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One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.

Scald burns can happen to anyone but there is a vulnerable population which can be affected that includes young children, elderly people and people with disabilities. Many people are unaware that it needs a short exposure period to hot tap water to cause serious burns. People at high risk of developing scald burns are:

  • Young children have thinner skin, this results in deeper and more severe burns. Children have greater body proportion that is exposed to a scalding substance.
  • Elderly people have thinner skin leading to deeper and more severe burns. Elderly people may also have other medical conditions that make them more liable to fall in the bathtub as well as decreased sensation of heat and poor microcirculation leading to slow release of heat from the burned tissue.
  • People with physical and cognitive disabilities
  • Crowded families and families with low socioeconomic status
  • Single parent and parents with poor education.

As a standard, the maximum temperature of water delivered to the tap by residential water heaters is 120 degree Fahrenheit (48 degree Celsius).

Temperature/scald burn:

113°F (45°C) lead to second degree burn in 2 hours and third degree burn in 3 hours 116.6°F (47°C) lead to second degree burn in 20 minutes and third degree burn in 45 minutes 118.4°F (48°C) lead to second degree burn in 15 minutes and third degree burn in 20 minutes 120°F (49°C) lead to second degree burn in 8 minutes and third degree burn in 10 minutes 124°F (51°C) lead to second degree burn in 2 minutes and third degree burn in 4.2 minutes 131°F (55°C) lead to second degree burn in 17 seconds and third degree burn in 30 seconds 140°F (60°C) lead to second degree burn in 3 seconds and third degree burn in 5 seconds
Hot beverages like coffee and tea are usually served at 160-180°F (71-82°C) and can cause instant burns when falling on the skin, these burns will require surgery.

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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Predisposing factors:

  • Burns (second degree and third degree burns).
  • Skin diseases such as boils, eczema and psoriasis.
  • Weak immune system such as in AIDS and patients using immunosuppressive drugs.
  • Diabetes. (feet burns in diabetic patients)
  • Old age.
  • Diseases affecting the circulation of blood to the lower limbs such as varicose veins.
  • I.V drug abusers.
  • Varicella.
  • Dense populations who share hygiene facilities and common living quarters such as nursing homes, homeless shelters and college dormitories.

Clinical features:

  • The area affected is red, tender and swollen.
  • Increased warmth in the affected area.
  • Regional enlargement of lymph nodes may be present.
  • Fever, headache, nausea and chills may be present.
  • Red streaking visible in the skin proximal to the area of cellulitis may be seen.
  • Abscess.
  • Ulceration.

Diagnosis:

  • No work up is needed in uncomplicated cellulitis and the diagnosis is based on the clinical features.
  • In complicated cases, cases with generalized sepsis and when any of the predisposing factors are present, the following tests may be done: Complete blood count, Blood culture, Blood urea nitrogen and creatinine level, US and others.

Treatment:

Cellulitis is potentially serious as it spreads quickly and can lead to more serious complications. If it is not treated, the infection can spread to the blood or lymph nodes and in rare cases the infection can spread to the fascia which is the deep layer of tissue causing a disease called Necrotizing Fasciitis (flesh eating bacteria) which is a medical emergency that can lead to death. Treatment of cellulitis include:

  • Rest of the affected area.
  • Antibiotics: either oral or intravenous depending on the severity of cellulitis, the presence of risk factors and presence of complications.
  • Pain killers.
  • Debridement of the dead tissue.
  • Hyperbaric oxygen therapy may be used in some cases.

Prevention:

Prevention is done by taking a good care of cuts, wounds and burns, if you develop signs and symptoms of cellulitis, seek medical help quickly to avoid complications. (see 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.

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The skin is the first line of defense against infection, it is composed of three layers, the epidermis, the dermis and the subcutaneous tissue layer (see the skin). Infection is the leading cause of death among hospitalized patients with burns. Normally the surface of the skin contains a mixture of microorganisms called normal skin flora, these flora live on the surface of skin and cause no disease unless the skin is damaged and/or the immune system is compromised. (see wound infection)

Cellulitis is an infection of the dermis and the subcutaneous tissue layer of the skin, cellulitis can be caused by normal skin flora or by exogenous bacteria, where in most cases the skin has previously been broken such as:

  • Second degree and third degree burns which lead to blister formation that can open and become infected.
  • Cracks in the skin.
  • Cuts in the skin.
  • Sites of intravenous catheter insertion.
  • Surgical wounds.

Cellulitis can affect any part of the skin but it commonly affects the skin on the face or the lower legs.

Causes:
The most common bacteria causing cellulitis is Group A Streptococcus and Staphylococcus aureus, both of them are part of the normal flora of the skin and are harmless when they are on the outer surface of the skin but cause infection when they enter the skin. Group A Streptococcus is found on the skin and the throat while Staphylococcus aureus is found on the skin and the mucosa (lining) of the nose and mouth. Other exogenous bacteria can cause cellulitis and in some cases people get cellulitis without a break in the skin.

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
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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The aim of physical therapy is to improve the movement and function of the affected area and to prevent and minimize scarring (hypertrophic, Keloid) as much as possible. Once the patient has sustained a burn injury such as a second or a third degree burn, the rehabilitation phase should begin as soon as possible.

Physical therapy usually starts at the time of admission; the patient will be assessed by a team of therapists who are part of the burn care team and rehabilitation will start accordingly.

Physical therapy may include:

  • Body and limb positioning.
  • Exercises: they are either active exercises done by the patient himself or passive exercises done by the physical therapist moving the area involved.
  • Splints: splint will be fitted by your therapist and need to be worn as instructed, if you develop an allergic reaction such as redness, blistering, itching, numbness or abnormal sensation when wearing the splint than you have to remove it and contact your therapist immediately.
  • Orthotic devices: some patients may need to use orthotic devices.

Physical therapy may be hard in the beginning because of the pain that is associated with the burn and surgeries, the sensitivity of the skin and the fear that the patient have. In children doing physical therapy may be harder; parents play an important role with the team in encouraging the child, helping him/her with their therapy and praising them.

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

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

For some a physical therapist will be assigned to them making home visits, if exercises are given to you by your therapist, it is important to do these exercises and increase your home activities as advised by your therapist.

Make sure to follow all the orders and instructions given to you, it may be hard in the beginning, you may get tired and frustrated but you have to remember that it is for your benefit and will become easier with time, the aim of the therapy is to restore the normal daily activities as much and as soon as possible and to prevent any deformities.

Make sure to attend all outpatient follow up appointments with the burn clinic as your physicians and therapists will monitor your progress and adjust what needs to be adjusted for you.

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

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Carbon monoxide (CO) is a colorless, odorless and tasteless gas. It is quite toxic to humans and other oxygen-breathing organisms. Carbon monoxide poisoning happens when enough carbon monoxide is inhaled. (See carbon monoxide poisoning)

Low levels of carbon monoxide are always present in air. It can also be produced from incomplete combustion of flame fueled devices such as fireplaces, furnaces, stoves, vehicles, space heaters and others.

Breathing carbon monoxide fumes decreases the blood’s ability to carry oxygen. Low levels of oxygen can lead to cell death, including cells in vital organs such as the brain and heart.

A carbon monoxide detector is a device with an alarm that is designed to detect elevated levels of carbon monoxide, the detectors can be AC powered, battery operated or hardwired. The AC powered unit may have a battery backup. As the weight of CO is almost identical to the weight of normal air, the detector can be installed near the ceiling or on a wall. The detector shouldn’t be placed near a fireplace and shouldn’t be installed near a smoke detector so that you are able to distinguish between a CO and a smoke detector alarm when there is an emergency situation.

CO detectors should be present in every home and each level needs a separate detector. If you have one CO detector it should be installed near the sleeping area and make sure that the alarm is loud enough so that you can wake up when it sounds.

When the alarm sounds, don’t panic, try to stay calm because the alarm is intended to sounds before you experience symptoms. Evacuate the house, gather all the members of household out to a safe area where there is fresh air. Check if anyone is experiencing symptoms of carbon monoxide poisoning (see CO poisoning), if yes than call 911. Ventilate the area and identify the source of the carbon monoxide and make sure that your appliances are checked by a professional as soon as possible.

Prevention of CO poisoning:

  • Install a carbon monoxide detector on each floor of your home. Test and replace the detector according to the instructions of the manufacture, check the batteries according to the manufacture instruction.
  • Check the battery once per year.
  • Inspect and properly maintain heating system, chimneys and appliances.
  • Use non electrical space heaters only in well ventilated areas.
  • Don’t use a gas oven or stove to heat your house.
  • Don’t burn charcoal inside your home, garage, tent or camper.
  • Don’t leave cars running inside the garage.
  • If you are using a kerosene heater indoors, make sure there is good ventilation

When buying a CO detector consider the location you want to install the detector in, the power source and the installation ease.

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:

  • Treatment of pressure ulcer starts by identifying and managing the underlying cause.
  • Relieving pressure by changing position and using pressure relieving mattresses or cushion is important for healing.
  • The treatment of a pressure ulcer depends on the stage of the ulcer. When the skin is intact, removing the pressure will allow the pressure ulcer to heal.
  • Pain medication may be used when the pressure ulcer is painful.
  • When the skin is broken, the protective barrier is no longer present leading to an increased risk of infection; antibiotics may be used when there are signs of infection (see wound infection).
  • When dead tissue is present, it should be removed by debridement as dead tissue increases the risk of infection and interferes with healing.
  • Cleansing the wound and dressing changes are important in decreasing infection.
  • Special dressings can be used to promote healing of pressure ulcers.
  • Deep ulcers especially those beyond stage 2 may be difficult to treat and if they are deep, they may require surgical repair.
  • Transplanting healthy skin to the affect area may be needed in some cases (see skin graft).
  • Topical negative pressure therapy (suction) may be used in some cases.
  • Your health care provider will decide what the best treatment options for you are and will assess the healing progress.
  • Healing time varies from days to months and some may not heal especially when there is an associated illness.

Prevention:

  • Frequent changes in the patient’s position, turning them every 2 hours in bed and every 30 to 60 minutes in a chair.
  • Checking the skin every day for redness, bruises and blisters and documenting the findings.
  • Keep the skin clean and avoiding dryness by using moisturizers.
  • Adequate fluids, protein, vitamins and minerals should be encouraged and correction of malnutrition when present.
  • Using foam cushions or pads or other supporting devices on the beds and chairs, ask your healthcare provider about the one that is suitable for you. Donut shaped cushions are not recommended as they may interfere with the flow of blood.

Complications of pressure ulcers:

  • Septicemia which is spread of infection from an infected ulcer to the blood.
  • Bone infection (osteomyelitis) from an infected ulcer.
  • Amputation of the limb in severe cases.

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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Also knows as bedsores, pressure sores and decubitus ulcers. Are areas of skin and underlying tissue damage that happens when the skin and underlying tissue over a bony prominence is compressed between that bony prominence and an external surface for a prolonged period of time, the unrelieved pressure on the skin and underlying tissue will lead to compression of the blood supply to that area, as a result of the decreased blood supply and oxygen the skin begins to die forming an ulcer. Friction of the skin created by the body sliding over a bed sheet, etc contributes also to the skin injury and the formation of ulcer, too much moister such as sweat and urine may also contribute to the formation of an ulcer. Although pressure ulcers can happen anywhere in the body, the hip, heal and buttocks are common sites.

Risk factors for pressure ulcers:

  • Persons at a high risk of developing pressure ulcers are those who are immobile due to an injury or an illness. Any injury or illness that leads to immobility or causes the patient to be bedridden for a long time will increase the risk of pressure ulcers.
  • Persons who have decreased or absence sensation due an injury or illness are also at risk.
  • Older persons have a higher risk because of their increased incidence of debilitating diseases and the thinning and fragility of their skin.

Signs and symptoms of pressure ulcers:

Depending on the severity, pressure ulcers are classified into four stages:

Stage 1: The skin is intact with pink or red coloration that doesn’t blanch with pressure; skin may be itchy, painful and may feel worm to the touch.
Stage 2: Partial thickness skin loss. There will be blistering or an open sore (ulcer), the area is red, painful and swollen, dead tissue may be present.
Stage 3: Full thickness skin loss, crater like ulcers are present that extends to the subcutaneous tissue.
Stage 4: Full thickness skin loss with the involvement of muscle, tendon, bone or joint.

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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Wound care at home is an important factor in the continuation of wound healing. A patient may come home with unhealed areas that still require wound care.
Dressing change and bathing:

  1. It is important to wash the hands with soap and water before and after dressing changes.
  2. Put surgical gloves on both hands.
  3. If dressing change is painful, pain medications might be needed (consult with your doctor), pain medications if needed have to be taken 30 minutes before changing the dressings to give them time to work.
  4. Dressing change may be done during bathing (ask your doctor if you can shower or bathe).
  5. Remove the old dressings carefully. Taking care not to disturb scabs on healing process.
  6. Look for any signs and symptoms of infection.
  7. Use lukewarm water, wash the wound gently with soap and water, use mild non deodorant soap (such as Dove), if you have used creams or ointments, make sure that you have removed all of it by using a clean white wash cloth (avoid using any cloth that contain dyes as it may be irritating to the skin).
  8. Dry the skin, apply creams, ointments, if they were given to you (consult your doctor for the type of creams and ointments).
  9. Cover the wound with a clean, dry dressing (consult your doctor for the type of dressing)

When Bathing a Child:

  1. Make sure that the hot water tank temperature is set below 120 degree F so that very hot water cannot be turned on accidentally.
  2. Make sure that the area where bathing is taking place (shower or tub) is clean.
  3. Fill the tub BEFORE placing child in the water, make sure the water is not too hot.
  4. Have a specific clean area where you will always perform the dressing change, make sure you have all the supplies needed for dressing change and have a place where you store them.
  5. Always look for signs and symptoms of infection especially in children as they may not be able to express what they feel.
  6. Contact your doctor immediately if there are any signs and symptoms of infection.

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

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Smoke inhalation injuries are caused by inhalation or exposure to hot gaseous products of combustion, this can cause serious respiratory complications, and it is the primary cause of death in victims with indoor fires.
In these injuries diagnosis is not always easy and symptoms may not appear until 24-48 hours after the exposure, that’s why it is important to immediately evaluate any person with suspected smoke inhalation.
Children under the age of 11 and adults over the age of 70 are most vulnerable to the effect of smoke inhalation; firefighters are at a great risk for smoke inhalation because of their occupation.

Smoke inhalation injuries are related to three causes:

  • Inhalation of carbon monoxide or cyanide (used in construction material) will impair or reduce the level of oxygen at the tissue level. This will manifest as shortness of breath and blue-gray or cherry-red skin color, carbon monoxide poisoning can appear symptomless up until the point where the patient becomes comatose. It is an immediate threat to life and is treated with 100% oxygen.
  • Hot gases cause heat injury by causing burns to the upper airways. Signs of heat damage are singed nasal hears, burns around and inside the nose and mouth, and internal swelling of the throat.
  • Inhalation of toxic gases and the products of combustion may cause irritation and chemical injury to the throat and lungs. This will manifest as noisy breathing, coughing, hoarseness of the voice, black or gray sputum, and fluids in the lungs.

Treatment:

  • Contact your doctor immediately whenever smoke is inhaled for more than a few minutes.
  • Treatment varies depending on the severity of the damage. The first step in the treatment is to maintain an open airway and supply adequate oxygen. The patient may be given 100% humidified oxygen through a mask if the airways are patent (intact) and the victim is stable. Oxygen is often the only treatment necessary. However other modes of treatment may be needed such as bronchodilators, suction, endotracheal intubation, chest physiotherapy, adequate fluid and antibiotics if there is infection.

Prognosis:
The prognosis for recovery is usually good with adequate medical treatment however the outcome depends on the severity of the smoke inhalation, if there were accompanying burns, injuries or medical conditions.

 

 

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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Most patients who suffer from burn injuries usually experience itching at some point during the healing process. Itching is one of the most problematic and distressing issues that the patient’s experience. It can vary in severity from one patient to the other and it can be severe that it interferes with sleeping, eating, moving and quality of life.

Itching usually starts during the healing process. It is usually worse at night, probably due to decreased movement and pain. It is increased with anything that increases the temperature of the body, for example activity on hot weather (because of the increase of histamine release which is one of the mediators for itching).

Itching can be decreased by:

  1. Keeping the burned area moist using skin moisturizers (check with your doctor first).
  2. Cool baths or cold compresses.
  3. Antihistamines like Benadryl.

Avoid the following:

  1. Dryness of the skin.
  2. Creams and moisturizers that contain perfumes as they may irritate the skin.
  3. Excessive heat as it may aggravate itching.

Itching may last for several months or even longer and usually diminishes with 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.