Burn Injury Resource Center

Also known as Adult Respiratory Distress Syndrome is a life threatening lung condition in which fluid accumulates in the lung leading to low levels of oxygen in the blood.

When a healthy person breathes, air will enter the nose and mouth passing through the trachea (windpipe) to reach the alveoli (air sacs) of the lungs. Oxygen will pass from the alveoli to small blood vessels surrounding the alveoli called the capillaries and from the capillaries to the bloodstream where it will be carried to different parts of the body. When the lung is injured from many causes including severe burns fluid and blood will leak from the capillaries into the alveoli, this will prevent air from entering the alveoli leading to decreased oxygen in the bloodstream and in turn decrease the oxygen supply to different organs which will affect their function. The lungs become inflamed, the inflammation will lead to scaring and fibrosis of the lungs causing the lungs to become stiff. This stiffness of the lung with fluid will make breathing very difficult for the patient.

Causes may include:

• Sepsis.
• Pneumonia.
• Severe burns.
• Massive body trauma.
• Inhalation of smoke or toxins.
• Gastric aspiration.
• Transfusion of multiple units of blood.
• Drug over dose.
• Pancreatitis.

Symptoms and signs include:

• Difficulty in breathing.
• Increased respiratory rate (tachypnea).
• Increased heart rate.
• Fever.
• Anxiety.
• Wheezing herd with a stethoscope.

Diagnosis:

Investigations include arterial blood gas measurement, Chest X-ray, monitoring pulmonary capillary pressure by a pulmonary artery catheter introduced through a vein. Depending on the cause other investigations may include Complete blood count, liver function test, renal function test, CT scan and bronchoscopy.

Treatment:

Patients with ARDS are hospitalized and are treated in the Intensive Care Unit which include

• Oxygen supplementation and the use of a mechanical ventilator (See mechanical ventilator part I, II).


• Antibiotics and corticosteroids may be used.


• Intravenous fluid to prevent dehydration and provide nutrition.

Outlook:

Survival rate of patients with ARDS has improved; among factors that affect the outlook are the age of the patient, underlying cause of ARDS and any associated illness. Normal lung function is resumed in some patients after recovery. However others may experience breathing difficulties ranging from mild to severe. Patients who spend a long time on the ventilator and those with severe disease are more liable for persistent lung 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.

Treatment:

Acute compartment syndrome is considered a medical emergency that requires immediate surgical treatment. The surgical procedure is called a fasciotomy which is simply done by making a long incision in the fascia to release the pressure building inside.

Subacute compartment syndrome is treated surgically by urgent fasciotomy.

Chronic compartment syndrome can be treated conservatively if it's in the lower limb (this may include the use of anti-inflammatory drugs, rest and elevation of the limb). If there is no improvement and the symptoms persist surgery may be necessary.

Complications:

If the pressure in the compartment is not relieved, this may lead to functional impairment of the affected area due to permanent damage to the nerves and muscles. In more severe cases limb amputation may be needed as a result of death of the muscles in the affected compartment which resulted from the lack of blood supply.

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.

A compartment is defined as a closed space of nerves, muscle tissue and blood vessels. This space is surrounded by fascia (thick layer of tissue) that doesn't stretch. When the pressure inside the compartment increases from any cause and if the pressure increases substantially, this may lead to the compression of the nerves, blood vessels and muscles inside the compartment. The result may be impaired blood flow and reduced oxygenation that may result in muscle and nerve damage. Compartment syndrome most commonly involves the forearm and lower leg although it can occur in other places. Compartment syndrome can be acute, subacute or chronic (see below).

Causes:

An injury that leads to an increase in the pressure inside the compartment may cause compartment syndrome, these may include:

• Burns.
• Car accidents or crush injuries.
• Hemorrhage (bleeding into the compartment).
• Tight bandages or casts.
• Intravenous drug injection.
• Surgery.

Signs and symptoms: may include

• Pain: it is usually severe pain and out of proportion with the injury. The pain doesn't respond to pain medication and is increased by stretching the muscle group within the compartment.
• Alteration or decrease sensation of the skin.
• Paleness of the skin.
• Weakness and in later stages paralysis of the limb may occur if not treated.
• Capillary refill time (the rate at which blood refills empty capillaries) of the digits is prolonged.
• Congestion of the digits.

Diagnosis:

• Clinical diagnosis based on the signs and symptoms.
• Measuring the pressure inside the compartment. This may be done by inserting a needle attached to a pressure meter into the compartment.

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.

Burned patients need all the support they can get from family, relatives and friends. A burn injury is one of the most painful traumas a patient can ever experience.

One of the major concerns and challenges a burned patient faces is infection, (see wound infection). Burn centers have strict guidelines regarding infection control, depending on the patient's condition. When visiting a patient with burns, you should know the visiting hours and the number of visitors allowed which may be limited depending on the patient's condition.

Visitors may be required to wear a gown, mask, cap and gloves when visiting the patient. The nurse will give you instructions on the protective clothing to decrease the risk of infection. Look for any signs outside the patient's door that will tell you if you have to wear these protective garments when entering the patient's room. It's important to follow these instructions. You have to wash your hands prior to entering and after leaving the patient. Avoid visiting the patient if you have an active cold or an infection and inform the nurse about it if you do visit.

For children to see the patient, permission may be required from the nurse. They may also have to wear the protective garments as well. It's important to keep a quiet atmosphere while visiting the patient. It is also important to know the resting period of the patient, the treatment periods and burn team round periods to avoid as you may be asked to leave the burn unit during these times.

Although it's hard to see your loved one suffering, it's important to keep a positive attitude in front of the patient encouraging him/her and raising the patient's spirit.

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.

It is a surgical procedure, in which a hole is created through the front of the neck and into the windpipe (trachea). A breathing tube (trach tube) is placed directly into the trachea through the opening to help the patient with breathing and to remove secretions from the lungs.

The condition that necessitated tracheostomy and the overall health of the patient will determine how long the tracheostomy will stay. A tracheostomy is usually temporary but some patients may need them for a longer period of time or even permanently.

Patients of all ages may need tracheostomy. It can be done on an emergency basis such as when there is trauma to the neck or on an elective basis. The type of anesthesia used for the procedure is general anesthesia.

Indications:

Among the conditions that tracheostomy may be used for:

• Airway injuries from smoke, steam or chemical burns.
• Congenital (inherited) abnormality of the larynx or trachea.
• Neck cancers that affect breathing.
• Severe face or neck injury.
• Severe allergic reactions or infection.
• Airway blocked by a large object.
• Spinal cord injuries.
• Long-term coma.
• Patients who need to be on ventilators (see Mechanical Ventilator part I, II) for more than 1-2 weeks.

Risks associated with tracheostomy may include:

• Risks related to anesthesia such as reactions to medication.
• Risks related to surgery such as bleeding and infection.
• Scarring of the trachea.
• Blockage of the tracheostomy from dried secretions and mucous.
• Nerve damage.
• Failure of the closure of tracheostomy after the removal of tube.

A therapist will work with the patient once the tracheostomy is mature to regain the ability to swallow normally. Some patients may need swallowing tests to make sure that they can swallow safely before starting normal swallowing. During the period where the tracheostomy is maturing, patients will be fed by other methods such as through a vein or through a tube that goes through the mouth or nose to the stomach.

As for talking, a speech therapist will work with the patient after the maturity of the tracheostomy to help him/her to use his/her voice clearly; one of the options is to use a speech valve that is attached to the tracheostomy tube.

When there is no longer a need for tracheostomy (temporary one), the tube will be removed eventually and healing will occur leaving a minimal scar.

Some Patients will be discharged home having a tracheostomy, they and their families will be taught how to take care of their tracheostomies at home. These patients should adhere to the safety precautions that they were taught such as exposure to water. It is recommended that a tracheostomy opening be covered by a loose covering when the patient is outdoors.

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.

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.
Clinical features of scald burns:
Clinical features of scald burns depend on the severity of burn whether it's a first,second or third degree burn. Clinical features may include:

• Redness of the skin
• Pain (may be absent in third degree burns as the nerves responsible for sensation may be destroyed)
• Swelling of the affected area
• Blisters (may develop in second degree burns)
• Peeling if the skin in the affected area
• White, stiff, waxy or charred skin (may happen in third degree burns)

Treatment:

• Avoid panicking and remove the victim from the source of burn as soon as possible.
• Cool the burned area immediately under running cool water for 10-30 minutes. Never use ice, any greasy substance or cream as this may lead to more damage
• Seek medical assistanace
• Keep the victim as comfortable as possible
• Remove any watch, jewelry or clothing from the affected area; don't try to remove anything that is stuck to the burned area as this may lead to more damage
• Cover the burned area with clean, non fluffy material to keep it clean and protect it from infection. Avoid breaking the blisters and avoid using adhesive dressings
• Treat associated symptoms like shock

When to seek medical assistance:

• When the victim is over 60 years of age or under 5 years of age
• When the victim is pregnant
• When there is pre-existing conditions such as lung disease, heart disease, compromised immune system
• When the burn is large, deep, or if blistering is present
• When the burn is located on the face, neck, hands, feet, joints, limbs, genital area, buttocks or around the upper body
• When there is signs of infection which may include increase redness, increase pain, increase swelling, fever, foul odor discharge, pus, non healing wound after several weeks or there is new unexplained symptoms
• When the victim has diffeculty breathing or has inhaled smoke or fumes

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.