Burn Injury Resource Center

Ice packs are used sometimes to treat muscle strains or sprains in different parts of the body. These packs if incorrectly used, can cause skin burns which may vary from mild such as first degree burns or more severe such as second and third degree burns. Cold burns are caused by the prolonged contact with icy objects or snow, as well as the exposure to windy conditions. The burn is cause by a drop in the temperature of the skin in contact with the ice pack, this drop in temperature causes the water contained in the cells to freeze forming sharp ice crystals and damaging the surrounding cell structure. In addition the blood vessels located close to the skin start to constrict and when the skin and the underlying tissues are exposed to prolonged cold or extreme cold, the flow of blood to the affected areas will be greatly reduced leading to damage to these areas. (See also Frostbite)

One of the most common ways this can occur is through the application of the ice pack directly on the skin of the injured area. There are certain factors that may increase the incidence of cold induced burn injuries, these may include:

• People who use medications that decrease the blood flow to the skin such as beta-blockers.
• People with peripheral vascular disease which decrease the blood flow to the affected tissue.
• People with peripheral neuropathy which decreases the ability to feel injuries.
• Smoking and diabetes.
• High velocity wind which increases the rate of heat loss from the skin.
• People who are not well dressed for extremely cold temperature.

Clinical features of cold induced burn injuries including ice packs are:

• Each individual may experience symptoms differently; the signs and symptoms depend on the severity.
• Pins and needles sensation followed by tingling and numbness.
• Redness and pain in the affected skin area.
• Firm or waxy skin which is white and completely numb (a sign that tissues have started to freeze).
• Skin blisters.
• Very severe frost bite may cause gangrene (blackened, dead tissue) and damage to the deep structures such as muscles and nerves.

Treatment of ice pack burn:

You may notice having an ice pack burn if you start developing the signs and symptoms of cold induced injury such as developing blisters, feel burning, numb, itchiness and/or pain sensation in the affected area. The color of the affected skin may turn yellowish-gray. The affected area need to be re-warmed to stop the burn from becoming severe.

• Warming process should be GRADUAL to avoid burning yourself and causing more damage to the skin. Soak the burned skin in warm water. The National Institute of Health suggests the temperature of water to be between 104 and 108 degree Fahrenheit for 20 minutes (never use hot water). You can use warm compresses or wrap yourself in blankets. Avoid massaging or moving the damaged area as this can cause the subcutaneous ice crystals in the tissue to move and cause more damage and avoid using direct dry heat to warm the affected area such as radiator or hair dryer as these areas are numb and can burn easily.
• You may need to use pain killers, local antibiotic ointment and/or dressing depending on the condition of the wound.

You should seek medical attention if the burned area:

• Doesn't begin to burn and/or tingle.
• Remain numb with the skin white, cold and hard when you touch it.
• Doesn't regain a pinkish complexion.

As these may be a signs of more severe damage of the blood vessels, nerves and muscles underneath the affected skin that may lead to gangrene.

How to avoid ice pack burns:

• Use the correct size and style of ice pack on the affected area, more than one ice pack may be needed in large areas.
• Put a barrier between your skin and the ice pack. You can use a thin folded hand towel or several layers of paper towels as a barrier. Using thick towels may keep the ice from affecting the area decreasing its benefit.
• Small children and elderly people can suffer skin burns and damage quicker than adults because of their fragile skin therefore it's safer to use frozen vegetables as a source of cold as these vegetables will melt and become soft well before they can cause damage to the skin.

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

When the skin is burned, it may heal by forming scars depending on the severity of injury. The more severe the injury (third degree burns), the more likely to develop scars and contractures.The aim of occupational therapy is to prevent or minimize the scars and deformities that may result from the burn injury. (See preventing and dealing with scars)

Occupational therapy is a skilled treatment that helps individuals achieve independence. OT may be started while the patient is still in the hospital and may be continued after discharge.

Occupational therapists evaluate the patient's need for a splint, positioning (sitting, comfort in bed) and exercises. They institute diversional activities, teach activities of daily living, provide a home program of splinting and exercises before discharge and home visits (if the patient needs them) after discharge.

The patient plays a major role in the recovery process. It may be difficult in the beginning with the pain and stress associated with the exercises, but with time it will be easier. The more time spent following the program, the faster the healing process and the less scaring and deformities.

Occupational therapy may be hard in the beginning because of the pain that is associated with the burn and surgeries, the sensitivity of the skin and the fear that the patient may experience. With children, doing occupational therapy may be more difficult. Parents play an important role in encouraging the child, helping him/her with their therapy and praising them.

Some patients will be transferred to a rehabilitation center after discharge from the burn center to continue their rehabilitation. The duration and type of therapy will depend on the condition of the patient and the severity of the burn.

Patients may be discharged home with instruction to continue Occupational therapy at home; compression garments may be given and used with exercising.

Make sure to attend all outpatient follow up appointments with the burn clinic. Your physicians and therapists will monitor your progress and make adjustments as 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.

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

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

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

After scar revision:

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

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

• The size of the scar
• The direction of the scar
• The nature and quality of your skin
• How well you take care of the wound after the operation.

If your scar looks worse at first, don't panic because the final result of your surgery may not be apparent for a year or more.

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

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

PTSD is a psychiatric disorder that may occur after the exposure to a traumatic event. People differ in their reaction to trauma; some will return back to normal after an exposure to a traumatic event, others will experience symptoms of post traumatic stress disorder. PTSD develops differently from one person to another. Symptoms of PTSD most commonly develop in the hours or days that follow the traumatic event , but can also happens weeks, months, or even years after the incident.

PTSD is some what common. It can affect those who personally experience the trauma, those who witness it, and those who pick up the pieces afterwards, including law enforcement officers and emergency response workers. In the United States, 60% of men and 50% of women experience a traumatic event during their lifetimes. The diagnosis of PTSD was developed by studying soldiers from war, and it was originally called "shell shock syndrome."

Many events and life situations may lead to the development of PTSD, these include:

• Exposure to severe burns such as third degree burns.
• Military combat.
• Sudden death of a loved one.
• Sexual assault or physical attack in childhood or adulthood.
• Exposure to terrorist attack.
• Exposure to natural disasters such as earthquake.
• Exposure to a serious accident.

PTSD can happen in adults as well as in children. The symptoms may rise suddenly, gradually or come and go over time. In adults, the symptoms may include:

• Any reminder of the traumatic event will produce upsetting memories and intense physical reactions like rapid breathing, palpitation, nausea, sweating and muscle tension.
• Having flashbacks, bad dreams (Re-living the events).
• People try to avoid situations and things that trigger the traumatic event.
• People isolate themselves from others and may feel emotionally numb, they may be less interested or lose interest in activities that they used to like.
• People feel irritable, anxious, have anger outbursts.
• Feeling that they are in constant danger.
• Having difficulty in concentrating.
• Having sleep difficulty.
• Having nightmares.
• Having depression.
• Having suicidal feelings and thoughts.

Children may show symptoms of PTSD depending on their age, young children may have nightmares, sleeping problems, fear and upset if the parents are not nearby, regression in a previously trained child such as bed wetting, and toilet training trouble.

Some people will develop PTSD after a trauma while others won't; people will have increased the risk of developing PTSD if:

• The person was seriously injured as a result of the trauma.
• The person was the one who was exposed directly to the trauma.
• The trauma was long lasting.
• The person was not in control during the event.
• The person had a previous mental issue.
• The person had a history of prior severe trauma.
• The person doesn't get that much help and support after the trauma.

Treatment:

• Counseling (talk therapy): this is one of the methods of treatment in which the person can get help and discuss his/her feeling that will help to get to normal life activities. Cognitive behavioral therapy (CBT) is a type of treatment that helps is promising and is the most effective in counseling. Family therapy may be effective too as PTSD not only affect the patient him/herself but those who are close to the patient, this therapy help the family understand what the patient is going through and communicate better with him/her.
• Medications: in the form of antidepressant medications.

Other diseases and conditions may occur with PTSD such as depression, panic attacks, drug and alcohol abuse.

• The earlier the treatment, the better the outcome as symptoms of PTSD may get worse.
• Seek medical help if you or your child has symptoms of PTSD.
• Seek help and support from your family or your close friends, they may be able to help and support you.

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.

Infection remains the most common complication of burn wounds, it's a major cause of death among burned patients. It can happen in the hospital or at home; it can be local (at the site of burn) or systemic (the spread of infection to other areas of the body).

As the skin plays an important role in protecting the body against infection and acts as a barrier that prevents Microbs from entering the body, the risk of infection increases when a burn injury happens.
Risk factors of developing a burn wound infection many include:

• The extent of burn, burns exceeding 30% of the total body surface area (TBSA) are at higher risk.
• The depth of burn, full thickness burns (third degree) are at higher risk.
• The location of burn, burns in the perineum are at higher risk of infection.
• The age of the patient, extremes of age are at higher risk because of lower immunity.
• The general condition of the patient, amonge conditions that increase the risk of infection are immunosuppression, obesity, diabetes and malnutrition.
• The type of organisims, their number and virulence.
• The quality of wound care provided for the patient.
• Duration of hospitalisation and number of days ventilated.

The incidence of infection and its mortality has significantly decreased due to the improvements in the techniques of burn wound care and infection control mesures. When infection happens, it can cause the wound to progress from a partial thickness (e.g second degree burns) to a full thickness (e.g third degree burns), can prevent or delay healing, can encourage scar formation and can result in septicemia and organ failure.

Burn wounds should be inspected daily for signs of infection especially in pediatric age group as they sometimes can't express their feelings of being unwell.

Warning signs of infection may include:

• Increased or persistant pain.
• Increased redness in or around the wound.
• Increased swelling in or around the wound.
• Increased drainage from the wound.
• Change in the color of drainage (green discharge or puss).
• Foul smell from the wound.
• Increased warm feeling from the wound.
• Bleeding from the wound between dressing change, or soaking the bandage with blood, unless there has been a trauma (remember that bleeding at the time of dressing change itself may be expected).
• Chills or fever greater than 101.4 degrees. Burned patients should check their tempreture daily.
• Complete loss of appetite.
• Persistent vomiting or diarrhea.

Helpfull tips in preventing wound infection:.

• Keep the burned area clean.
• Look for any signs or symptoms of infection during dressing change.
• Follow a strict sterile protocol during wound dressing change (see home wound care).
• It's important in infants to observe any change in the appearance of wound or change in activity level (not playful, fails to hold eye contact, lethargic) children can't express what they feel. Contact the doctor immediately if you observe any sign or symptom of infection.
• Topical antibiotic ointments may be prescribed as a prophylactic (preventive) measure in burned patients.
• Infection delays wound healing, encourages scarring (as a result of collagen deposition in reaction to the infection) and may result in bacteremia and organ failure (systemic 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.

Itching:
Itching occurs with healing and newly healed burned areas. Itching can be a major problem for some children when they are in the hospital as well as after being discharged home. Itching is caused by the overlapping tissues formed by the scar itself. This tissue lack the nerve endings that is present in normal skin but due to the surrounding normal tissue that still has nerve endings, they become stimulated by scar tissue thus the characteristic itch kicks in. Itching should decrease as scar tissue matures. Itching can disturb or even prevent your child's sleeping. Although it's hard, try to prevent your child from scraching the burned areas as these areas are still raw (immature) and may bleed easily or get infected with continous or vigorous scraching.
Among the things that help in decreasing your child's itching are:

Keeping the burned area lubricated by applying cream and massage the burned areas on a regular basis.

Wearing loose clothes made of natural materials such as 100% cotton with light colors.

Avoiding clothes or elastics over the clothes like waistbands.

Avoiding your child of prespiring and becoming hot.

Encourage your child to wear compression garments as prescribed. Compression (pressure) garments must be worn 23 hours a day and taken off only when bathing your child.

Clip your child's fingernails regularly, there are certian gloves that your child can wear to prevent him/her from scraching the burned area.

Tell your child whenever possible to elevate the affected area.

If itching becomes severe or prblematic for your child, please call your doctor as he/ she may prescribe medications that can help with itching.

Applying lotion or cream:
Healing burn wounds as well as skin grafts, donor sites and scars all require creaming on a regular basis to prevent these areas from becoming dry, becoming sore and cracking. The reason for that is because the healing and newly healed skin is unable to lubricate itself in the same way as the normal skin does.

These are some helpful tips regarding applying lotions or creams on your child's affected areas:

Apply the lotion or cream as often as needed, follow the instructions given to you, this should be repeated 2-3 times a day. It may be needed more often if the your child's skin is particularly dry.

Use enough lotion or cream to lightly lubricate your child's skin. Gently rub and massage the cream until it disappears, the skin shouldn't feel greasy after putting the lotion rather it should feel moist and soft.

Massage involves firm pressure in circular waves over the scar.

Avoid using lotions or creams recommended by your friends or family, also avoid using lotions or creams containing chemicals or perfumes as healing and newly healed skin is very sensitive and can be damaged by the wrong lubricant.

It's important that you cleanse your child's skin every day as the build up of lotion or cream may cause skin irritation and clog the skin pores. Excessive lotions or creams can also damage pressure garments

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.

Burn injuries are not only devestating for the patient but for the whole family. A common question the parents ask, is for how long their child will be hospitalized in the hospital. When the time comes, the Burn team will begin planning for discharge. The case manager or the social worker assined to the patient will assist with coordinating discharge plans. Among the things discharge plan deal with is, caring for the child at home, potential complications , follow up appointments and refferals if the child need them.
Caring for your child at home involves the following:

Medications:
Mnay burned children are discharged home with several medications. Before leaving the hospital make sure to ask any question you have about the medication of your child, you should know how to give these medications, when and for how long, what are they used for, and what are the side effects that may happen as a result of using these medications. Continue giving these medications as described by the treating physician even if you think that your child is feeling well and if you have any concern or question, don't hesitate to call the treating physician.

Diet:
A well balanced diet with a lot of fluids is necessary for the healing process. Start your child with small frequent meals. See also nutrition and burns.

Activity:
An important part of well being and recovery is to help your child engage in light activity as soon as possible. It's normal for your child in the begining to feel weakness and fatigue as he/she has been in the hospial for a period of time without using the muscles but this will improve with time. Activity help in increasing the circulation (blood supply), decrease scaring, improve contractures, and prevent the loss and improve muscle strength. Follow the instructions given to you by the burn team. Some chilren may need to be reffered to physical therapy and/or occupational therapy as needed, they may get these services at home. Make sure that your child aviods all strenuous activities and contact sports until cleared by the treating physician. See preventing and dealing with scars.

Changing dressings:
An important part of the burn care is dressings as they protect the burn wound from injury, keep ointments or creams on the wound and absorb any fluid or discharge drawn out of the wound. You play an important role in observing dressing condition and dressing change. The burn team before discharge will teach you how to change your child's dressing, how often and for how long. Dressing change may be frightening and painful for your child, it's better to give pain your child pain medication 30 minutes before dressing change.

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

As the winter season is progressing with the temperature falling and as the heating cost is rising, more people are using portable space heaters to help lower the bills paied for energy. There are many models of space heaters including those that are electric, those that burn kerosine, propane and other fuels. Many homeowners chose the electric model as they don't produce an open flame and don't produce noxious fumes therefore they appear safer. According to the U.S. Consumer Product Safety Commission (CPSC), many homeoners exhibit a false sense of security related to electric space heaters and appliances which can, infact, be very dangerous when used improperly. The CPSC warns that although space heaters don't produce an open flame, they do produce enough heat to ignite flammable objects near by such as clothing (see flammable clothing), furniture rugs, papers, as well as the risk of electric shock and electrocutions.

According to the U.S. Consumer safety Commission, more than 25,000 residental fires, 300 deaths, and 6,000 burn injuries every year are associated with the improper use of portable space heaters. If you are you are using an electric space heater, consider these safety tips:

• Shop for heaters with safety certification. Portable space heaters that are listed by Nationaly Recognized testing Laboratories (NRTLs) have been certified after being tested and proven to meet specific safety standards.
• When purchesing a heater, purchase one with a guard around the heating elements.
• Make sure to read and follow the instructions for operating and maintaning a space heater before using it.
• Plug the heater directly into an outlet. If you have to use an extension cord, make sure that this cord is a heavy duty cord make with No. 14 gauge or larger. Using an inappropriate cord increase the chance of over heating, fires, burns and electrical shock and burn injuries. Never run the heater's cord or the extension cord under the carpet or rug
• Shut off and unplug the heater when leaving it un attended. Turn off the space heater and unplug it when you leave a room or going to bed.
• Do regular inspection and cleaning of the space heater (annually) to make sure that they are safe to operate as contaminants and dust can become fuel for fire. Never operate a defective heater.
• Keep portable electric heaters away from water to aviod electric shock and electrocutions, and never touch an electric heater with a wet hand.
• Never use an electric heater to dry clothes by placing placing clothing over it.
• Always place the space heater on an even surface and never place it near areas where children may play or where people may bump into or trip over.
• keep children, pets, any flammable or anything that may ignite at least three feet away from all heating equipment.
• Try purchesing space heaters that will automatically shut off when knocked over or when they are too hot.
• Install smoke alarms and carbon monoxide detectors on each floor of your home. Test these detectors at least once a month to make sure they are in a good working condition.
• Make sure when using fireplaces that they are properly vented to the outside as inproper ventelation may lead to smoke accumulation that they lead to smoke inhalation injury.

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.

Boiling water steam can cause steam burns. The burn can vary in severity from a minor to a major burn. It can be a first degree burn part I, II, second degree or a third degree burn part I, II. The temperature of boiling water steam is more than 100 degree centigrade (which is 212 degrees Fahrenheit) and pure steam is invisible, therefore the person can be in danger of a steam burn without being aware of it. Steam can be inhaled leading to airway burns that can have serious consequences and can end in the patient's death.

When a patient has a steam burn, it's important to assess the severity of the burn, a superficial steam burn can be treated at home see first degree burns part I, II. Major burns need medical attention.

Avoid the following:

• Don't over cool the burned area as it may lead to shock.
• Don't use ice to cool the burned area as it may cause further damage.
• Don't use bandages that are adhesive as it may adhere to the burned skin.
• Don't apply butter or oils to the burned area as it interferes with the healing process and can make the burn worse.

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.

After being discharged home from the hospital, a new phase of wound care starts at home. The new healing skin needs special care and consideration in which you play a major role.

Bathing: the first thing to be done before getting into a shower or a tub is to test the temperature of the water as your new skin is sensitive to extreme cold or extreme hot water and can be injured easily. Make sure that the area where bathing is taking place (shower or tub) is clean. Always look for signs and symptoms of infection of infection especially in children as they may not be able to speak. Gently wash with a clean soft towel instead of vigorously rubbing as this will lesson any discomfort associated with bathing. Use your medications as described before washing the wound if you have any open area. Continue to wash these area as directed according to the instructions that you have been given and with applying medication as directed.

Scarring: it's very difficult to tell how much scarring will be perminant in the beginnig. People vary in their tendency to scar, some people have a greater tendency to scar than others and it's difficult to determine how much scarring each patient will have as the amount is determend depending on the depth of the burn as well as individual basis. There are 2 types of scars, Keliod and hypertrophic scars.

A keloid scar is a type of scar that results in an overgrowth of tissue at the site of healed skin injury due to aggressive healing process. This type of scar grows and extends beyond the site of injury unlike hypertrophic scar. They occur as a result of the body's continuous production of collagen which is a fibrous protein after the healing of the wound. They often appear red or pink in color as compared to the surrounding normal skin. They are firm, rubbery lesions; they may appear shiny or as fibrous nodules. Keloid scars may be accompanied by severe itching, pain and may limit mobility if they are extensive. They may vary in size and some types may increase in size. They may occur anywhere on the body although some areas are more susceptible to form keloid scars such as the deltoid region. They occur more often in darker skinned patients.

A hypertrophic scar is an elevated scar that appears red, thick and raised as a lump on the skin, hypertrophic scars usually feel firm to the touch, and they may be sensitive to changes in temperature or texture. They don't grow beyond the injury site or incision (unlike a keloid scar which grows beyond the original site of the injury). Hypertrophic scars usually start to develop within weeks after the injury and often improve in appearance with time, which may take few years.
Treatment of scars is not easy, scars have the tendency to re-occur and multiple treatments may be required. Treatment may include compression garments, steriod injuction, cryotherapy, surgical therapy and laser surgery.

It's important to follow your doctor's instructions. if you have been prescribed compression garments, it is important to wear them for 23 hours a day (taken off only when bathing), as they can minimize scarring. If you were taught any exercises than you have to do them as they will minimize the scarring.

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.

Wound care at home is one of the important factors in the continuation of wound healing. You may be discharged from the hospital with unhealed wound areas that still require wound care. Before being discharged, the social worker will have a meeting with you to discuss your discharge arrangement. According to your burn severity and your needs, you may be sent home or to a rehabilitaion facility were you will be provided with services according to your needs such as Physical therapy (PT), Occupational therapy (OT), and Speech therapy (ST).

Being discharged home after a lengthy hospital stay is one of the exciting moments for a burned victim. Your healing skin requires special attention and care. Some of the facts that you should pay attention to include:

• Skin dryness: when the skin is burned, the oil producing glands in the skin (Sebaceous glands) will be damaged or destroyed and your skin will appear dry and scaly. Until the time some of these glands will begin functioning again, lubricants are needed. Avoid using lubricant that contains chemicals or alcohol as they may lead to skin irritation and blister formation. Use the lubricants as directed by your treating physician.
• Blisters: blisters occur in grafted or healed skin. Bumping against objects, friction and rubbing with linen can cause blisters. As the new skin matures and thickens, the tendency to form blisters decreases. Contact your burn clinic or treating physician when blisters when blisters form to take instructions on how to take care of them.
• Exposure to sun: you should protect your new skin from the effect of sunlight as the new skin is more sensitive and takes shorter time to burn. Direct contact with sunlight should be avoided at all times. Protection from sunburn can be done by: limiting exposure to sun specially in the peak hours (10am-3pm), Wearing sunscreens with a sun protective factor (SPF) of at least 30, Applying sunscreen 30 minutes prior to sun exposure (to allow skin to absorb it); sunscreen absorbs ultraviolet light reducing the amount that reaches the skin, Wear sunscreens when swimming in an outdoor pool, Wear hats, protective clothing and sunglasses with UV protection, Use lip balm with sunscreen to protect lips from burning, Look for shady areas, An ounce of prevention is worth a pound of cure.
• Exposure to cold: the new skin is thinner and with time it will mature therefore it will be more sensitive to cold. When the weather is cold, slight numbness and tingling may be experienced especially in the feet and hands, this sensation will decrease with time. Wearing warm cloth and avoiding cold exposure help in decreasing the discomfort.
• Itching: the new skin is dry and scaly due to the destruction of the oil producing glands which take time for some of these glands to function again. Itching is usually associated with healing, dry and scaly skin. Vigorous scratching should be avoided as this may lead to a break in the healing skin as well as a superadded infection. Use lubricants (mineral oil, lotions) as needed. Contact your physician in case of severe itching as he/she may prescribe medications for that purpose.
• Skin discoloration: skin discoloration that may be noticed in the healing area is a result of the normal healing process. The color may vary from light to brown or even gray in color as the discoloration varies depending on the natural color of your skin. The time needed for the skin to return to its natural color depends on the severity of burn as it may take several months in superficial and some second degree burns while others may take a longer time, some skin discolorations may be permanent in severe burns such as third degree 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.

The two most important problems encountered clinically with burned patients are infection and dehydration. When a person is burned and depending on the severity of burn, the blood vessels including the capillaries may be affected. Combined with the release of chemical substances into the blood, this will lead to increased capillary permeability to fluids, leading to the leaking of fluids from the blood vessels into the tissues. The higher the percentage of burned skin, the more severe the loss of fluid will be and the greater the dehydration will be.

In a third degree burn the entire thickness of skin (epidermis and dermis) is involved and nerve endings have been destroyed. The body's barrier against water loss is no longer there. When the protective covering does not exist, fluid seeps from the burned area causing dehydration and electrolyte imbalance. Unless fluids are replaced immediately, renal shut down and hypovolemic shock will occur. Skin is both a physical barrier, preventing water loss, and also a chemical barrier, preventing the growth of bacteria.

Fluid replacement is one of the important objectives in the initial treatment of burned patients. The amount of fluid needed and the method of fluid given depends on the surface area of the skin burned as well as other factors. There are many formulas used to calculate the amount of fluid needed for resuscitation; one of them is called the Parklund Formula in which after the amount of fluids is calculated, it is given through an IV route and the type of fluid is usually Ringer Lactate because it's composition is simillar to the extracellular fluid.

Dehydration can be a life threatening complication that may even lead to death. Urine output (0.5 ml/kg/hour in adult and 1 ml/kg/hour in children) is one of the methods used to evaluate adequate fluid resuscitation. Over resuscitation may lead to compartment syndrome. Patients with minor burns can be resuscitated with oral rehydration therapy. You have to make sure that you are taking enough fluids, not vomiting and is producing a satisfactory amount of urine.

Edema (accumulation of fluid in bodily tissue or body cavity) may become worse after fluid resuscitation and if this edema is in a compartment (closed space of nerves, muscle tissue and blood vessels) covered by dead tissue as a result of the burn which is inelastic and can't expand, this edema may lead to compression of the blood vessels in the compartment leading to compression of circulation in which escharotomy may be needed to release that pressure. It is advisable to watch the burned areas, especially in the extremities, for signs of decrease blood flow to the affected area.

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.

As a burned patient you have certain rights being in a hospital or a physician's clinic. These rights are available to all patients. Many hospitals in New York and other states have patient advocates, their duty is to help you if you have any problrm during your path of treatment.
Your rights include the following:

1. The right to be informed of all your rights.
2. The right to have adqequate health care.
3. The right to choose your care provider.
4. The right to recieve information from your doctor regarding your treatment.
5. The right to discuss the benifits, side effects, risks, cost and reasonable alternatives .
6. The right to make your own decisions regarding the care you are receiving.
7. The right to keep your medical information private.
8. The right to get a copy of your medical records.
9. The right to receive reasonable continuity of care.

What is an informed Consent:

An informed consent is a consent taken from the patient for a surgical or medical procedure or a treatment after achieving an understanding of the relevant medical facts and the risks involved. The informed consent is a kind of protection for the physician from being sued in the future for negligence and malpractice. Patients should be competent in order to give an informed consent, if the patient is incapable of providing competent consent a family member will do that.

For you as a patient, what should you understood from the informed consent:

1. The type of procedure done and wether it's a major or a minor one.
2. The purpose of the procedure.
3. The benefits, side effects and risks of the procedure.
4. The other alternative methods of treatment.

What should you do before signing an informed consent:

Burn injuries can be overwhelming for both the patient and his/her relatives due to the magnitude of the injury. Patients and their relatives should remain calm as much as they can, they should read, uderstand and ask any question they have regarding the procedure to be done, it's benifits, risks and alternatives.

Don't feel intimidated to ask any question that comes in mind. If it's an elective procedure then try to arrive early so that you have enough time to read and fully understand all the information on the informed consent (take your time and don't rush). If you don't understand something in the consent, don't hesitate to ask as often these consents has medical terms that are hard to understand.

By signing an informed consent form you are giving your permission to the treating physician to perform the procedure required and as every procedure has it's own risks and complications, you should feel fully confident that all your questions and concerns has been answered. In most cases your treating physician will explain to you the content of the informed consent before doing the procedure 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.

Burns are one of the most devastating and serious injuries that can happen in a person's life, not for the victim only but for the relatives as well. Depending on the severity of burns, some of them may need to be referred to the hospital for treatment such as second and third degree burns
The initial contact of the victim with the burn service starts usually with the Emergency Department, and perhaps it's the only injury that need specialist treatment by a team of medical, surgical and nursing personnel who have a specific specialization. The Emergency department may be confusing for both the patient and the relatives; on the other hand the arrival of the patient to the emergency department is one of most dramatic events in the surgical practice.

Sometimes an atmosphere of tension is created in the emergency department due to the pain and fear of the patient and his/her relatives, the magnitude of the injury and the visibility of the damage therefore it's important for the patient and the relatives to stay calm as much as they can and to interact with the medical and surgical team treating the patient as they play an important role in the healing process of their patient.

The duration that the patient needs to stay in the Emergency Department varies from one patient to another, some patients stay for a short period of time while others may need to stay for a long time (several hours) for the evaluation during which the staff will provide the patient's relatives with updates on the patient's condition. The family of the patient should not hesitate or feel intimidated to ask any question they have regarding their patient as for some of them this is a new experience they haven't gone through before.

Following the evaluation and depending on the patient's condition, some patients are discharged home while others are admitted to the hospital or transferred to a specialized burn center for further treatment.

The criteria for transferring a patient to a burn center may include:

• Burns involving the face, eyes, hands, feet, genitalia, perineum or major joints.
• Third degree burns regardless size of burn and age of the patient.
• Partial thickness burn 5-10% total body surface area.
• Chemical burns.
• Electrical burns including lightning injury.
• Patients with burns who suffer inhalation injury.
• Patients with preexisting medical condition that can complicate the burn injury and prolong the recovery process.
• Burns in children in whom the hospital is without qualified equipment or personal to care for the child.

Family members are encouraged to ask questions and seek explanations regarding the condition of their loved ones. Family members are also encouraged to take care of themselves by getting enough nutrition and rest besides leaving the hospital when possible. The team caring for the patient gives frequent reports to immediate family members regarding the condition of the patient.

The burn is not a superficial and localized injury affecting only the skin; it's systemic and affects most systems in the body therefore there are 2 teams involved in the treatment of burned patient. The Surgical and the medical teams. The surgical team is responsible for caring of the burn injury in all its aspects. The medical team is responsible for the general condition of the patient not only the burn. Victims of burn injuries may be eligible to receive legal compensation for their pain, suffering, medical bills, and physical damage.

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. Your initial consultation is always free, and you won't need to pay any attorney fees until they help you win monetary compensation.

One of the cases they handled involves an infant who was burned as the result of domestic hot water that measured 158 degrees Fahrenheit. She suffered 2nd and 3rd degree burns over 20% of her body. She was hospitalized for one month. Debridement and skin grafting was done. She developed an infection and she passed away. A case was brought against the landlord for the excessively high water temperature and the medical professionals who failed to diagnose and treat the infection that caused her untimely death.

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.

The amniotic membrane is a thin membrane that surrounds the fetus during pregnancy. The amniotic membrane can be used as a temporary coverage for burn wounds such as second and third degree burns. It can be used for both superficial and deep burn wounds as well as after dermoabrasion and in donor region. It can be obtained from the placenta. The pregnant has to be free from STDs and other diseases. The smell and the color of the placenta should be normal. As the number of patients surviving the burn injury is increasing due to the improved management of burn injuries, the use of biological dressing including the amniotic membrane is increasing in many parts of the world.

The advantages of using amniotic membrane as coverage for burn wounds are:

1. Decrease fluid loss from the burned surface.
2. Its use is not associated with immunological problems or allergic reactions.
3. Available in large size.
4. It's available in enough quantity.
5. The histological structure of the amniotic membrane is similar to the structure of the skin.
6. Decreases pain and decreases the possibility of keloid or scar formation.

The disadvantage of using amniotic membrane is the difficulty for viral infection screening and therefore there is some risk of transmission of viral infections such as Hepatitis unless preservation methods can eliminate the possibility of viral contamination.

The amniotic membrane doesn't vascularize (form blood vessels), but still can provide an effective method of temporary wound closure.

The type of amniotic membrane that is used for superficial burns is different from that used for deep burns. For deep burns, the amnion (a thin sac that surrounds and protects the fetus) and Chorion (one of the membranes that exist during pregnancy between the developing fetus and mother) are used while for superficial burns the amnion alone is used. To facilitate the control of bacterial overgrowth, the amniotic membrane is treated with silver.

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.