April 16, 2013

Out Patient Care of Burns (Part II)

Patients with small partial thickness burns can be treated as outpatients. Adults with less than 15% body surface area (BSA) partial thickness burns and children with less then 10% body surface area partial thickness burns can be candidates for outpatient treatment.

Treatment:
A- Emergency treatment:

  • The first thing to do to minimize the injury is removing the person from the source of heat and remove any burned or tight clothes, jewelry and any plastic coverings that may retain heat causing deeper injury.
  • Run cool (not cold) water over the burned areafor at least 15 minutes.Aviod using ice, butter or other types of grease as it may cause more damage.
  • For chemical burns, if the chemical that caused the burn is dry then it should be brushed off the skin by a person wearing gloves. If the chemical is wet, it should be flushed the affected area with cool running water for at least 20 minutes. You have to call the poison control center specially if the chemical substance was swallowed then call 911.
  • Tetnas prophylaxis is only indicated when the burned patient is a child and he/she is not up to date with the immunization schedule or if the burned patient is an adult whose last tetnus immunization was more than 10 years ago.

B- Non Emergent Treatment:

  • Use soap and water to clean the wound
  • Don't open blister, leave them intact as opening the blisters may lead to infection
  • If the burn is on the face, apply bacitracin, neomycin or other similar agents. Protect the affected area of the face from the exposure to sun.
  • If the burns are on the trunk and/or extremities, apply 1% silver sulfadiazine or other iodine creams and cover the area with a clean dressing. The patinet and the family should be given instructions on how clean and care for the wound.
  • Follow up outpatient appointments should be scheduled for the patient to follow up the healing process.
  • Pain relief medications such as acetaminophen and anti-itching medications such as benadryl are given to the patient with teaching on how to use the medicine. Pain medicine should be taken approximately 30 minutes before dressing change. Emolient cream shoud be used once the burn wound is heald to lubricate the area, decrease itching and protect the skin.
  • Burned areas should be protected from sun exposure by using protective clothes and sun screens for at least one year after healing, also avoid going out in the sun peak hours. Patients should also be instructed about the importance of balanced nutrition and wound healing
  • (see also how to care for your burn following hospital discharge)

Infection Prevention:

  • Patients and their families when discharged home should be tought and given written instructions on how to do home wound care and dressing change in an asepic technique.
  • Hand wash both bofore and after wound care is an important step in decreasing the incidance of infection. Places where wound care is done should be cleaned before and after they have been used.
  • Patients and their families should be tought the sings and symptoms of wound infection including fever, increased pain and/or tenderness, increased redness, increased swelling, increased warmth in the area around the wound, bad odor drainage from the wound, wound dehiscence (opening of the edges of the wound)

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 4, 2013

Out Patient Care of Burns

Not all burn patients need to be admitted to the hospital for treatment as some of these burn patients can be treated as outpatients including first degree burns and some second degree burns. Small partial thickness burns can be treated in an outpatient setting. Adults with les than 15% body surface area partial thickness burns and children with less than 10% body surface area partial thickness burns can usually be treated safely as outpatients. These patinets after being treated they should have a supportive home enviroment. Abuse or neglect has to be excluded specially with children, smoke inhalation should also be excluded as it is one of the major causes of dealth in burned patients.

What type of burns are eligible to be treated in an outpatient setting:

  • Adults with less than 15% body surface area partial thickness burns and children with less than 10% body surface area partial thickness burns.
  • No or minimal underlying medical conditions.
  • No smoke inhalation with adequate airway.
  • No added injury or trauma.
  • No evidence of neglect or abuse
  • No circumferential burns (burns that go all the way around a body part) see also Escharotomy
  • Ability to drink enough amount of fluids (to avoid hypovolemic shock)
  • No or minimal involvement of the face, hands, joints and the genitalia as involvement of these areas my lead to scars and contractures
  • No chemical burn injury as patients with chemical burns need to be admitted to the hospital
  • The presence of supportive home enviroment in which the patient and his/her family can follow the plan of care. See also 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.
April 3, 2013

Poisoning due to Cyanide

Cyanide is a toxic chemical substance that is found in a gas or a salt form. The gaseous form is colorless with a bitter almonds odor. Cyanide can be ingested by mouth, inhaled or absorbed by the skin.

Cyanide is used in the synthesis of some plastic items; it can be used in cleaning metal as well as in other industrial or laboratory settings. Cyanide is also naturally present in some pits and seeds of fruits such as apricots and almonds but it's in a small amount. Nitroprusside is a drug that may lead to cyanide toxicity if it's given in an improper dose. During a house fire, cyanide gas is produced due to the combustion of common household materials. Inhalation of cyanide leads to cyanide poisoning. Cyanide can be used in chemical warfare and poisoning.

Cyanide simply works by decreasing the oxygen content of the blood by causing a chemical change that prevent oxygen from getting into the hemoglobin of the red blood cell and this will lead to tissue hypoxia.

Signs and symptoms of cyanide poisoning:

  • Headache.
  • Dizziness.
  • Faintness.
  • Flushing.
  • Nausea.
  • Vomiting.
  • Bitter almond smell
  • Rapid breathing.
  • Rapid heart rate (tachycardia).
  • Abdominal pain.
  • Weakness.
  • Fainting.
  • Confusion.
Poisoning with large amount of cyanide may lead to:
  • Convulsions.
  • Paralysis.
  • Coma (loss of consciousness).
  • Shock.
  • Cardiac arrhythmia.
  • Respiratory arrest (stop breathing).
  • Cardiovascular collapse.
  • Death
.

Diagnosis:

Diagnosis will depend on the history of exposure to cyanide and the symptoms of the patient if they are present.

Treatment:

  • Seek medical attention as soon as possible.
  • The success of the treatment depends on the time between the exposure and treatment and on the concentration of the exposure.
  • Move away from the area where cyanide gas is present to an area with fresh air.
  • Don't induce vomiting if cyanide has been swollen.
  • The antidote for cyanide is the administration of amylnitrate followed by the administration of sodium thiosulfate. A new approved antidote is Hydroxocobalamin.
  • Treatment in the hospital will depend on the condition of the patient including airway management, oxygen supplementation, cardiopulmonary resuscitation, intravenous fluids and other medications depending on the situation.
  • In cases where poisoning was due to Nitroprusside (antihypertensive drug) in a hospital then the drug should be discontinued.
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, 2013

Wound Debridement

Debridement is defined as the process of removing dead tissue and contaminated material from and around a wound to expose healthy tissue.

When the skin gets burned and tissue dies, the dead tissue will naturally fall of as part of the healing process of the skin. In other cases where the burns are more severe, wound debridement will be needed. Dead tissue is a good medium for bacteria to grow and that is why it is important to remove it (bacteria can lead to infection).

Debridement methods are:

Surgical, Chemical, Mechanical and Autolytic.

The wound will be assessed to determine: the best debridement method by examining the depth, extent and location of the wound; whether it lies close to other structures like bones, the risk of infection and antibiotic use, and the type of pain management that will be used during and after the procedure.


  • Surgical debridement:

  • This is done using scalpels, forceps, scissors and other instruments to cut dead tissue from the wound. It is the most effective method used if the wound is large, has deep tissue damage, and may be done if the wound debridement is urgent. The wound will be cleaned with saline and then the dead tissue will be cut, this method may need to be repeated more than once and sometimes skin grafts may need to be transplanted into the debrided site.

  • Mechanical debridement:

  • This is done by applying a saline moistened dressing over the wound and allowing it to dry and adhere to the dead tissue, when the dressing is removed the dead tissue will be pulled with it, this method is one of the oldest and can be very painful.

  • Chemical debridement:
    This is done by using enzymes and other compounds to dissolve dead tissue in the wound.
  • Autolytic debridement:

  • This method involves using dressings that retain wound fluids, allowing the body itself to naturally get rid of the dead tissue. This method is not used if the wound is infected or quick treatment is needed, it takes more time than the other methods and is a good method if the body cannot tolerate more forceful treatment.
Debridement is done under general or local anesthesia, pain medications may be given if there is pain.

It is important to take good care of the debrided burned area by keeping the wound and the dressing clean and dry. Contact the doctor if there are signs of infection (discharge from the wound, color change, swelling, redness, increasing pain, excessive bleeding, fever and chills).

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 20, 2013

Third Degree Burns in Pregnancy (part II)

The incidance of burns during pregnancy are more common in developing countries then developed countries. Treatment of burns during pregnency may not be easy as during treatment both the wellbeing of the mother and the baby has to be taken into consideration. Topical and systemic treatment of burns in pregnant women may cause serious effects on the health of the fetus including fetal malformations.

Treatment of burns in pregnant women may include:

  • Monitoring of the mother and the fetus by frequent ultrasounds, fetal heart monitoring, measuring blood clotting factors on a daily bases and other tests as needed.
  • Determining the gestational age, the extent of the burn and other associated maternal illnesses.
  • Preventing hypovolaemic shock by adequate fluid replacement and maintenance of blood pressure.
  • Using safe drugs that won't affect the mother and the fetal development.
  • Semi sitting position can improve the oxygenation of thr pregnant woment.
  • First degree burns are superfecial involving the epidermis. The skin is painful and red, it heals without any reidual scarring.
  • Second degree burns involve the epidermis and part of the dermis . The skin is painful and healing may leave scarring depending on the depth of the burn.
  • Third degree burn is a full thickness burn which is painless due to the destruction of the neves. It heals with scarring.
  • Treatment of burns is more difficult in the first trimester of pregnancy because of the high risk of abortion.
  • If there is smoke inhalation of the mother mechanical ventilation support should be started as soon as possible.
  • All burned females of childbearing age should be tested for pregnancy.

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 6, 2013

Third Degree Burns in Pregnancy (part I)

Anyone is susceptable for burn injuries including pregnant women. The incidence of burns during pregnancy is higher in developing countries compared to developed countries. Most of the burns happening in pregnant women are accidental and are caused by different causes. The most common causes are scalding followed by flame injury. Other causes my include chemical, flash, electrical and friction burns.

The management of burns in pregnant women is not easy, it requires a multidisciplinary approch with close monitoring of fetal and maternal well being. For the mother the aim of the treatment is to restore full range of function and to minimize damages as much as possible. For the fetus the aim of treatment is reach full term being healthy without any congenital abnormalities. Treatment is more difficult in the first trimester of pregnancy because of thr risk of abortion. When the mother is at or near term, delivery should be done as soon as possible.

Minor burns may have no effect on the course of pregnancy but burns of at least 35% of total body surface area can induce early delivery and/or fetal loss. When a burn injury happen in a pregnant lady and depending on the severity of the burn there will be multiple body reactions among which are the following:

  • An increase in the capillary permeability leading to the leak of fluid from the vesseles to the outside resulting in a decrease in the mother's fluid volume (hypovolemia) that in turn will lead to a reduction in the uterine blood flow, amniotic fluid and placental blood supply leading to placental insufficiency, fetal hypoxia (decrease oxygen) and ischemia. Leaking of fluid from the capillaries will also lead to a decrease in the mother's blood pressure (hypotension) if she is inadequately resuscitated.
  • As a result of the mother's smoke inhalation and chemical irritation to the airway, the maternal oxygen saturation will decrease leading in turn to a decrease in the fetal oxygen saturation (hypoxia).
  • Overwhelming maternal systemic infection leading to maternal septic shock that wil lead to fetal hypoxia and acidosis.
  • The release of enzymes and inflammatory mediators that stimulate uterine contractions
.

Some or all of these reactions may lead to Spontaneous uterine contractions that lead to abortion or premature delivery after intrauterine death of the featus.

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


January 8, 2013

Third Degree Burns and Tissue Expansion

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.

December 6, 2012

Fire Prevention and Safety

Fires and burns are one of leading causes of household injuries. Simple things can be done to prevent or decrease these risks of fires and the resulting burns which include:


  • Have a proper escape plan in case of an emergency.

  • Make sure that a smoke detector is installed and it is working properly.

  • Check the smoke detector every year.

  • Make sure that you have a working, fully charged fire extinguisher.

  • Make sure that your water heater is set to 120 degrees or less to avoid scalds, install radiator cover, and isolate exposed steam pipes.

  • Fire places and burning candles should never be left unattended, dispose of cigarettes, and matches carefully; never place anything that may burn near a water heater, space heater, stove top, or near a furnace,

  • If a kitchen fire occurs, don't panic, know how to handle it and put it out. For oven fires, close the door and turn off the oven. For a stovetop fire, use a lid to smother it.

  • Children should be taught never to play with matches, lighters, or gasoline; they should never be allowed to handle fireworks; never leave young children alone; place pots on the rear burner of the stove and turn the handles inward out of the reach of children; make sure that the stovetop is clean as residue grease can catch fire; make sure that the stove is turned off when you are finished; children should be taught what to do if they smell smoke of hear the smoke alarm.

  • Never place electric cords under rugs or bedding. Heat or sparks from these cords may cause a fire.

  • Always check electrical cords for signs of wear and replace cracked or frayed cords to avoid shock and fire. Don't overload outlets or power strips, and cover unused outlets with plastic plugs.

  • When dealing with chemical substances, protective clothing should be used; all chemical substances should be stored in tamper proof containers out of reach of children; chemicals should never be stored in food or drink containers; different products that contain toxic chemicals should not be mixed together as they may give off toxic fumes; avoid using potentially toxic substances in the kitchen or around food.

  • If your clothes are on fire, stop, drop and roll.

  • In case there is a fire in a building, you should move to the floor where the air is cool and clear because hot air carrying harmful gasses will rise up.

  • Know the emergency phone numbers for your area. In most places it is 911. Teach children the emergency number and post it near each phone.

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

November 29, 2012

Burn Wound healing and Laughter

Laughter is free, it has many positive effects on the physical and mental health and no known negative side effects. Laughter binds people together, infact it's the shortest distance between two people.
A team of researches from the University of Leeds, UK, found laughing habits in people suffering from wounds can accelerate healing compared to using advanced technology.

The effect of laughter may include:

  • Laughter stimulates the release of endorphines, when the endorphins level increase in the brain, the pain perception decreases leding to a decrease in pain.
  • When we laugh, the diaphragm will move leading the blood to move more smoothly throughout the body icreasing the ability of the body to use oxygen and this may lead to faster healing of the wound.
  • Laugh raises the activity and number of natural killer cells (NK cells). NK cells are cells attack and play a major role in rejection of viral infected cells and some types of tumor cells. NK cells are part of the immune system.
  • Helps prevent heart disease ( astudy done in the University of Maryland Medical Center)
  • An increase in Immunoglobulin A (IgA) antibody which help to fight upper respiratory tract infection. There are five types of Immunoglobulins in our body (IgA, IgG, IgM, IgE, IgD).
  • An increase in immunoglobulin G (IgG) antibody, they are the most common type of antibodies in our body and play an important role in fighting viral and bacterial infections, they also cross the placenta (the only Ig that has this ability) and help in protecting the fetus.
  • An increase in immunoglobulin M (IgM) which are the first antibody type produced in response to an infection.
  • An increase in T helper cells, therse are the cells attacked by HIV virus.
  • An increase in gamma interferon which regulates the body's ability to turn on the immune system.
  • An increased in in complement 3 which is part of our immune system that helps antibodies pierce through infected or dysfunctional cells inorder to destroy them.
  • An increase in number and activation of T cells as well as an increase in the ratio of helper/suppressor T cells.
  • An increase in the number of B cells, they are the cells which make all the immunoglobulins.
The effect of laughter on stress:
  • Lowers dopamine level which is associated with elevated blood pressure.
  • Lowers epinephrine.
  • Lowers growth hormone level in the blood.
  • Lowers cortisol level.
  • Lowers other stress hormones.
  • Lowers blood pressure and heart rate after initial short rise.
  • Reduces anxiety and fear.
  • Relaxes our muscles.
  • improves mood.
A stronge immune system is important in burn wound healing. Laughter boosts the immune system and increases the number of immunoglobulins which help fight infections. Infection is the most common complication of burns and is the major cause of death in burn victims. Make use of this easy to use strong medicine as it will not only make you happy, but will make everyone around you happy, it's contagious.

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

See also The effect of stress on the skin, Burn wound care at home.


November 27, 2012

Third Degree Burns and Keloid Scar (Part II)

There is no treatment that can cure and remove keloid scars 100 percent. Patients who have family history of keloid scar or previous history of keloid scar have high possibility of keloid recurrence more then others. Keloid scar may be treated by one or more of the following methods:

Surgery:

It may be the most effective way to remove large keloids. Surgery can be used by itself or with other treatment methods to decrease the possibility of recurrence as there is a possibility of keloid recurrerence an example is using surgery and steriod injection into the keloid scar or using surgery and other treatment methods to decrease recurrence rate.

Laser therapy:
Laser treatment is healpfull when the keloid scar is thin as the laser bean works on the surface of the keloid scar, it's less effective when the keloid scar is thick. Your physician will discuss with you the best method of treatment of your keloid.

Cryosurgery therapy:

Cryosurgery which is freezing of the keloid scar is usually used for small scars only as it causes freezing of the scar and as a result blanching of the skin underneath the scar.

Radiation therapy:

Radiation therapy can be used alone as a treatment method but is more effective within 7 days of after surgical keloid removal.The risk of developing cancer from radiation is small as the radiation device used for this treatment emits smalllow radiation dose.

Creams, Pasts and Gels:

Creams, Gels and Pasts are most effective when the keloid scar is newly formed but still its effectivenes is limited even with newly formed keloid scars.

Silicone sheets:

Silicone sheets can be taped on to the keloid scar. You need to wear the sheets constantly for several weeks or several months.

As keloid scars differ in shape, size and causation from one person to another, the response to treatment also differ among different individuals therefore what might work for one person may not work for you and vise versa.

The combination of two or more treatment methods is usually more effective than using one method by itself and the recurrence is less when combining two or more methods together.

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

November 6, 2012

Endotrachial Intubation

It is a medical procedure in which a tube is placed into the trachea to open the airway, remove blockages and to provide oxygen, medication or anesthesia. It may be attached to a machine called a respirator that will breathe for the patient while the tube is still in place. Airway control and mechanical ventilation are often necessary in the treatment of severe burn injuries.

Swelling in the upper airway is a major concern in any person with a burn injury. Swelling may lead to acute respiratory insufficiency, in children the airway is smaller therefore they are more prone to develop airway obstruction from burn. Swelling and damage to the airway may be caused by inhalation of the gases and fumes caused by combustion and/or the effect of heat on the tissue (see smoke inhalation). The extent of the damage to the airways is not directly related to the severity of skin burns and in some cases it may become the greatest therapeutic problem in a gravely burned patient.

Although obstruction of the upper airways caused by edema (swelling of the tissue) may happen acutely, it may not be present until the edema is sufficient enough to produce clinical evidence of impaired airway patency which may take 12-18 hours. Therefore it is important to monitor the patient for any difficulty in respiration even though the patient may not have any problems initially.

Extensive face and neck burns increase the risk of airway compression and the need for early endotracheal intubation. Deep face burns may lead to airway obstruction due to intraoral edema which will in turn decrease the clearance of intraoral secretions and impair the protection of the airway from aspiration. Deep neck burns will increase the risk of airway compression and the need for early endotracheal intubation due to the external compression of the larynx by the swollen neck.

A decision will be made by the treating physician after initial assessment as to whether or not the airway can be managed safely without an endotracheal tube. The treating physician will also make the determination of how long the patient will be intubated and when the tube is taken out depending on the condition of the patient.

When the patient is intubated, he/she may stay in bed for a prolonged period of time, this may increase the risk of developing Deep venous thrombosis (see Deep venous thrombosis part I, II) which is the main cause of pulmonary embolism, these patients are given prophylactic measures to decrease the risk of deep venous thrombosis (medications and compression devices). Make sure that these devices are worn all the time and if they are disconnected (to walk or visit the restroom), make sure that they are reconnected when the patient returns to his/her bed.

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 9, 2012

Visiting a Burned Patient In The Hospital

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

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

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

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

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

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

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.

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.

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.