No one can prepare for a burn injury and few are prepared to treat burns quickly and accurately. As a caregiver for someone with a burn injury, you feel anxious and overwhelmed by the sheer complexities of care. Knowing what to expect can help to ease your fears and provide better care in the home environment.
Today, many highly specialized burn centers exist to treat patients far more efficiently. This has boosted the number of specially trained surgeons, who can perform surgery earlier for improved recovery times. Topical and systemic antibiotics are more effective, reducing infections. Nutrition has improved, helping burn injury patients to heal faster. Fluid resuscitation protocols and treatment of inhalation injuries has vastly improved, meaning less fluid on the lungs, a reduced risk of pneumonia and enhanced outcomes. Biologic and synthetic skin substitutes have come a long way in aiding the management of acute burn injuries and post burn reconstructions.
Despite these assurances, you’re probably wondering who will help you care for your loved one, who will be on the medical team, how the burn injury affects the body, and which steps will help your loved one heal, among other concerns.
At the Burn Center
When the burn injury first occurs, the medical team immediately assesses its severity. Can the patient breathe without assistance? How are his vital signs? What other medical conditions are present in the patient? A treatment plan is formulated, based on this and other information. Depending on the severity of the burn injury, the patient will go through several stages of recovery.
The first stage is stabilization, the initial care and assessment. At this time, the patient’s family also meets with burn care team to get information on the injury assessment, and provides information on the patient’s health history and insurance coverage.
During the first hour of care, the patient will be placed on a cardiac monitor, receive several intravenous (IV) lines for fluids, pain medications and other types of medications, and breathing is assessed for ventilation needs. An arterial (“A”) line may be placed into the patient’s artery to record critical body functions. The patient may also be given an oxygen mask and a pulse oximeter to track breathing and respirations. A nasogastric (“NG”) tube may be placed in the patient’s nose and down into his stomach to help with digestive needs. A feeding tube may be inserted to ensure the patient is receiving enough of the right types of calories. A Foley catheter may be placed in the patient’s bladder to prevent getting out of bed to use the bathroom. Blood and urine samples will be taken regularly.
You will hear many alarm bells and see many burn injury professionals caring for your loved one. It will be overwhelming, but try to remember that this is all part of the initial care process. Each tube, line, medication and tracking device has a job to do in helping your loved one to recover from a burn injury.
Following stabilization, wound care begins. This is the next stage of recovery, involving caring for the actual burn injuries and providing medical support as needed. Some care will take place in the patient’s room, while other types of care may take place in rooms specialized for the purpose. Burns are cleaned, debrided (removal of dead skin), and dressed with special medications and bandages. Very deep burns may require operating room procedures. Skin grafts may be placed at this time if necessary for healing.
Over the next few weeks, the burns will continue to heal. The processes are repeated as necessary to maximize healing.
Once the burn team has met the patient’s acute needs, he or she may be transferred to a rehabilitation center for continued treatment. Here, a therapist will share the physical and occupational therapy program to ensure ongoing recovery. You may meet with a social worker prior to hospital discharge.
At Home Burn Injury Care
The patient’s healing burn injuries will require special care at home. While bathing is ok, do not allow the patient to soak in a tub. Avoid water temperature extremes, and wash very gently. Dry with a soft towel. Avoid open wounds. Apply all medications as prescribed. Healing skin will be dry and possibly itchy. This stems from destruction of the skin’s oil glands, so you may use an artificial lubricant or mineral oil, but avoid those containing lanolin and alcohol, as blisters may occur. Don’t scratch delicate skin as it may break the skin. If itching is severe, talk to your doctor.
Grafted skin may produce blisters, but this is not a cause for alarm in most cases. Your clinician can provide instructions on caring for blisters. Similarly, the patient’s skin may bruise more easily as it is thinner and more sensitive. Avoid tight clothing or shoes during this time. Gradually, the skin will thicken and the bruising and blistering will diminish. Along with bruising, you may note some discoloration, which is also normal. Some discoloration may be permanent; other areas of the skin may eventually return to the patient’s normal skin color. Walking may create less discomfort than standing in one place, as standing causes blood to pool in the feet, causing swelling and additional discoloration. Scarring will likely occur. Depending on the depth of the burns, scarring may be permanent or temporary. Scars that cause the patient concern about personal appearance or that make motion more difficult should be addressed by your clinician.
Newly healed skin is more sensitive to heat and cold. For the first year of healing, the patient should avoid contact with the sun at all times. Protect the patient’s skin with light, loose clothing and a hat to protect the head and neck. Always apply sunscreen. The patient may experience tingling and numbness when exposed to cold temperatures. While these sensations gradually decrease, discomfort can be alleviated with warm, loose fitting clothing.
The patient may exercise in moderation to improve circulation and decrease discomfort. Healing skin may feel stiff or tight. Moving the joints and muscles can help with this sensation, as well as preventing limbs from fixing in a rigid position. Your occupational therapist probably provided a home exercise program and can arrange for both outpatient physical therapy as well as working with the patient to resolve motion difficulties.
Pay close attention to the patient’s nutrition, choosing foods rich in proteins, vitamins and minerals, and helping the patient to maintain a healthy weight. Any special dietary needs can be addressed prior to hospital discharge.