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Why Burn Injuries Should Receive Specialized Care
Dr. Peter H. Grossman shares information on burn care and why these types of injuries require specialized care.
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Learn more about Peter H. Grossman, MD
Peter H. Grossman, MD
Dr. Peter H. Grossman, President of the Los Angeles Society of Plastic Surgeons, is a Board-certified plastic surgeon whose private medical practice is divided between cosmetic and reconstructive surgery and the care of the burn-injured patient. The diverse nature of Dr. Grossman’s practice and his vast experience as a reconstructive surgeon has made him one of the most sought after surgeons in the region.Learn more about Peter H. Grossman, MD
Transcription:
Why Burn Injuries Should Receive Specialized Care
Introduction: This is Hello Healthy a Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Memorial Hospital has partnered with the Grossman Burn Center to make the highest level of care for burn survivors available close to home. The Grossman Burn Center is renowned for its specialized care and pioneering techniques that help burn survivors recover faster. So let's learn more with Dr. Peter Grossman, medical director of the Grossman Burn Center at Memorial Hospital. Dr. Grossman, thanks so much for your time. So first off, why is it important that burn injuries are seen by a specialist?
Dr. Grossman: Well, you know, probably more than any other injury burns leave a mark. I don't mean to be flippant with that response. I mean that they leave a scar that is visually disturbing, functionally impairing, and emotionally very difficult for patients to deal with, as it will be with them oftentimes for the rest of their lives. And so it really is a area of trauma that requires a level of expertise so that you can maximize the outcome for the patient so that they can have a better quality of life. Not just the immediacy of when the injury occurs, but the long-term effects that that do result from burns scarring. That's why it's really important for us, a specialist who has some level of expertise and experience to be able to deliver the best outcome for the patient.
Host: Those are three really important considerations when it comes to a burn. Not only is a person dealing with it cosmetically cause you can see the scar, but there is the functionality and the emotional aspect as well. So how are burn injuries different than other injuries?
Dr. Grossman: Well, burns are progressive and dynamic by their nature, and initially the way they look is not the way they are going to look the next day or the day after that. The progression of cell injury or cell death to the skin continues to occur. And oftentimes a burn doesn't look so bad when it first happens, but then the consequences of the cell injury become very apparent. And the problem is when it is treated too cavalier like initially then the problems and the consequences of infection or subsequent scarring or even life threatening illness can develop. So one who doesn't have necessarily the opportunity to have seen what happens to a burn can often miss some key elements to the successful treatment of a burn injury. Most of the visual aspect of a burn injury can be seen by an onlooker. If you have a broken bone, you may have a surface scar from a surgery, but the bone itself isn't visualized. But if you have a burn injury, not only can it be visualized, but the inelasticity of the scarring that occurs, can pull and deform and disfigure the body in a way that can impede function and create a sense of embarrassment and sadness for a patient. And that can be incredibly painful for the patient emotionally, not just physically.
Host: So the person has that to deal with as well. So then why is it important to receive treatment soon after the burn injury?
Dr. Grossman: The faster a wound heals, the better the result, the longer it takes for a body to heal, the more chance there is for infection in a burn wound. The more chance that a burn scar that may only be partially the depths of the entire skin can convert to the entire depth, or in essence, a second degree burn can convert to a third degree burn. You want to maximize the bodies ability to heal and sometimes that means you have to remove the unhealthy tissue and create an environment in which the body can heal. And sometimes that means taking a skin graft from the patient's own tissue or perhaps utilizing some of the newer technology, being able to use laboratory developed skin. To give the patient an environment in which not only do they heal, but they don't over heal because the body is, the body is a wonderful healing machine, but sometimes it over heels. And when it over heels and produces too much scar tissue, that scar tissue lacks elasticity and lacks function and can actually create a much greater problem than one would anticipate. By treating a burn early, you can help the body heal the wound in a much more controlled fashion.
Host: So then what happens is specialized care isn't received in a timely manner?
Dr. Grossman: If specialized treatment isn't received timely, then you're at a much greater risk of developing the complications of burn injury. The first complication is infection. Our body serves as our protective barrier from the outside world and when that barrier has been disrupted, bacteria and pathogens can get inside of us and we can become very, very sick and the larger the burn, the more chance of that happening. The other consequence that happens from that is that a burn is physiologically exhausting on the body and if not treated well, then other body systems can start to break down because the body is utilizing so much energy on the actual healing of the burn injury itself. Then you go onto what happens even if a burn does heal. Again, the body is a great healing machine, but given some obstacles, the body can sometimes have problems in getting the most efficient healing to occur.
And in those situations, the overdevelopment of scar tissue tends to pull the areas together and that can limit range of motion. So if you have a burn on your arm, you know, sometimes you might not be able to fully extend it or burn on your foot, you may not be able to put weight on it. Or a burn to your face, it can pull and distract and even stop you from closing your eyes or opening your mouth. There are many different consequences of what happens to burns that aren't treated properly. It's not simply something that it should be taken lightly. It really is something that deserves the same level of expertise that someone who has heart disease, would have. You going to see a cardiologist or a cardiac surgeon, someone who has a problem with their brain, they're going to see a neurologist or neurosurgeon. Really, when you're dealing with a burn injury, you should see that specialist, you should see an expert in burn medicine and burn surgery.
Host: So, speaking of seeing an expert in someone that specializes in this, what other burns services does the Grossman burn center at Memorial Hospital provide?
Dr. Grossman: The Grossman Burn Center at Memorial is a comprehensive burn center. We look at patients not just from the physical trauma that they've had, but the emotional trauma. And it's not just the patient, but it's family members. Imagine that you have a child who is traumatized. Not only do you feel terrible for your child's pain, but you're scared as a parent, you know, and you wonder what could you have done differently and what will the future hold? We have therapists to help family members deal with the emotional trauma. We have pediatricians who deal with not just with the burn injury, but with the problems that pediatric patients would develop. We have intensive care physicians who can handle some of the other complications that can occur when someone goes through a trauma. The heart problems, kidney problems, multitude of other medical issues.
And psychological services are available initially. But beyond that, we're able to offer reconstructive services, so once the patient leaves the hospital from their acute injury, they're not left on their own to go find the best way to reach their optimal outcome. They become part of our family. And we will follow them not just through the acute care, but through the long-term process of rehabilitation and ultimate reconstruction and recovery. We have a saying that once you leave the hospital, you're really only halfway home because the consequences of burn scarring continues to develop after the initial healing period. And without treating that, you really aren't optimizing the outcomes for the patient. And that aspect of wound care deals not only with the physical and aesthetic aspect of the patient, but the emotional aspect of the patient as well.
Host: Right. And as you've been explaining to us, Dr. Grossman, not only is there the physical trauma, there's also the functional trauma and the emotional trauma as well. And I like how you say burn victims become part of the family. I'm sure that alone is very comforting to many. So let's talk about burns in general. We've all picked up the hot pan or grabbed something hot that we shouldn't have. When is a burn injury considered serious and should be seen by a specialist?
Dr. Grossman: Well, rule number one is if you're not sure you should see a specialist. I think that the last thing we want to have is people underestimate and miss an injury. We can always tell you, don't worry about it. Now, having said that, we recognize that that's not always convenient for everybody. And sometimes for smaller burns, it would be better if we had the ability to relay our knowledge to patients so they don't have to travel long periods of time or spend a great deal of their day going out and seeking expert care. So we like to be able to go out into the community, to educate schools, to educate businesses, to educate everybody within the community of what is serious and what can be treated, either at home or as an outpatient. So the first guide for an area of burn injuries, if you see a disruption in the texture of your skin, a blister, technically at that point you have a burn that is a second degree burn.
And that burn if treated well, might end up doing okay. But you've got to give the body an environment in which it can heal. If you get blistering that converts to an open weeping type of wound, then that should definitely be seen by a burn expert or at least a healthcare professional who can then guide you to tell you whether or not you should see the burn expert. If you have a burn that's greater than 10% of your body surface area, and if you think about your own hand, your hand is about 1% of your total body. So if you see that you have more than 10 hands of your, that's a burn that really requires burn center evaluation. If you have a burn to a very important area of your body and we consider the important areas, your hands, the areas in how we make a living, the feet, how we emulate, the face, our appearance, the major joints. If you have a burn over any of those areas, a burn specialist should see you so that you don't end up with complications to those areas.
Host: Okay. Those are good guidelines to follow. So then for smaller, less serious burns, what first aid should be done?
Dr. Grossman: For burns that are smaller, burns that are within an area that the patient feels a sense of comfort. Then the guidelines that we have is to try to cool the burn down. When a burn first happens, there's an inflammatory process, the body tries to react to trying to heal the wound, but that inflammation causes swelling and the swelling can cause pressure to the tiny little blood vessels in the skin. And choke off those blood vessels and convert a burn from being a second degree burn into a deeper third to be burn. So we recommend cooling the burn for three to five minutes under cold water. That's not saying put ice on a burn because the problem with ice is that you can create a frost injury and that would be equally as problematic. But running under cool water will slow down the inflammatory process. Then placing some, antibiotic ointment that you're familiar with is probably the easiest thing to do to initially take care of a burn injury. If you have a burn that's larger than a small area, that's one that we're really recommending that you get a little bit more advanced burn assessment.
Host: So that's really good information right there. Cool water, not ice. I can remember burning my hand in my younger days grabbing a hot exhaust pipe and putting ice on it. So that's a no, no. Cool water, not ice. And then put some antibiotic ointment on it. And then when in doubt when you're not sure, seek medical advice.
Dr. Grossman: That's right.
Host: Dr. Grossman. This has been fantastic and very informative. Thank you so much for your time.
Dr. Grossman: I really appreciate you giving me the opportunity to speak to you and I hope to speak to again some time soon.
Host: That's Dr. Peter Grossman, Medical Director of the Grossman Burn Center at Memorial Hospital. For more information, just go to dignityhealth.org then click on Central California services and there you'll see Grossman Burn Center. Click on that and that's where you'll find all the information on this fabulous center. And if you've liked what you've heard, please share it on your social channels and be sure to check out the Volt Podcast library for topics of interest to you. This is Hello Healthy a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.
Why Burn Injuries Should Receive Specialized Care
Introduction: This is Hello Healthy a Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Memorial Hospital has partnered with the Grossman Burn Center to make the highest level of care for burn survivors available close to home. The Grossman Burn Center is renowned for its specialized care and pioneering techniques that help burn survivors recover faster. So let's learn more with Dr. Peter Grossman, medical director of the Grossman Burn Center at Memorial Hospital. Dr. Grossman, thanks so much for your time. So first off, why is it important that burn injuries are seen by a specialist?
Dr. Grossman: Well, you know, probably more than any other injury burns leave a mark. I don't mean to be flippant with that response. I mean that they leave a scar that is visually disturbing, functionally impairing, and emotionally very difficult for patients to deal with, as it will be with them oftentimes for the rest of their lives. And so it really is a area of trauma that requires a level of expertise so that you can maximize the outcome for the patient so that they can have a better quality of life. Not just the immediacy of when the injury occurs, but the long-term effects that that do result from burns scarring. That's why it's really important for us, a specialist who has some level of expertise and experience to be able to deliver the best outcome for the patient.
Host: Those are three really important considerations when it comes to a burn. Not only is a person dealing with it cosmetically cause you can see the scar, but there is the functionality and the emotional aspect as well. So how are burn injuries different than other injuries?
Dr. Grossman: Well, burns are progressive and dynamic by their nature, and initially the way they look is not the way they are going to look the next day or the day after that. The progression of cell injury or cell death to the skin continues to occur. And oftentimes a burn doesn't look so bad when it first happens, but then the consequences of the cell injury become very apparent. And the problem is when it is treated too cavalier like initially then the problems and the consequences of infection or subsequent scarring or even life threatening illness can develop. So one who doesn't have necessarily the opportunity to have seen what happens to a burn can often miss some key elements to the successful treatment of a burn injury. Most of the visual aspect of a burn injury can be seen by an onlooker. If you have a broken bone, you may have a surface scar from a surgery, but the bone itself isn't visualized. But if you have a burn injury, not only can it be visualized, but the inelasticity of the scarring that occurs, can pull and deform and disfigure the body in a way that can impede function and create a sense of embarrassment and sadness for a patient. And that can be incredibly painful for the patient emotionally, not just physically.
Host: So the person has that to deal with as well. So then why is it important to receive treatment soon after the burn injury?
Dr. Grossman: The faster a wound heals, the better the result, the longer it takes for a body to heal, the more chance there is for infection in a burn wound. The more chance that a burn scar that may only be partially the depths of the entire skin can convert to the entire depth, or in essence, a second degree burn can convert to a third degree burn. You want to maximize the bodies ability to heal and sometimes that means you have to remove the unhealthy tissue and create an environment in which the body can heal. And sometimes that means taking a skin graft from the patient's own tissue or perhaps utilizing some of the newer technology, being able to use laboratory developed skin. To give the patient an environment in which not only do they heal, but they don't over heal because the body is, the body is a wonderful healing machine, but sometimes it over heels. And when it over heels and produces too much scar tissue, that scar tissue lacks elasticity and lacks function and can actually create a much greater problem than one would anticipate. By treating a burn early, you can help the body heal the wound in a much more controlled fashion.
Host: So then what happens is specialized care isn't received in a timely manner?
Dr. Grossman: If specialized treatment isn't received timely, then you're at a much greater risk of developing the complications of burn injury. The first complication is infection. Our body serves as our protective barrier from the outside world and when that barrier has been disrupted, bacteria and pathogens can get inside of us and we can become very, very sick and the larger the burn, the more chance of that happening. The other consequence that happens from that is that a burn is physiologically exhausting on the body and if not treated well, then other body systems can start to break down because the body is utilizing so much energy on the actual healing of the burn injury itself. Then you go onto what happens even if a burn does heal. Again, the body is a great healing machine, but given some obstacles, the body can sometimes have problems in getting the most efficient healing to occur.
And in those situations, the overdevelopment of scar tissue tends to pull the areas together and that can limit range of motion. So if you have a burn on your arm, you know, sometimes you might not be able to fully extend it or burn on your foot, you may not be able to put weight on it. Or a burn to your face, it can pull and distract and even stop you from closing your eyes or opening your mouth. There are many different consequences of what happens to burns that aren't treated properly. It's not simply something that it should be taken lightly. It really is something that deserves the same level of expertise that someone who has heart disease, would have. You going to see a cardiologist or a cardiac surgeon, someone who has a problem with their brain, they're going to see a neurologist or neurosurgeon. Really, when you're dealing with a burn injury, you should see that specialist, you should see an expert in burn medicine and burn surgery.
Host: So, speaking of seeing an expert in someone that specializes in this, what other burns services does the Grossman burn center at Memorial Hospital provide?
Dr. Grossman: The Grossman Burn Center at Memorial is a comprehensive burn center. We look at patients not just from the physical trauma that they've had, but the emotional trauma. And it's not just the patient, but it's family members. Imagine that you have a child who is traumatized. Not only do you feel terrible for your child's pain, but you're scared as a parent, you know, and you wonder what could you have done differently and what will the future hold? We have therapists to help family members deal with the emotional trauma. We have pediatricians who deal with not just with the burn injury, but with the problems that pediatric patients would develop. We have intensive care physicians who can handle some of the other complications that can occur when someone goes through a trauma. The heart problems, kidney problems, multitude of other medical issues.
And psychological services are available initially. But beyond that, we're able to offer reconstructive services, so once the patient leaves the hospital from their acute injury, they're not left on their own to go find the best way to reach their optimal outcome. They become part of our family. And we will follow them not just through the acute care, but through the long-term process of rehabilitation and ultimate reconstruction and recovery. We have a saying that once you leave the hospital, you're really only halfway home because the consequences of burn scarring continues to develop after the initial healing period. And without treating that, you really aren't optimizing the outcomes for the patient. And that aspect of wound care deals not only with the physical and aesthetic aspect of the patient, but the emotional aspect of the patient as well.
Host: Right. And as you've been explaining to us, Dr. Grossman, not only is there the physical trauma, there's also the functional trauma and the emotional trauma as well. And I like how you say burn victims become part of the family. I'm sure that alone is very comforting to many. So let's talk about burns in general. We've all picked up the hot pan or grabbed something hot that we shouldn't have. When is a burn injury considered serious and should be seen by a specialist?
Dr. Grossman: Well, rule number one is if you're not sure you should see a specialist. I think that the last thing we want to have is people underestimate and miss an injury. We can always tell you, don't worry about it. Now, having said that, we recognize that that's not always convenient for everybody. And sometimes for smaller burns, it would be better if we had the ability to relay our knowledge to patients so they don't have to travel long periods of time or spend a great deal of their day going out and seeking expert care. So we like to be able to go out into the community, to educate schools, to educate businesses, to educate everybody within the community of what is serious and what can be treated, either at home or as an outpatient. So the first guide for an area of burn injuries, if you see a disruption in the texture of your skin, a blister, technically at that point you have a burn that is a second degree burn.
And that burn if treated well, might end up doing okay. But you've got to give the body an environment in which it can heal. If you get blistering that converts to an open weeping type of wound, then that should definitely be seen by a burn expert or at least a healthcare professional who can then guide you to tell you whether or not you should see the burn expert. If you have a burn that's greater than 10% of your body surface area, and if you think about your own hand, your hand is about 1% of your total body. So if you see that you have more than 10 hands of your, that's a burn that really requires burn center evaluation. If you have a burn to a very important area of your body and we consider the important areas, your hands, the areas in how we make a living, the feet, how we emulate, the face, our appearance, the major joints. If you have a burn over any of those areas, a burn specialist should see you so that you don't end up with complications to those areas.
Host: Okay. Those are good guidelines to follow. So then for smaller, less serious burns, what first aid should be done?
Dr. Grossman: For burns that are smaller, burns that are within an area that the patient feels a sense of comfort. Then the guidelines that we have is to try to cool the burn down. When a burn first happens, there's an inflammatory process, the body tries to react to trying to heal the wound, but that inflammation causes swelling and the swelling can cause pressure to the tiny little blood vessels in the skin. And choke off those blood vessels and convert a burn from being a second degree burn into a deeper third to be burn. So we recommend cooling the burn for three to five minutes under cold water. That's not saying put ice on a burn because the problem with ice is that you can create a frost injury and that would be equally as problematic. But running under cool water will slow down the inflammatory process. Then placing some, antibiotic ointment that you're familiar with is probably the easiest thing to do to initially take care of a burn injury. If you have a burn that's larger than a small area, that's one that we're really recommending that you get a little bit more advanced burn assessment.
Host: So that's really good information right there. Cool water, not ice. I can remember burning my hand in my younger days grabbing a hot exhaust pipe and putting ice on it. So that's a no, no. Cool water, not ice. And then put some antibiotic ointment on it. And then when in doubt when you're not sure, seek medical advice.
Dr. Grossman: That's right.
Host: Dr. Grossman. This has been fantastic and very informative. Thank you so much for your time.
Dr. Grossman: I really appreciate you giving me the opportunity to speak to you and I hope to speak to again some time soon.
Host: That's Dr. Peter Grossman, Medical Director of the Grossman Burn Center at Memorial Hospital. For more information, just go to dignityhealth.org then click on Central California services and there you'll see Grossman Burn Center. Click on that and that's where you'll find all the information on this fabulous center. And if you've liked what you've heard, please share it on your social channels and be sure to check out the Volt Podcast library for topics of interest to you. This is Hello Healthy a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.