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July 24, 2014

Global View of Burned Patients

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.


July 15, 2014

Laser Skin Burns After Hair Removal

Laser hair removal is one of the medical procedures used to remove unwanted hair from the skin. Laser simply works by distinguishing color differences between the hair and the skin, it goes and hits the darker color area which is the hair, leading to heating of the hair follicle and destroying it making it unable to grow new hair.

This procedure has become more popular over the years, and although laser hair removal is relatively safe in the hands of an experienced technician, side effects may occur. These side effects may range from skin swelling and redness to skin burns and even scaring (replacement of normal skin with fibrous tissue).

Skin burns occur either due to the prolonged use of the laser on specific areas or may result when the intensity of heat is too high. The skin will absorb the laser energy which may lead to skin burns. These burns are usually minor burns but severe burns may also occur ( Second degree burns and third degree burns). Seek medical attention if the burn doesn't heal or it takes a long time healing.

Other side effects of laser hair removal may include:

Redness, swelling, slight pain, infection, bleeding, color change in the form of darkening of the skin (hyperpigmentation) or lightening of the skin (hypopigmentation).

Before going through a laser hair removal procedure, make sure you discuss all the other options available. You should discuss all the concerns and questions you have with a laser specialist, he/she should be able to answer all your questions, explain all the risks associated with the procedure and tell you if you are an appropriate candidate for the procedure. The success of the procedure depends on how much experience and training the technician/specialist has.

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

July 14, 2014

Keloid Scar

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.

Treatment:

The treatment of keloid scar varies and the recurrence after treatment is common. Treatment may include:

  1. Steroid injection: this involves injecting steroid into the keloid scar, it may help to reduce the size of the scar and decrease itching and redness that may be associated with these scars. It may be used with other procedures like surgery.
  2. External pressure therapy: eg, compression garments.
  3. Cryotherapy: this involves freezing the keloid scar with a medication.
  4. Surgical therapy: is used if the keloid scar is not responsive to nonsurgical treatment.
  5. Laser surgery: this method involves the use of different lasers depending on the underlying cause of scar. It may be used to smooth the scar, remove abnormal color of a scar, or flatten a scar. This method is often done with other methods like steroid injection.
  • Keloid scars have the tendency to re-occur and multiple treatments may be required.
  • It is 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.

July 11, 2014

Skin Graft

It is a surgical procedure which involves the placement of a piece of healthy skin in areas where the skin is damaged. It is usually done in an operating room under local or general anesthesia depending on the size of the graft.

Skin grafts can be classified into:

  1. Autografts: where the skin for the graft is taken from the same person.
  2. Allograft: where the skin for the graft is taken from another person.
  3. Xenograft: where the skin for the graft is taken from animals (usually pigs).
A skin graft can be partial thickness where the first two layers of skin are taken, or full thickness skin grafts where the entire thickness of skin is taken which is done in patients with deeper tissue loss.
  • The area where the healthy skin is taken from is called the donor site.
  • The donor site can be any area of the body; it is usually in areas hidden by clothes like the inner thigh.
  • The area which receives the healthy skin is called the recipient site (the graft site).
The donor site will be covered with a dressing for the first one to two weeks. It usually heals within 10-14 days. Lotion is applied to the donor site after the dressing comes off.


For the recipient site (graft site) the dressing is left in place for two to five days before it is changed. The area is very fragile and great care should be taken to ensure that it is protected from trauma and heavy stretching for two to three weeks.

Complications:

  1. Infection.
  2. Bleeding.
  3. Graft failure.
  4. Graft rejection.
  5. Scarring.
  6. Skin discoloration.
  7. Chronic pain.
  8. Change in the sensitivity of skin.
Future care:

It is important to take care of the graft area by protecting it from excessive sun exposure, protect it from dryness (use ointment or creams after consulting with your doctor).


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

July 10, 2014

Burns And Fluid Replacement

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.

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 for fluid 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. 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.


  • Fluid is replaced to prevent hypovolemic shock and other associated complications such as kidney failure.

  • Patients with minor burns can be resuscitated with oral rehydration therapy. You have to make sure that your child is taking enough fluids, is not vomiting and that he/she is producing a satisfactory amount of urine.

  • Ringer lactate is usually given because it's composition is most like normal extracellular fluid.

  • Fluid that leaks from the burned area can accumulate in the burned area only if the burned area was small; if the burned area was large this may lead to accumulation of fluid everywhere in the body.

  • 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 (see Escharatomy) after fluid resuscitation.


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

July 9, 2014

Nutrition And Burns

One of the important components of burn care is nutritional support, nutrition is important for the recovery and healing process of a burned patient. After a burn injury and depending on the severity, the body reacts by increase production of certain hormones which will cause the body to need more nutrition accompanied sometimes with alteration in the carbohydrate, protein and fat breakdown.

There are many ways to assess the nutritional needs of the patient taking into consideration the age, body weight, the percentage of body surface burned, and other factors. The Curreri formula is used for adults and children, Harris-Benedict formula is used for adults and the Galvaston formula used for children. Dietitians and doctors will assess, monitor, and adjust nutrition frequently as patients condition improves or deteriorates.

There are different ways of delivering these nutrients to the patient, depending on the burn and the patient's condition. The patient may be fed by mouth, through the veins, the intestinal tract through a tube or a combination of more than one method.

Proteins:

Patients with burns need a lot of proteins during healing because of the loss of protein through the burn wound and the muscle breakdown trying to produce extra energy for the healing process.

Carbohydrates:

Carbohydrates make up the bulk of the nutrition and provide the majority of calorie intake. These carbohydrates will be turned by the body into glucose that will be used by the burn wounds as a source of energy. In fact burn wounds can't use any other source. Carbohydrates will provide the energy for healing allowing protein eaten to be used to rebuilt muscles rather than being used as a source of fuel.

Fat:

Fat is also needed to provide essential amino acids (essential amino acids are amino acids that the body can't synthesize and has to be supplied) and extra calories, it is recommended that no more than 30% of calories come from fat; too much fat can weaken the immune system.


  • Additional vitamin and mineral supplements may be indicated; among these vitamins are vitamin C, D and E, minerals such as Selenium and Zinc may also be needed. These vitamins and minerals play a role in wound healing, immune response and preventing free radicals from causing damage to the tissues.

  • Burned infants and children represent more complex diet therapy challenges because in addition to the increased nutritional needs imposed by the burn, growth and developmental requirements must be considered. The patient will be assessed and nutritional needs will be calculated as soon as possible after hospital admission.

  • Parents have an important role in the healing process and in encouraging their child to eat, parents after consulting with child's physician and dietitian can bring the child's favorite food and have to praise the child even when small amount of food eaten.

  • It is important to follow the instructions given to you at the time of discharge as some patients may be discharged home with special instructions regarding nutritional requirements.

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

July 8, 2014

Sunburn (part II)

Protection from sunburn:

  1. The sun is most intense between 10am-3pm, so try to limit exposure during these hours.
  2. Wear sunscreens with a sun protective factor (SPF) of at least 30.
  3. Apply sunscreen 30 minutes prior to sun exposure (to allow skin to absorb it); sunscreen absorbs ultraviolet light reducing the amount that reaches the skin.
  4. Wear sunscreens when swimming in an outdoor pool.
  5. Wear hats, protective clothing and sunglasses with UV protection.
  6. Use lip balm with sunscreen to protect lips from burning.
  7. Look for shady areas.
  8. An ounce of prevention is worth a pound of cure.

You should seek medical attention if you experience any of the following:

  1. Feeling dizzy, rapid breathing or rapid pulse, pale or cool skin, extreme thirst, no urine output, sunken eyes.
  2. Fever nausea or rash.
  3. Painful eyes which are sensitive to light.
  4. Blisters which are severe and painful.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
July 4, 2014

Malignant Melanoma (part II)

Types of malignant melanoma:

  • Superficial spreading melanoma: this type appears as a brown or a black lesion, flat or slightly raised that may show irregular borders and color variegation. It's the most common type of melanoma in whites and most often appears on the upper arm and back in men and on the legs in women. This type spread initially through the epidermis which is the top layer of the skin, it can spread to the other layers of the skin (dermis and subcutaneous tissue) or even other parts of the body if it's not diagnosed and treated early.
  • Nodular melanoma: this type of melanoma spreads quickly therefore it's the most aggressive type; it appears as a rapidly enlarging lump that is usually black in color. It may ulcerate and present as a non healing skin ulcer.
  • Acral lentiginous melanoma: this type usually appears as a black or brown macule that has an irregular border on the palm of the hand, sole of the feet and under the nail. It's the most common among darker skin color people.
  • Mucosal melanoma: this type may appear on the eyelid, lips, esophagus, penis, vulva, and anus.
  • Lentigo maligna melanoma: this type appears on sun damaged skin of the face, neck and scalp as an irregular shaped, pigmented, flat lesion.
Diagnosis:

Diagnosis is made by examining a new appearing lesion or a change in a previously present lesion, when there is a suspicion, a biopsy will be taken and examined under the microscope to confirm the diagnosis. Other diagnostic test maybe needed to diagnose how far the disease has spread such as US, CT scan, MRI and others.

Treatment:

Treatment is usually done by surgically removing the melanoma with removing normal skin surrounding the lesion. Skin graft maybe needed when the lesion is large. In advanced cases lymph nodes maybe removed if melanoma has spread to lymph nodes. Other modalities of treatment maybe used depending on the stage of the disease which includes Chemotherapy, radiotherapy, and immunotherapy. They may be used in combination depending on the stage of the disease.

Regular follow up is important after treatment to make sure that the tumor hasn't returned back as malignant melanoma has a risk of recurrence.

Prevention:

  • Wearing protective clothes help to protect the skin from the effect of sunlight and avoid going out during peak hours from 10am-4pm.
  • Using broad spectrum sunscreens with a sun protection factor of at least 15 or more. Wearing sunscreen 30 minutes before sunlight exposure and on all exposed body areas. Reapply frequently.
  • Tanning beds avoidance.
  • Regularly check your skin for any abnormal skin lesion and any change in previously present lesion, notify your doctor of any skin suspicious lesion.
  • Have your doctor examine your skin regularly.

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

July 3, 2014

Malignant Melanoma (part I)

Malignant melanoma is a serious skin cancer affecting the melanocytes. Melanocytes are cells located at the base of the epidermis (see the skin). They are responsible for producing Melanin which is a protein that gives color to the skin, eyes and hair. In the skin melanin pigment acts as an umbrella that absorbs and protects the skin from the effect of ultraviolet radiation. The more melanin produced by melanocyes, the darker the skin.

Malignant melanoma known also as melanoma happens when melanocytes begin to grow in an uncontrollable way. It can happen at all ages but it's more common in young adults and the risk increases with age. Although anyone can be affected, there are certain risk factors that increase the risk of having malignant melanoma and these risk factors include:

  • Fair colored skin.
  • Excessive sunlight exposure.
  • History of sunburn.
  • Previous history of melanoma or other skin cancer squamous or basal cell carcinoma.
  • Family history of melanoma.
  • Presence of large number of moles (more than 50).
  • Presence of abnormal moles (called a typical or dysplastic mole).
  • People with low immune system such as those with Aids or having organ transplantation.
  • People with Xeroderma pigmentosa witch is a genetic disorder.

Signs and symptoms:

Malignant melanoma can appear in normal looking skin or can be appear in a previously present mole or freckle. Warning Changes in a mole or a freckle include:

The ABCDE guide:

  • A for asymmetry in shape where one half is different from the other half.
  • B for border, change in border may include notched or poorly defined border.
  • C for color, uneven distribution of color or more than one color in a lesion is a warning sign.
  • D for diameter, lesions with a diameter greater than 6 millimeter is a warning sign.
  • E for evolving (changing, enlarging).
Other warning changes may include:
  • Itching.
  • Change in consistency eg, become hard.
  • Change in sensation.
  • Bleeding.
  • Oozing.
  • Pigment spread to the surrounding skin.
Malignant melanoma can appear anywhere in the body where melanocytes are present, some appear on sun exposed areas such as the face and hands while others can appear in places such as under the nail (subungual), between the toes, palms and soles, the eye, genitals and mouth. Primary tumors are more common on the back in men and on the lower extremity in women.

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

July 2, 2014

Basal Cell Carcinoma (BCC)

Also called Skin cancer-basal cell, Rodent ulcer

It is the most common type of skin cancer. It originates from the basal cells of the epidermis (see the skin). It occurs more often in men than women and used to be more common after the age of 40 but it is more and more being seen in younger people. Ultraviolet light exposure from sun or other source is the main predisposing factor for developing BCC and that is why the majority occur on sun exposed areas such as face, neck and ear but they can also occur in areas which are not exposed to sunlight.

Certain risk factors increase the risk of basal cell carcinoma which may include:

  • People with chronic exposure to sunlight.
  • People with fair skin.
  • People with red, blond or light brown hair.
  • People with blue or green eyes.
  • People with suppressed or low immunity.
  • People who have been exposed to x-ray or other radiation forms for prolonged time.
  • Arsenic exposure.
clinical features:

There is more than one type of BCC and the appearances vary depending on the type of BCC, it may appear as:

  • A bump or a pearly nodule, it may appear as a light pink, brown or flesh colored.
  • An easy bleeding sore or a sore that doesn't heal.
  • A well defined red and scaly patch.
  • A scar like lesion.
Diagnosis:

Diagnosis is made by taking a history, examining the lesion and confirming the diagnosis by taking a skin biopsy. There are many types of biopsies and the patient is given local anesthesia before taking the biopsy to numb the skin.

Treatment:

Treatment depends on the type, extent and the location of BCC. Treatment includes:

  • Surgical excision of the tumor after using local anesthesia followed by closing the wound with stitches.
  • Curettage and electrodessication in which the cancer cells are scrapped away with a curette and the remaining is destroyed with an electrical current that generates heat.
  • Mohs surgery in which the surgeon after removing each piece of skin, examines it under a microscope to check if there is any cancer cells left behind, if tumor cells are still present another piece is removed until the skin sample is free from cancer cells. Among other methods, this method provides the highest cure rate.
  • Cryotherapy: this method freezes the tumor cells using liquid nitrogen leading to their destruction.
  • Radiation therapy: this method may be use when cancer has spread to lymph nodes or other organs or for patients who can't withstand surgery.
  • Topical creams such as imiguimod used for treatment of superficial BCC.

Prevention:

  • Protecting the skin from the effect of sunlight by wearing protective clothes which include hats, clothes with long sleeves and UV protective glasses.
  • Avoid exposure to sunlight in peak hours from 10am-4pm.
  • Sunlight protection by using a broad spectrum sunscreen with a sun protective factor of at least 15 or higher. Apply the sunscreen to all areas of the body 30 minutes before sun exposure. Reapply it frequently.
  • Examining the skin regularly for any lesion that recently appeared, changes in an existing lesion that may be suspicious include: growing, any change in appearance, bleeding, pain, itching, inflammation or a lesion that never heals completely
  • Full skin examination by a qualified physician once a year.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
July 1, 2014

Skin Cancers

The skin like other organs in the body can be affected by cancer. Skin cancer is an abnormal and uncontrolled growth of skin cells that can be divided into three types:

  • Squamous cell carcinoma.
  • Basal cell carcinoma.
  • Malignant melanoma.

Squamous cell carcinoma:

This type of cancer originates from the squamous cells present in the epidermis which is the outer most layer of the skin (see the skin). Too much exposure to ultraviolet light of sun is the most common cause and that's why it is more common on areas that are exposed to sun light.

Certain factors increase the risk of squamous skin cancer which may include:

  • Sunlight exposure for a long time.
  • People with fair skin are more affected than people with dark skin because they have less melanin pigment which protects the skin from sunlight.
  • People who have been exposed to x-rays for a prolonged time.
  • Burns, ulcers and old scars on the skin.
  • Exposure to chemical substances such as arsenic.
  • Old age people.
  • Genetic disorders eg, Xeroderma pigmentosum.
  • People with suppressed or low immunity.
Squamous cell carcinoma can appear on any area of the body but it mostly appear on sun exposed areas such as the head and neck including the ears and lips, back of the hands.

Symptoms and signs:

  • In early stages the skin change may include a skin bump that may be pink or red in color with a rough or scaly surface.
  • A change in a pre existing lesion is a warning sign.
  • Actinic Keratosis is a precancerous skin lesion that may change to squamous cell cancer, changes in Actinic Keratosis may be a warning sign for developing squamous cell carcinoma, and these changes may include: increase in size, increase in redness, bleeding, thickening or pain.
  • This type of cancer has the ability to spread to the deeper layers of the skin and may also spread to other areas of the body as well.
Diagnosis:

Diagnosis is usually made by examining the lesion and confirmed by taking a skin biopsy, there are many types of biopsies and the patient is given local anesthesia before taking the biopsy to numb the skin.

Treatment:

The earlier the diagnosis is, the better is the cure rate. Factors that determine the treatment options are: tumor size, the location of tumor and whether or not the tumor has spread.

  • Cutting the tumor out (excision) after giving local anesthesia and then the wound is closed with stitches.
  • Curettage and electrodessication in which the cancer cells are scrapped away with a curette and the remaining is destroyed with an electrical current that generates heat. This type of treatment is used for small squamous cell carcinoma.
  • Cryotherapy: this method freezes the tumor cells using liquid nitrogen leading to their destruction.
  • Advanced surgery called Mohs surgery in which the surgeon after removing each piece of skin, examines it under a microscope to check if there is any cancer cells left behind, if tumor cells are still present another piece is removed until the skin sample is free from cancer cells. This type of surgery is mostly used for tumors on the face such as the ears or for difficult or recurring tumors.
  • Actinic keratosis and some cases of Bowen's disease which is the earliest form of squamous cell cancer can be treated with 5-fluorouracil containing lotion or imiquimod.
  • Radiotherapy: this method may be used when the tumor is large, in places where it is difficult to remove or to relieve symptoms when the tumor has spread to other parts of the body. Radiotherapy maybe used alone or in combination with surgery.
  • Chemotherapy: this method is used in cases where there is spread of the tumor to other body parts. In advanced cases, chemotherapy is added to surgery or radiation.
  • Photodynamic laser therapy: may be used in Bowen's disease.
Prevention:
  • As sun exposure is the most important factor, protecting the skin by wearing protective clothes which include hats, long sleeve clothes and UV protective glasses and try to stay out of the sun during peak sunny hours from 10am-4pm.
  • Using sunscreens with a sun protective factor (SPF) of at least 15. For children and persons with fair skin use sun protective factor of 30.
  • Regular checking of the skin for any lesion that recently appeared, changes in an existing lesion that may be suspicious include: growing, any change in appearance, bleeding, pain, itching, inflammation or a lesion that never heals completely.

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

June 24, 2014

Third Degree Burns and Hydrotherapy

Hydrotherapy is the external use of water in the medical treatment of certain diseases. Most burn units in hospitals have hydrotherapy rooms. Hydrotherapy softens and removes dead tissue enabling new healthy tissue to form and promote healing.

Hydrotherapy can have other effects in addition to removing dead and damaged tissue, it can:

  • prevent the fluid loss through the burned skinwhich may result in fliuid deplesion and dehydration.
  • Remove debris and clean the wound surface.
  • Provide a good environment for wound healing.
  • Decrease the risk of infection.
  • Decrease the risk of scar tissue formation.
  • The wound has microbial flora, hydrotherapy help adjust them.
  • Help facilitate physical therapy.
  • Promote healing and the formation of healthy tissue.
  • Help provide comfort for the patient.
Hydrotherapy for burns can start within a few days of the trauma once patients have recovered from the initial shock and their condition has stabilized. Burn patients often receive daily hydrotherapy throughout their hospitalization. As the burn begins to heal, hydrotherapy may be reduced to three times per week on an outpatient basis. Hydrotherapy is administrated by nurses and specialized technicians. Sometimes physicians or physical therapists are also involved in the hydrotherapy sessions.

Immersion hydrotherapy:
Many burn units use immersion hydrotherapy on all patients, regardless of the extent of the affected body surface. Immersion hydrotherapy is performed in tubs called hydrotanks, or burn tanks; these may be equipped with lifts to ease the patient in and out. Hydrotherapy tubs must be carefully disinfected after each use, since infection of the damaged tissue is one of the most serious side effects of burns. Disposable liners are used in some burn tubs, and the water is sterilized. Hydrotherapy for burns should never be performed in a public tub because of the risk of infection.

Shower hydrotherapy:
Many burn units are replacing immersion hydrotherapy with shower hydrotherapy, because of the risk of infection from hydrotubs and because showering immediately rinses away dead skin and bacteria. Showering removes dead tissue as effectively as immersion hydrotherapy. A shower trolley or stretcher is draped with a sterilized disposable plastic sheet to reduce the risk of contamination that can cause infection. The patient lies on the sheet and receives hydrotherapy through a showerhead. Patients with less severe burns can be showered while sitting in a chair. Shower hydrotherapy utilizes tap water, but a chlorine solution is run through the showerhead to disinfect it. Handheld showerheads are recommended when performing hydrotherapy at home, since strong hospital-grade disinfectants require special handling.

The duration of hydrotherapy treatments varies greatly. Hydrotherapy for burns is often performed for just a few minutes at a time because it can be intensely painful. Pain medication is often administrated before hydrotherapy, and general anesthesia may be required before performing hydrotherapy on the most severe burn victims. In some centers water friendly virtual reality have been used during burn treatment in hydrotherapy tubs. This diverts the patient's attention away from the pain signals.

Burn patients often undergo physical therapy during hydrotherapy. The physical therapist encourages the patient to perform movements and participate in the bathing when possible.

Hydrotherapy and chemical burns:
When hydrotherapy is administrated for chemical burns, either acid or alkali, within one minute, there is far less damage to skin than if treatment is delayed for even three minute. A delay in hydrotherapy can lead to irreversible damage. Prolonged gentle rinsing of the burn with a large volume of water under low pressure dilutes the chemical, washes it out of the skin and normalizes the PH of 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.

June 18, 2014

Tissue Expansion and Burns

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.

June 11, 2014

Stress Ulcer (Gastritis) and Third Degree Burns

Gastritis refers to inflammation of the lining (mucosa) of the stomach which may progress to form an ulcer.

Risk factors:

  1. Patients on mechanical ventilators or who are intubated for more than 24 hours.
  2. Smoke inhalation.
  3. Severe burns such as third degree burns.
  4. Trauma.
  5. Severe illness.
  6. Shock such as septic shock, hemorrhagic shock, etc.
  7. Patients with multiple organ failure.
The risk of developing stress ulcer in severe burns has decreased with the improvements of critical care and the use of medications.

Signs and symptoms:

  1. Can be a symptomatic in early stages.
  2. Burning pain.
  3. Blood mixed with vomitus that will have the color of coffee.
  4. Melena which is the passage of blood in stool.
  5. Hematemesis in severe cases which is the vomiting of pure blood.
Preventive measures in burned patients are the use of medications such as antacids and other medications which decrease the effect of gastric acid on the mucosa. Adequate fluid replacement after a burn injury will decrease the risk of developing stress gastritis as decreased blood supply to the stomach (ischemia) that results from fluid loss in burned patients plays a role in the development of the disease. Early feeding is also one of the important preventive measures.

If a stress ulcer develops, the treating physician will determine the type of treatment needed. In certain conditions surgical intervention 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.

June 5, 2014

Third Degree Burns in Pediatrics

One of the most common causes of hospital admission of pediatric patients is burns. Most pediatric burns occur at home. The most common cause of burns in young children is exposure to hot liquids (scald injury) such as hot water. Contact with hot objects is the second most common cause of burn in young children. Pediatric burns differ from adult burns in many aspects.

Their skin is more sensitive and less resistant to heat and because it is harder for them to escape from the burning object, this may lead to longer exposure which may increase the burn severity.

Pediatrics have a smaller body size than adults with a greater body surface area in relation to their weight. Fluid loss is proportionally greater in young children when compared to the same percentage of burn in adults because of their smaller circulating volume and different distribution of body fluids leading to more rapid onset of fluid and electrolyte disturbance and imbalance. Therefore pediatrics especially infants develop hypovolemic shock faster and fluid replacement should be started as soon as possible which is calculated according to certain formulas.

Small children are at a greater risk to have a decrease in body temperature (hypothermia) due to the insufficiency of their thermoregulatory system, they are less tolerant to changes in temperature (see regulation of body temperature).

In case there is a burn to the genital area and the child is still wearing diapers, special attention should be taken as the burned area may be contaminated easily making it more susceptible for infection.

Pediatric patients with burns are harder to cannulate (insert a cannula) than adults and the smaller the child is the harder it is. Airway intubation is also harder in pediatrics than adults and the smaller the child is, the harder it is to intubate especially after burns that affect the airways. That is why trachiostomy is sometimes needed.

One of the things that differentiate small children from adults is the inability of small children to speak and express what they feel. The parents play a major role in this case because they know their child better than anyone else and know when there is something wrong with him/her. Therefore when your child is to be discharged you have to make sure that your child is feeling well.

Prevention of scald burns:

  • Water heater thermostat should not be set higher than 120 degrees.
  • Bathtub water should be checked before putting the child in the tub.
  • Never leave the child in the bathtub alone as he/she might turn on the facet or the water may become too hot and lead to scaled injury.
  • Keep hot liquids out of the reach of children like turning pot handles on the stove out of the reach of children.
  • Avoid carrying hot object while carrying the child.

According to the Consumer Product Safety Commission a child exposed to hot tap water of 140 degree for three seconds develops a third degree burn.

According to the National Center for Health Statistics between 2001 and 2005, each year approximately 116,600 children are treated for fire/burn injuries. Fires and burns are the third leading cause of unintentional death among children aged 1-14 years in 2004.

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.