Transcription:
Caring for Burn Injuries

Melanie Cole (Host):  Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed. So you can make informed healthcare choices for yourself and your whole family. Back to health features, conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell medicine.

I'm Melanie Cole and I invite you to listen. As we discuss acute burn care and wounds, how the burn team at Weill Cornell medicine cares for burn patients using 21st century technology with an old-fashioned personal touch. Joining me today is Dr. Phillip Chang. He's an Assistant Professor of Surgery in the Division of Trauma, Burns, Critical Care, and acute care surgery at Weill Cornell medicine.

And he's an assistant attending surgeon at New York Presbyterian hospital, Weill Cornell medical center. Dr. Chang, it's such a pleasure to have you join us. This is a really great topic. So, as you're telling us about the prevalence of burns in the adult population, tell us the different types of burns that you see and the most common ways for each of these types to occur.

Philip Chang, MD (Guest): Melanie. Thank you very much for having me on today. I'm really excited to be here, to talk to you all today about the different kinds of burns and how to deal with these burn injuries. We typically will classify burn injuries in categories based on the cause of the burn. Thermal, which can be caused by heat sources, such as steam, hot water or contact with hot substances, chemical burns, which can be due to contact with any one of a number of chemicals that can be available in the household or workplace and electrical, which can happen not just in the workplace, but also when we're traveling from home to work.

For example, if you accidentally touch the thorough subway line. More commonly, the electrical burns that we tend to see in this day and age tend to be associated with accidents involving cell phone chargers, but any one of these ways of being injured will ultimately lead to a skin injury that we call a burn. And that, depending on the depth of injury, may require a very intense medical treatment.

Host: Well then tell us, I find it so interesting when you mentioned the things with cell phone and chords and such because gosh, how common is that now? So, what are some of the complications? Other than what we see on our skin Can it go deeper Dr. Chang? What
 can it do?

Dr. Chang: Especially for electrical burns. That is definitely a risk. The electricity can travel throughout the body and have a number of effects on different body parts. For example, electrical burns, even a simple one, such as contact with household current can actually affect the eyes. It can increase the risk of early cataract formation I had a patient, a number of years back who was just hanging out lights, holiday lights, and she had a mild shock or what she thought was a mild shock through that light cord. And then about four weeks later started developing cataracts in her eyes, which required treatment. Other ways electricity can also cause harm to the body can be injury to the muscles, which can then in turn lead to injury to the kidneys, there can also be effects on the heart and the brain. So, electrical burns can be quite serious and do require prompt medical evaluation.

Host: then let's expand on that Dr. Chang. How do we know the severity of it and whether it requires an ER visit? What are some red flags, things that you want us to know? Whether we burn ourselves on the stove or hanging lights or because of our phones or a chemical burn, because we're dealing with so many chemicals right now. And so tell us what we would notice that would be a red flag that would say don't try and treat this one at home. Call your doctor, get to the ER?

Dr. Chang: Burn injuries happen, it's estimated that about a couple of million Americans every year. The good news is the vast majority of those injuries usually can be handled with simple first aid at home. However, obviously some of these burns can become more serious and it's estimated that approximately 400,000 emergency department visits occur every year to evaluate burn injuries. Some of the signs that let you know that you should definitely seek out medical attention can include if it's a larger burn area. For example, if the burn encompasses an entire forearm or entire part of the leg, especially if it goes all the way around, that is a burn that does require medical attention burns to sensitive areas such as the face, genitalia, hands and feet should also be evaluated in a timely fashion by professional Third-degree burns, burns that have gone beyond blistering, but now have a blackened or leathery appearance. Those are very concerning and those also need evaluation. Finally burn wounds that are also in the context of other traumatic accidents like for example, a car fire or someone we'll say was jumping out of a burning building.

Those are definitely patients who need to be seen at a burn center that also has trauma capabilities as well. In general, if you are in doubt, it never hurts to call for a quick opinion from your local emergency department or urgent care to see if your burn wounds should be seen promptly.

Melanie Cole (Host): That's really good advice. And I have done that myself as I love to cook, and I bet there are many like me, Dr. Chang, that we burn ourselves kind of all the time. Maybe if we're busy cooking, doing these things. So, before we get into treatments at the hospital, what kind of treatment do you guys approve of that we can do at home. And if it doesn't seem so severe, doesn't hit any of those markers you just mentioned. Do we use cold water, salve there's a lot of these wives tales, they used to put butter and all of these different things on there. What do we do? And do we also take an anti-inflammatory? Is there any reason not to take one of those?

Dr. Chang: Great questions, Melanie. The first step in any burning process is stop the burn. Now, if this is involving a flame such as if your clothes catch on fire, you want to stop what you're doing, drop to the ground and roll. So stop, drop and roll, like you're taught in school. If this is any other burn injury the cooling process is very important.

So, like you said, running that affected area, that's been injured under cool running water. For at least 10 minutes is critical for helping decrease the progression of the injury. Ice is actually not a good idea. I know people say they feel better after applying ice, but the ice can actually drop the temperature of the skin too much thus causing the blood flow to stop to that area. And that can actually be worsen the burn injury. So, you don't want to do ice. You want to do cool running water for at least 10 minutes. You mentioned some of the other things that sometimes people will put on burns. We have seen the gamut of food products placed on, everything from toothpaste to salsa, to honey, to ketchup.

None of those is a great idea. A, they will be quite painful because mostly substances tend to be acidic and B they also may have bacteria growing in them that could actually increase the risk of infection. So, simple cool running water is your best bet. In terms of pain control, either Tylenol or ibuprofen is a great idea for controlling pain assuming of course you have no reasons that would prevent you from taking those medications, but that can definitely help with pain immediately before you decide to seek expert medical attention.

Host: I cannot believe that you said people have tried things like salsa and ketchup. That would seem to be so painful. It's like hurting me, even hearing about that when I know how burns feel, even if they're the littlest burn on your finger or your hand. Burns are so painful. So, Dr. Chang and before you tell us some of the really incredible treatments you have available at the hospital, what should we look for?

If we have treated our own burns and we're keeping an eye on it and we're doing what you say and we're keeping it covered and whatever we're supposed to be doing, what are some signs that we should be looking for to make sure that it's not infected? And then we maybe need to see the doctor again?

Dr. Chang: Associated with most second-degree burns, we often will see blistering and blistering can be very concerning for a person. The good news is the blister is the body's natural way of dealing with a burn injury in terms of it serves as a natural bandage over the area. Needless to say, the blisters do contain a fluid. So, when the blister eventually does pop and it usually, will, a clear straw colored or serous fluid as we call it will sometimes come out of that fluid, that is not infected fluid. That's just the body's fluid that's built up underneath that blister. So, that's perfectly natural and is not a sign of infection.

Now, indications for when you might be start worrying about signs of infection would include if you start seeing redness on the uninjured skin next to the burn wound, if that redness is starting to increase in size. Also, if you're starting to notice increased pain, along with that redness those would be very concerning signs that a localized wound infection is starting to occur.

Other signs you could watch out for would include if you're starting to have fevers and would have no other reason to have those fevers. And especially if you start losing appetite or start feeling more tired than usual, that is a sign you should definitely seek medical attention as soon as possible because your body might be sending you these signs to say, hey, I need help. So, it’s important to seek medical help. If you start feeling these signs of infection.

Host: That is such great advice and so important for us to hear. So now, if we do end up at the hospital, we've called 9-1-1, or someone has brought us there, we've been burned. What can you do for us? And as I said in the intro, tell us how the burn team at Weill Cornell Medicine is using this 21st century technology with that old fashioned personal touch.

Dr. Chang: So we are blessed to have some the latest and greatest technologies available to help take care of our patients. First of all when you come to our burn centers, you are cared for by a multi-disciplinary team that not only includes burn doctors, but as well as expert burn nurses who are skilled in the various wound care treatments necessary to help get the best possible outcome.

We also have Burn Pharmacists, Nutrition Experts, Physical Therapists, Hand Therapists, Occupational Therapists, Psychiatrists, Psychologists, and other specialists who are all dedicated, focusing on the care of the burn patient. Some of the technologies we are now using that have been developed in the past five to 10 years, includes special what we call multi-day dressings. These are special bandages that have silver in them, which can combat a wide range of bacteria and thus significantly reduced the risk of infection. The best part of these multi-day dressings is that they can be placed on a burn wound and the dressing does not need to be changed for a week.

This greatly diminishes pain and discomfort for the patient. And what previously was an injury that would require a one to two week hospitalization can now be managed at home with these multi-day dressings. Other technologies that we have available in case there's a much more serious burn injury that does require surgery; there are special skin substitutes that we can now place on wounds that can help regenerate the full layers of skin. Especially for deep burns that go down to the muscle or bone. We also have a technology to be able to grow skin cells in a laboratory setting that can be applied to burn wounds for the most seriously injured patients.

And there are other technologies in the pipeline to actually clean up burn wounds without the need for surgery. So, it's a very exciting time in the burn field in terms of bringing new technologies that can really help shorten hospital stays and improve the appearance of scars. Finally, in terms of a burn scar, some burns unfortunately do lead to scarring and we have an entire scar rehabilitation program that is designed to help achieve the best possible outcome in the appearance of this scars and includes both nonsurgical and surgical treatments to achieve that goal.

Host: Wow. That is some amazing technology, Dr. Chang. As we get ready to wrap up, tell us about the follow-up care. And you've mentioned this multidisciplinary team and all of these specialists that are involved. There certainly is an emotional and psychosocial aspect to burns that maybe some other injuries really don't come along with, but burns can show, they leave long lasting as you mentioned scars, they can be painful while they heal or itchy. Tell us how you work aftercare, what is involved and how does your multidisciplinary team help a patient really that's suffered maybe even more severe burns to get through that and come out for better outcomes.

Dr. Chang: So as the cliche goes, burns are more than just skin deep, especially a large burn injury, a burn injury that affects over 20% of the body can lead to effects on all the organ systems of the body, the brain, the heart, lungs, the kidneys and other organs. And as you mentioned the burn injury, even after we've healed the skin injury and the skin has healed, it can lead to lifelong changes in the psychological wellbeing of the patient, as well as the emotional wellbeing.

This is especially true of burn injuries that affect the face and the hand. For those reasons, it really does take the expertise of the multidisciplinary team to help patients go through the healing process and help them be able to return to their families and society in a meaningful way. We do this by ensuring that the multidisciplinary team is available both for the inpatient care for those patients who do need to be admitted to the hospital, as well as in the outpatient clinic where they will be not just seen by the Burn Surgeon, but as well as the other members of the burn team to help with the different aspects of their care. Itching often requires not just medications to deal with it but sometimes other modalities such as silicone gel sheets or custom-made pressure garments. Ultimately, sometimes even laser treatments are necessary to address the more serious itching issues.

The emotional aspects can be very difficult for burn patients to come over alone, especially if, other members of their family were injured as well. Fortunately, we have our Burn Psychologists, and Psychiatrists, and Social Workers who are able to provide a lot of that social support. There's also an incredible group called the Phoenix Society, which has set up burn survivor support groups around the country, and these burns survivor groups who meet regularly and offer a great forum to offer that emotional and psychological support for each other.

Host: Wow, this is great information. And Dr. Chang, as we know that National Burn Awareness Week is observed on Sunday, February 7th, that week in 2021, tell us what we can do to prevent burns. You've mentioned electrical burns and thermal burns and chemical burns. And all of these things are around us all the time. And certainly in these unprecedented times, we're using all kinds of chemicals to disinfect everything around us. Tell us what you'd like us to know about preventing burns so that we don't have to go through all of this.

Dr. Chang: So many of my burn patients will say, after they've been injured, I was just careless for one second and it's led to this injury that's going to affect me for my life. This is truly a case where an ounce of prevention will totally avoid the need for a pound of cure. The most common burn injuries we see in adult patients are caused by accidental spills of hot liquids. So, in the home setting, it's very important to do simple things, such as making sure that when you take that hot bowl of ramen noodles from the microwave, or even a cup that you use appropriate potholders that you protect your hands as you're taking out those hot plates and cups making sure that the pot handles are turned away on the stove from the edge so that you don't accidentally knock off the pot.

Every once in a while, when we're cooking something with grease, grease fires do happen in the kitchen. So, it's very important to make sure we have either a fire extinguisher or fire blankets available to help put out those flames that occur. Other means include making sure that appropriate covers are placed over the chemicals and their containers and that there is a safe, designated area to put those chemicals that is a way from heat and also away from children and animals that could potentially get into those chemicals. And then finally especially when it comes to electricity, I think there's a habit for a lot of people to use their cell phones connected to their chargers when they're bathing or lying down in beds. That I think there's a habit for a lot of people to use their cell phones connected to their chargers when they're bathing or lying down in beds.

That is a no-no. You probably have seen on the media, some incidences of people who've been electrocuted to death because their cell phone charger cables or batteries fell into the bathtub. So, again, don't charge the phone in the bathtub save the phone for once you're out of the bathtub and out of water.

Host: Wow, absolutely great advice, Dr. Chang. What an excellent guest you are. Thank you for really, really important information and Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to thank our listeners and invite the audience to download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google Play Music. For more health tips like this, please go to WeillCornell.org and search podcasts and parents, don't forget to check out our Kids’ Health Cast. I'm Melanie Cole,