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Monday, August 22, 2011

Face Burns

Dear doctor,

Sunday evening my Dad was going to barbeque dinner. There was a leak in the propane tank and there was a flash when he lit the bbq that burned his arms, hands, legs, and face. His hair caught on fire, most of his beard and hair is now gone. Eyelashes and eyebrows are gone as well. He was immediately taken to the ER where they gave him morphine for the pain. This made him vomit and his blood pressure dropped to 58/27. They intubated  him as a precautionary measure and his blood pressure was stabilized. They then moved him to a burn unit in a hospital in SF.

After examining him that night, they said that most of his burns are 1st and 2nd degree. They extubated him late Monday morning and lifted his diet restrictions. Their main concern is infection at this point and his left leg. This area saw the worst damage and they are observing him for 2-3 days to see if he will need surgery.

I read your information on 2nd degree burns and feel that it was extremely well written and understandable for the lay person. Thank you so much for that. The history with my Dad is that he had a staphylococcus infection 4 years ago and endocarditis. He had 50% damage to his heart at that time due to a previous heart attack and the damage from the infection. He had a quadruple bypass 10 years ago and as of the last appointment a month ago the bypasses  are holding. They did say that he is in the beginning stages of liver failure last month as well as congestive heart failure. He is 62 years old.

His blood pressure has been holding steady after that initial drop and he said that he isn't in any pain right now. He is an 8 hour drive away from me right now and they tell me that he is stable, but I can't help but feel that any surgery on him at this point would be very rough on him. Today is the second day of observation and I am planning on heading down to be with him either later today or tomorrow. 

My question is, are my concerns warranted? I feel silly because they say he is stable and to not come, but my gut tells me otherwise. I'm sure by the time you read this I will already be there; I guess I just wanted some reassurance. I am worried that his previous health issues
will make this current trauma worse.

Sorry to take up your time, I just found a lot of comfort in your posts and hoped you might have a thought or two.

Sincerely,
Lori



Dear Ms. Lori,

Thank you very much for you question. I am sorry to hear that your father had a burn accident. We are sorry for the delay in replying because we have a lot of queries waiting. The superficial loss of hair is not significant since one can have the hair burnt and lost from the fire and heat, though the skin may not be burnt. Some patients react to morphine by vomiting and lowering of the blood pressure this usually gets controlled once corrective measures or medication are given.

That he was intubated appears more of a prophylactic measure since they extubated him within 24 hours and he appears to be stable. Also the fact that the BbQ must likely have been in an open space means that inhalation injury to the lungs are unlikely. Most of his burns were 1st and 2nd degree burns- as you said- 1st degree burns- should not be of any worry- it’s like sunburn and will heal quickly. For the 2nd degree burn areas it will depends on whether they are superficial or deep. From what you describe and by the history I feel it may be a 2nd degree superficial burn which will heal, but we can’t be sure till we examine the burn itself.
In view of his medical illnesses prophylactic antibiotic coverage should be discussed with his treating surgeon and may be a good idea. A physician should also be involved to manage his medical problems (heart and liver problems). Finally the area of the deep burn if present may be small as I presume from your description. Good timely analgesics should be helpful along with local dressings and care of the wound. An ophthalmologist should also check his eyes to rule out any burn injury to the eye which is quite common in patients with face burns.

I hope he recovers quickly and that he may not need any surgery by God’s grace.

With best regards,
asktheburnsurgeon+

Lori wrote to us again…..

Dear doctor,
Thank you so much for your response. You are correct that the bbq was in an open area. He was lucky because he shut his eyes and mouth before there was any damage to his lungs or eyes.
An update on my Dad. The enzyme cream that they used to eat away at the dead tissue is working really well. They do not believe that surgery will be necessary for now. He is continuing with the debridment baths every day for now, which have become very painful for him, but they are working. There has even been talk about discharge this weekend. We are so grateful that he is progressing so well. Seeing the other patients in the burn unit made me realize how lucky he was.
Thank you again for your response. Of course you can put this up on your website. The posts on there helped me at a time when I had no idea which way this would go. If our story can help someone else, please use it.
Thank you again,
Lori






Saturday, April 23, 2011

102 Burn Pictures- Learning through Pictures +

The visual presentation of burns and burn problems is critical to the understanding of burn management. We at Ask The Burn Surgeon present a series of burn pictures and videos that should help the reader understand and learn more about burns as well as create burn awareness. One should look at the pictures and try to identify the post burn day, the cause of burn (in some cases), the depth of the burn, healing or non healing burn wounds, the need for surgery, skin grafting or flap reconstuction and the presence of infection. We have provided only a heading for the burn pictures as the page is still under construction and as we add more pictures and videos, we encourage our readers to ask questions freely, which will be answered in detail on this site regarding any picture or patient. Please quote the image number  to identify the image. 
All photos and material presented here unless otherwise stated, is the property of asktheburnsurgeon. Copyright and other intellectual property laws protect these materials. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law. A single copy of the materials available may be made, solely for personal, noncommercial use. Individuals must preserve any copyright or other notices contained in or associated with them. Users may not distribute such copies to others, whether or not in electronic form, whether or not for a charge or other consideration, without prior written consent of the copyright holder of the materials. Contact information for requests for permission to reproduce or distribute materials: asktheburnsurgeon@yahoo.com
                                                                   
 
1) 2 months post burn, hypertrophic scar nose ,  047

2) 2nd degree  burns, lower abdomen, genitalia, groin and thighs  038

3)2nd degree burns hand, wrist , healing  089

4) 2nd degree burns hand, wrist and forearm 191

5) 2nd degree deep  burns hand, 3rd week post burn  082

6) 2nd degree deep  burns,  hands,  third week post burn 080

7) unhealed2nd degree deep burns, healed 2nd degree
superficial burns, 3rd week post burn  005

8) 2nd degree deep burns healing with hypertrophic scar formation 069

9)  2nd degree deep burns healing with hypertrophic scar formation,
unhealed small areas of 3rd degree burn index finger and hand  068

10) 2nd degree deep burns with 3rd degree burns of inner thigh 023

11)  2nd degree deep burns, flamazine dressing day 5,  125

12)  2nd degree foot burns, healing, 18th post burn day  151


13)  2nd degree superficial burn

14) coal tar burns, 2nd degree superficial burn
healed, 22 days post burn 143

15)  2nd degree superficial burns 1

16) 2nd degree superficial burns healed,
small lenear strip of 2nd degree deep burn unhealed  (2)

17)  2nd degree superficial burns of the hand , wrist and forearm 054

18) 2nd degree superficial burns,  hand, 055

19)  2nd degree superficial burns, both hands,  053


20) 3rd degree burns,  untreated, needs skin grafting 029

21)  3rd week, 2nd degree deep burns of the hand and forearm,  104

22)  5 months post burn, hypertrophic scars, post burn scar,
after chemical  burns, deep 2nd degree burns, 161

23)  28 day post burn, second degree deep burn dorsum hand, 
 unhealed,  rest second degree superficial burns healed,  075

24 ) both thighs 2nd degree deep burns periphery and
3rd degree burns central area, needs  tangential excision
 of the burn eschar and skin grafting  134

25) burn dorsum hand, unhealed, need surgery - skin grafting ,
rest second degree superficial burns healed 074

26)  burn dorsum hand unhealed, rest second degree
superficial burns healed 076

27) burn eschar breakdown, untreated, 3rd degree burns 031

28)  chemical burns, deep second degree burns, healed, day 34, 116


29)  coal tar burns, bitumen burns, hands- day one, 144


30) day14, second degree deep and superficial burns,
electrical flash burns, knee, calf, leg,  137

31)  day 2  mixed 2nd degree superficial and deep burns  019

32) day 2 post burn,  mixed 2nd degree superficial and deep burns 018

33)  day 3 , second degree burns palm, hand wrist and forearm,108

34)  day 3 , second degree burns palm, hand wrist and forearm, 109

35) day 3, face burns, neck burns, scalds,
2nd degree superficial burns 166

36)  day 5, 2nd degree deep burns of the hand  060

37)  day 5, deep second degree burns hand and fingers 182

38)  day 10, second degree superficial burns, ankle burns,  155

39)  electrical flash burns, day 10, second degreee burns,
hand, wrist, 112

40) day 16 , second degree superficial burns, 
scald burns , healing  168

41) day 18, second degree superficial burns hand and fingers
healing  077

42) day 18, second degree superficial burns, 
scald burns , healing 170

43) day 20, healing hand burns  129

44) day 23 , 2nd degree deep  burns  081

45) day 24, healing second degree superficial and
patchy deep burns , hand , fingers,  072

46) day 25 , third degree burns neck, was treated
elsewhere by mebo dressing, should undergo surgery,
excision and skin grafting 043

47) day 28 post burn, 2nd degree deep burns healing,
 granulation tissue,   067

48)  deep 2nd degree burns


49) deep 2nd degree burn - day three after the burn 096

50) deep 2nd degree burns hand 098

52) deep 2nd degree burns hand  097

53)  deep 2nd degree burns hand  and wrist 092


54) deep 2nd degree burns of the hand, palm and forearm- day 2,  107

55) deep 2nd degree burns with some areas of third degree burns  101

56) deep burns , skin grafted , mesh graft, needing graft care  059

57) deep dermal burns, 2nd degree deep burns hand dorsum, forearm and arm 099

58) deep dermal burns, 2nd degree deep burns hand, wrist  100

59) deep dermal, 2nd degree deep burns , hand  065

60) deep second degree and third degree burns chest , untreated, with granulation tissue and scar hypertrophy,  044

61) deep second degree burns and third degree burns,  040

62) deep second degree burns forearm 180

63) deep second degree burns upper arm 176

64) deep second degree burns, flame burns, 139

65) deep second degree burns, third degree burns  041

66) electrical burns, post burn contractures,  mpj extension contracture, with post burn scarring , skin graft dorsum hand,  114

67) electrical flash burns, forehead burns, third degree unhealed , day 28, granulation tissue, rest second degree healed,  046

68) face burns 2nd degree  020

69) face burns, chest burns, deep second degree, healed, hypertrophic scarring, post burn scars, 045

70) fingers, hand and forearm, 2nd degree burns - superficial and deep 193

71) flame burns, 2nd degree burns healed with pigmentation  085

73) flame burns, 2nd degree palm burns 194

74) flame burns, day 12, abdomen , groins, genetalia, flamazine dressing, 042

75) flame burns, day 24 , deep second degree burns. needs surgery , excision  of wound and skin grafting  157

76) flame burns, deep second degree burns hand  102

77)  flame burns, fire burns, day 3, second degree burns hand and fingers,  111


79) hand and forearm burns  124

80) hand and forearm burns  190

81) hand and forearm burns   123

82) hand burns 130

83) healed second degree burns, deep on the fingers, with hypertrophic scarring 118

84) healed 2nd degree  burns with hypo pigmentation 083

85) healed 2nd degree  degree burns with scarring   087

86) healed 2nd degree  degree burns with scarring   and hypopigmentation and hyper pigmentation  088

87) healed 2nd degree  degree burns with scarring   and pigmentation 084

88)  healed 2nd degree  degree burns with scarring   and pigmentation  086

89) healed 2nd degree burns with  hypo pigmentation  078

90) healed 2nd degree burns with  hypo pigmentation  079

91) healed burns, second degree burns, legs, 24 days,  189

92) healed hot oil burns, scald burns day 18, 153

93) healed mixed 2nd degree superficial and deep burns 011

94) healed mixed 2nd degree superficial and deep burns 012

95) healed palm burns, chemical burns, day 22,  110

96) healed post burn hypopigmentation, full function, hand and wrist burns, 184

97) healed second degree burns foot dorsum 22 days post burns 150

98) healed second degree burns left forearm and wrist, 18 day post burns, 167

99) healed second degree burns of both hands following coal tar burns 144

100) healed second degree burns of the right arm, forearm, elbow, wrist and hand 177

101) healed second degree burns right shoulder and right arm at 3 weeks  146


102) Healed second degree burns of the forearm at 3 weeks

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