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Burn Prevention. University Health Care Burn Center http://uuhsc.utah.edu/burncenter. BTICU services Five States Idaho Montana Nevada Wyoming Utah. University Health Care Burn Center Statistics. Number of Inpatients ...................... 355
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University Health Care Burn Centerhttp://uuhsc.utah.edu/burncenter BTICU services Five States Idaho Montana Nevada Wyoming Utah
University Health Care Burn Center Statistics • Number of Inpatients ...................... 355 Burns: 260 ( 73.2%) Non-burn: 95 (26.8%) • Average Burn Size .......................... 10.9 % National Average…….13% • Children ........................................... 34 % • Out of State Referrals ..................... 40 % • Number of Outpatients Visits….. >5,000
Patient Demographics Gender Ethnicity
We Treat All Ages Mean age (years): 34.3±24.1 years Over 30% of our patients are children
How Do Our Patients Get Burned? Circumstance Place of Occurrence
The BTICU • 12 Bed ICU • Adult and Pediatric • Enclosed Unit • OR • OP • Burn Therapy Let’s take a tour!
Nurses Station This is the nurse’s station. Our unit is a square unlike many ICU’s. Burn care is a team approach; we rely upon each other to care for the very demanding needs of a burn victim.
Patients Room These are patient rooms. The room on the left is a patient room without a patient in it. The room on the right is a patient’s room that has a patient in it. As you can see burn patients take lots of equipment. This patent has 8 IV’s, a ventilator that is breathing for him, dressings all over his body and special arm boards to keep his arms stretched out so the skin doesn’t contract.
The Tank Room is where burn patients go once a day for their dressing changes. The shower table has hand held showerheads. We usually clean new burn wounds twice a day, once on the shower table and once in bed. Why do burns need to be cleaned so frequently? The burned tissue is dead, will grow bacteria and then get infected. When burn patients are able to walk they can go to the lowboy or shower chair. The lowboy is a big metal tub. Shower Chair Shower Table Tank Room Lowboy
Operating Room The burn unit has their own operating room that is just for burns and wounds. This is the hallway to the operating room. You can see on the left side of this slide where the Doctors scrub for surgery. When doctors and nurses go into this hall they have to wear special clothing like hats, shoe covers, masks and scrubs to protect the patients from getting sick after their surgery. People with burns that are deep 2nd degree or 3rd degree go to the operating room for a graft..
Physical Therapy Department This is the physical therapy department. Burned and grafted skin contracts or shrinks down if it is not stretched regularly. Burn patients begin stretching as early as the first day after they are burned. Physical Therapists range patient’s at the bedside even if they are sedated because they loose so much motion when lying in a bed. Once they are able to get up they are taken to the therapy room to stretch and exercise.
Outpatient Clinic Doctors, Nurse Practitioners and Physical Therapists see patients in the outpatient clinic. The outpatient clinic is a doctor’s office that specializes in wounds and burns.
The BTICU Team • Physicians • Residents and Interns • Nurse • Health Care Assistant • Health Unit Coordinator • Physical Therapist • Occupational Therapist • Rehabilitation Aide • Social Worker • Child Life Specialist • Respiratory Therapist • Dietician • Pharmacist • Discharge Coordinator • The Patient & Family
There are many ways here people can get burned by flame!! • Fireworks are dangerous and could result in burns to you or a bystander. They can also cause a fire by landing on flammable materials. • Sparklers account for three-quarters of all firework injuries for children under 5. A sparkler stick can be as hot as 1800 degrees F. which will sear anything it comes in contact with. • Every summer we see children and adults that have been burned by camp fires. Children generally get burned by falling in or coming in contact with hot coals. There is usually alcohol involved when adults get burned around a campfire. Make sure you are wearing tight fitting cotton clothes when you are around a fire. Polyester clothing catches on fire much quicker and sticks to you. • The leading cause of fire deaths, among the very young, is children playing with fire, primarily matches and lighters. For young children lighters look like toys. Since kids are naturally attracted to lighters make sure you keep them out of reach. • Thousands of people are burned every year across the United States by the misuse of gasoline. Gasoline has only one function and that is to fuel an engine. Any other use, such as using it to start a fire, is dangerous and carries the risk of severe burns. • When filling motorcycles, four-wheelers, wave runners or lawn mowers the engine needs to be cold. If gasoline gets on a warm engine it can ignite and cause a fire. Be very careful!!!
Flame These are the type of wounds you could receive from a flame injury. Many men are involved in flame injuries when they try priming carburetors or when using propane gas grills.
It is hard to believe it but tap water is dangerous. Did you know that hot water is the leading cause of burn injury to children? Children’s skin is thinner than ours so it burns quicker. • Never leave a child alone in the bathtub. Children as young as 9 months can topple in a bathtub, mostly because they have big heads and they fall easily • Be very careful when drinking hot liquids that you don’t spill it on yourself and never drink hot liquids when you are holding a baby. • Remember when cooking to turn the pot handles in. A child could grab a handle and pull the pot down on themselves. Ramen Noodles and mashed potatoes are sticky and stay in place continuing to burn the person even after the fluid is gone. • Be very careful when heating liquids in the microwave. The containers may feel only warm, rather than hot, and can result in splashing or spilling of scalding hot liquids. • Unfortunately, we have people that abuse children by punishing them with hot water forcing their bodies into water. We work closely with DCFS!
Scald These are pictures of children that were burned with hot liquids. One pulled hot tea onto her head and the other had hot coffee spilt onto him.
Contact burns are burns that occur when you touch something that is hot or has friction. • Many adults have been burned when using irons of any type. Be very careful to never leave the cord hanging down even when you have unplugged it, as they stay hot for a long time. Every year curious children receive burns to their faces or hands often from curling irons. These are generally very deep and often require grafting. • You need to be aware of dangerous areas in your home such as fireplaces, space heaters, barbeque grills and ovens. They get very hot and children can touch and receive very bad burns quickly. When using these items be aware of the location of any children in the home at all times! • Muffler burns happen to every age range from the very young to the old. They are painful! Make sure you are always wearing the appropriate riding gear whenever you ride motorcycles or ATV’s. • We see many friction burns every year. These are generally caused by friction toys or treadmills.
Contact The pictures to the right are contact burns from fireplaces. The picture below is a treadmill burn from a child playing around a treadmill when someone was on it.
Electrical This is the flow of Electricity. We are great conductors of Electricity because we are full of water. The skin provides a great deal of resistance so the electricity is transformed into heat as it passes through the skin. The electricity goes through the skin and follows the path of least resistance. Bone is dense so it follows the bone burning the muscle and tissue all along the path. It exits where you have contact with something such as the ground.
Electrical Lightning Injuries
The previous photo is one of the most famous photos ever taken of lightning hitting a tree. If you look closely, you can see a minor arc from the lightning bolt to the electrical pole near the house. This type of minor arc is the type that usually injures survivors. It’s not surprising that most people hit directly with lightning bolts like the one shown here don’t survive. Lightning is a relatively rare cause of death, killing between 50 and 300 Americans yearly, although about 1,000 people hit by lightning every year. You should remember that most deaths from lightning are NOT caused by burns, but by cardiac arrest. Patients who receive prompt CPR often recover; many patients die because they are alone when struck, and help isn't available. This headline is from a recent local accident in which a family was camping in the Uinta Mountains in Northern Utah. An electrical storm blew in and the two adults sat under a tree in aluminum chairs. The tree was hit by lightning and they were both killed.
Electrical As you can see the burn does not look too bad but the second is a similar burn after debridement in the operating room. The damage is much greater than you could see initially.
There are many chemicals that we come in contact with every day. Many of us have come in contact with chemicals however did not receive burns. The reason we did not receive a chemical burn was due to the length of exposure. Chemicals are either acids or alkaline. These items are outside the body’s normal ph range of 7.25-7.45. Although acid is thought to be more dangerous, acid burns upon contact. Alkali leaches into your body and burns over a period of time with very little discomfort noted.
Chemical These pictures are all different types of burns. The tongue burn was from a child putting something like the lid of liquid plummer in his mouth. The leg is a lye burn from a man that was laying cement. The ph of cement is 11 so it is very alkaline. The cement got into his boot during the day and at the end of the day his leg was burned due to the length of exposure.
Sunburn It is really important that you apply sunscreen every 2 hours. Frequently we forget to apply it when we are out in the cold but it is important to use sunscreen especially if we are skiing or boarding. Also make sure you check the expiration on the container as expired sunscreen will not provide protection. Every time you get sunburned your risk for skin cancer goes up.
Sunburn Here are a few pictures of sunburns. This baby actually has a second degree burn from being outside too long.
House Fire This is a picture of a man that was burned in a house fire. Remember that many people do not make it out of the house if they are sleeping unless they have some sort of fire or smoke detectors.
Carbon Monoxide is a colorless, odorless gas • that is heavier than air!! • Carbon Monoxide is a product of incomplete combustion; it replaces oxygen on the body’s red blood cells. • Because of the decreased oxygen circulating around the body the individual will complain of • light-headedness • headache • confusion • fatigue followed by sleep • If this is not reversed, • death will occur.
Smoke Detectors!!! • Change batteries every 6 months. • Test smoke detectors regularly. • Smoke detectors should be located in every room. • Deaths occur at night from improperly maintained Smoke Detectors!
Remember Stop, Drop and Roll!
Your Fire Escape Plan should include- • Two escape routes. • Your family should practice the escape routes during a fire drill. • If you are in a fire keep low to the floor and crawl under the smoke to the nearest door or window. • Touch the door before you open it. If it is warm the fire could be on the other side and you need to find a different exit. • Cover your mouth and nose so you don’t breath in the smoke. • Go to an outside family meeting place. • Never go back inside a burning building.
Have you ever used a Fire extinguisher? Make sure you know where fire extinguishers are located and how to use them.
*Stop the Burning Process* Secure the Scene and Prevent Further Injury!! Flame Burns:Smother with water or a blanket (STOP, DROP, and ROLL) Remove smoldering clothing Scald Injuries:Cool with water; Remove clothing Electrical:Be sure current is off before touching the patient! Observe and treat for cardiac arrest Chemical:Dilute copiously with water Do not attempt to neutralize the chemical Protect yourself and the patient from further harm!
Burn TreatmentDon'ts Don’t soak/pack in ice/ice water: * Cooling helps if performed immediately. * Effects are over within minutes. * Frostbite, hypothermia are real risks. Don’t use occlusive dressings like Saran-wrap.
The Treatment of Minor Burns Don’t hurt them: they’ll heal on their own. Keep them clean. Keep them comfortable. Debride blisters. Clean with bland soap and remove dirt and old ointments. Apply a BLAND ointment dressing. Dress with non-stick gauze or leave open. Change twice daily. Encourage immediate, active range of motion: “Rehabilitation begins at the time of injury”. Follow up in Burn Clinic as needed.
