notified that a report has been made and the CPS has to notify the parents in writing within seven days.
  2. Be given the contact information of the case worker and his/her supervisor (name, phone number and which department), if not given, the parents should ask for it.
  3. Ask for a copy of the information in the Central Register report, all the information in the report can be given to the parents apart from information regarding the person who made the report.
  4. Ask the caseworker and the supervisor about the case progress and its status.
  5. Parents should save all the documents and papers they get and attend all the meetings regarding the case.
  6. Be told by CPS about your rights if a case of child abuse or neglect is found.
  7. Request to change the information in the report if the parents think that the information in the report is inaccurate.
  8. Ask any question they have about the case. Don't hesitate to ask any question you have about your case.
Talk to the caseworker you are assigned to if you are not getting the services that you need. Services that are available differ from one place to another. Some programs and community services are free.

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.

July 6, 2012

Steven Johnson Syndrome and Burns (Part II)

Steven Johnson Syndrome is a systemic allergic reaction that has high morbidty and can lead to death in severe cases. It is charactarized by the appearance of rash on the skin and the mucous membrane. This syndrome can affect the eye, respiratory and nasal tracts, vagina and the urethra.

What are the complications of Steven Johnson Syndrome:

Steven Johnson Syndrome may affect any organ in the body. Some are serious and may even lead to death. Complications may include:

Skin complications: a target shaped rash appearing on the skin and mucous membrane that is red to purple in color that may lead to the formation of scars, other complications may include skin peeling, abnormal nail growth and scarring hair fall.

Eye complications: dryness of the eyes, corneal holes and ulcers, Conjuctival damage, damage to the eye tissues, scarring or complete visual loss.

Shock and sepsis: sepsis is a medical emergency in which bacteria enters the bloodstream and spreads through the blood to dofferent body organs that may lead to shock and organ failure.

Damage to internal organs: inflammation caused by the disease may cause damage to the internal organs such as the kidney, liver, heart and lungs. It may lead to respiratory failure,renal failure, scarring and stenosis in the vagina and the penis.

Diagnosis of Steven Johnson Syndrome:

The diagnosis of the disease is done by taking the patient's history, performing a physical exam looking for the signs and symptoms of the disease and/or performing laboratory test in the form of a skin biopsy.

Treatment:

Steven Johnson Syndrome is considered as a dermatological emergency and may require hospital admission as it may lead to death in severe cases. The cause of the disease should be identified if possible. If the cause is an allergic reaction to a drug, the drug should be discontinued. a precipitating agent should also be identified and removed.
The initial treatment is simillar to the treatment of patient with thermal burns. The treatment given to the patinet is both symptomatic to treat symptoms such as pain medications and mouth wash and supporive treatment to support such as feeding and intravenous fluids. Among the medicine used are Dexamethasone, cyclosporine, intravenous immunoglobin and others.

What is the prognosis:

Steven Johnson Syndrome is a rare medical condition with a low mortality rate (5%). Proper and early treatment help cure the disease and prevents complications. Risks include corneal ulceration and loss of vision or damage to other organs, that's why it's important for the patient to consult with an ophthalmologist if there is an eye complaint.

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.

July 2, 2012

Steven Johnson Syndrome and Burns (Part I)

Steven Johnson Syndrome is a systemic allergic reaction that has high morbidty and can lead to death in severe cases. It is charactarized by the appearance of rash on the skin and the mucous membrane. This syndrome can affect the eye, respiratory and nasal tracts, vagina and the urethra.

Causes: Steven Johnson Syndrome can be idiopathic (no known cause) or as a result of an immunological reaction to immunologic stimuli that can be diseases, drugs or infections, among these stimuli are:

A- Infections and diseases: They may include

  • Systemic Lupus Erythematosus (SLE)
  • Staphylococcal Scalded Skin Syndrome
  • Staphylococcus aurus
  • Herpes simplex virus type 2
  • Orf
  • Histoplasmosis
  • mycoplasma pnemumoniae

B- Drugs:They may include

  • Isoniazide
  • Phenytoin
  • Carbamazepine
  • Barbiturates
  • Clindamycin
  • Penicillamine
  • Thiabendazole
  • Procainamide
  • Diltiazem
  • Terbinafine
  • Suramine
  • Leflunomide

Clinical features of the disease:
Symptoms vary from one patient to another, It may affect the skin, the mucous membrane, it may affect the skin and the mucous membrane and may lead to pealing of the skin. When the disease involves the mucous membrane the mouth and eyes are affected in a severe way. it may lead to visial impairment. Common signs and symptoms include:


  • skin lesions which are itchy and painful

  • Skin blisters, target shaped skin lesions and/or burn like skin lesions

  • Mucous membrane lesions, blisters, swelling and/or ulcers

  • Mouth and throat rash and/or blisters

  • Gental rash and/or blisters

  • Malase, itching, cough and sore throat

  • Flue like symptoms, fever and headache

  • Conjuctival rash and/or blisters, vision loss

  • swollen painful eyes, corneal blisters, holes and/or erosion, loss of visio

Progression of the disease:
Steven Johnson Syndrome vary from mild to severe. In the early stages of disease the patient presented with flue like symptoms including sore throat, joint pain, malaise etc. with the progress of disease, skin lesions start to develop throughout the boday and continue to progress leading to blindness in advanced cases.

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.