Six Non-Heat Injuries That Burn Center Doctors Should Treat
When most people think of a burn center, they think of heat-related injuries. While we are the only adult burn treatment center in the Washington metropolitan area, we treat far more than just burns. Many patients benefit from our expertise in skin and wound care, whether we are helping them deal with issues such as smoke inhalation and scars or traumatic skin injuries.
Apart from treating patients for burns, we provide expert care for a number of conditions you might not expect a burn center to specialize in—particularly the six I’ve outlined below.
In many ways, frostbite is similar to a burn in terms of skin damage. However, injuries from extreme cold can be more unpredictable than thermal injuries, or those caused by heat.
Successful treatment of frostbite depends on getting expert care within 24 hours of the injury. During that time, blood vessels in the affected tissue start to become blocked, and the tissue receives less oxygenation from the bloodstream and begins to die. If we see patients within that 24-hour window, we may be able to use special chemicals or the expertise of our interventional radiology colleagues to reopen the blood vessels and restore normal blood flow. If patients don’t get help within 24 hours of a frostbite injury, much of our ability to save the injured tissue is gone. Amputations of fingers and toes may then become necessary to save hands, arms, feet, and legs.
Get to an emergency department right away if you think you may have frostbite. One of the telltale symptoms is any sort of numbness or tingling in the affected area after being exposed to cold. Also, watch for gray- or blue-colored skin in the exposed area. Color changes are a very serious sign of frostbite, especially the farther they extend up the limb toward the body.
2. Electrical injuries
Injuries from electricity can be especially dangerous because skin changes seen at the surface might be only a fraction of the total damage underneath. Low-voltage electricity typically causes minor injuries, but can be especially dangerous for people who have an irregular heartbeat or heart disease.
Contact with high-voltage electricity often involves the electrical current entering the body, traveling along a bone, and exiting the body at some other point. Along the way, the electricity can damage skin, nerves, muscle, and internal organs. We typically see high-voltage electrical injuries in two instances: lightning strikes and injuries at work.
Electrical injuries usually happen to people who are in good health and who are working, so these injuries can be especially devastating for families. The patient might need to be in the hospital for a long time as they recover, which can lead to long periods without a steady paycheck. If the patient’s heart is badly injured by electrical current, these injuries can be fatal.
A specialized burn and trauma center like ours is staffed by specialists from a number of fields, allowing us to provide whole-patient care. For example, we had a patient suffer spinal fractures and a laceration to the spleen after receiving an electrical shock and suffering a major fall. His successful care depended on a number of experts, including:
- Burn care doctors and nurses
- Trauma doctors
3. Pressure injuries
Pressure injuries happen when an area of skin is pressed against a surface for an extended period of time. These injuries behave like deep burns, resulting in a loss of blood flow and even death of the affected skin in some cases.
We don’t see these develop in most people who sit or lie still for long periods because they subconsciously move or fidget to relieve the pressure. However, people who are unconscious, paralyzed, or otherwise injured might not be able to do that. For example, you might be familiar with bedsores, which can develop in people who are unable to walk and who aren’t moved regularly to relieve pressure on their skin.
We have treated people who were found by loved ones or coworkers after they had been down and unmoving for long periods of time. One patient was pinned under a piece of heavy equipment at work. Another had suffered a stroke and had been lying immobile on the floor. In severe cases such as these, we might need to perform surgery to treat the pressure injury and allow the affected skin to heal properly.
Someone who has a #stroke and lies immobile on a hard surface for just 30 minutes might be at risk for a #pressure injury, which behaves like a deep #burn and can cause serious #skin damage. via @MedStarWHC
4. Skin diseases
We often partner with our dermatology colleagues to care for patients who have rare skin diseases that cause them to shed their top layer of skin, much like what happens in a burn injury. Some of these include:
- Bullous pemphigoid, which causes large fluid-filled blisters to develop on the skin
- Stevens-Johnson syndrome, which involves a painful, blistering rash
- Toxic epidermal necrolysis, a more severe form of Stevens-Johnson syndrome
Patients with these diseases who are treated in our Burn Center have access to specialized nurses, rehabilitation therapy, a pharmacist, and a dietitian. These providers understand patients’ unique needs as they recover from injuries that cover large areas of their bodies.
5. Chemical exposure
Certain chemicals can cause injuries that penetrate deeper into a patient’s skin than a heat injury would. Most chemical burns happen at work for people whose jobs involve manufacturing or exposure to dangerous substances, but we do see patients who came into contact with common household products, such as cleaning supplies. Some of the many substances that can cause chemical burns include:
- Battery acid, such as from a car battery
- Bleach, including drain cleaners
- Chlorine and other chemicals used in household swimming pools
The severity of a chemical burn depends on several factors, including the strength of the chemical and the amount of time the skin was exposed to it. Be sure to thoroughly rinse the skin with water if you come into contact with a chemical, and get medical help if the burned area is:
- Blackened, reddened, or blistered
- Deep or larger than an inch in diameter
- In a sensitive location of the body, such as the eyes, face, hands, feet, genitals, buttocks, or any major joint
- Painful or numb
6. Diabetic wounds
We often see patients with diabetes who have been referred to us with wounds they have had for a long time that aren’t healing and might put them at risk for amputation. Our vast experience with skin injuries often means we can preserve their fingers, toes, hands, or feet.
People with diabetes also have special needs when it comes to burns because of a nerve condition called diabetic neuropathy that leads to a decreased feeling and temperature sensitivity in the hands, legs, and feet. We often see patients with diabetic neuropathy who burn themselves in the bathtub or shower because they can’t feel how hot the water is. These patients may suffer more severe burns than they otherwise would, and typically have delayed wound healing.
Related reading: Saving limbs and improving lives: The Center for Limb Salvage
Treating the unpredictable
One thing these very different types of injuries have in common is their unpredictability. Patients with these conditions can experience significant symptom changes in 24, 48, or even 72 hours. The advantage of a specialty burn center like ours is that we see non-heat “burns” of every severity all day, every day. When time is short, and a life is on the line, the specialists at our Burn Center can have the resources to save limbs and lives.
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