September 2012 Archives

September 27, 2012

Tap Water and Scald Burns (part II)

Hot water scalds can cause severe burn injuries leading to lengthy hospital stay that may result in scaring and permanent disfigurement or even death. As the majority of these scalds injuries happen at home it's important to follow certian measures that may prevent these types of burn injuries which are common in elderly, young children and people with disabilities.

Prevention of tap water scald injuries may include:

  • Setting water heater thermostats at a temperature not higher than 120°F (49°C), the safest water to bathe is about 100°F (37°C)
  • Educating parents and caregivers about the consequences and complications of hot water scald injuries
  • Constant adult supervision of young children, children with disabilities and elderly who have difficulty in removing themselves from hot water while in bath water or near facets.
  • Filling tub with cold water first then add hot water, check the temperature of sink or bath water before allowing children contact with it.
  • Don't bathroom tub unattended while it's filling and never leave older sibling with a younger one alone in bath water or near faucets
  • Facing children away from tap handles in a bathtub or sink while bathing them so that the child can't reach the handle and turning the handle to the cold position when not in use
  • Keeping bathroom door closed when not using it and not using it as a play area
  • In elderly and unsteady people install grab bars and non slip mats in the showers or tubs
  • If there is difficulty or a problem with standing unassisted than use a shower chair when showering or bathing.
  • Elderly and People who need assistance have to be provided with a way to call for help like a bell or a whistle in case of emergency
  • To prevent sudden fluctuations in water temperature while someone is showering avoid running water, flushing the toilet or using a machine that uses water
  • Installing a master thermostatic mixing valve at the water heater and thermostatic mixing valves in bathrooms
  • Installing an anti scald devices which are inexpensive, simple to install on most existing taps and can be found in pluming and hardware stores. These devices are heat sensitive and interrupt or stop the flow of water when its temperature reaches a predetermined temperature generally 110-114° but before reaching 120°F (49°C)
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 25, 2012

Tap Water and Scald Burns (part I)

One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.

Scald burns can happen to anyone but there is a vulnerable population which can be affected that includes young children, elderly people and people with disabilities. Many people are unaware that it needs a short exposure period to hot tap water to cause serious burns. People at high risk of developing scald burns are:

  • Young children have thinner skin, this results in deeper and more severe burns. Children have greater body proportion that is exposed to a scalding substance.
  • Elderly people have thinner skin leading to deeper and more severe burns. Elderly people may also have other medical conditions that make them more liable to fall in the bathtub as well as decreased sensation of heat and poor microcirculation leading to slow release of heat from the burned tissue.
  • People with physical and cognitive disabilities
  • Crowded families and families with low socioeconomic status
  • Single parent and parents with poor education.
As a standard, the maximum temperature of water delivered to the tap by residential water heaters is 120 degree Fahrenheit (48 degree Celsius).

Temperature/scald burn:

113°F (45°C) lead to second degree burn in 2 hours and third degree burn in 3 hours
116.6°F (47°C) lead to second degree burn in 20 minutes and third degree burn in 45 minutes
118.4°F (48°C) lead to second degree burn in 15 minutes and third degree burn in 20 minutes
120°F (49°C) lead to second degree burn in 8 minutes and third degree burn in 10 minutes
124°F (51°C) lead to second degree burn in 2 minutes and third degree burn in 4.2 minutes
131°F (55°C) lead to second degree burn in 17 seconds and third degree burn in 30 seconds
140°F (60°C) lead to second degree burn in 3 seconds and third degree burn in 5 seconds

Hot beverages like coffee and tea are usually served at 160-180°F (71-82°C) and can cause instant burns when falling on the skin, these burns will require surgery.

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 20, 2012

Intentional Burns

Intentional burns are less frequent than accidental burns but can happen. They are either burns that are caused by the person to him/herself or burns caused by one person to another one. Children and elderly are susceptible to abuse by burns. In children scald and contact burn injuries are the most common type of intentional burn injury. These injuries have a higher death rate than accidental burns and require a longer stay period in the hospital. Elderly cases are reported with much less frequency than children due to embarrassment or fearing that the person who is causing the injury will repeat it again. Things that raise a suspicion of abuse are:

  • The story given doesn't go along with the injury that happened.
  • Giving different explanations about how the accident happened.
  • There are multiple injuries and this is not the first one.
  • The shape and location of the injury may give an indication that it's an induced injury.
For elderly people suspected to have an induced burn injury, they should be reported. For children with suspected abuse, a call should be made to report it to the police, child protective services, and /or a doctor. If you are the one who is exposed to the injury you should look for help. If you are taking care of a child and you can't control your anger seek help. If a person you know is the one who is exposed to the insult than try to seek help for him/her.

If a person is causing burns to his/herself, a psychological evaluation and treatment may be needed.

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 11, 2012

Severe Burns and Cellulitis (Part II)

Predisposing factors:

  • Burns (second degree and third degree burns).
  • Skin diseases such as boils, eczema and psoriasis.
  • Weak immune system such as in AIDS and patients using immunosuppressive drugs.
  • Diabetes. (feet burns in diabetic patients)
  • Old age.
  • Diseases affecting the circulation of blood to the lower limbs such as varicose veins.
  • I.V drug abusers.
  • Varicella.
  • Dense populations who share hygiene facilities and common living quarters such as nursing homes, homeless shelters and college dormitories.
Clinical features:
  • The area affected is red, tender and swollen.
  • Increased warmth in the affected area.
  • Regional enlargement of lymph nodes may be present.
  • Fever, headache, nausea and chills may be present.
  • Red streaking visible in the skin proximal to the area of cellulitis may be seen.
  • Abscess.
  • Ulceration.
Diagnosis:
  • No work up is needed in uncomplicated cellulitis and the diagnosis is based on the clinical features.
  • In complicated cases, cases with generalized sepsis and when any of the predisposing factors are present, the following tests may be done: Complete blood count, Blood culture, Blood urea nitrogen and creatinine level, US and others.
Treatment:

Cellulitis is potentially serious as it spreads quickly and can lead to more serious complications. If it is not treated, the infection can spread to the blood or lymph nodes and in rare cases the infection can spread to the fascia which is the deep layer of tissue causing a disease called Necrotizing Fasciitis (flesh eating bacteria) which is a medical emergency that can lead to death. Treatment of cellulitis include:

  • Rest of the affected area.
  • Antibiotics: either oral or intravenous depending on the severity of cellulitis, the presence of risk factors and presence of complications.
  • Pain killers.
  • Debridement of the dead tissue.
  • Hyperbaric oxygen therapy may be used in some cases.
Prevention:

Prevention is done by taking a good care of cuts, wounds and burns, if you develop signs and symptoms of cellulitis, seek medical help quickly to avoid complications. (see burn wound care at home)

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 6, 2012

Severe Burns and Cellulitis (Part I)

The skin is the first line of defense against infection, it is composed of three layers, the epidermis, the dermis and the subcutaneous tissue layer (see the skin). Infection is the leading cause of death among hospitalized patients with burns. Normally the surface of the skin contains a mixture of microorganisms called normal skin flora, these flora live on the surface of skin and cause no disease unless the skin is damaged and/or the immune system is compromised. (see wound infection)

Cellulitis is an infection of the dermis and the subcutaneous tissue layer of the skin, cellulitis can be caused by normal skin flora or by exogenous bacteria, where in most cases the skin has previously been broken such as:

  • Second degree and third degree burns which lead to blister formation that can open and become infected.
  • Cracks in the skin.
  • Cuts in the skin.
  • Sites of intravenous catheter insertion.
  • Surgical wounds.
Cellulitis can affect any part of the skin but it commonly affects the skin on the face or the lower legs.

Causes:
The most common bacteria causing cellulitis is Group A Streptococcus and Staphylococcus aureus, both of them are part of the normal flora of the skin and are harmless when they are on the outer surface of the skin but cause infection when they enter the skin. Group A Streptococcus is found on the skin and the throat while Staphylococcus aureus is found on the skin and the mucosa (lining) of the nose and mouth. Other exogenous bacteria can cause cellulitis and in some cases people get cellulitis without a break in the skin.

Kramer and Pollack, LLP; are VERY well versed in all aspects of representing burn injury victims. They have handled a multitude of burn injury cases ranging from hot water scald burns, to stove tipping cases to explosion cases. They are competent, experienced and very thorough

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.