Medical

Published on: September 29, 2010

Central Venous Line and Infections (part I)

A central venous line (central line, central venous catheter) is a long, thin, soft plastic tube that is introduced through a small cut in the skin into a large vein in the neck (internal jugular vein), arm ( arm vein), chest (subclavian vein) or groin (femoral vein). It is used to administer fluids, blood products, nutrients and medications over an extended period of time.

A central venous line is often placed in patients who require care in the intensive care unit to provide nutrition, medication and fluids. Infection can be one of the complications associated with the use of a central venous catheter. Blood stream infection can happen when bacteria and/or fungi enter the blood stream. Other complications may include bleeding, pain, blockage, kinking or shifting of the catheter, air embolism and lung collapse.

As the central venous line is introduced through an opening in the skin, bacteria can grow in this line making the patient more susceptible for blood born infection. Infections associated with a central venous line can be very serious as the bacteria causing these infections can multiply and spread quickly to the entire blood stream causing septicemia which can be fatal.

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Published on: September 28, 2010

Scar Massage

By Larry Kramer

As the burn wound heals a scar will form. A scar is a fibrous tissue that will replace the normal tissue that was damaged by the burn injury. Depending on the severity of the injury a hypertrophic scar may form.

Scar massage can be used in the treatment of a hypertrophic scar in combination with other modalities of treatment. Scar massage can be started once the burn scar is mature enough to tolerate sheering forces, it stretches the scar and breaks down the fibrous bands, and this allows the scar to be more elastic and stretchy. Scar massage can also help in cases of contracture scars.

Heat and lubricants may be used with scar massage to increase tissue flexibility. It is found that scar massage can decrease itching and is also used for pain desensitization. Scar massage will be performed by your therapist, it may be painful in the beginning but with time your scar will become better and you will be happier. You and/or your family will be taught how to perform scar massage. Scar massage is performed twice or more a day (3-5 times is preferred). You have to follow the instructions given to you by your therapist who will frequently assess the condition of the scar and the progress of treatment.

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Published on: September 27, 2010

The Effect of Burns on the Kidneys

By Larry Kramer

One of the life threatening complications of severe burns is acute renal (kidney) failure (ARF). ARF is a sudden loss of the kidney’s ability to excrete waste, concentrate urine and conserve electrolytes.

According to a study done in Helsinki burn Center between 1988 and 2001, the mortality of ICU patients with ARF was 44.1% where as patients without ARF was only 6.9%. It is shown that the severity of the burn, the presence of smoke inhalational injury and the age of the patient are among the factors that play a role in the incidence of ARF. According to Holm and colleagues (Acute Renal Failure in Severely Burned Patients), if ARF occurs within the first 5 days after the burn injury it’s early ARF, decrease blood pressure due to inadequate fluid replacement and the presence of myoglobin (muscle protein) in urine due to the destruction of muscle tissue as a result of burn, are common causes. If ARF occurs after 5 days of injury, it is late ARF; sepsis (severe infection spreading through the blood stream) is the most common cause.

ARF is treated with dialysis. As burns associated with ARF will worsen the prognosis, early preventive measures taken to reduce this complication include proper fluid replacement, infection prevention, early wound debridement, and excision of dead tissue.

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Published on: September 21, 2010

Iron Burns in Young Children

By Larry Kramer

Contact burns are common in young children. young children have the curiosity to explore things, they can get iron burns. Common causes of burns include leaving a child unattended while leaving a hot cloth iron or hair iron to cool.

It is also possible for adult using a cloth iron or a hair iron to suffer a burn. It is of great importance to avoid distractions (phone calls, conversations, television) while using any type of iron. It is also recommended that the iron be unplugged when not in use.

The surface area burned is small but it may be of concern depending upon the severity (see second degree burns and third degree burns)

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Published on: August 13, 2010

Stop, Drop and Roll

By Larry Kramer

Injuries from fire can be devastating injuries. This method is used to reduce the injuries caused by fire by extinguishing fire on a person’s clothes. You should react quickly when your clothes catches fire, there is no time to delay. You should do the following steps:

Stop: avoid running and stand still.

Drop: drop to the ground in a prone position (laying flat), cover your face with your hands to avoid injury to your face.

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Published on: August 10, 2010

Skin Donation

By Larry Kramer

The skin is the largest organ in the body. The skin has many important functions (see the skin). Skin can be donated for, and used by Patients with severe burns and patients with other injuries. The donated skin is transplanted to these patients which helps to decrease the pain, acts as a barrier to prevent infection, prevents body fluid loss and helps in body temperature regulation. The donated skin can be use as a temporary treatment for patients with severe burns and as the patient’s own skin heals, it can be grafted on the burned area as a permanent covering.

The person will make the decision to donate his or her skin in the same manner as other organ donations. This decision will not effect the medical care given to that person before his/her death. Every attempt will be made to save the person’s life and the skin will only be taken after the death of the person.

Donating skin will not cause body disfigurement; the skin harvest is composed of a very thin layer of skin taken from the abdomen, back and legs. The person who donates the skin (the donor) should not have any transmissible disease such as hepatitis.

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Published on: August 9, 2010

Burns due to Hot Tar

By Larry Kramer

Tar is used in paving and in the commercial roofing industry. Tar is heated and used while it’s hot. Hot tar can cause serious burn injuries. For example hot tar may come in contact with the skin through splashing or spilling. When it comes in contact with the skin, hot tar solidifies and sticks to the skin leading to serious injury. Workers carrying hot tar containers on a ladder are susceptible to falling the ladder in unsafe conditions leading to burns and other serious injuries. Freshly applied hot tar is slippery and as it cools down, it becomes sticky. This can cause a tripping or slipping hazards. There is also the risk of fire. Hot lugger and kettle are used to prepare hot tar. Vapors created from use of this equipment are flammable. Great care should be taken to avoid contact with an ignition source.

If there is a burn injury from a hot tar, cool the burned area with water, cover it with a dry clean sheet and seek medical attention (see chemical burns). Avoid removing the tar with a chemical substance. Personnel should be trained on how to apply first aid measures to injured workers. If a worker slips and falls or there is a suspicion of other injuries beside burn injury avoid moving the person (assuming they are not lying on the newly paved hot tar) as extra movement may lead to additional injury. In case of eye injury, flush the eye with cool water and seek 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.

Published on: August 2, 2010

The Effect of Sun on the Skin

By Larry Kramer

The sun plays an important role in the manufacture of vitamin D. The sun has ultraviolet rays which can be harmful to the skin. There are three types of rays, Ultraviolet A, B and C. Ultraviolet A rays penetrate the skin more deeply than ultraviolet B. it’s responsible for wrinkles, skin tanning and premature aging of the skin. Ultraviolet B rays affect the epidermis which is the outer layer of the skin and is responsible for sunburns. Ultraviolet C rays are absorbed almost completely by the ozone layer. Both A and B rays can harm the skin and can cause skin cancer.

Wrinkles:

The skin is held together in a smooth and a firm way by a protein called collagen. UVA rays damage collagen leading to the formation of wrinkles.

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Published on: July 29, 2010

Home Burn Remedies

By Larry Kramer

First degree burns part I, II are minor burns and can be treated with home remedies. Second degree burns and third degree burns part I, II. need medical attention.

The first step is washing the burned area with cool water. Avoid using ice as it can cause further damage.

Home remedies include:

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Published on: July 16, 2010

Discharge

By Larry Kramer

Some patients when burned will need to be admitted to the hospital while others don’t. When a patient with burns is admitted to the hospital, he/she will be assessed in the burn unit by a team called the burn team. According to the assessment, treatment will be provided to the patient. With time, most patients will improve and at some point a discharge plan will be set for the patient. The patient will be examined by the treating physicians and other members of the burn team before the patient is discharged. In almost all cases, the burn team makes the right decision.

In some cases:

If the burn team decided to discharge you from the hospital but you think that you are no ready to be discharged, (either you are not feeling well or for some reason you think that you shouldn’t be discharged) and you disagree with the decision to discharge you have to tell the team that there is something wrong with you, and you are not feeling well enough to be discharged. If the team still thinks that you should be discharged you can contact the patient’s services representative or anyone who you think can help. Tell them that you disagree with the burn team’s decision to discharge.

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