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Thursday, December 17, 2009

‘Sixth sense technology’ and +Burn management+


 Pranav Mistry with his ingenious “sixth sense” has amazed the world of technologists. What was developed over decades and appeared to be the “state of art” yesterday has been deemed “outdated” today. When Douglas Engelbart invented the mouse, little did he know that one day his mouse would lead Pranav into a new world of technology where the digital world would begin to comprehend human gestures.

For us as burn surgeons we still use the old fashioned Humby knife designed by Graham Humby while he was a medical student in Guys London hospital. Though we have mechanized it and made the dermatome, there is need for major technological advances. We need dermatomes that will automatically adjust the blades once the desired thickness is entered so that the skin is uniformly cut irrespective of the pressure applied. We need devices that will evaluate the burn depth intraoperatively and help to limit the extent of excision when coupled with the dermatome. We need devices that will continuously monitor the blood while the patient is undergoing surgery, evaluate the biochemical parameters (electrolytes, Ca, Ph, Hb levels and others) and correct them automatically.
We are lacking in skin substitutes which are presently not only expensive but also cumbersome. Besides skin culture is available in few specialized centers. Unless reliable and permanent skin substitutes are developed and skin culture techniques become easy to set up surgical management of major burn patients will always be a difficult issue. Tissue engineering and stem cells have a big role to play in burns and we are still in the ‘infancy’ in this area.
One important reason why digital technology has advanced rapidly is the large financial resources at hand. Financiers back with millions of dollars ‘tech geniuses’ whose ‘ideas’ they think will hopefully work out in the future and rake in millions. Obviously we cannot expect financiers to come forward in the burn arena where pain, suffering, human emotions and values play in the balance between life and death. This can be replaced by governments who must actively participate and provide strong financial backing for the meager few who enter as burn professionals. Philanthropic foundations must also actively participate in this endeavor. Health reforms must include burns as a major topic. More medical professionals need to be attracted to this field. Researches need to be encouraged, more grants need to be provided and international collaboration should advance our knowledge and understanding of burns.
The ‘sixth sense technology’ in burns need to be developed to alleviate the pain and suffering and create hope for patients with major burns.

Monday, December 14, 2009

Burn prevention -1

Dear Burn Surgeon,Can you please tell me about the first aid for burns and how to avoid burns in general?
Susan A.

Thank you Ms Susan for your question. There are two issues related to your question.

1. Prevention of burns in general.
2. First aid treatment of burns.

I shall address prevention of burns in general in this blog.

One of the most important aspects of prevention is ‘burn awareness ‘. Anything which is hot, which carries electricity, or is chemical in nature can cause burn. Your antennas must sense the danger as you carry on with your daily routines. When you enter the kitchen, cooking gas is the imminent danger. Keep children out of the kitchen. (See answer to question 1 in my previous blog for more information- Burns in kitchen). Avoid wearing loose and flammable clothing while cooking. Most longeries are highly inflammable and you stand the risk of the ‘fire’ falling in love with you and engulfing you. If you suspect a cooking gas leak, tighten all gas valves and open the windows. Avoid smoking, striking a match or putting an electric switch on as any spark will set the gas aflame and blow you out of the roof.Gas cylinders are potential time bombs in the kitchen and gas leak detectors can be of great help to detect leaks and control them.
Keeping a fire extinguisher in the kitchen is a good idea in case of a fire so is the smoke alarm or fire alarm. While using the microwave do not put in metal or food items that can explode like eggs or brinjals (also avoid plastics as they release toxic dioxins). Use pan handlers, safety gloves and hooks to handle hot utensils and avoid burns. While cooking it will be prudent to keep the pan handles away from edge if the cooking range as well as the other gas burners. Avoid storing anything or putting up shelves above the cooking range , so as to avoid burns while trying to reach them. Curtains in the kitchen or hanging towels can be dangerous particularly if they are close to the cooking range.

When you spread out lunch or dinner do not leave any hot stuff like soups etc unattended, your child will overturn it and get burnt while you are away. Always check the temperature of food made ready to feed your kids especially infants and toddlers (a thermometer will help).

While ironing realizes that your child can touch the hot iron and have a contact burn. Keep the hot iron out of reach of children. When you see your child playing with a lighter or match sticks- beware tomorrow he may light up the barn or set the house on fire or get burnt himself. Fire Crackers or fireworks are dangerous and if you have to burst a few crackers select the once which are really safe and always keep children under supervision.Rockets are dangerous and a misdirected one can cause havoc.

When your car radiator is over heated beware you might suffer severe scalds from hot radiator water; wait till it cools before you tinker with it. You shouldn’t expect a cold shower when you open a hot radiator lid. Candle lights are great and romantic but often are a source of fire in the house, especially if your child is inquisitive and decides to play with it. The bath is a place of relaxation after a hard day work but can cause burns if you are not careful especially in winter. Shower safe devices and tap devices which will let you monitor the temperature are helpful. Infants are unable to voice themselves and it is our responsibility to see that they don’t get burns when we wash or bathe them. If you are a diabetic or epileptic be careful in the bath as you may lose consciousness and suffer burns.

The bed room is relatively safe but if you decide to smoke or have hot coffee in bed, beware you will either light up your life or tip your coffee and burn your “main part”. Barbeques are exciting but keep children away and be careful while pouring petrol and lighting liquids over the coal. The guest won’t like to see you barbequed!! If you have chemicals in the house like drain cleaners, oven cleaners, acids or alkalis, beware you or your family can suffer chemical burns. Keep them safely out of reach of children and use them carefully. Avoid contact with eyes and hands and avoid inhaling them. The beach is a great place and basking in the sun can be good for your tan but beware sun tan can end in sunburns; limit your exposure and use a sunscreen with a good SPF.
Children in school beware- laboratories are places where chemical burns and fires occur, so be careful with your experiments. Safety first!

All electrical devices in the house – TV, video, radio, satellite receiver, computer, microwave, electric cooker and others are potential source of electrical burns. Earthing should be provided wherever needed, bare wires should be secured and plug points should be safe. Children should be kept away from all these devices. Warming milk bottles in the microwave ovens can be a source of infant burns and you must make sure of the temperature before feeding your child.
Gas leak detectors, smoke detector and fire alarms are of great help and should be installed in all homes. Every house, school, colleges, office or any establishment must have an ‘escape plan’ ready so that the inmates know how to escape in case of fire. Regular drills must be organized so that ‘fire escape’ becomes a natural instinct that overcomes the ‘fear factor ’.
I have found some great resources on the net which I have included as links for burn prevention on your right.

Along with ‘burn awareness’ a bit of “paranoia and a dash of obsession” will go a long way in preventing burns. This Christmas let us serve some 'burn awareness' along with our Christmas cakes.

wishing you all merry christmas +!!!!