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Diabetes mellitus is a chronic disease that has many complications, among which is the effect of diabetes on the blood vessels leading to damage, narrowing and may lead to blockage of the blood vessels, leading to alteration of blood perfusion and subsequent reduction in the oxygen and nutritional delivery to the tissues which will affect wound healing. Diabetes can affect the nerves leading to nerve damage (diabetic neuropathy); nerves affected are responsible for temperature, pressure, texture and pain sensation. The nerves of the lower legs and feet when affected can lead to insensitivity to temperature and pain in the lower legs and feet and patients may experience numbness and tingling sensation in these areas.

Diabetic patients with neuropathy have an increased risk of burn injuries. These burns may happen from soaking the feet in hot water, heating pads, walking on hot surface, and contact with a warming device such as heaters. Because of the impaired sensation of the feet in these patients, they may sustain a burn injury without being aware of it. These patients have poor wound healing due to the effect of diabetes on the nerves and blood vessels and the increased risk of wound infection in diabetic patients.

Burns in diabetic patients even when they are minor may lead to ulceration of the wound, serious infection and even amputation of the limb. Therefore preventing and early recognition of burns in diabetic patients is very important.

Prevention:

  • Maintain a proper glucose level.
  • Test water temperature before going into the bath with a sensitive body part such as the elbow.
  • Avoid using a contact warming device such as a heater.
  • Inspect your feet and toes every day for infection, burns, bruises and ulcer.
  • Avoid walking barefoot even inside the house.
  • Avoid using heating pads.
  • Don’t wear tight or loose shoes; wear a well fit shoe with a soft, thick socks.
  • Contact your doctor if there is an infection, an ulcer or a burn which is not healing well.
  • Make sure your feet are examined during each doctor’s visit

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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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Flash burns to the eye:

A flash burn to the eye occurs when the person is exposed to a bright ultraviolet light. Causes of flash burn to the eye may include:

  • Welding torch.
  • Direct sunlight.
  • Some types of lamps like halogen lamps.
  • Sunlamp in a tanning salon.
  • Lightning.

Signs and symptoms may include:

  • Usually both eyes are affected.
  • Pain that may be mild to very severe.
  • Sensitivity to light.
  • Redness and watery eye.
  • Blurred vision.
  • Feeling that there may be something in the eyes.

Treatment:

Seek medical advice and follow the physician’s orders, place pads over both eyes until medical help is available.

Prevention:

  • Wear sun glasses that protect against ultraviolet light.
  • Wear safety goggles to protect the eye.
  • When welding always wear a welder’s mask.
  • In children with burned eyes applying first aid may be harder depending on the age of the child and his/her ability to cooperate. You need to stay calm and may need to have another adult help you with holding the child to facilitate flushing the eyes (if appropriate).
  • It may take up to 24 hours after the burn to determine the seriousness of the eye injury.
  • Some problems such as infection do not show up right away and that is why it is important to follow up with your doctor to make sure that the eyes are healing properly.

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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Burns to the eyes can be caused by many different things such as chemicals, hot air, steam, sunlight, welding equipments etc.

Chemical burns:

They can be caused by solid chemicals, liquid chemicals, chemical fumes or powdered material. Damage to the eyes may be minimized if they are washed quickly. The most dangerous chemical burns involve strong acids or alkali (base) substances.

Signs and symptoms:

  • Severe pain: because the pain is so severe, the patient tend to keep the eye closed and by keeping it closed this will keep the substance in contact with the eye for a longer period of time which may increase and worsen the damage.
  • Redness and swelling of the eye.
  • Inability or reluctance of opening the eye.
  • Tears from the eye.
  • Scarring and perforation of the eye.
  • Inability to see.

Treatment:

Treatment of chemical burns of the eye should be done immediately even before medical help arrives. Open the eye and flush it with cool water for at least 10 minutes. Quickly flushing and diluting the chemical substance reduces the chance of permanent eye damage. Make sure to avoid contaminating the good eye by avoiding the contaminated water from falling into it. Hold a sterile pad across the eye until you arrive at the hospital where further treatment will be initiated as needed.

Bursts of flames or flash fires from explosives or stoves may cause injury to the eyes and the lids. Hot air or steam can burn the eyes as well as the face. First aid treatment for heat burns to the eyes or the area around the eye involve flushing the eye with cool water and seeking medical attention.

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 the skin is burned and depending on the severity of the burn, tissue will die, this dead tissue is called an eschar which is inelastic and can’t expand.

When the burn is a circumferential (burned all the way around) second and third degree burn, eschar will form and with the edema (fluid leak from injured vessels) formed; the pressure will increase in the burned area. If this happens in arms and legs, this will lead to compression of the underlying veins arteries and nerves acting like a tourniquet. If the circumferential burn happens in the neck or chest, the pressure will prevent chest expansion leading to breathing problems. In these situations escharatomy is often needed.

Escharotomy is a surgical procedure done by making an incision through the eschar to relieve the underlying pressure, measuring the pressure in the compartment (closed space of nerves, muscle tissue and blood vessels) distal (furthest) to the affected area is one of the parameters used to determine the timing of escharatomy. Another way to determine the timing of the escharotomy is clinically by assessing the perfusion (the flow of blood) distal to the area affected.

In the limb:

Signs in the limb that may indicate the need for an escharotomy:

1. Signs of compression of blood vessels leading to loss of circulation which may include:

  • Pallor (pale color of skin due to reduced blood flow) of the affected area.
  • Cyanosis (bluish discoloration of skin resulting from inadequate oxygenation) of the affected area.
  • Reduced or absent capillary return (blood which fills empty capillaries) related to capillary return in non affected area (non burned area).
  • The affected area becomes cold.
  • As a late sign the pulses in the affected area will impalpable.

2. Numbness.

3. Decreased oxygen saturation detected by pulse oximetry (a non invasive device that measure the oxygen level in the blood).

In the chest:

Circumferential burns to the chest wall may lead to restriction of the chest wall movement leading to respiratory compression. Sometimes non circumferential burns may need escharotomy when they interfere with and restrict chest movement. Abdominal circumferential burns may lead to respiratory compression as they may lead to restriction in the movement of diaphragm which plays a role in respiration. The following may indicate chest escharotomy:

  1. Circumferential full thickness burns to the chest and abdomen.
  2. Examination showing reduced air entry on both sides.
  3. Examination showing restriction in the chest wall movement or abdominal movement.
  4. Increased respiratory rate.
  5. Shallow breathing because of restriction of chest wall movement.
  6. Hypoxaemia (Insufficient oxygenation of the blood).
  • Infants under one year of age are abdominal breathers (their respiration is predominantly diaphragmatic); therefore burn to the abdomen in a pediatric patient may lead to respiratory compression.

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

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

Causes may include:

Symptoms and signs include:

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

Diagnosis:

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

Treatment:
Patients with ARDS are usually hospitalized and treated in the Intensive Care Unit, The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve:

  • Oxygen supplementation and the use of a mechanical ventilator (See mechanical ventilator part I, II).
  • Medications may be used in the form of antibiotics to treat infection, corticosteroids to reduce inflammation, pain medicine to reduce the pain, muscle relaxents to relax the muscles and decrease muscle spasms, antianxiety medications to decrease anxiety.
  • Intravenous fluid to prevent dehydration and provide nutrition.

Outlook:

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

Possible complications:

  • Multiorgan system failure.
  • Ventilator associated lung infection (pneumonia).
  • Ventilator induced lung injury such as lung collapse and lung scarring (pulmonary fibrosis).

Support Groups
Many family members of patients with ARDS may suffer from severe stress. This stress can often be relieved by joining support groups where members can share common problems and experiences.

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:

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

Subacute compartment syndrome is treated surgically by urgent fasciotomy.

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

Complications:

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

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

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

Causes:

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

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

Signs and symptoms: may include

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

Diagnosis:

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

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

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According to the Center of Disease Control and Prevention (CDC), death from fire injury is the third common unintentional cause of fetal home injury. As fire claims the lives of many people each year and destroys properties and belongings; Smoke detectors play a big and important role in preventing such fires. Smoke detectors are devices that detect smoke or other combustion products and when they sense them an alarm will sound alerting people for the danger of fire.

There are two types of smoke detectors:

1- Ionization smoke detectors: this device detects smoke particles emitted from fire whether they are visible or invisible. Smoke changes the electric current which triggers the start of the alarm.

2- Photoelectric smoke detector: this device detects large particles of smoke, when smoke is sensed, there is a light bulb in the device that reflects the smoke to a photocell, this photocell will be activated leading to the alarm sounding.

There are devices that have both ionization and photoelectric properties. Some work on batteries other work on electrical current; there are types that work on both.

Smoke detectors should be installed outside each sleeping area on each floor level; smoke detectors should also be installed near living areas such as the living room and family rooms and also in the basement. When the smoke detector is installed test it by pressing the test button which will check the function of the smoke detector. Smoke detectors should be kept away from places that may lead to false alarms such as wooden stoves and fireplaces. In addition the alarm can sound from other things such as dust and fresh paint fumes.

Smoke detectors should be checked regularly and batteries should be replaced at least once a year and cleaned once a year.

You should also have an escape plan and you should practice the plan. Be familiar with the alarm sound and if you hear the alarm sound try to find the nearest exit by crawling on your hands and knees to a safe place. Stop, drop and roll if your clothes catch fire and avoid running. Call the fire department and don’t try to return back to the burning building. See also (Third Degree Burns, Smoke Inhalation Injury, and Keloid Scars)

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 the skin is burned, contracture scars may form, these contracture scars will affect the range of motion in the affected area and one of the methods used for scar treatment is Z-plasty.

Z-plasty is a surgical procedure used to improve the functional and/or cosmetic appearance of the scars.

Cosmetic Z-plasty is the repositioning the scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable.

Functional Z-plasty is the lengthening of the scar to relieve the tension caused by that scar. This procedure can be used as one of the treatment methods for burn contracture scars.

Z-plasty procedure is done by making a Z shape incision in a way that the part of the scar that needs lengthening or re-aligning is running with the central limb of the Z shape. The flaps of skin formed by the other line of the Z are rotated and sewn into a new position.

Z-plasty may be used in other conditions such as closing cutaneous defects, correcting stenosis such as external auditory canal stenosis and other conditions.

Complications of Z-Plasty may include wound infection, necrosis (death) of the flap, formation of haematoma under the flap and others.

Several factors may affect the success of Z-plasty procedure one of which is the medical history of the patient. Patients with risk factors that affect the blood supply to the skin like diabetes, or other medical problems relating to the skin may preclude Z-plasty as an option.

Scars left after Z-plasty procedure may take a long time to reach their final appearance. You have to keep in mind that when Z-plasty is used for cosmetic reasons, it will not make the scar go away but it will make it less obvious.

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

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

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

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

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