Medical Treatment of the Burn
When you have a burn injury, you may be sent to the emergency department of your local hospital. Here, your burn injury will be assessed and treatment begun. The physician at the hospital may decide you would benefit from being treated at a more specialized facility called a burn center. Therefore, you may be transferred to a different department or to another hospital where the burn centre is located.
These burn centres are usually small units containing around 10 beds. They are comprehensively equipped to effectively treat patients with critical burn injuries. Health care professionals at these centres are highly trained and experienced, each with a different key role to help you recover from your injury and are made as comfortable as possible. They have an unusual degree of empathy to help patients through the difficult emotional trauma associated with severe burn injuries.
If you are looking for basic first aid tips, please click here. For severe burn emergencies, call 911.
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The burn team
Primarily, plastic surgeons oversee all the care given to patients at a burn centre. As the burn injury heals, these medical specialists have the expertise to ensure the best possible healing and the least amount of scarring. Other medical specialists may be called on under the guidance of the plastic surgeon. You may hear the term “fellow” or “resident”; these are qualified physicians training to become specialists in burn care. They have been assigned to the burn unit under the supervision of the plastic surgeon.
The nurses who work in the burn centre are the mainstay of all patient care in the unit. Because of the nature of burn injuries, these nurses work with patients for long periods of time and get to know them and their families very well.
The role of the nurse is to offer as much supportive care as possible and ensure the patients’ critical needs are communicated to the appropriate members of the burn team. The degree of emotional support, positive mental outlook and caring that these nurses provide to patients and family members is very important to the patients’ overall recovery.
Nurses assess, on an ongoing basis, the patient’s condition and assist the physician in the planning and implementation of treatment.
There may also be a clinical nurse specialist who works directly with patients and family members, providing teaching and psychological support in the burn centre and the hospital, as well as after the patient is discharged from the medical facility. Such a nurse works with the bedside nurse and the other members of the medical team on all patient care issues.
The administrator of the burn centre’s nursing unit is responsible for coordinating all aspects of patient care, ensuring all the necessary resources (products, personnel, equipment and so on) are available. This nurse is in charge of the management and smooth running of the burn centre.
While patients and family members will probably have contact with all the various nursing specialists mentioned above, the initial key nurse to speak with about the daily issues of care is the bedside nurse on duty that day.
A burn injury makes huge demands on the body and there is usually a basic need for a well balanced, high protein, high calorie diet to ensure the healing nutritional requirements are met. Patients generally need a variety of extra supplements, vitamins and minerals that the dietician can order. After discharge from the medical facility, patients must keep to a sound nutritional plan to maintain optimum healing.
Also known as the physical therapist, this health care professional helps patients regain or maintain physical functioning, like arm or leg movement, that may have been diminished after the burn injury. The physiotherapist provides patients with a range of motion (ROM) exercises that, over a period of time, help get the muscles and joints back to normal. Initially, these exercises are generally carried out in the hydrotherapy room or when the dressings are removed. In this way, the exercises will not be restricted due to bulky dressings. In most cases, it is important to begin the exercises as soon as possible.
Occupational therapist (OT)
These rehabilitation specialists help patients become more adaptable and self-sufficient in their daily functioning. Assistance can be provided with dexterity exercises or adaptive devices such as special cutlery or lifting aids to help in daily activities.
These professionals have a comprehensive understanding of the practical and emotional issues involved with a brain injury. They are available to patients and their family members to help with the following:
• Emotional issues
• Insurance claims
• Financial assistance issues
• Accommodation issues for family members planning to stay near the burn centre
• Communication with the medical team, if necessary
Being an out-patient
Once you have been admitted to hospital and the initial assessment and treatment have been carried out, you may be a candidate for treatment as an out-patient. The medical team may have decided that your burns are superficial with the potential to heal by re-epithelialization (new skin cells growing on their own) within 7 to 10 days. There are other factors, such as whether you live nearby and the support – or lack of support – you have at home; whether the burns are located in non-critical parts of the body, and whether you are capable of participating in home treatment. These are just some of the factors the medical team will take into consideration when making its assessment. As an out-patient, you may be required to come to the hospital every day or every three days – each case is unique.
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Upon arrival at the burn centre or emergency department, the first priority is to ensure that the patient’s breathing airway is open and that lost bodily fluids are replaced. After this, the severity of the burn is determined and treatment priorities are established. Burn severity is assessed according to the following five factors:
1. The extent of the burn;
2. The depth of the burn wound;
3. The age of the injured person;
4. The patient’s medical history, and
5. The part of the body that is burned.
The actual choice of treatment can vary, but all burn centres have the same common objectives:
Prevention of infection or desiccation (drying out) of the wound
• Removal of unnecessary tissue
• Preparation of a clean wound bed for new skin to grow
• Healing of skin grafts
• Minimization of systemic (within the body) infection
• Reduction of scars and contractures
In the beginning, a burn injury carries with it a sense of emergency due to pain and the necessity to minimize the initial skin damage. Burn centres and emergency departments are aware of the necessary priorities of care. The emergent period, for instance, is the time during which all the activities take place when you initially arrive at the medical facility. Following this is the acute period, where the focus is on wound care and prevention/management of any complications. The third or rehabilitation phase focuses on restoring the patient to a productive place in society.
The following is an overview of the many different treatments a patient can experience:
Burn bath or shower, also known as hydrotherapy
The patient may be immersed in a burn bath or showered on a cart shower, where initial cleansing and assessment of the burn takes place. These baths may be carried out once a day or periodically throughout the hospital stay until the wounds are healed.
The bath is usually a saline-water bath; alternatively, the patient may be gently showered with tap water while lying on a plinth. During this hydrotherapy, loose dead tissue (known as eschar) can be gently removed (debrided) using sterile scissors and forceps. Pain medication should always be given and the treatment limited to about 20 minutes or up until the point where the patient can’t tolerate the treatment for long.
After this burn bath or shower, further decisions are made regarding how to treat the wound.
Cleansing the wound
Gentle, but thorough, cleansing of the burn areas with soft gauze can remove some of the sot and loose debris for easier inspection of the wound. Chemical burns will be flushed or flooded with water for 20 minutes or longer. Tar burns require numerous applications of emulsifying agents, such as Tween 80®, or Polysporin® ointment, or vegetable or mineral oil. After several days, it will be possible to remove the tar without damaging any of the healthy tissue.
Here is a basic scenario of treatment for a variety of burns: