The first thing that comes to mind when I think of a “burn patient” is an image of a firefighter carrying a person from the rubble of a building engulfed in flames. However, here in Bangladesh, most commonly, burns result from activities of daily living. For example, because the majority of Bangladeshis do not have electric stoves in their homes, most of the cooking is done in large pots above open fires. Mothers and their children frequently fall into these hot curry pots and incur extensive burns. However, out here, even one’s occupation can pose potential hazards. One patient I observed last week on the ward was a daily laborer at a local brick factory. Bricks are made by hand at outdoor factories, and while he was working beside the kiln, the bricks he was standing on broke and gave way throwing him into the hot coals burning both his legs from the knees down and also affecting his left hand.
As you can probably imagine, proper burn care is an essential element of medical treatment here at Memorial Christian Hospital. So, the question is “What does the typical process of burn care or treatment look like?”
This is a brief overview of general burn cases:
First, the attending physician will examine the patient and assess the severity of the burn. A basic three tier-scale is used to designate the severity. The least acute burn rating is a first degree burn. In such cases the burned area is red and painful and may sometimes even have minor blistering. Only the first layer of skin tissue (the epidermis) has been affected. An example of a first degree burn might include a mild sunburn. A second degree burn is where the first layer of skin tissue (the epidermis) has been penetrated and the second layer (the dermis) is now affected. The depth of penetration of the dermis determines the severity of a second degree burn (the deeper, the more acute the case). Second degree burns are extremely painful; the injured area is very swollen, red, blistered, and may be splotchy in appearance. The most acute classification is a third degree burn. These are also referred to as full thickness burns because all layers of the skin have been compromised. Burns can penetrate all the way up to or through the fat layer, muscle, or bone lying beneath the dermis. Third degree burns may appear either black and charred, or white because the blood supply has been destroyed to the area. In some cases the affected area is not painful indicating that nerves have been damaged (http://www.mayoclinic.org/first-aid/first-aid-burns/basics/art-20056649).
In addition to assessing the acuity and depth of the burn, a physician must also determine the extent of the burn (or how much skin was injured). A system has been developed that ranks burns according to the percentage of the body affected. For adults the “rule of nines” can be used to determine the total percentage of area burned for each section of the body (http://www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.htm).
For an adult who has been burned, the percent of the body involved can be calculated as follows:
- Head = 9%
- Chest (front) = 9%
- Abdomen (front) = 9%
- Upper/mid/low back and buttocks = 18%
- Each arm = 9% (front = 4.5%, back = 4.5%)
- Groin = 1%
- Each leg = 18% total (front = 9%, back = 9%)
Following the initial assessment, the medical staff will tend to the patient’s wounds and remove any dead tissue so that healthy tissue can begin to grow. If the burns are deep enough (generally second or third degree burns) debridement of tissue may be necessary. Dead tissue will be cut, or shaved away until the physician reaches the point at which the tissue begins to bleed again. Blood indicates healing; the skin cannot recover or re-grow if there is no blood flow. This is why debridement is crucial. The patient will receive daily dressing changes and ointment application. Here the most common ointment used is a cream known as silvadene. This ointment has antibiotic properties that help to stop the growth of bacteria in the open wound. The most important reason for applying an antibiotic is to prevent any infection from spreading into the blood stream where it could cause sepsis.
About 3 weeks out into treatment, physicians will assess the patient’s healing rate and determine if skin grafts will be necessary. However, a surgeon can only perform a skin graft if the tissue shows granulation. New pink granulating tissue is the most important point of the healing process; it indicates that blood flow and new tissue is being laid down in the damaged area. Therefore, if you place a new graft on granulating tissue, the graft should hopefully take and be received because there is an adequate supply of blood to the area to ensure continued healing.
A person may spend up to several months in the hospital recovering from burns and undergoing several grafts if the burn is severe enough. Obviously recovery for burn patients is not only exhausting and frustrating physically, but mentally and emotionally as well. Patients' jobs are on hold so their family is losing income, or mothers have to stay away from their families to care for injured children. It is a very difficult season to endure. Even after physical healing has occurred the patient will still have to cope with going back to their normal life bearing not only the physical scars of their encounter, but the emotional scarring as well.
I hope this short snippet has allowed you to understand the basic overview and process of burn care. Please, as you pray for MCH and the medical staff and patients here, remember to specifically pray for those healing from burns. Pray for wisdom for our medical staff in managing their treatment and recovery. But most importantly pray for not only the continued physical healing and the well being of the patient but their spiritual healing and restoration as well; that they would see the grace and gift of healing God is offering to them.
If you would like to see a health video on Burn Patients from Health and Hope Productions, please click here.