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Third degree burns are burns that causes injury to all  layers of the skin (epidermis, dermis and subcutaneous tissue), it may also damage the muscles and bones. These burns are serious and may result in extensive scarring as well as other injuries and limitations. Third degree burns are vulnerable for  many complications, some of which are due to  the burn injury itself while others are due to the reaction of the body during treatment and healing process.

Complications may include:

Burn Infection:

The skin act as the main barrier against infection and when this is lost, the body becomes susceptible for infection by variable pathogens. Infection is one of the most common complications of burn injuries and the risk is more with third degree burns due to the depth of the burn and the wide area involved. When infection is severe, septicemia and septic shock may result due to the spread of infection to the blood stream which is a serious condition that may lead to multi-organ failure and death therefore, urgent treatment is needed.

Fluid loss and hypovolemia:

Hypovolemia is defined as a decrease in the volume of blood or fluids in the body. When the blood vessels are damaged as a result of a burn injury, their permeability to fluid increase leading to excessive fluid loss leading to a decrease in the blood volume of the patient. In addition, one of the functions of skin is to act as an insulation barrier to regulate the insensible fluid loss from the body, when this is lost in burn injury, the rate fluid loss and evaporation increases leading to hypovolemia. Hypovolemic shock and electrolyte imbalance may also happen due to excessive fluid loss, therefore fluid and electrolyte replacement are one of the main steps of burn management.

Deep vein thrombosis (DVT) and pulmonary embolism:

Patients who sustain third degree burns may need to stay bedridden for a long period of time. Lower limb muscle contraction during movement and walking act as a pump pushing the blood from the lower extremities back to the heart against gravity. Extended periods of bed rest increases the risk of developing blood clots as immobility can interfere with circulation of blood making it slower and causing the blood to collect in the veins forming blood clots. When these clots lodge in the veins of the limbs, it can cause DVT which is a serious condition that need to be treated as it may lead to pulmonary embolism and death if left untreated. It is important to start ambulating as soon as possible as the longer the patient is bedridden, the higher the risk of developing blood clots and DVT.  Using blood thinners and pneumatic compression devices (directed by the treating team) can reduce the risk of developing blood clots.

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.


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During the recovery process, burned patient begins to heal both physically and emotionally. Some patients and depending on the severity of the burn injury (second and third degree burns) will go through painful procedures and treatments and start to be aware of the impact of the injury and how their injuries have changed their lives as some may lose loved ones and some may lose everything they have worked for.

Patients in this stage may experience sleep disturbance due to many factors including being in a hospital environmental with the lights and the staff awakening them for medication and vital signs checking. Anxiety and depression as a result of the burn also play a role in sleep disturbance so as nightmares, agitation and pain for the burn injuries. Psychological issues (pre-burn) such as depression may have an adverse effect on the outcome of the patient. These patients may stay in the hospital for a longer time and may have more severe psychological consequences after the injury.

Anxiety and depression counseling may be helpful to reassure the patient that after a trauma like this, it’s not uncommon to experience these symptoms and these symptoms may disappear on their own with time. Sometimes medication may be needed in addition to counseling.

Drugs, in the form of Opiates, may be used to treat the pain. They can be either long acting or short acting. Long acting opiates are used for pain caused by the burn injury while short acting opiates are used for pain due to procedures performed such as wound care.

Non drug methods include hypnosis and cognitive behavioral therapy. A new technique called virtual reality can be helpful in burn patients, these patients often experience excruciating sensations of pain, and this will distract the attention of the patient from the painful procedures as a person can only focus on one stimulus at a time.

In severe burn injury or when there is inhalational injuries, patients may need to be admitted to the intensive care unit of the hospital. In this scary environment with all the tubes and instruments attached to the patient, the painful procedures that the patient is going through, separation from friends and family, limited outside communication, struggling for survival and other factors such as the high doses of medications used in the treatment, infections, metabolic conditions and others may contribute to the patient’s symptoms; the patient may experience psychological issues such as extreme drowsiness, confusion, disorientation and delirium and the patient may start to misinterpret his/her surrounding when there is an altered state of consciousness, like misidentifying friends, hear things that are not really there, etc.

Members of the burn team taking care of the patient will work with the patient’s family to do whatever they can to enhance recovery. The patient is encouraged to deal with this unusual situation in the intensive care unit with whatever means possible such as denial. Family members play an important role in the recovery, although it is hard and distressing for them to see a loved one in this condition and going through all of this, they should always be calm and give hope to the patient as this will help in the recovery.

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.

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Nutritional support is considered as a critical component in the treatment and wound healing of patients suffering from burn injuries (second and third degree burns). The aim of the nutritional support is to provide enough nutrients and supplements either enteral (feeding using the gastrointestinal tract such as oral or feeding tube) and/or parenteral (intravenous infusion) to meet the body demands in response to the metabolic changes that happen in moderate to severe burns. It have been shown that the early introduction of enteral feeding in the burned patients is vital for survival (Rodriguez et al, 2011).

When a burn happens and depending on the severity of the burn, the body react to the injury by increasing the production and secretion of certain hormones which in turn cause an increase in the metabolic demand (hypermetabolic response) that will result in the need of more nutritional support which may sometimes be accompanied by alteration in the carbohydrate, protein and fat breakdown.

The nutritional needs of the patient can be assessed in many ways taking into consideration many factors including the age of the patient, body weight, the percentage of the body surface area burned among other factors. The Curreri formula is used for adults and children. The Harris-Benedict formula is used for adults and the Galvaston formula used for children. Dietitians and treating doctors will assess, monitor, and adjust the nutritional needs frequently as the patient’s condition improves or deteriorates.

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

1- Carbohydrates:

It is important to provide enough amount of carbohydrates to supply the energy needed and to spare proteins from being broken down and used as a source of energy. 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. Carbohydrates will provide the energy for healing allowing protein eaten to be used to rebuild muscles rather than being used as a source of fuel.

2- Proteins:

The provision of adequate amount of proteins is essential to replenish the depleted protein stores because of the loss of proteins through the burn wound. Proteins are also important to rebuild the muscles as the muscle tissue is broken down during the healing process to produce the extra energy needed for healing.

3- 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 result in significant stress on the liver as well as weaken the immune system.

4- Vitamins and minerals:

After a burn injury, it has been found that patients have reduced levels of iron, zinc, copper and selenium as well as vitamins A, C, E and D. These vitamins and minerals play a role in wound healing, immune response and preventing free radicals from causing damage to the tissues. Decrease of the level of these elements may lead to reduced immune function and poor wound healing.

  • 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.

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Treatment may not stop itching completely but help in decreasing the severity of itching. Some patients may need more than one treatment option depending on the intensity of itching and the quality of life affected. Your treating physician or care provider will determine the best treatment for you.

Treatment may include:

1- Oral medications:

  • Oral antihistamines: these medications act by blocking the histamine receptors which trigger the itching cycle. They are available over the counter in different forms including syrups for children and tablets for adults. An e.g is Benadryl. Please contact your treating physician before using any over the counter medications for advice including dose and frequency.
  • Sleeping medicine: they may be used after consulting with the treating physician if itching disturbs sleeping.


2- Topical medications:

  • Emollients: which are used to moisturize the skin and decrease skin dryness as dryness aggravates itching. They should be applied regularly and after bathing. It is advised to use fragrance- free moisturizers as those containing perfumes may irritate the skin.
  • Topical Antihistamines: these medications block the effect of histamine which is one of the mediators of itching. They can be found over the counter such as Diphenydramine.

3- Cool baths or cold compresses: they can provide temporary relief as heat may aggravate itching. Excessive bathing should be avoided as it causes more skin dryness. Moisturizers should be applied after bathing to keep the skin moist.

4- Compression garments: they should be used 23 hours/day and may help with itching.

5- Gentle massage of the skin: massaging the skin may produce some relief.

6- Itching in children is more difficult to deal with. It may interfere with school as it makes it harder to concentrate. Cutting the finger nails short can help in reducing scratching; using distraction methods and activities can break the itch-scratch cycle such is watching television and playing games.

7- Using sunscreens and protective clothing when exposed to the sun and trying to avoid sun exposure during peak hours as heat exposure aggravates itching.

8- Using fragrance free detergents and moisturizers as perfumes may irritate the skin.

9- Avoiding skin dryness and excessive heat.


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.

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Itching is the feeling or sensation that leads to the desire to scratch. Itching is a normal part of the healing process and most patients recovering from burn injuries experience itching at some point during their recovery. The itching sensation happens due to the activation of sensory neurons that have their peripheral nerve endings situated on the surface of the skin (Stein, 1983).

There prevalence of itching to happen post burn is high; it initially affects more than 90% of burned patients (Carrougher et al, 2013). When the skin is burned, the oil glands (Pilosebaceous glands) location in the skin will be damaged. These gland are responsible for secreting an oily material (sebum) that lubricates the skin and keep it moist. As a result of the lack of these glands in the healing and scar tissue, the skin will be dry leading to the sensation of itching that can be problematic and distressing to the patient.

The severity of itching varies from one patient to another; the frequency of itching and its intensity may not be related to the severity and size of the burned area. Itching may be so severe that it may interfere sleeping, eating, working, moving and the quality of life of the patient. Anything that increases the temperature of the body may lead to an increase in the itching sensation (due to an increase in the histamine release which is one of the mediators of itching) such as physical activities including sports and exercise.

Itching is usually worse at night due to decreased movement and pain making falling asleep more difficult. Itching may increase in areas where a skin graft is used to treat the burned area as well as in the donor area where the graft is taken from. Scratching due to continuous itching may lead to beading and opening of the healing areas which are fragile making it more liable for infection. The onset of scratching to the point of bleeding is usually linked to pruritus (chronic or long lasting itchiness) and specific personality type (Gauffin et al, 2015). Patient with thick scars, at a young age and with dry skin are more liable for post burn itching (Carrougher et al, 2013). Itching usually improves as the healing process proceeds and becomes less over time.


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.



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Treatment of keloid scars may be challenging and some patients may need more than one treatment option; others may need to repeat the treatment more than once. The available treatment options may include:

  • Compression garments: the idea behind wearing compression garments is that these garments apply continuous pressure on the keloid scar which will help to flatten and improve the scar appearance. It is important to wear these garments in the early stages of scar formation as the scar will respond better when the compression garments are used since the beginning were the scar is still fresh and immature. Compression garments should not be loose and should be worn for 23 hours a day and taken only when bathing and during dressing change. Burned patients may be asked to wear the garments for years. Ask your treating physician for how long you should wear them.
  • Surgery: surgical removal of keloids was traditionally recommended however, there is a high incidence of recurrence of the keloid scar (50%-100%) if surgery is not combined with other modalities of treatment. The recurrent keloid may be larger and more severe than the original one that was present. Surgical removal is done by excising the keloid and suturing the area to help close the wound or using skin graft is the area is big combined with another method such as silicone gel.
  • Steroid injection into the scar: it is considered as a mainstay for both treatment and prevention of recurrence. The way steroid injection works is by promoting the breakdown of collagen fibers and decreasing the inflammation which will help flatten the scar and make it less tender. An example of steroid injection is Triamcinolone.
  • Applying steroid impregnated tape to the area of keloid for 12 hours a day. Avoid applying the tape on the normal skin as it may cause thinning of the normal skin.
  • Applying silicone gel sheeting or dressing to the keloid area: this method may be used as an alternative to the injection of steroid. This method should be used for several months however, there is limited evidence to suggest its effectiveness to treat or prevent keloid scars.
  • Laser therapy: this method is usually used in combination with steroid injections to get the best results possible. Using laser usually decreases the redness of the scar, make it more smooth or flat without affecting the size of the scar.
  • Cryotherapy: this is done by freezing the keloid using liquid nitrogen at an early stage to prevent it from growing and getting bigger.
  • Radiotherapy: this method uses low dose superficial radiotherapy, it is mainly used to prevent the recurrence of severe keloid scars.
  • Medication: such as 5- fluorouracil, interferon and bleomycin.

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.

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After a burn injury, the body tries to repair and heal the damaged skin by forming new tissue as part of the natural healing process. Collagen which is an important structural protein plays an important role in the healing process (Di Lullo et al, 2002). Collagen accumulates around the damaged area and builds up to help the wound seal the area. Usually there is a balance between the production and the breakdown of collagen.

The healing process can cause a scar to appear which usually fades away over time by becoming smoother and less noticeable. When the scar continue to grow and invade the healthy surrounding skin, it will form what is called a keloid. Keloid scars are bigger than the original wound that was created by the burn injury. They are usually higher than the normal surrounding skin, hairless and shiny, and can feel rubbery to touch.

Keloids can affect anyone but, certain people are more predisposed to form keloids more than others such as African, African-Caribbean and south Indian communities (Dark skin people tend to get keloids easier than fair skin people). More than 50 percent of patients with keloid scarring have a positive family history of keloids (Bayat et al 2005). The bigger and the deeper the burn is (reaching the dermis), the more are the chances of forming a keloid scar. It is hard to tell how much the patient will scar after a burn injury; most second and third degree burns will cause some degree of scaring.

Certain areas of the body tend to form keloids more than others when exposed to burns or trauma such as the earlobes, the sternum area, the upper back, the back of the neck and the upper arms. People usually develop keloids between the ages of 10 and 30 years but it can happen at any age. Keloids are not contagious (not transmittable by direct or indirect contact), usually not painful and are benign (non-cancerous). Very rarely, keloids may become cancerous.

Keloids can happen even after a minor trauma like an insect bite. They can develop early as the wound is healing or may take them months or even years to form. If a patient had a keloid before than he/she is at an increased risk of developing a keloid in the future. Keloid may cause disfigurement or psychological distress in some patients depending on the site, size and appearance of the scar. Keloids may limit the range of motion or cause contractures if they are located on or near a joint.

Keloid treatment can be difficult and the response to treatment is not always successful and some patients may need more than one treatment type. Despite the presence of several treatment options, there is no option which is completely effective and there is no way of preventing keloids from happening but, there are some measures that can be done to minimize the effect of the scar.

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.

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Burn injuries can be very traumatic and painful and may take a long time to recover. Many complications can happen as a result of the burn injury including infection, scaring, disfigurement, contractures, reduced or limited mobility, loss of function, muscle, ligament, or nerve damage, mental and psychological trauma, amputation of a limb and even death in severe cases.

The more severe the burn is (second and third degree), the more damage to the body it creates. Burn injuries may need extended periods of hospital stay as well as prolong care and a lot of follow ups for rehabilitation after hospital discharge. Some burn victims may need services such as physical therapy, occupational therapy, psychiatric counselling, plastic or cosmetic surgery; all these may create an extra burden on the patient mentally, physically and psychologically.

Some burned victims may lose their homes and all their belongings as a result of the fire. Families and caretakers of a burned patient may also be traumatized and need help in dealing with the impact of the trauma.

Having a burn injury lawyer to represent you is very important and it is advised to contact a burn injury lawyer as soon as possible to get the best outcome and compensation possible. Kramer and Pollack, LLP have great experience in handling all types of burn injuries. They are specially trained in dealing with cases of burned patients and their families. You won’t be charged any fees unless they win the case for you; their fees will come out of the amount they recover for you.

Kramer and Pollack law firm will help you with the following:

  • Determine and prove who was at fault, by analysing all the facts and circumstances that were involved in your case. Where and how the incident happen can determine who is at fault. Once a responsible party is identified, the firm will file a case on your behalf in the specialized court of low to prove that the carelessness and negligence of the defendant party was the cause of your injuries, pain and suffering.
  • Get you the compensation you are entitled to for present and future pain and suffering and for any loss of property and belongings. The severity of the burn injury and who was the party at fault for the incident will determine the amount of compensation you receive. If the victim dies as a result of a burn injury, the family of the deceased person may be able to pursue a wrongful death case to acquire compensation for their financial loss.
  • Medical treatment for buns is expensive; it may be prolonged and may even be lifelong creating a financial burden on the patient and the family. The law firm will make sure that you are adequately compensated including the cost for present and future medical expenses and needs.
  • If the burn injury happens at the work place, Kramer & Pollack can help you to establish a workers compensation claim to pay for the medical expenses, disability and lost wages.
  • Providing personal support including educating you on your rights, dealing with all aspects of your case and getting you the best compensation possible


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.

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Burn injuries whether it is first degree, second degree or third degree are very common and can happen to anyone; they can be devastating and life changing. It is estimated that 11 million burned patients worldwide needed medical attention in 2004 and about 300,000 patients died as a result of that (Peck, 2011). In the US more than 300 children ranging between the ages of 0-19 years are treated in the emergency room on a daily bases as a result of injuries related to burns and 2 children die as a result of their burns (CDC Data, 2012).

The most common complication of burn, is infection (Herndon, 2012). Signs and symptoms of infection may include; fever, foul smelling discharge from the area, increased redness in the surrounding area of the burn, increased swelling in the area and increased tenderness (pain) in the area. It’s very important to look for signs and symptoms of infection and contact your care provider right away if you notice any of the above symptoms.

It is important to keep your burns clean to avoid infection. When bathing the burn area, the first thing to do before getting into the shower or tub is to test the temperature of the water as the burned and new skin is sensitive to extreme cold or extreme hot water and can be injured easily. To avoid hot water burns and scalds, set the thermostat on your hot water heater to below 120 degree Fahrenheit (48.9 C).

Make sure that the area where bathing is taking place (shower or tub) is clean. 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 your wound if you have any open area. Continue to wash the burn areas and apply the medication as directed and follow the instructions that you have been given to you by your treating physician.

During the healing process, the burned areas may appear and feel dry and scaly, the reason for that is because the glands which are responsible for lobrecating the skin and produce oil (Sebaceous Glands) are damaged or destroyed and until the time some of these glands begin functioning again, lubricants must be used to keep the skin moist. You should avoid using lubricants that contain alcohol or chemicals as they may irritate the skin and cause blister formation.

Also it is important to protect the 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 the exposure to sun especially in the peak hours (10am-3pm), if you have to then look for shady areas.
  • Wearing sunscreens with sun protective factor (SPF) of at least 30. Apply the sunscreen 30 minutes prior to sun exposure to allow the 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 the lips from burning.

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.

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Facial burns can be very serious depending on the severity and the extent of the area involved. Facial burns can affect the epidermis, which is the first layer of the skin or can be deeper, affecting the dermis which is the second layer of the skin. From 2009-2013, more than 200,000 Emergency Department visits were nationally reported as a result of burns to the head and neck (Heilbronn et al, 2015).

Facial burns affecting the Epidermis can happen as a result of severe sunburns as well flash burns resulting from various explosions. These burns may be associated with pain, redness and swelling of the face (oedema); they usually heal without leaving a scar on the face.

Deeper burns affecting the Epidermis and the Dermis may result from thermal, chemical, electrical injuries or flash burns from gas explosion. These burns may be associated with swelling of the face and pain, but when they are deep enough affecting the nerve endings which convey pain sensation these burns can be less painful. Usually deep burns leave scarring on the face when they heal.

Facial burns are important because they may lead to serious consequences; including but not limited to:

  • Airway oedema and airway obstruction.
  • Eye injury.
  • Speech and swallowing dysfunction.
  • Facial sensory deficiency.
  • Facial scarring and disfigurement.

It is important to assess the following in a patient with facial burns while waiting for help to arrive:

  • Airway patency (can they breathe?)
  • Breathing
  • Circulation.
  • Inhalation injury
  • Associated injures that may result as the victim tries to escape from the cause of the burn.

The face is highly vascular and this gives it a high potential for self-healing when the burns are superficial. Topical antiseptic agents can be used to cleanse the burns on the face, to prepare for the application of further topical agents, or to prepare the burn for debridement (Ward, 1995). An example of an antiseptic agent is povidone iodine.

Topical antimicrobial agents are medications that play an important role in the topical burn treatment; they are used to minimize bacterial proliferation and fungal colonisation. The perfect antimicrobial agent used as a topical prophylactic agent would have a long acting duration, activity against a wide spectrum of micro-organism, the ability to penetrate dead and necrotic tissue without the body absorbing it, and having a low toxicity (Monafo 1990). Examples of antimicrobial agents are Silver nitrate and Silver sulphadiazine (SSD).

Alternative remedies are available in the form of topical therapy for the treatment of facial burns such as Aloe Vera gel which may expedite the rate of re-epithelisation (forming new tissue) and promote the wound healing process in partial thickness skin burns (Maenthaisong 2007). Honey is also another remedy that has been used for superficial and partial thickness burns, it is said to prevent bacterial overgrowth, form a physical barrier and may lead to more rapid healing.

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