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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






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