July 1, 2014

Skin Cancers

The skin like other organs in the body can be affected by cancer. Skin cancer is an abnormal and uncontrolled growth of skin cells that can be divided into three types:

  • Squamous cell carcinoma.
  • Basal cell carcinoma.
  • Malignant melanoma.

Squamous cell carcinoma:

This type of cancer originates from the squamous cells present in the epidermis which is the outer most layer of the skin (see the skin). Too much exposure to ultraviolet light of sun is the most common cause and that's why it is more common on areas that are exposed to sun light.

Certain factors increase the risk of squamous skin cancer which may include:

  • Sunlight exposure for a long time.
  • People with fair skin are more affected than people with dark skin because they have less melanin pigment which protects the skin from sunlight.
  • People who have been exposed to x-rays for a prolonged time.
  • Burns, ulcers and old scars on the skin.
  • Exposure to chemical substances such as arsenic.
  • Old age people.
  • Genetic disorders eg, Xeroderma pigmentosum.
  • People with suppressed or low immunity.
Squamous cell carcinoma can appear on any area of the body but it mostly appear on sun exposed areas such as the head and neck including the ears and lips, back of the hands.

Symptoms and signs:

  • In early stages the skin change may include a skin bump that may be pink or red in color with a rough or scaly surface.
  • A change in a pre existing lesion is a warning sign.
  • Actinic Keratosis is a precancerous skin lesion that may change to squamous cell cancer, changes in Actinic Keratosis may be a warning sign for developing squamous cell carcinoma, and these changes may include: increase in size, increase in redness, bleeding, thickening or pain.
  • This type of cancer has the ability to spread to the deeper layers of the skin and may also spread to other areas of the body as well.
Diagnosis:

Diagnosis is usually made by examining the lesion and confirmed by taking a skin biopsy, there are many types of biopsies and the patient is given local anesthesia before taking the biopsy to numb the skin.

Treatment:

The earlier the diagnosis is, the better is the cure rate. Factors that determine the treatment options are: tumor size, the location of tumor and whether or not the tumor has spread.

  • Cutting the tumor out (excision) after giving local anesthesia and then the wound is closed with stitches.
  • Curettage and electrodessication in which the cancer cells are scrapped away with a curette and the remaining is destroyed with an electrical current that generates heat. This type of treatment is used for small squamous cell carcinoma.
  • Cryotherapy: this method freezes the tumor cells using liquid nitrogen leading to their destruction.
  • Advanced surgery called Mohs surgery in which the surgeon after removing each piece of skin, examines it under a microscope to check if there is any cancer cells left behind, if tumor cells are still present another piece is removed until the skin sample is free from cancer cells. This type of surgery is mostly used for tumors on the face such as the ears or for difficult or recurring tumors.
  • Actinic keratosis and some cases of Bowen's disease which is the earliest form of squamous cell cancer can be treated with 5-fluorouracil containing lotion or imiquimod.
  • Radiotherapy: this method may be used when the tumor is large, in places where it is difficult to remove or to relieve symptoms when the tumor has spread to other parts of the body. Radiotherapy maybe used alone or in combination with surgery.
  • Chemotherapy: this method is used in cases where there is spread of the tumor to other body parts. In advanced cases, chemotherapy is added to surgery or radiation.
  • Photodynamic laser therapy: may be used in Bowen's disease.
Prevention:
  • As sun exposure is the most important factor, protecting the skin by wearing protective clothes which include hats, long sleeve clothes and UV protective glasses and try to stay out of the sun during peak sunny hours from 10am-4pm.
  • Using sunscreens with a sun protective factor (SPF) of at least 15. For children and persons with fair skin use sun protective factor of 30.
  • Regular checking of the skin for any lesion that recently appeared, changes in an existing lesion that may be suspicious include: growing, any change in appearance, bleeding, pain, itching, inflammation or a lesion that never heals completely.

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.

June 24, 2014

Third Degree Burns and Hydrotherapy

Hydrotherapy is the external use of water in the medical treatment of certain diseases. Most burn units in hospitals have hydrotherapy rooms. Hydrotherapy softens and removes dead tissue enabling new healthy tissue to form and promote healing.

Hydrotherapy can have other effects in addition to removing dead and damaged tissue, it can:

  • prevent the fluid loss through the burned skinwhich may result in fliuid deplesion and dehydration.
  • Remove debris and clean the wound surface.
  • Provide a good environment for wound healing.
  • Decrease the risk of infection.
  • Decrease the risk of scar tissue formation.
  • The wound has microbial flora, hydrotherapy help adjust them.
  • Help facilitate physical therapy.
  • Promote healing and the formation of healthy tissue.
  • Help provide comfort for the patient.
Hydrotherapy for burns can start within a few days of the trauma once patients have recovered from the initial shock and their condition has stabilized. Burn patients often receive daily hydrotherapy throughout their hospitalization. As the burn begins to heal, hydrotherapy may be reduced to three times per week on an outpatient basis. Hydrotherapy is administrated by nurses and specialized technicians. Sometimes physicians or physical therapists are also involved in the hydrotherapy sessions.

Immersion hydrotherapy:
Many burn units use immersion hydrotherapy on all patients, regardless of the extent of the affected body surface. Immersion hydrotherapy is performed in tubs called hydrotanks, or burn tanks; these may be equipped with lifts to ease the patient in and out. Hydrotherapy tubs must be carefully disinfected after each use, since infection of the damaged tissue is one of the most serious side effects of burns. Disposable liners are used in some burn tubs, and the water is sterilized. Hydrotherapy for burns should never be performed in a public tub because of the risk of infection.

Shower hydrotherapy:
Many burn units are replacing immersion hydrotherapy with shower hydrotherapy, because of the risk of infection from hydrotubs and because showering immediately rinses away dead skin and bacteria. Showering removes dead tissue as effectively as immersion hydrotherapy. A shower trolley or stretcher is draped with a sterilized disposable plastic sheet to reduce the risk of contamination that can cause infection. The patient lies on the sheet and receives hydrotherapy through a showerhead. Patients with less severe burns can be showered while sitting in a chair. Shower hydrotherapy utilizes tap water, but a chlorine solution is run through the showerhead to disinfect it. Handheld showerheads are recommended when performing hydrotherapy at home, since strong hospital-grade disinfectants require special handling.

The duration of hydrotherapy treatments varies greatly. Hydrotherapy for burns is often performed for just a few minutes at a time because it can be intensely painful. Pain medication is often administrated before hydrotherapy, and general anesthesia may be required before performing hydrotherapy on the most severe burn victims. In some centers water friendly virtual reality have been used during burn treatment in hydrotherapy tubs. This diverts the patient's attention away from the pain signals.

Burn patients often undergo physical therapy during hydrotherapy. The physical therapist encourages the patient to perform movements and participate in the bathing when possible.

Hydrotherapy and chemical burns:
When hydrotherapy is administrated for chemical burns, either acid or alkali, within one minute, there is far less damage to skin than if treatment is delayed for even three minute. A delay in hydrotherapy can lead to irreversible damage. Prolonged gentle rinsing of the burn with a large volume of water under low pressure dilutes the chemical, washes it out of the skin and normalizes the PH of the skin.

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.

June 18, 2014

Tissue Expansion and Burns

Tissue expansion is a procedure that allows the body to grow extra skin. It is done by inserting a silicone balloon expander under the skin near the area to be repaired (such as scars happening after burns) and then gradually filling the balloon with salt water over time causing the skin to stretch and grow (keeping the skin under tension causes new cells to form).

Tissue expansion is used in conditions such as breast reconstruction surgery, repairing burns, scars, large birth marks, hairy areas such as the scalp (the extra skin is still able to grow hair).

After the skin stretches the scaring is surgically removed and the expanded skin is extended to meet healthy un-scarred skin.

The advantage of this procedure is that it provides a good match of color, texture and hair bearing quality. The expanded skin has a smaller risk of dying because the skin remains attached to the donor's area blood and nerve supply. Scars are often less apparent because the skin is not removed from one area and transferred to another.

The main disadvantage of the procedure is related to the length of time needed to grow/stretch the skin which may be as long as three to four months. The expander during the expansion process appears as a bulge. Frequent visits to the surgeon are required for salt water injection to expand the balloon. There are risks related to the anesthesia and the surgery such as infection and bleeding.

The silicone balloon expander is inserted by a plastic surgeon under the skin in an initial surgery followed by salt water injection through a period of time than the expander is removed and the new tissue is put in place. During this process most patients feel temporary discomfort which can be controlled by medication prescribed to you by your physician.

You should contact your physician if you see any indication of wound infection. You have to avoid applying any undue pressure to the area around the tissue expander such as poking it or wearing tight clothes over the area.

Tissue expansion can be an effective method to make scars that result from burns less noticeable; it is not a replacement for skin graft. Skin grafts are usually done when the tissue is destroyed in severe burns.

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.

June 11, 2014

Stress Ulcer (Gastritis) and Third Degree Burns

Gastritis refers to inflammation of the lining (mucosa) of the stomach which may progress to form an ulcer.

Risk factors:

  1. Patients on mechanical ventilators or who are intubated for more than 24 hours.
  2. Smoke inhalation.
  3. Severe burns such as third degree burns.
  4. Trauma.
  5. Severe illness.
  6. Shock such as septic shock, hemorrhagic shock, etc.
  7. Patients with multiple organ failure.
The risk of developing stress ulcer in severe burns has decreased with the improvements of critical care and the use of medications.

Signs and symptoms:

  1. Can be a symptomatic in early stages.
  2. Burning pain.
  3. Blood mixed with vomitus that will have the color of coffee.
  4. Melena which is the passage of blood in stool.
  5. Hematemesis in severe cases which is the vomiting of pure blood.
Preventive measures in burned patients are the use of medications such as antacids and other medications which decrease the effect of gastric acid on the mucosa. Adequate fluid replacement after a burn injury will decrease the risk of developing stress gastritis as decreased blood supply to the stomach (ischemia) that results from fluid loss in burned patients plays a role in the development of the disease. Early feeding is also one of the important preventive measures.

If a stress ulcer develops, the treating physician will determine the type of treatment needed. In certain conditions surgical intervention 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.

June 5, 2014

Third Degree 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.

June 4, 2014

Scars of the Face

Burn injury may be severe and may involve any part of the body including the face. Facial scars are considered in general as a cosmetic problem, whether or not they are hypertrophic. There are several ways to reduce the appearance of facial scars. Often the scar is simply cut out and closed with tiny stitches, leaving a thinner less noticeable scar.

If the scar lies across the natural skin creases (or lines of relaxation) the surgeon may be able to re-position the scar using Z- Plasty to run parallel to these lines, where it will be less conspicuous.

Some facial scars can be softened using a technique called dermabration, a controlled scraping of the skin using a hand held high speed rotary wheel. Dermabration leaves a smoother surface to the skin but it won't completely erase the scar.

After scar revision:

With any kind of scar revision it's very important to follow your surgeon's instructions to make sure the wound heals properly. Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities.

As you heal, keep in mind that no scar can be removed completely; the degree of improvement depends on:

  • The size of the scar
  • The direction of the scar
  • The nature and quality of your skin
  • How well you take care of the wound after the operation.
If your scar looks worse at first, don't panic because the final result of your surgery may not be apparent for a year or more.

As there are different methods of facial scar removal and each has its benefits and risks, you will want to schedule an appointment with a practitioner that specializes in facial scar removal before having the procedure completed because they will explain all these risks and benefits. You might also want to do your research on the practitioner that you choose because some are more experienced than others and you will want to choose the one that will provide you with the best results.

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.

May 20, 2014

Nosocomial Infections and Burns (Part III)

Nosocomial infection also known as Hospital acquired infection (HAI) is an infection that the patient acquires when he/she is admitted to a hospital or a health care facility for any reason other than that infection. The infection should have not been present or incubating prior to the patient's being admitted to the hospital.

Certain factors may affect the susceptibility of the patient to get nosocomial:

  1. The age of the patient: elderly and infants are more susceptible for infection.
  2. The presence of pre-existing diseases (co-morbidity): chronic diseases such as chronic kidney disease, chronic liver disease and diabetes can increase the patient's risk for contracting a nosocomial infection as all these diseases may interfere with the immunity of the patient making him/her more susceptible for infection.
  3. Low or compromised immune system: any condition that suppresses the immune system can increase the susceptibility of the patient for a nosocomial infection.
  4. Malignancy, chemotherapy and radiotherapy: as all may suppress the immune system.
  5. Treatment with Antibiotics: this can cause the growth of antibiotic resistant micro-organisms that can cause nosocomial infection.
  6. Procedures and surgeries: therapeutic and/or diagnostic procedures and surgeries may increase the susceptibility of the patient for a nosocomial infection.

Measures taken by the healthcare staff to prevent and/or control nosocomial infection:

  • Proper hand washing and/or cleansing.
  • Wearing gloves, masks and gowns.
  • Aseptic technique and procedure practice.
  • Isolating patients with communicable diseases.
  • Proper disinfection and sterilization of reusable equipment.
  • Immunization patients at risk.
  • Proper disposal of waste product.
  • Prophylaxis
  • Educating patients and public about the causes, methodS of transmission, treatment and prevention of infection

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.


April 23, 2014

Nosocomial Infections and Burns (Part II)

Nosocomial infection also known as Hospital acquired infection (HAI) is an infection that the patient acquires when he/she is admitted to a hospital or a health care facility for any reason other than that infection. The infection should have not been present or incubating prior to the patient's being admitted to the hospital.

Origin of Nosocomial infection:

Nasocomial infection can be external (from out side the body) or internal (from the inside of the body).

External (Exogenous) infection: examples of external sources of infection may include

  1. Catheters such as the urine catheter (Foley Catheter)
  2. Instruments such as speculum, scissor, forceps.
  3. Hands if they are not properly sterilized.
  4. Blood product transfusion which can transmit Hepatitis B and HIV.
  5. IV lines like Central and Picc lines.
  6. Respiratory equipment such as ventilators.
  7. Airborne infection: such as Tuberculosis (TB).
  8. Linen that are contaminated.
Internal (Endogenous) infections: Internal sources of infection may include
  1. Skin: Certain bacteria live on the skin of many healthy individuals without causing any infection. However, these bacteria can cause skin infections if they enter the body through a break in the skin as in burns, open wounds and cuts. Staphylococcus aureus (Staph) is a bacteria that can be found living on the skin and in the nose of many healthy people without causing any infections. This bacteria can cause skin infections such as boils when the circumstances are appropriate.
  2. Oropharynx.
  3. Respiratory System.
  4. Gastrointestinal tract.
  • Pathogens that cause nosocomial infections can be Bacteria, Fungi, Viruses and Protozoa.
  • Pathogens vary in their virulence (the ability of a microorganism to cause disease); the more virulent the organism is, the less the number needed to produce the disease.
  • The sicker the patient is, the higher the risk of contracting a nasoconial infection.
  • The lower the patient's immunity is, the higher the risk of getting a nasocomial infection.
  • Certain circumstances may favor the growth and survival of the microorganism such as wet versus dry objects. Contamination is heavier in wet objects than dry objects.

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.

April 17, 2014

Nosocomial Infections and Burns (Part I)

Nosocomial infection also known as Hospital acquired infection (HAI) is an infection that the patient acquires when he/she is admitted to a hospital or a health care facility for any reason other than that infection. The infection should have not been present or incubating prior to the patient's being admitted to the hospital.

Sites of Nosocomial infections:

  • Burns and wounds: When there is a burn injury the skin becomes more vulnerable for all kinds of infections not only nosocomial infections and this may increase the risk of sepsis and septic shock.
  • Urinary tract: It is the most frequent nosocomial infection site, foley catheterization accounts for more than 50% of nosocomial urinary tract infection, that's why the catheter must be removed as soon as there is no need for it to stay to decrease the risk of infection.
  • Blood stream: This is common in central line cathetarization where the nosocomial infection may happen at the skin in the site of entry of the catheter or along the path of the catheter under the skin.
  • Respiratory tract: This type of nosocomial infection is most common in critically ill patients, patients in the intensive care unit (ICU) and those on ventilators (ventilator associated pneumonia). These infections are associated with high infection associated complications and pneumonia.
  • Gastrointestinal tract (GIT): In children gastrointeritis is the most common nosocomial infection which is mainly caused by a virus called Rotavirus. In developed countries a bacteria called Clostridium difficle is the major cause of nosocomial gastrointeritis in adults.
  • Surgical site: The more complicated the procedure is, the higher the risk of having a nosocomial infection.

Factors determining the risk of nosocomial infections:

  • Duration of hospital stay: The longer the patient stays in the hospital, the higher the risk of exposure to nosocomial pathogens and the greater the chance of being infected.
  • Age of the patient: Elderly and neonates are at higher risk of contracting a nosocomial infection.
  • Immune status: The immune system plays a major role in fighting infections. Patients with low or suppressed immunity are at a higher risk for nosocomial infections. Conditions that suppress the immune system may include malignancy, chemotherapy, radiotherapy, steriod drugs and malnutrition.
  • Procedures and interventions: Procedures such as Endoscopy and surgery increases the risk of infections.
  • Hospital and care personnel: Cleanliness of the hospital and health care workers hygiene plays an important role in the transmission and spread of nosocomial infection.
  • General health of the patient: The general health of the patient has a role as the presence of comorbidities increases the risk of contracting infections.
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.
March 11, 2014

Diabetic Patients with Feet Burns

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

.
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.

March 4, 2014

Eye Burns (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.

February 27, 2014

Eye Burns (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.

December 12, 2013

Escharotomy and Burns

When the skin is burned and depending on the severity of the burn, tissue will die, this dead tissue is called an eschar which is inelastic and can't expand.

When the burn is a circumferential (burned all the way around) second and third degree burn, eschar will form and with the edema (fluid leak from injured vessels) formed; the pressure will increase in the burned area. If this happens in arms and legs, this will lead to compression of the underlying veins arteries and nerves acting like a tourniquet. If the circumferential burn happens in the neck or chest, the pressure will prevent chest expansion leading to breathing problems. In these situations escharatomy is often needed.

Escharotomy is a surgical procedure done by making an incision through the eschar to relieve the underlying pressure, measuring the pressure in the compartment (closed space of nerves, muscle tissue and blood vessels) distal (furthest) to the affected area is one of the parameters used to determine the timing of escharatomy. Another way to determine the timing of the escharotomy is clinically by assessing the perfusion (the flow of blood) distal to the area affected.

In the limb:

Signs in the limb that may indicate the need for an escharotomy:

1. Signs of compression of blood vessels leading to loss of circulation which may include:

  • Pallor (pale color of skin due to reduced blood flow) of the affected area.
  • Cyanosis (bluish discoloration of skin resulting from inadequate oxygenation) of the affected area.
  • Reduced or absent capillary return (blood which fills empty capillaries) related to capillary return in non affected area (non burned area).
  • The affected area becomes cold.
  • As a late sign the pulses in the affected area will impalpable.
2. Numbness.

3. Decreased oxygen saturation detected by pulse oximetry (a non invasive device that measure the oxygen level in the blood).

In the chest:

Circumferential burns to the chest wall may lead to restriction of the chest wall movement leading to respiratory compression. Sometimes non circumferential burns may need escharotomy when they interfere with and restrict chest movement. Abdominal circumferential burns may lead to respiratory compression as they may lead to restriction in the movement of diaphragm which plays a role in respiration. The following may indicate chest escharotomy:

  1. Circumferential full thickness burns to the chest and abdomen.
  2. Examination showing reduced air entry on both sides.
  3. Examination showing restriction in the chest wall movement or abdominal movement.
  4. Increased respiratory rate.
  5. Shallow breathing because of restriction of chest wall movement.
  6. Hypoxaemia (Insufficient oxygenation of the blood).
  • Infants under one year of age are abdominal breathers (their respiration is predominantly diaphragmatic); therefore burn to the abdomen in a pediatric patient may lead to respiratory compression.
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.
December 5, 2013

Acute Respiratory Distress Syndrome (ARDS)

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:

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 usually hospitalized and treated in the Intensive Care Unit, The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve:

  • Oxygen supplementation and the use of a mechanical ventilator (See mechanical ventilator part I, II).
  • Medications may be used in the form of antibiotics to treat infection, corticosteroids to reduce inflammation, pain medicine to reduce the pain, muscle relaxents to relax the muscles and decrease muscle spasms, antianxiety medications to decrease anxiety.
  • 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.

Possible complications:

  • Multiorgan system failure.
  • Ventilator associated lung infection (pneumonia).
  • Ventilator induced lung injury such as lung collapse and lung scarring (pulmonary fibrosis).

Support Groups
Many family members of patients with ARDS may suffer from severe stress. This stress can often be relieved by joining support groups where members can share common problems and experiences.

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.

December 3, 2013

Compartment Syndrome (part II)

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.