October 3, 2012

Tracheostomy

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

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

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

Indications:

Among the conditions that tracheostomy may be used for:

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

Risks associated with tracheostomy may include:

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

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

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

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

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

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

October 2, 2012

Tap Water and Scald Burns (part III)

One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.
Clinical features of scald burns:
Clinical features of scald burns depend on the severity of burn whether it's a first,second or third degree burn. Clinical features may include:

  • Redness of the skin
  • Pain (may be absent in third degree burns as the nerves responsible for sensation may be destroyed)
  • Swelling of the affected area
  • Blisters (may develop in second degree burns)
  • Peeling if the skin in the affected area
  • White, stiff, waxy or charred skin (may happen in third degree burns)
Treatment:
  • Avoid panicking and remove the victim from the source of burn as soon as possible.
  • Cool the burned area immediately under running cool water for 10-30 minutes. Never use ice, any greasy substance or cream as this may lead to more damage
  • Seek medical assistanace
  • Keep the victim as comfortable as possible
  • Remove any watch, jewelry or clothing from the affected area; don't try to remove anything that is stuck to the burned area as this may lead to more damage
  • Cover the burned area with clean, non fluffy material to keep it clean and protect it from infection. Avoid breaking the blisters and avoid using adhesive dressings
  • Treat associated symptoms like shock
When to seek medical assistance:
  • When the victim is over 60 years of age or under 5 years of age
  • When the victim is pregnant
  • When there is pre-existing conditions such as lung disease, heart disease, compromised immune system
  • When the burn is large, deep, or if blistering is present
  • When the burn is located on the face, neck, hands, feet, joints, limbs, genital area, buttocks or around the upper body
  • When there is signs of infection which may include increase redness, increase pain, increase swelling, fever, foul odor discharge, pus, non healing wound after several weeks or there is new unexplained symptoms
  • When the victim has diffeculty breathing or has inhaled smoke or fumes

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

September 27, 2012

Tap Water and Scald Burns (part II)

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

Prevention of tap water scald injuries may include:

  • Setting water heater thermostats at a temperature not higher than 120°F (49°C), the safest water to bathe is about 100°F (37°C)
  • Educating parents and caregivers about the consequences and complications of hot water scald injuries
  • Constant adult supervision of young children, children with disabilities and elderly who have difficulty in removing themselves from hot water while in bath water or near facets.
  • Filling tub with cold water first then add hot water, check the temperature of sink or bath water before allowing children contact with it.
  • Don't bathroom tub unattended while it's filling and never leave older sibling with a younger one alone in bath water or near faucets
  • Facing children away from tap handles in a bathtub or sink while bathing them so that the child can't reach the handle and turning the handle to the cold position when not in use
  • Keeping bathroom door closed when not using it and not using it as a play area
  • In elderly and unsteady people install grab bars and non slip mats in the showers or tubs
  • If there is difficulty or a problem with standing unassisted than use a shower chair when showering or bathing.
  • Elderly and People who need assistance have to be provided with a way to call for help like a bell or a whistle in case of emergency
  • To prevent sudden fluctuations in water temperature while someone is showering avoid running water, flushing the toilet or using a machine that uses water
  • Installing a master thermostatic mixing valve at the water heater and thermostatic mixing valves in bathrooms
  • Installing an anti scald devices which are inexpensive, simple to install on most existing taps and can be found in pluming and hardware stores. These devices are heat sensitive and interrupt or stop the flow of water when its temperature reaches a predetermined temperature generally 110-114° but before reaching 120°F (49°C)
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


September 25, 2012

Tap Water and Scald Burns (part I)

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

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

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

Temperature/scald burn:

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

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

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


September 20, 2012

Intentional Burns

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

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

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

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

September 11, 2012

Severe Burns and Cellulitis (Part II)

Predisposing factors:

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

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

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

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

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

September 6, 2012

Severe Burns and Cellulitis (Part I)

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

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

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

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

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

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


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.