January 17, 2011

Scald Burns in Restaurant Workers (part I)

Scaled burns are one of the most common causes of burns in restaurants. They occur when the skin comes into contact with hot liquids or steam. Scalds with hot oil are generally more severe than those from hot water because oil heats to higher temperatures than water and oil is thicker so it may remain on the skin for a longer period of time. Scalds from water are very frequent in the restaurant industry and can cause third degree burns, (see also third degree burns part II) almost instantaneously if the water is boiling or simmering.

Job site hazards:

  • Slip or trip hazards can cause workers to stumble or fall. Slips, trips and falls are common events leading to restaurant worker burns. Many serious burns occur when employees slip and reach to steady themselves. This action often knocks hot liquids off of counters/stovetops on to the worker.
  • Carrying full containers of hot liquids is very dangerous to the employee carrying the container and to those working around them.
  • Cooking with boiling water, hot oil or other hot liquids puts you at risk of being burned from splashes or spills. Follow all safety procedures when cooking using hot liquids,
  • Working with or around pressurized cooking equipment is also dangerous. If pressurized equipment is not properly maintained or used, it can explode causing serious steam injuries.
  • Steam from microwaves can reach temperatures greater than 200 degrees rapidly in covered containers. Puncture plastic wrap or use vented containers to allow steam to escape while cooking in the microwave, or wait at least one minute before removing the cover.
  • Cleaning deep fryers or around deep fryers are common tasks associated with burn injuries in restaurants. Extreme caution should be used when cleaning the deep fryer and surrounding kitchen area.
Scaled burns are preventable and both the employers and the employees can reduce the risk of these injuries. 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.
January 11, 2011

Work Related Burn injuries in fast food restaurants to youth and how to prevent them

According to the report, injury risk factors may include inexperience, a reluctance to ask questions, absence of awareness of their legal rights and others.

When there is a burn injury at the job site, the immediate and proper first aid treatment may decrease the severity of the burn injury. Clean and flush the area with cool water, don't apply ice as it may cause more injury, cover the burn area with a clean dressing then seek medical help.

In restaurants, employers and employees should have easy access to first aid materials and should be trained on how to perform the basic first aid when there is a burn injury.
Among the proven measures to reduce burn injury in work places are frequent cleaning the floor with a grease cutting agent that can help preventing burns from the slip of an employee and getting in contact with a hot grill, coarse quarry tiles for flooring, using mates that are slip resistant and using gloves and handles equipped grill screens, scrapers and bricks can help prevent burns in employees who are working with or cleaning grills.

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.


January 11, 2011

I Suffered A Burn Injury, Do I Have A Case?

When someone suffers a burn injury, their immediate concern is their health, well being and what the future holds. The burn victim and their family should also consider whether or not the burns were the result of negligence. This question is best analyzed, considered and answered by a lawyer who has a considerable amount of experience in handling burn injury accident cases. One firm has a reputation of being very knowledgeable, diligent and savvy in this particular area of the law, that firm is Kramer & Pollack, LLP.. They have handled various burn cases resulting from fires, scalding water, stove tip overs, explosions, electrocutions , etc (here are some of the cases they have been involved with). They have been there for many families in the hours and days following catastrophic burns suffered by children and adults alike. They have held the hands of parents as their children lie trembling in pain in the burn unit. Their advice and guidance has been priceless and cherished by so many people.

We will ask Mr. Kramer to comment on different burn cases regarding liability or negligence. Liability or negligence means fault. In other words, Mr. Kramer will analyze different burn cases with respect to the role or responsibility other people or entities may have had which led to or could have avoided the burn injury. Most of the analysis will deal with 3rd degree burns (see also third degree burns part II).

You may think at first that the facts leading up to a burn injury are not sufficient to form the basis of a lawsuit. For example if you learned that someone was burned in a fire started as the result of a drug dispute you might think... how could the landlord be responsible. Or in another situation you may learn that a fire was started by a child who was playing with matches. If you thought in both situations that there was no case you would be wrong. These and many other cases will be analyzed in upcoming posts.

January 10, 2011

Chemical Peels

Are chemical solutions that are used to slough off and peel off the damaged outer layer to improve and smooth the texture of facial skin. Chemical peels can be used for facial blemishes, wrinkles and uneven skin pigmentation. It can also be used to remove precancerous skin growth and soften and reduce acne scaring. Chemical peels are most commonly performed for cosmetic purposes.

Formulas used as chemical peels include Alphahydroxy acids (AHAs), Trichloroacetic acid (TCA) and phenol.

Alphahydroxy acids: such as glycolic acid, salicylic acid and fruit acid, are considered as light chemical peels that may be used to treat areas of dryness, fine wrinkling, pigmentation which is uneven and acne.

Trichloroacetic acid: can be used in many concentrations. It's used as an intermediate to deep peeling agent, it may be used for treating superficial blemishes, fine surface wrinkles and skin pigmentation problems. TCA is preferred for darker skin patients; it can be used on the neck or other areas of the body and may require treatment with AHA or Retin-A cream.

Phenol: it's used to produce deep chemical peels; it is the strongest among the chemical solutions and its effect is long lasting. It should only be used for facial peels. It is used for the treatment of blotches caused by sun exposure or aging, precancerous growth and coarse facial wrinkles. Phenol effect is long lasting. Phenol peels may take several months to heal and may cause permanent lightning of the skin.

Complications of chemical peels:

Possible complications of chemical peels may include swelling, infection, burns, scarring, cold sore outbreaks and skin pigment change.

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.

November 12, 2010

Burns From Hydrofluoric Acid (HF) Part II:

Treatment:

Emergency medical attention should be sought when there is suspicion of poisoning:

If there is skin contact, treatment may include:

  • Removing the contaminated clothing.
  • Rinsing the wound area with copious amount of water.
  • Calcium or magnesium solutions, it can be given in the form of topical gel and may also be given in the form of injection.
  • Pain medication.
  • Monitoring the patient for signs of systemic poisoning.
For swallowing: treatment may include
  • Avoid inducing vomiting.
  • Gastric lavage (inserting a tube to the stomach though the nose to empty the stomach).
  • Pain medication.
  • Endoscopy to visualize the internal organs because of high risk of viscus perforation.
  • Endotracheal intubation to keep the trachea (wind pipe) open.
  • Calcium and magnesium solutions to neutralize the acid.
For inhalation treatment may include:
  • 100% oxygen through a face mask.
  • Intubation for severe injury.
  • Delivering calcium into the lungs through breathing treatments.
  • Pain medication.
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.
November 11, 2010

Burns From Hydrofluoric Acid (HF) Part I:

Hydrofluoric acid is a combination of hydrogen fluoride in water; it is used mainly for industrial purposes such as glass etching, metal cleaning and pesticide production. It's also found in house hold uses such as rust removers and heavy duty cleaners and aluminum brighteners.

Hydrofluoric acid is a weak acid that exists predominantly in the undissociated state that enables the acid to penetrate deep in the skin and soft tissue. Liquefactive necrosis of soft tissue and bones is caused when fluoride is liberated from hydrofluoric acid in tissue. Electrolyte disturbance can happen when the free fluoride ion binds to calcium and magnesium ions. Systemic toxicity can result from exposure to HF due to its ability to penetrate tissue, the degree of toxicity depend on the duration of exposure, the concentration of HF, the exposure route and the size of surface area affected. Any co morbidities should be considered with these factors to determine poisoning severity and treatment type to be given.

Clinical features of exposure to HF:

From touching the acid:

This type of exposure is the most common type in which the digits of the fingers are the parts of the body affected. The clinical features depend on the concentration of HF the person is exposed to. If the concentration was more than 50% there will be immediate pain with the skin becoming erythematous (Red) within minutes and blistering and edema (swollen) within hours. In severe burns there will be a central grey area of coagulative necrosis. It may take up to 8 hours for erythema and pain to develop at the site of contact when the concentration is between 20-50%. If the concentration is less than 20% symptoms may take more than 24 hours to appear. Burns from HF may be very painful and out of proportion to the burn appearance.

From swallowing the acid:

  • Nausea and vomiting.
  • fever
  • Inability to breathe as a result of swelling of the throat.
  • Severe pain in the mouth and throat.
  • Severe abdominal pain.
  • Rapid decrease in blood pressure.
  • Perforation of viscus.
  • Inflammation and bleeding of the stomach.
  • Death.
From inhaling the acid:
  • Fever.
  • Chills.
  • Bluish discoloration of the fingernails and lips.
  • Coughing.
  • Tightness of the chest.
  • Difficulty in breathing.
  • Chocking.
  • Fluid in the lung (pulmonary edema).
  • Acute respiratory distress syndrome.
  • Lung hemorrhage.

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.

October 28, 2010

Feet Burn In Diabetic Patients

Diabetes mellitus is a chronic disease that has many complications, among which is the effect of diabetes on the blood vessels leading to damage, narrowing and may lead to blockage of the blood vessels, leading to alteration of blood perfusion and subsequent reduction in the oxygen and nutritional delivery to the tissues which will affect wound healing. Diabetes can affect the nerves leading to nerve damage (diabetic neuropathy); nerves affected are responsible for temperature, pressure, texture and pain sensation. The nerves of the lower legs and feet when affected can lead to insensitivity to temperature and pain in the lower legs and feet and patients may experience numbness and tingling sensation in these areas.

Diabetic patients with neuropathy have an increased risk of burn injuries. These burns may happen from soaking the feet in hot water, heating pads, walking on hot surface, and contact with a warming device such as heaters. Because of the impaired sensation of the feet in these patients, they may sustain a burn injury without being aware of it. These patients have poor wound healing due to the effect of diabetes on the nerves and blood vessels and the increased risk of wound infection in diabetic patients.

Burns in diabetic patients even when they are minor may lead to ulceration of the wound, serious infection and even amputation of the limb. Therefore preventing and early recognition of burns in diabetic patients is very important.

Prevention:


  • Maintain a proper glucose level.

  • Test water temperature before going into the bath with a sensitive body part such as the elbow.

  • Avoid using a contact warming device such as a heater.

  • Inspect your feet and toes every day for infection, burns, bruises and ulcer.

  • Avoid walking barefoot even inside the house.

  • Avoid using heating pads.

  • Don't wear tight or loose shoes; wear a well fit shoe with a soft, thick socks.

  • Contact your doctor if there is an infection, an ulcer or a burn which is not healing well.

  • Make sure your feet are examined during each doctor's visit

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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.

October 27, 2010

Face Transplant

Face transplant is an advanced medical procedure that involves replacing part or all of the patient's face with a donor (cadaver) face.

Face transplant can be a partial transplant in which only a section of the tissue is taken from the donor and given to the patient who is receiving it (recipient). It can be a full face transplant in which the entire face is transplanted or the face and the underlying scalp are transplanted. Face transplant is similar to other organ transplant in which the immune system may reject the transplant. The immune system will attack and destroy any tissue that it recognizes as foreign. Even if there is a match in tissue between the donor and recipient, there is still the possibility of rejection. Such patients will have to be on drugs that suppress the immune system for a long period of time. These immune suppressant drugs will increase the risk of infection. There are other risks involved in face transplant such as risks related to surgery like infection.

The world's first partial face transplant was carried out in November of 2005 in France for a patient who had her face ravaged by her dog, the operation was successful, it took 15-hours and the patient is fine now. The donor of the face should be a person who is on life support who has brain death with no hope of recovering (the face tissue has to be viable receiving blood supply); this may be a concern as the family of the donor must be willing to turn off the life support machine.

The face features of a person depend on the skin and the underlying muscle and bone. The patient only receives skin from the donor. Therefore the person who receives a face transplant will not look exactly like the donor but his/her features will be a combination of his/her original features and the features of the donor. Having a different face can be emotionally traumatic; these patients may need counseling.

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.

October 22, 2010

Burns In Pediatrics

One of the most common causes of hospital admission of pediatric patients is burns. Most pediatric burns occur at home. The most common cause of burns in young children is exposure to hot liquids (scald injury) such as hot water. Contact with hot objects is the second most common cause of burn in young children. Pediatric burns differ from adult burns in many aspects.

Their skin is more sensitive and less resistant to heat and because it is harder for them to escape from the burning object, this may lead to longer exposure which may increase the burn severity.

Pediatrics have a smaller body size than adults with a greater body surface area in relation to their weight. Fluid loss is proportionally greater in young children when compared to the same percentage of burn in adults because of their smaller circulating volume and different distribution of body fluids leading to more rapid onset of fluid and electrolyte disturbance and imbalance. Therefore pediatrics especially infants develop hypovolemic shock faster and fluid replacement should be started as soon as possible which is calculated according to certain formulas.

Small children are at a greater risk to have a decrease in body temperature (hypothermia) due to the insufficiency of their thermoregulatory system, they are less tolerant to changes in temperature (see regulation of body temperature).

In case there is a burn to the genital area and the child is still wearing diapers, special attention should be taken as the burned area may be contaminated easily making it more susceptible for infection.

Pediatric patients with burns are harder to cannulate (insert a cannula) than adults and the smaller the child is the harder it is. Airway intubation is also harder in pediatrics than adults and the smaller the child is, the harder it is to intubate especially after burns that affect the airways. That is why trachiostomy is sometimes needed.

One of the things that differentiate small children from adults is the inability of small children to speak and express what they feel. The parents play a major role in this case because they know their child better than anyone else and know when there is something wrong with him/her. Therefore when your child is to be discharged you have to make sure that your child is feeling well.

Prevention of scald burns:

  • Water heater thermostat should not be set higher than 120 degrees.
  • Bathtub water should be checked before putting the child in the tub.
  • Never leave the child in the bathtub alone as he/she might turn on the facet or the water may become too hot and lead to scaled injury.
  • Keep hot liquids out of the reach of children like turning pot handles on the stove out of the reach of children.
  • Avoid carrying hot object while carrying the child.

According to the Consumer Product Safety Commission a child exposed to hot tap water of 140 degree for three seconds develops a third degree burn.

According to the National Center for Health Statistics between 2001 and 2005, each year approximately 116,600 children are treated for fire/burn injuries. Fires and burns are the third leading cause of unintentional death among children aged 1-14 years in 2004.

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.

October 19, 2010

Burns To The Eyes (Part II)

Flash burns to the eye:

A flash burn to the eye occurs when the person is exposed to a bright ultraviolet light. Causes of flash burn to the eye may include:


  • Welding torch.

  • Direct sunlight.

  • Some types of lamps like halogen lamps.

  • Sunlamp in a tanning salon.

  • Lightning.


Signs and symptoms may include:

  • Usually both eyes are affected.
  • Pain that may be mild to very severe.
  • Sensitivity to light.
  • Redness and watery eye.
  • Blurred vision.
  • Feeling that there may be something in the eyes.
Treatment:


Seek medical advice and follow the physician's orders, place pads over both eyes until medical help is available.

Prevention:

  • Wear sun glasses that protect against ultraviolet light.
  • Wear safety goggles to protect the eye.
  • When welding always wear a welder's mask.
  • In children with burned eyes applying first aid may be harder depending on the age of the child and his/her ability to cooperate. You need to stay calm and may need to have another adult help you with holding the child to facilitate flushing the eyes (if appropriate).
  • It may take up to 24 hours after the burn to determine the seriousness of the eye injury.
  • Some problems such as infection do not show up right away and that is why it is important to follow up with your doctor to make sure that the eyes are healing properly.

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.

October 18, 2010

Burns To The Eyes (Part I)

Burns to the eyes can be caused by many different things such as chemicals, hot air, steam, sunlight, welding equipments etc.

Chemical burns:

They can be caused by solid chemicals, liquid chemicals, chemical fumes or powdered material. Damage to the eyes may be minimized if they are washed quickly. The most dangerous chemical burns involve strong acids or alkali (base) substances.

Signs and symptoms:

  • Severe pain: because the pain is so severe, the patient tend to keep the eye closed and by keeping it closed this will keep the substance in contact with the eye for a longer period of time which may increase and worsen the damage.
  • Redness and swelling of the eye.
  • Inability or reluctance of opening the eye.
  • Tears from the eye.
  • Scarring and perforation of the eye.
  • Inability to see.
Treatment:

Treatment of chemical burns of the eye should be done immediately even before medical help arrives. Open the eye and flush it with cool water for at least 10 minutes. Quickly flushing and diluting the chemical substance reduces the chance of permanent eye damage. Make sure to avoid contaminating the good eye by avoiding the contaminated water from falling into it. Hold a sterile pad across the eye until you arrive at the hospital where further treatment will be initiated as needed.

Bursts of flames or flash fires from explosives or stoves may cause injury to the eyes and the lids. Hot air or steam can burn the eyes as well as the face. First aid treatment for heat burns to the eyes or the area around the eye involve flushing the eye with cool water and seeking medical attention.

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.

October 15, 2010

Surviving a Burn Injury

Burns are one of the most devastating experiences an individual can have. Un- like having an illness or disease that has been diagnosed after a battery of tests and examinations, no one expects to suffer a burn. Who expects the cold water to turn boiling hot without warning while taking a shower? Who would imagine that an old woman scalds herself in the bath tub resulting in a devastating injury which causes enormous physical and mental suffering? Who goes to sleep safe in their bed only to wake up in the midst of a blazing fire? Firemen face the risk of being burned every time they respond to a call. These are some of the real life stories witnessed by a retired Chaplain who has served in one of our nation's top metropolitan burn centers. She has witnessed the worst of the worst, the miracles of modern medicine, the incredible strength of the human spirit and the ability of the body to heal. She will share what she has learned, what she has seen, and what other burn survivors have gone through. You are invited to share your personal story as well.

October 14, 2010

Burn Severity (Part II)

It is important to determine the severity of the burn as this will determine the type of treatment that is necessary and where the burned patient should receive treatment. Minor burns may be treated at home or in a doctor's office. These are defined as first- or second-degree burns covering less than 15 percent of an adult's body or less than 10 percent of a child's body, or a third-degree burn on less than 2 percent BSA. Moderate burns should be treated at a hospital. These are defined as first- or second-degree burns covering 15 percent to 25 percent of an adult's body or 10 percent to 20 percent of a child's body, or a third-degree burn on 2 percent to 10 percent BSA. Critical, or major, burns are the most serious and should be treated in a specialized burn unit. These are defined as first- or second-degree burns covering more than 25 percent of an adult's body or more than 20 percent of a child's body, or a third-degree burn on more than 10 percent BSA. In addition, burns involving the hands, feet, face, eyes, ears, or genitals are considered critical.

NOTE: these are only guidelines. Classification of the type and extent of a burn should be done only by medical professionals. It is best to err on the side of caution and seek medical attention. What you may consider minor may in fact be severe.

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.

October 13, 2010

Burn Severity (Part I)

A burn is an injury to the tissue; it can be caused by heat, chemicals, electricity, radiation or friction.
Burns can be classified according to the depth of burn: first degree, second degree and third degree burns. It can also be classified into superficial partial thickness which is the first degree, deep partial thickness which is the second degree and the full thickness area which is the third degree burns.
The severity of burn is affected by many factors which are:


  1. The degree (depth) of burned area: first, second and third degree burn.

  2. The total body surface area (percentage) affected: burns are measured as a percentage of the total body surface area affected; one of the ways used is the rule of nines which divides the body into sections of 9 percent. This rule is adjusted for children and infants because they have a larger head and neck surface area and smaller limbs surface area.

  3. Location of burn: there are certain areas in the body that require special care when they are affected, if the face is affected there will be a risk of breathing problems because of swelling and inflammation. If the hands and feet are affected there is a risk of having limitation of movement because of scarring. If the perineum (the area of the body extending from the anus to the genitals) is affected, there is a risk of having contractures (tightening of skin) and infection. Circumferential burn (one that goes around a finger, toe, arm, leg, neck, or chest) is considered more severe than a non circumferential one because it can have a tourniquet effect on circulation or breathing (compress the vessels or airways). Eye burns are also important as they may cause blindness.

  4. The age of the person: toddler aged children have more damage to their skin than similar burns in older children and adults because they have thinner skin.

  5. Associated injuries like fractures or pre-existing medical conditions like heart conditions and immune suppression.

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 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.