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Burn Unit by Barbara Ravage

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Burn Unit: Saving Lives After the Flames by Barbara Ravage

About the Author

Barbara Ravage is a freelance science and health writer and editor living in Massachusetts. She is a graduate of Barnard College in New York City. She has also written biographies and books on nutrition. Much of this book is about the burn unit at Massachusetts General Hospital in Boston. Starting in 2002, the author spent eighteen months there gathering information.

Epidermis

  • squamous epithelial cells

Dermis

  • nerves
  • capillaries
  • lymph ducts
  • immune cells
  • hair follicles
  • sweat glands
  • oil ducts

Eschar

The dead tissue on the surface of a burn is called eschar. The word is pronounced ess-kar and comes from the Greek word for scab. Eschar may be red, white, brown or black.  For deep burns, eschar must be removed for the wound to heal.

First Degree Burns

  • superficial
  • epidermis only
  • painful
  • get better on their own
  • leaves no scars
  • example: sunburn

Second Degree Burns

  • penetrates dermis partially
  • may heal on their own
  • may required skin graft, depending on depth

Third Degree Burns

  • penetrate dermis completely, to the layer of fat
  • has eschar
  • less painful than second-degree burns, because nerves have been destroyed
  • cannot heal on their own
  • wIll form scars

Fourth Degree Burns

  • go through layer of fat, fascia, muscle and perhaps even bone
  • sometimes limb amputation is the only option

Rhabdomyolysis

Large amounts of dead muscle tissue may be more than the kidneys can handle (protein contains lots of nitrogen, which the kidneys must excrete in the urine). This situation is called rhabdomyolysis. The burn patient must be kept well hydrated to help the kidneys clear the nitrogen waste. Nut-brown urine is a sign of rhabdomyolysis.

Infection

Infection is the main threat for the burn victim. Dead tissue is food for bacteria. Clostridium perfringens and MRSA (methicillin resistant staphylococcus aureus) are two serious pathogens that burn patients need to worry about. Vancomycin is often used for pathogens that are antibiotic-resistant, but it can cause tinnitus and hearing loss.

Bathing the Burn Patient

Pathogenic bacteria must be prevented from traveling from (a) one part of the patient’s body to another part of that same patient’s body, and also (b) from one patient to another patient. This has made nurses more reluctant to immerse a patient’s body in a bath tub full of water. Even if you thoroughly disinfect the bath tub between patients, the water can still transmit the infection from one part of a body to another part of the same body.

Silver

Silver compounds have been found to be good at killing bacteria. For many years, newborn babies received silver nitrate solution in their eyes, to kill any gonorrhea bacteria they may have picked up from their mother. Silver nitrate and sulfadiazine are both common topical antimicrobial drugs used for burn patients. Gauze pads coated with silver particles are also used in burn dressings.

Skin Grafts

If a skin graft is taken from one part of the body and used to replace skin elsewhere that has been destroyed by the burn, what happens to the region that the graft was taken from? Don’t we now have another region that has no skin? Well, the author explains that when the skin graft is removed, the dermis is sliced horizontally through the middle, so that the bottom half of the dermis remains at the original location. Nurses and doctors should ask the burn victim whether he or she has an identical twin. Skin taken from an identical twin will not be rejected by the immune system. Sometimes pig skin and cadaver skin are used as a temporary fix. Eventually, they will be rejected.

Scar Formation

A scar is not made of normal skin, but rather of a simpler kind of cells. In a hypertrophic scar, the collagen is not laid down in parallel but rather in a chaotic pattern. This produces thick, raised, tough knots of scar tissue. A keloid is an extreme type of hypertrophic scar that extends beyond the region of injury.

Inhalation Injuries

Inhalation injuries, injuries to the lungs when smoke from a fire is inhaled, are a major problem for burn patients. Symptoms of inhalation injuries include crackly breathing, cough, and breathlessness It is the toxic chemicals in the smoke, more than its heat, that damage the lungs. These chemicals damage the basement membranes of lung’s alveoli, causing the basement membranes to slough off their epithelial cells. These dead epithelial cells are food for bacteria, and pneumonia often results. So this debris in the lungs must be suctioned out with a bronchoscope (under anesthesia).

Hyperbaric Oxygen

In hyperbaric oxygen therapy, the patient is placed in a chamber full of pure oxygen under a high pressure. The main use of hyperbaric oxygen therapy is to clear carbon monoxide from the lungs and bloodstream. It is hardly ever used for burn wound healing. Hyperbaric oxygen is also used for divers suffering from the bends (also called caisson disease (lookup) and decompression sickness

Itching

Itching is the worst long-term symptom of a burn injury. There is no good treatment for itching from burn scars.



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