Treating the Burn Patient
A minor, first-degree burn may only require simple at-home treatment, but burns that are severe or are located in sensitive areas of the body typically require specialized treatment at a burn center. Tampa General Hospital is one of about 70 hospitals in the country to have earned Burn Center verification by the American Burn Association in conjunction with the American College of Surgeons. This mark of distinction means that TGH meets strict guidelines regarding our facilities, patient care, procedures performed, and staff members. Additionally, our surgeons make it a priority to stay up-to-date on and test the latest treatments for burn patients, ensuring that our adult and pediatric?patients receive the most comprehensive and advanced care possible.
Treatment of a burn injury at TGH begins by cleaning the skin and applying medicine and dressings over the burn(s). After the medical evaluation, cleaning, and dressing of the wounds is completed, the patient is moved to a room. The medical team¡¯s immediate concern is controlling physical dangers, starting intravenous (IV) lines to replace lost fluids, and actual wound care. Burn patients require special treatment to replace bodily fluids and are very susceptible to infections. Additional care is needed to prevent the permanent scarring, deformity, and dysfunction that severe burn injuries can cause. The staff at TGH will do everything it can to make the patient as comfortable as possible throughout the treatment process.
All burn patients are cared for by a highly trained staff that includes physicians, nurse practitioners, nurses, physical and occupational therapists, respiratory therapists, social workers, psychologists, and recreational therapists specializing in burn treatment and recovery. In addition, patient representatives, dietitians, child life specialists, and chaplains are available to assist patients and their families. Integrative medicine services are also available.
Some of the treatments burn patients at TGH receive include:
Skin allows us to be weatherproof while at the same time keeping our own bodily fluids inside. When the skin is burned, bodily fluids seep out. These lost fluids must be replaced. With large burns, the fluids are replaced with an IV. The IV machine feeds the replacement fluids into the body in carefully controlled amounts. For smaller burns, fluids may be replaced by drinking.
Edema is swelling. Swelling may occur just around the burned area or it may be systemic, meaning over the entire body. The larger the burn, the greater the swelling will be. Chances are that the first time you see your loved one after they have been burned, swelling will be present. The swelling can distort features to the point that you may no longer recognize them. This swelling should begin to lessen after a few days.
It may be necessary to assist the patient¡¯s breathing. This may be done with a simple mask supplying oxygen or through a tube. Intubation is the insertion of a tube through the patient¡¯s mouth or nose, directly into the windpipe. The patient can breathe through this tube, but will not be able to speak because the tube is below the vocal cords. If necessary, a ventilator can be attached to the tube to further assist breathing.
A person who has sustained a burn requires a massive amount of calories as their body¡¯s metabolic rate goes into overdrive. The metabolism speeds up to compensate for the burn injury and to begin the healing process. A feeding tube may be inserted through the nose into the stomach. Liquid food is fed to the stomach around the clock.
Foley Catheter Insertion
The Foley catheter is used to help patients urinate. A small rubber tube is inserted into the bladder, and a small balloon is inflated with sterile water to keep the catheter in place. The catheter drains the fluid from the bladder into a bag that hangs on the bed. The bag is monitored to determine how much urine is being produced, which helps the doctor determine if more or less fluid should be given to the patient.
A burn patient may get a lot of X-rays. These X-rays check the placement of the various tubes, such as the feeding tube, to make sure they are where they need to be. An intubated patient usually gets daily X-rays of their lungs to watch for signs of infection and pneumonia.
Skin grafting is a surgical procedure during which skin is moved from one area of the body to another that has sustained a burn. There are several types of skin grafts:
Allograft or cadaver skin is used as a temporary biological dressing over a cleansed (excised) wound. These are held in place with surgical staples.
Autograft is the skin taken from an unburned area of the burn patient. It is a permanent replacement.
The autograft is removed with a tool called a dermatome, which actually slices an extremely thin layer of skin from the burned person¡¯s body. This layer is .010 to .012 of an inch in thickness.
The two types of autografts are ¡°sheet¡± and ¡°mesh.¡± Sheet grafts are taken from an unburned area of the person¡¯s body. The sheet graft contains no holes or stretching so it takes a larger donor site to cover the same amount of burned area. The advantage of sheet grafts is durability and less noticeable scarring. The disadvantage of sheet grafts is the possibility of loss due to fluid building up beneath the graft.
Mesh grafts cover more area. The skin is taken from the donor site, then perforated. These perforations allow the skin to be stretched, thereby covering more area. The other main advantage of mesh grafts is that the perforations allow drainage. The disadvantages of the mesh grafts are that they are not as durable as sheet grafts and the perforations leave more noticeable scarring.
Outpatient Rehabilitation & Burn Scar Treatment
After receiving inpatient treatment in the burn center, patients continue with rehabilitation services on an outpatient basis. TGH¡¯s Outpatient Rehabilitation has a specialized team of occupational therapists who help burn survivors complete a variety of therapies, including range of motion exercises, scar management, and the fitting of pressure garments to reduce scarring.?Click here to learn more about our burn rehabilitation services.
TGH also offers fractional CO2 laser therapy, a burn scar treatment that helps break down thickened scar tissue. Scars thicken over time, reducing function and range of motion in the affected area and causing pain. Fractional CO2 laser treatment can restore function, improve range of motion, as well as reveal smoother and softer skin beneath. To learn more about our burn scar laser treatment and to make an appointment, click here.