Burn Injury Resource Center

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.

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.

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.

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.

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.

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.

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.

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.

Keloid scar is a benign scar composed of dense fibrous tissue formed as a result of an abnormal healing process in response to skin injury, extending beyond the original borders of the wound or inflammatory response. There is little to be done to prevent them and even with its removal there is a possibility of keloid recurrence. Keloid scar may affect the patient both physically and emotionally as it may become a cosmetic problem depending on its location on the body.

Keloid scar can happen in any age and can affect both sexes. The incidance of keloid scar varies among different races, it's more common among blacks, hispanics and Asians and less common in Caucasians for unknown reasons. Both genetic and enviromental factors play a role in the formation of keloid scar. Keloid scar may form following skin inflamation such as acne vulgaris or skin injury such as second and third degree burns. Keloid may happen may appear months after skin inflammation or trauma but may take up to a year to develop.

Keloid scar can present as a firm nodule which can be skin coloured, hypopigmented (lighter in colour) or erythematous (red in colour) and is often located at the site of the injury (such as burn), wound which could be surgical or non-surgical or other lesion. Most common locations of keloid scar include the shoulders, , chest, sternal area, earlobes and back of the neck. Symptoms of keloid scar may include pain, itching and mobility limitalion if it is located over a joint area.

See also: Hypertrophic scars, Contractures, Burns and itching, Occupational therapy and third degree burns, Prevention and dealing with scars, Physical therapy and third degree burns, Scar massage, Psychological consequences of burns, Compression 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.

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.

Also known as Adult Respiratory Distress Syndrome is a life threatening lung condition in which fluid accumulates in the lung leading to low levels of oxygen in the blood.

When a healthy person breathes, air will enter the nose and mouth passing through the trachea (windpipe) to reach the alveoli (air sacs) of the lungs. Oxygen will pass from the alveoli to small blood vessels surrounding the alveoli called the capillaries and from the capillaries to the bloodstream where it will be carried to different parts of the body. When the lung is injured from many causes including severe burns fluid and blood will leak from the capillaries into the alveoli, this will prevent air from entering the alveoli leading to decreased oxygen in the bloodstream and in turn decrease the oxygen supply to different organs which will affect their function. The lungs become inflamed, the inflammation will lead to scaring and fibrosis of the lungs causing the lungs to become stiff. This stiffness of the lung with fluid will make breathing very difficult for the patient.

Causes may include:

• Sepsis.
• Pneumonia.
• Severe burns.
• Massive body trauma.
• Inhalation of smoke or toxins.
• Gastric aspiration.
• Transfusion of multiple units of blood.
• Drug over dose.
• Pancreatitis.

Symptoms and signs include:

• Difficulty in breathing.
• Increased respiratory rate (tachypnea).
• Increased heart rate.
• Fever.
• Anxiety.
• Wheezing herd with a stethoscope.

Diagnosis:

Investigations include arterial blood gas measurement, Chest X-ray, monitoring pulmonary capillary pressure by a pulmonary artery catheter introduced through a vein. Depending on the cause other investigations may include Complete blood count, liver function test, renal function test, CT scan and bronchoscopy.

Treatment:

Patients with ARDS are hospitalized and are treated in the Intensive Care Unit which include

• Oxygen supplementation and the use of a mechanical ventilator (See mechanical ventilator part I, II).


• Antibiotics and corticosteroids may be used.


• Intravenous fluid to prevent dehydration and provide nutrition.

Outlook:

Survival rate of patients with ARDS has improved; among factors that affect the outlook are the age of the patient, underlying cause of ARDS and any associated illness. Normal lung function is resumed in some patients after recovery. However others may experience breathing difficulties ranging from mild to severe. Patients who spend a long time on the ventilator and those with severe disease are more liable for persistent lung damage.

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.

Treatment:

Acute compartment syndrome is considered a medical emergency that requires immediate surgical treatment. The surgical procedure is called a fasciotomy which is simply done by making a long incision in the fascia to release the pressure building inside.

Subacute compartment syndrome is treated surgically by urgent fasciotomy.

Chronic compartment syndrome can be treated conservatively if it's in the lower limb (this may include the use of anti-inflammatory drugs, rest and elevation of the limb). If there is no improvement and the symptoms persist surgery may be necessary.

Complications:

If the pressure in the compartment is not relieved, this may lead to functional impairment of the affected area due to permanent damage to the nerves and muscles. In more severe cases limb amputation may be needed as a result of death of the muscles in the affected compartment which resulted from the lack of blood supply.

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

A compartment is defined as a closed space of nerves, muscle tissue and blood vessels. This space is surrounded by fascia (thick layer of tissue) that doesn't stretch. When the pressure inside the compartment increases from any cause and if the pressure increases substantially, this may lead to the compression of the nerves, blood vessels and muscles inside the compartment. The result may be impaired blood flow and reduced oxygenation that may result in muscle and nerve damage. Compartment syndrome most commonly involves the forearm and lower leg although it can occur in other places. Compartment syndrome can be acute, subacute or chronic (see below).

Causes:

An injury that leads to an increase in the pressure inside the compartment may cause compartment syndrome, these may include:

• Burns.
• Car accidents or crush injuries.
• Hemorrhage (bleeding into the compartment).
• Tight bandages or casts.
• Intravenous drug injection.
• Surgery.

Signs and symptoms: may include

• Pain: it is usually severe pain and out of proportion with the injury. The pain doesn't respond to pain medication and is increased by stretching the muscle group within the compartment.
• Alteration or decrease sensation of the skin.
• Paleness of the skin.
• Weakness and in later stages paralysis of the limb may occur if not treated.
• Capillary refill time (the rate at which blood refills empty capillaries) of the digits is prolonged.
• Congestion of the digits.

Diagnosis:

• Clinical diagnosis based on the signs and symptoms.
• Measuring the pressure inside the compartment. This may be done by inserting a needle attached to a pressure meter into the compartment.

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.

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.

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.