Treating the Burn Patient
Treatment of a burn injury begins by cleaning the skin and applying medicine and dressings over the burn(s). After the medical evaluation, cleaning, and dressing of the wounds, the patient is moved to a room. The medical team’s immediate concern is controlling physical dangers, starting intravenous lines to replace lost fluids, and actual wound care. Burn patients require special treatment to replace bodily fluids, and are very susceptible to infections. The staff at TGH will do everything it can to make the patient as comfortable as possible. Specialized treatment is required to prevent the permanent scarring, deformity and dysfunction that severe burn injuries can cause.
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. After inpatient treatment in the burn center, patients continue with rehabilitation services, including therapy and the fitting of pressure garments to reduce scarring.
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.
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. The intubated patient usually gets daily x-rays of their lungs to watch for signs of infection and pneumonia.
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 to 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 advantages to mesh grafts are the perforations which allow drainage and, since it has been stretched, it covers more area. The disadvantages of the mesh grafts are that they are not as durable as sheet grafts and the perforations leave more noticeable scarring.