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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Is reddening of the skin occurring after exposure to the sun or other ultraviolet light. It happens when the amount of sun exposure exceeds the ability of the body to protect the skin. The body protects the skin through melanin pigment which acts like an umbrella that covers the skin. Sunburn is a burn which is most commonly a first degree burn part I, II, more severe or deep sunburns can lead to second degree burns with the formation of blisters and rarely third degree burns part I, II. Very light skinned people can have sunburns in less than 15 minutes of exposure to midday sun while dark skinned people may tolerate the same exposure for hours.

Symptoms:

Symptoms of sunburn typically don’t develop until about 2-6 hours after sun exposure, while in children it happens as little as 15-30 minutes after being exposed to the sun without adequate protection.

  1. Pain, red, tender skin, the pain is greatest between 6 and 48 hours after sun exposure.
  2. Blistering can occur hours to days later.
  3. Fever, chills and rash may occur.
  4. Peeling of the skin usually follows several days later.

The symptoms of sunburn are usually temporary while the damage to the skin is often irreversible and may have serious long term effects including skin cancer.

Treatment of sunburns:

  1. Cool baths and showers, or you can place cool wet compresses.
  2. Soothing lotions may be applied if there is no blistering.
  3. If blisters are present don’t break them because that can increase the risk of them getting infected, cover them with a dry bandage.
  4. Pain reducers like Tylenol or Motrin.
  5. If it’s a child, extra fluid might be needed to avoid dehydration.
  6. Oral antihistamine may be needed when the sunburned area begins to peel and become itchy.

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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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.

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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.