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.


August 30, 2012

People's Reaction To Scars

One of the challenges that a burn survivor faces after discharge is the reaction of society to his/her scars. According to George Pessotti a burn survivor and the author of Reasons for Living, "most people mean no harm when they stare or ask questions. They're simply curious; they want to know what happened to you for different reasons"

The face is the mirror of the person, the first thing that most people look at when they see a person is the face, and it gives clues about the person like background, age and mood. Scarring of the face after a burn injury may lead to psychological and social difficulties for the patient.

Burn survivors deal with scars differently, each will cope with it in his/ her own way, some will try to move on with life and forget what happened as much as they can. Others will isolate themselves from the community, live their lives in the shadow or turn to drugs and alcohol.

In addition to the physical trauma some have to deal with the loss of their home, income and may be grieving the loss of a family member (in the fire). It's not uncommon that the patient may experience different emotions like anger, anxiety, fear, frustration, self guilt and depression. The road to recovery may be long but there will always be light at the end of the tunnel. Patients are encouraged to speak with family, close friends, attend support groups, and seek counseling if they need it.

The human brain works in an amazing way. Positive thinking can lead to better coping skills and decreased negative stress. If you put positive thoughts in your brain the results will be positive and vice versa. Simply focus on the solutions and not the problem as the problem has happened and can't be changed but the solution is in your hand. When you see people looking at your scars in a strange or suspicious way, explain to them what happened.

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.

August 28, 2012

Dermabrasion

Is a surgical procedure involving the removal (sanding) of the damaged top layer of the skin using a specialized instrument called a dermabrader. This procedure is used for scars as well as other skin conditions such as wrinkles and tattoos.

Dermabrasion improves the appearance of the scar or other skin abnormality as a new layer of skin will replace the skin that has been treated. This procedure won't entirely remove the scar or other abnormality but it will improve its appearance by softening the edges of the scar or other lesion.

The procedure can be done in a surgeon's office or in an outpatient surgical facility. After the procedure the skin will be swollen, red and tender. Swelling gradually subsides within 2-3 weeks. You may feel some burning, itching, aching or discomfort for a while after the surgery. Pain medication, antibiotics and anti-swelling medications can be prescribed. Ointment and special dressing will help speed the healing process and your physician will give you instructions on how to care for the wound. Healing usually occurs within seven to ten days.

At first the new skin that is formed is pink in color but will gradually return to its normal appearance. The skin pinkness will largely fade within 2 to 3 months. The new skin should closely match the surrounding skin when full color returns. You can resume your normal activities within 2 weeks. Any activity that can cause injury to the area that has been treated should be avoided. You should also avoid sports for 4 to 6 weeks. Sun protection is also important to avoid pigment alteration. Avoid exposure to sunlight both direct and indirect for at least 6 months and use sunscreens on a regular basis when outdoors.

Skin color changes in the form of increased pigment (darker) or decreased pigment (lighter) after treatment is one of the complications of dermabrasion.

You should contact your doctor if:


  • The redness and swelling persists in the treated area as this could be a sign of a scar forming.

  • There is discharge or yellowish crusting as this may indicate an 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.

August 22, 2012

Third Degree Burns to the Fingers

Skin is a sensative organ that has many functions among which is the protection of the body against external harmful enviromental factors. The skin may be damaged when it comes in contact with a hot object. The severity of the burn depends on the intensity of the heat and the duration of time heat is applied.

Hand and finger burns are usually common and are caused by the accidental touch of boiling water or hot objects. Most of these burns are not dangerous but they are of heigh priority becauase of the functional importance of the hand and fingers therefore they have to be treated as soon as possible to avoid serious complications. Burns to the fingers can be first, second or third degree burns.

  • First degree burns are superficial were there is redness and blisters of the skin.
  • Second degree burns are partial thickness skin damage with blisters present.
  • Third degree burns are full thickness skin damage where the skin is leathery and white in color.
  • Fourth degree burns are the same as third degree burns but with damage to deeper structures such as tendons, bones and joints.

What to do if your fingers are exposed to a burn injury:

  • Be calm and hold the fingers under cool water (not cold water) such as putting the fingers under running cool tap water or soak them in water in order to reduce the heat. Avoid treating the burned fingers with ice as this may lead top frost bite.
  • Separate the fingers and cover them with sterile and clean dressing or bandage.
  • If there is pain then use pain medications to relieve pain and swelling. Pain medications are not recommended to be given to children as it may affect their liver.
  • Apply moisturizers or burn ointments to the affected area which will help in keeping the area moist.
  • Keep the burned area elevated to reduce swelling.
  • You can use home remedies to treat simple burns like honey after the skin has cooled down (see Home burn remedies).
Precautions and prevention:
  • Aviod using butter, oil and ice while teating the burned area, butter and oil may prevent heat from escaping the wound leading to elevation of temperature. Ice may lead to frost bite.
  • If the affected area is blackened, completely blistered or the burn spread on more than 2-3 inches in area then you should seek emergency medical treatment as this may indicate a second or a third degree burn.
  • Contact your physician immediatly if there is any signs or symptoms of infection of the burned area like fever, increase redness, increase pain, swelling, tenderness, foul smelling discharge ( see wound infection and Burn wound care at home).
  • You should be careful while handling hot objects that may cause burns.
  • Follow safety measures while using any electrical device, heater or oven.
  • Keep children away from any source that may cause them burn or injury such as hot water, stoves, heaters, electrical cords, fireworks ( see Fire prevention and safety)
  • Water heater temperature should never be set more then 120 degree.

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.


August 21, 2012

Flammable Liquids

Flammable and combustible liquids are liquids that can burn. These liquids give off vapors that mix with air and can catch on fire from a source of ignition causing serious burns. The vapor is actually what burns, not the liquid. The lowest temperature at which the liquid gives off enough vapor to be ignited is called the flashpoint.

Flammable and combustible liquids include gasoline, kerosene, paint and paint thinners, solvents, cleaners, polishes and others. There are certain rules to be followed to avoid serious burns from flammable liquids which include:

  • Read the manufacturer's label on the flammable liquid container before its use.
  • Flammable liquids should be kept away from open flames and sparks.
  • Always store flammable liquids in the original manufacturer's containers or approved cans.
  • Flammable liquids should not be used near open flame or any source of heat.
  • Always use flammable liquids in a well ventilated area.
  • You should never smoke around flammable liquids.
  • Empty containers that contained flammable liquids should be properly discarded.
  • Avoid spilling flammable liquids on you, if this should occur; rinse the area thoroughly as soon as possible.
  • Don't use flammable liquids for purposes for which they are not intended.
  • Be aware that cell phones should not be used while pumping gas (the cell phone could ignite the fumes).
  • Never fill a gas can in the bed of a pick up truck (the fumes will be contained within the bed of the truck).
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.
August 15, 2012

Third Degree Burns due to Natural Gas Explosion

Natural gas can leak and lead to a gas explosion if there is a source of ignition. Gas explosions may lead to serious burn injuries including third degree burns part I, part II and smoke inhalation injuries. Appliances that may leak gas and lead to gas explosion include:

  • Ovens, cook tops
  • Gas generators.
  • Space heaters
  • Water heaters
  • Dryers
  • Outdoor grills
  • Central heating and cooling systems
  • Fireplaces
  • Gas lights
If you smell gas at your home follow these safety tips:
  • Notify the people in your house and leave the house immediately.
  • Don't turn lights on or off as it may act as an ignition source.
  • Don't light a match
  • Don't switch on any electrical device.
  • Don't use cell phones
  • After leaving your home, alert your gas company and the fire department about the problem
.

When an accident happens liability can fall on any of the following entities:

  • The gas company
  • The appliance seller
  • The appliance distributer
  • The appliance manufacturer
  • The person or company who recently installed the appliance or repaired the appliance.
  • The landlord.
Accidents due to gas explosion may be prevented or reduced by frequent checks and maintenance of appliances by a professional. Don't try to repair a leak yourself.

Properties of natural gas:

  • Natural gas is lighter than air.
  • Natural gas has no odor (odorless). A minute amount of odorant such as t-butyl mercaptan, with a rotting like smell is added to the odorless gas, so that leaks can be detected before a fire or explosion occurs. Sometimes a related compound such as thiophane is used, with a rotten-egg smell.
  • Natural gas has no color (colorless).
  • Natural gas has a narrow combustion limit (meaning the % of natural gas in the air by volume must fall within a certain amount for an explosion to occur).
For more information about natural gas see the following link.

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.

July 25, 2012

Factors Affecting The Healing of Burns

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


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

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

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

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

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 24, 2012

Third Degree Burns and Burn Recovery Beds

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

Risk factors for bed sores:

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

Air chamber burn bed:

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


July 17, 2012

Severe Burns and Sleep Disturbance (part II)

Treatment of sleep disturbance associated with severe burns:

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

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

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

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

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

2- Relaxation techniques:

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

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

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


July 11, 2012

Severe Burns and Sleep Disturbance (part I)

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

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

These causes may include:

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

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

  1. Cause the healing process to be slower.
  2. Worsen pain.
  3. Cause depression.
  4. Cause behavioral changes.
  5. Cause restlessness and energy lack.
  6. Cause concentration problems and increase accidents risk.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


July 10, 2012

Child Protective Services (CPS): New York

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

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

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

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

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 6, 2012

Steven Johnson Syndrome and Burns (Part II)

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

What are the complications of Steven Johnson Syndrome:

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

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

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

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

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

Diagnosis of Steven Johnson Syndrome:

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

Treatment:

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

What is the prognosis:

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 2, 2012

Steven Johnson Syndrome and Burns (Part I)

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

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

A- Infections and diseases: They may include

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

B- Drugs:They may include

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

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


  • skin lesions which are itchy and painful

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

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

  • Mouth and throat rash and/or blisters

  • Gental rash and/or blisters

  • Malase, itching, cough and sore throat

  • Flue like symptoms, fever and headache

  • Conjuctival rash and/or blisters, vision loss

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

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

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

June 29, 2012

A Burn Survivor Finds Hope and Happiness from People Who Helped Him Recover

The following is a first-hand account of a survivor of severe burns, as told to CNN.com. This story should give hope to all victims of severe burns that they can overcome their injuries, and lead a productive and happy life.

"I came to America as a transfer student in the fall of 2004. I did three years of computer engineering in India and then transferred to Purdue University Calumet. On July 2, 2005, just a month before graduation, a man who lived on the first floor of my apartment building set fire to his own apartment deliberately.

The fire started at 4:30 a.m. My roommate and I could not jump out, because the balcony and windows were engulfed in flames. As my roommate fell unconscious in front of me, I started running down the stairs but I also passed out from smoke inhalation. A firefighter found my body a few minutes later and pulled me out of the building.

As the paramedics were taking me to the hospital, I heard one of them say, 'This guy is 95 percent burned--he doesn't have a chance to survive.' At that moment, I thought about my family and how I came to America to get good education, and now I didn't have a chance to live. I was soon unconscious again, and I woke up later in the University of Chicago burn unit--four months later, because they had me in an induced coma for all that time.

The man's wife, his baby and my roommate all died in the fire. After seven months in Chicago, I was transferred to Wishard Health Services in Indianapolis for my rehabilitation. I don't have any family in America so I lived in a nursing home. I stayed there for over two years while I went through reconstructive surgeries to regain range of motion in my arms.

For more than five years, I went through an intense therapy program. I wore a face mask for three years and pressure garments on my entire body; I wore dynamic splints on my hands, wrists and elbows to increase range of motion, endured daily dressing changes on my wounds, and performed painful exercises to restore function in all of my joints.

I wanted to get a business degree so I studied in my extra time. I scheduled my final exam and got a six-hour pass to leave the nursing home to take the test. I scored well on the test and was accepted into the Indiana University Kelley School of Business in Indianapolis. I chose the part-time program because I didn't know how much I would be able to handle.

My doctors did everything they could to help me regain range of motion in my arms. Even after 54 surgeries, I am still very limited. I don't have any finger movement in my left hand and limited finger movement in my right hand. I type with one finger. I rely on various adaptive equipment to perform the activities of daily living.

I have not seen most of my family in India since the accident seven years ago, because I am still waiting for a U.S. green card. My sister has been denied a visa four times in trying to visit me.

I have been able to come out of this tragedy because of the values that my parents instilled in me and the help from my occupational therapist. My parents taught me the value of education, hard work and perseverance. They taught me to be happy in life no matter what the circumstances. They taught me that "we can always find someone who is in worse condition than we are in. So be thankful for what you have."

I call my occupational therapist 'my guardian angel.' God sent her into my life when I was in the deepest and darkest pit of my life. She took me to church every Sunday while I was in the nursing home, which brought some normalcy into my life. Today, I can live independently because of her hard work.

After three years, I graduated with my degree in May 2012. I am now seeking a job in finance. To give back to the community, I volunteered in the Wishard Burn Unit's therapy department between many of my surgeries. I still visit the Wishard Burn Unit in Indianapolis and talk to other burn patients about my experience. I also lecture at Indiana University-Purdue University Indianapolis to occupational therapy students about all the adaptive equipment I use to live independently.

I have had some wonderful people in my life who have helped me in my journey. I plan to do the same for other people who have suffered severe burns.

If you or someone you know suffers an injury such as third degree burns or smoke inhalation, you should call Kramer & Pollack LLP in Mineola, New York so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a strong legal case.