Hennepin Burn Center Patient & Family Guide
This booklet will help you and your family learn more about your burn injury and treatment. The Burn Center Team is available to help you through this difficult time. Table of Contents Who is the Burn Center Team...1 Understanding Skin and Burn Injury...3 Care of a Skin and Burn Injury...6 Common Questions as your Wounds are Healing...8 It s Up to You...14 Words for Family Members...15 Pain Management...17 Patient Rights...20 2
Who is the Burn Center Team? At HCMC we use a team approach to care. Members of the Burn Center Team have special training to provide the best care possible. Doctor HCMC is a teaching hospital and more than one doctor will be involved in your care. The staff doctor is in charge of your care. The resident doctor has graduated from medical school and is currently in specialty training. Nursing Staff The nurses are specialists, skilled to observe and care for the burn patients. Nurses are patient and family advocates and coordinate activities of the health care team. Health care assistants are also available to help with dressing changes and other daily patient care. Physical Therapist (PT) The physical therapist evaluates joint and muscle movement and works to improve your muscle strength and movement through exercise. The PT may also help you with walking and endurance. Occupational Therapist (OT) An occupational therapist works with your hands, arms, neck, and face and helps with your daily activities. Special splints or positioning devices may be used to keep a part of your body in the correct position. After your burn heals, pressure garments (if needed) are fitted by the OT. 3
Respiratory Therapist (RT) A respiratory therapist manages respiratory (breathing) treatments and exercises and takes care of the breathing equipment that you may need. Psychologist (adult and child) A psychologist will help you or your child express or manage emotions, and help support you and your family. Dietitian The dietitian evaluates and helps you meet your special nutrition needs during the healing period. Social Worker The social worker is able to help you and your family with social concerns. These concerns may include emotional support, financial needs, and assistance making the plans for follow-up care after discharge from the hospital. Patient Services Coordinator Patient Services Coordinators are resource persons to you and your family. They gather and relay information to other team members. Chaplain The chaplain is experienced in helping you express your emotional and spiritual needs. A chaplain is available 24 hours a day to assist you and your family. 4 Child Life Specialist The child life specialist is available to assess the special needs of children in the hospital. The child life specialist uses play therapy to help children cope or divert their attention away from the burn injury.
Understanding Skin and Burn Injury Functions of the Skin EPIDERMIS protective layer of skin regenerating basal cell layer DERMIS living skin organ fat layer muscle hair shaft sweat duct sebaceous gland nerve endings hair follicle blood capillaries sweat gland blood vessels bone The skin protects deeper tissues from injury, drying, and from invasion by foreign organisms. It contains the peripheral ending of many sensory nerves, sweat glands, hair roots, blood vessels, and oil glands. It also plays an important role in regulating body temperature. 5
Degrees of Damage EPIDERMIS 1ST DEGREE BURN DERMIS 2ND DEGREE BURN FAT MUSCLE BONE 3RD DEGREE BURN 4TH DEGREE BURN Cause Sunburn Hot liquids splashed on skin Flash fires Flame, electricity, chemicals, immersion in hot liquids Prolonged exposure to flame, electricity, chemicals or immersion in hot liquids Characteristics 1st DEGREE Red May have blister formation 2nd DEGREE Pink or mottled red Blisters and weeping Painful 3rd DEGREE White or charred and dry. Painless White or black leathery appearance Painless Actual Damage Only outer layer of skin has been damaged. The wound will heal within 5-7 days leaving no permanent scars. Only part of the skin has been damaged. Enough skin cells remain to provide new skin. The wound will heal by itself. All of the skin has been destroyed. There may also be destruction of the fat, muscle and bone depending upon temperature and duration of exposure of burning agent. Regeneration of the skin is not possible. These areas must be skin grafted. 6
Understanding Skin and Burn Injury What is Skin? The skin is the largest organ in the body. It is made of 3 layers. - Epidermis: The outer, thin layer. It produces melanin, which gives your skin color to protect you from the sun. There is more melanin in dark skin, freckles, and moles. - Dermis: The inner, thick layer. It contains blood vessels, nerves, hair follicles, oil and sweat glands. - Subcutaneous: The layer of fat tissue. What Does the Skin Do? What Happens When the Skin is Burned? - Protects against infection and injury - Waterproof action (prevents loss of body fluids) - Temperature control (shivering, sweating) - Sensory control (feel hot, cold, pain, pressure) - Germs are able to enter the body (infections risk is higher). - Skin will lose body fluids. - Temperature control may be more difficult. You may have a fever or chills. The depth of a burn refers to the number of skin layers damaged. This is measured in degrees: first, second, third, and fourth. 7
What is the Depth or Degree of the Burn? First degree burn - like a sunburn - skin is red - no blisters - heals in a few days, as only the outer layer (epidermis) is burned Second degree burn (partial thickness) - deeper and more painful injury than first - skin is red or pink and may be blotchy - blisters may be present - light (superficial) second degree burns heal in 7 to 28 days - deep second degree burns may require skin grafting to heal It is sometimes difficult to distinguish a second degree burn from a third degree burn. Third degree burn (full thickness) - damages all skin layers - muscle, fat, and large blood vessels may also be damaged - skin is whiter than normal, yellow-brown, or black - usually pain-free because the nerves have been destroyed - cannot heal itself, it needs skin grafting to heal Fourth degree burn - most serious burn - all skin layers are destroyed - muscle and bone have also been damaged - may require a series of surgeries such as muscle or tissue graft, or even amputation - often electrical burns are fourth degree 8
What is the Percent of the Burn? How Serious is the Burn? The percent is a calculated number used to describe how large an area of the body is burned. It s commonly called the Total Body Surface Area (TBSA). The doctor will look at certain factors to determine severity of the burn. These factors will affect healing. - depth (degree) and size (percent) of the burn - where the burn is located - age - health and nutrition before the burn - complications (smoke inhalation, infection) A burn can change over the first 24 to 48 hours, making it difficult to estimate how severe it is. A burn that appears minor at first may change to be more severe. All of these factors are considered in your plan of care. The Burn Center Team will discuss this with you and keep you informed on the progress of the burn. Care for a Skin and Burn Injury When you arrive at the Burn Center, many procedures or cares are started to treat your burn injury. You may feel overwhelmed at first. Your nurse and doctor will discuss with you what cares and routines will be done. What is wound care and why is it done? Wound care is an important part of your daily routine to promote healing. Wound cleansing (hydrotherapy or water therapy) removes (debrides) damaged, dead skin (eschar) using a special soap to help prevent infection. 9
Cleansing may be done in a: - bed, - shower trolley (a special portable cart), - shower, - tub, - whirlpool, The burn area is shaved to help decrease infection risk. This includes the scalp, but not the eyebrows. The Burn Center staff wears protective gear during dressing changes for infection control. These are gowns or plastic aprons, hats, masks, gloves, and goggles. You may have a fever and chills, or feel cold during and after the dressing change. Special heat lamps are used to provide more warmth as needed. What happens after the cleansing? Photographs of the burn are taken when you are admitted and once a week to keep a record of how the burn is healing. These are a permanent part of your medical record. You are asked for verbal or written consent before photos are taken. You or your family may see the photos if you choose. Special dressings (bandages) are applied to the burn wound to: - prevent infection - help healing, and - make you more comfortable. 10
Here are some common medications used with burn dressings: Bacitracin clear antibiotic ointment, mostly used with face burns, light (superficial) second degree burns, or grafted areas. Nystatin yellow cream or ointment used to treat fungal infections. Silver sulfadiazine (Silvadene, Thermazine) white antibiotic cream, used with second and third degree burns. Helps to soften eschar to debride more easily. Sulfamylon white antibiotic cream, mostly used on ear burns. How can the pain be managed? A burn injury can be painful. The amount and type of pain can change daily. The treatment of burns such as dressing changes, exercises, and positioning are painful, but necessary for the burn to heal without problems. Although all the pain cannot be taken away, there are ways to reduce some of the discomfort. - elevate burn areas - change your position frequently - take slow, deep breaths during painful procedures - use imagery: think about fun or pleasant memories to help you relax - get involved in activities to distract your pain such as games, crafts, reading, TV, music - a psychologist is also available to help you if needed 11
Medication - medication needs may differ from person to person - discuss with your nurse or doctor how your medicine is working - most common medications used for pain control: Morphine, Tylenol with Codeine, Percocet, Motrin - other medications for anxiety: Valium, Ativan, Versed - see pages 17-19 for additional information on Pain Management Special Cares or Equipment The percent and depth of your burn injury will determine what is needed for your treatment. Not all patients need all of these: Intravenous fluids (IV): A tube (catheter) that goes into your vein is used to replace the fluids the body loses through the burn. Arterial line (art line): A small tube (catheter) that goes into an artery and connects to a monitor. The monitor gives a constant blood pressure reading. The art line is also used to get blood samples. Cardiac monitor (EKG monitor): Electrode patches are put on the chest and are connected by wires to a monitor. It is used to watch your heartbeat. Intubation: A tube (ET tube) placed through the nose or mouth, down the windpipe (trachea) into the lungs. The ET tube is connected to a machine (respirator or ventilator), to help you breathe. If you have inhaled a large amount of smoke or if you have severe face or neck burns, intubation is usually needed. You are not able to talk with this tube in place. 12
Oximeter: A device attached to your finger, toe, or ear connects to a machine that measures the oxygen in your blood. Escharotomy: A cut (incision) through the burned dead tissue (eschar) to relieve pressure and improve the blood flow or circulation. Foley catheter: A small tube placed into the bladder to drain the urine. This helps to monitor how your kidneys are working. Restraints: Sometimes soft wrist restraints may be needed to prevent you from accidentally pulling out IV lines, intubation tubes, or disturbing grafts. Patients with restraints will be observed and care provided per hospital standard. We will explain to you and your family when and why restraints would be needed. Specialty beds or mattresses: Decreases amount of pressure on burns and wounds for patients who require special positioning and prolonged bedrest. Feeding tube: See page 21 for more information. 13
Common Questions as Your Wounds are Healing How Does the Burn Heal? The burned skin changes in size, shape, and color as it is healing. Swelling (edema) and drainage: Fluid collects at the burn area and can leak out of the burned skin onto dressings. If your face is burned, it may become puffy and your eyes may swell shut for a short period. To help treat swelling, the burn area is raised up (elevated) with pillows, wedges, or with the bed position raised. Epithelial buds: These are small new skin buds. They are pink or red areas that grow in size and number until a very thin layer of skin covers the burn. If the burn is first or second degree, it will heal itself. The burn wound fills in slowly from the outside edge to the inside. Granulation tissue: Sometimes skin buds do not form, or they start but then stop. This new tissue has a large, round, and bumpy appearance. This burn does not heal by itself. It is called a deep second degree or third degree (full thickness) burn. These need skin grafting to heal. When is Surgery Needed? Skin grafting surgery is needed when the burn depth or degree has damaged all the skin layers. The best time for grafting is difficult to predict. There can be a long waiting period, which depends on the area to be grafted and the type of graft. 14
What is Primary Closure? What is Skin Grafting? What is a Donor Site? A primary closure is a surgical procedure where burned skin (eschar) is removed (excised), and the skin is pulled together and closed with staples or stitches. Only small burns can be treated this way. It requires no grafting. Skin grafting is transplanting non-burned skin (donor skin) from one area to a burn area. This is done while you are asleep in surgery, after all the dead tissue (eschar) has been removed. This is an area of non-burned skin removed to be used as a graft to heal the burn area. - Non-burned skin is removed by a special tool (dermatone), which is like a shaver. - This donor skin is placed over the burn area and held in place with either staples or stitches (sutures). - The donor site is like a second degree burn. - It is painful at first. - It will heal in 7 to 14 days. Scalp donor site - Frequently used donor site in adults and children. - Preferred donor site in children. - Shaving the scalp is done before surgery. - When the scalp heals, the hair will grow back and no scar is seen. - Hair will not grow on the newly grafted area. 15
Most common dressings for donor sites: Tegaderm transparent film dressing. A clear plastic sheet, may be left in place for one week. Duoderm hydrocolloid a tan sheet or wafer; changed when it leaks or in one week. What are the Different Types of Skin Grafts? There are 2 categories of skin grafts: temporary and permanent. Temporary This graft is meant to be short term; it will slough or melt after period of time. HOMOGRAFT Using skin from another person (cadaver). The graft usually only last from a few days to weeks. This graft keeps the remaining healthy tissue from drying out and dying. It is used when the burn is so deep that a permanent graft will not take or accept its own skin. Permanent Your body will accept this graft to heal your wound. It is long-lasting (permanent). AUTOGRAFT This your body s own skin. This is the only skin your body will accept or take on a permanent basis. After an area has been used as a donor site, it may be used again (re-harvested) after it has fully healed. There are two types of autografts: Sheet graft is a thin, solid layer of skin. It is mostly used on hands, face, and neck burns. 16
Mesh graft is a thin layer of skin with small slits cut through it. It has a fish-net appearance, which helps the graft cover a larger area. The skin between the mesh area fills in slowly and the pattern is permanent, but may fade with time. What Happens After Skin Grafting? - The dressing is not changed for 3-5 days. This gives the graft time to take or grow. - Some grafts are flushed (irrigated) through plastic tubes to keep the graft area moist. This is done with the dressings left in place. - After the 3-5 days, the dressing is changed to check the healing (which is described as percent of graft take ). Donor site care depends on the place where the skin was taken and the type of dressings used. Your nurse will let you know the routine care of your donor site. Exercise and activity are limited until the doctors feel the graft is strong enough to move. This gives the graft a better chance to grow. Depending on the area grafted, you may be on bed rest for several days after grafting. You may have a splint or cast to keep the area from moving. Splints or foam pads may be used to keep the grafted area of the body from moving. Will the Color of Burned Skin Change? Skin color (pigment) returns slowly. First it has a spotty, dotted look, then a solid color. It may take a few months after the skin has fully healed before the pigment returns. Your burned skin may not return to its pre-burn appearance. It may be lighter or darker than your normal pre-burn color. 17
Will the Texture of the Burn Skin Change? After a burn injury, the normal pressure from the outer and inner skin layers is gone. This results in a bumpy appearance (nodules) of the healed new skin. This is called scar tissue. Not all people scar. - Hypertrophic scars: Overgrowth of scar tissue due to excess protein (collagen) in the skin. - Keloid scarring: Overgrowth of scar tissue that goes beyond the edges of the burn injury. This is a rare inherited (genetic) problem. What are Pressure Garments? Pressure garments are special clothes with elastic worn after the burn has completely healed. As the burn heals, you may see areas of raised, red scar tissue develop. Pressure garments such as Tubigrip or Jobst help keep scars flat and smooth by constant pressure or compression, to keep them from becoming raised and bumpy. Not every burn patient needs to wear special pressure garments. Usually if the burn heals in less than 2 weeks, none are needed. What to know about pressure garments: - They protect the new skin and support new blood vessels. - They help decrease scarring, itching, and swelling. - They are worn 24 hours a day, like a second skin. - They need to be worn for 6 months to 2 years until the scar stops changing (new skin is mature ). - Two sets are used, so one is washed while the other is worn. - Pressure clothes fit tightly in order to work well. - They may be uncomfortable at first. - Your nurse will tell you what lotion to use to help with dry and itchy skin. 18
What is a face mask or transparent orthosis? Why is Excercise Needed? What are Splints? A face mask is a special clear plastic splint that is molded to conform to your face. It is used to keep the scars on your face or neck flat and smooth to decrease scarring. It also keeps your skin from pulling in or shrinking (contracting). The occupational therapist will make this for you. It needs to be adjusted on a regular basis. Exercise - promotes circulation to start wound healing - maintains or increases movement - maintains or increases strength and endurance - prevents area from becoming tight and contracted - helps you to return, as closely as possible, to your pre-burn function - Splints are devices used to prevent contractures or stretch out tight skin. - They help keep the joint straight, or in the best position for healing. - Splints may sometimes be uncomfortable but are needed to help the burns heal well. - Splints can be made for any part of the body. If you need a splint, your occupational therapist will teach you how and when to wear it. What is a Conracture? - This is a shortening of scar tissue, which causes a joint area to have less motion. - Sometimes surgery is needed to release the tight skin to provide better movement of an area. - Sometimes the contracture can be stretched out by you, your family, and your therapist. 19
Why Do I Have to Eat So Much Food? - Your body needs energy to heal. This energy comes from eating food, which gives you calories. You need 3 to 5 times more calories than before your burn to heal. - Protein is also needed to re-build new skin. Burns are more likely to become infected and do not heal without enough protein or calories. Examples of food with high protein: meat, poultry, eggs, cheese, milk, beans. - Water is limited because it has no calories or food value. It may make you feel full so you are not able to eat enough food. - Snacks are given between meals and at bedtime to help you get enough food. - Your family may bring in food to help you eat more, but it should not be junk food. Junk food does not promote healing. Check with your nurse before bringing in food. - The dietitian is the person who decides how much protein and calories are needed for the percent of burn, your height, and weight. - A record of all you eat and drink is kept (calorie count) and given to the dietitian to see if your needs are being met. - You are weighed every day to help see if you are getting enough protein and calories. 20
What is a Feeding Tube? - A feeding tube is a small tube that is placed through the nose, down the throat, and into the stomach. - It is used if you cannot eat enough food to heal your burns. - Special liquid feeding is given through this tube. - Sometimes feedings are given just at night, and sometimes they are given all day and night. - When you are able to eat enough food for the amount of protein and calories needed, the tube will be removed. Follow-Up Care Your outpatient care will be continued in our onsite outpatient Burn and Wound Clinic. This will be done on an as needed basis. If care is to be delivered outside of HCMC, we will help arrange this, and also periodic follow-up at HCMC clinics. 21
It s Up to You While you are in the Burn Center, you will play an active and important role in your burn care. It takes motivation to move from being dependent to becoming a more independent person ready for discharge. There will be a transition or change during your hospital stay from the nurses taking care of you, to you doing more for yourself. This is a HUGE part of your recovery.the Burn Team gives you the responsibility to have the freedom to return to your former lifestyle as closely as you can. You will be encouraged to do as much self care as possible. Families are asked not to help you with daily tasks such as eating, grooming, and dressing. If you do not take the responsibility to reach for independence, you may lose it forever. How Can I Cope with All of This? 22 You cannot do this alone. Support from family, friends, and the Burn Center Team is needed to help you recover. You may feel helpless or powerless because you are dependent on the medical staff for many needs. Being anxious, angry, or depressed are normal feelings to have when thinking about your pain, healing, or the possibility of surgery. It can be a long, frustrating time because the recovery is slow. You may have many other concerns such as: the cost of being in the hospital, change in family routine, your job, physical appearance, or your relationship with your spouse or significant other. You may be anxious about sexuality and intimacy. These problems or feelings may be new for you, and you may not know how to react. The Burn Center Team members are available to listen and to talk to you about your concerns.
Other members of the Burn Center Team are also able to help you. The social worker may help with finances, work-related problems, and returning to home issues. The chaplain is available to listen to you, and offer you support. The psychologist is available to help you talk about thoughts, feelings, and fears. The days may seem very long, even when you are busy. You may want to take a break from the exercise, eating, and burn care. The Burn Center has games and crafts available, or your family may bring in items, if approved by the staff. There are TVs and VCR/DVD players available. Reading books and newspapers may help the days go by faster. Words for Family Members Family members and friends frequently wonder what they can do and how they can best help. Because the burn injury your loved one has affects the family as well, you need to take care of yourself! Get enough sleep, food, and exercise. Ask other family and friends for support and encouragement. Your loved one will need your support and encouragement throughout his recovery and rehabilitation. If you do not take care of yourself, you may wear out during this time. If you cannot visit, do call or write. If you can visit, be aware of the patient s needs, which may change often. Ask what he needs or wants from you (the nurse can help with this). Sometimes he may want to talk, other days it is best to just be there quietly. Don t forget to touch or hold him. If you are nervous, ask the nurse to help you. At first he may not remember his visitors, so it may be helpful to keep a guest journal. If the hospital stay will 23
be long, try to spread out the visitors. In the beginning, many visitors may come and he will be too tired to enjoy them and may be too polite to say so. Later on, he may feel more able to have visitors, and this will be the time when he needs the most support. Help your loved one express his feelings and fears. Give support when it is needed, but be honest. Be gentle if you need to tell him something unpleasant. Reinforce treatments and progress. Encourage him to keep pushing forward, even though it may be painful. Let him know you understand he is in pain. Resist the urge to do things for him when he needs to do them himself. Be aware that some of his wishes cannot be met. Know that he may get anxious, depressed, and seem angry with you or with the Burn Center Team. Try to understand that this is a reaction to the burn, its pain, treatment, and the changes it has forced on him. Some of these changes may be major and lifelong. He needs time and support to adjust. Your careful listening and understanding is very important. The Burn Center Team also realizes this is a difficult time for you. You may feel alone, afraid, or angry when trying to deal with all the changes in your life. Members of the Burn Center Team are available to listen to you. We encourage you to talk about your feelings, concerns, and frustrations. Speaking with your family member or friends may be helpful and give you support. How Can I Help my Child? Your child may see the burn and the pain as a punishment for something he did wrong. He may be afraid that you are angry with him for getting burned and that you do not love him anymore. It is important for you to tell your child that you don t blame him for the injury and that you do still love him. 24
Your child needs to see and feel that you love and care for him. He misses you very much when you are not here. Many children like having pictures of you to look at and hold onto when you are not here. It also helps to bring in a favorite blanket or toy. Let the staff know what is routine, like meals, naps, and bedtime stories. We like to know what is special for your child so we can keep his schedule here as much as possible like it is at home. Special visiting may be granted for brothers and sisters. Please ask the charge nurse about this. Phone calls, letters, and tape recorded letters are good ways to keep in touch with your child and valuable when you are not here. Play helps a child think about something other than the pain. We encourage you to play, read, and talk with your child. We also set time aside each weekday for the child life specialist, who will play games with your child. If your child is missing school, arrangements may be made for a tutor to teach him when he is well enough. If your child is a teenager, he will have a lot of questions and concerns about the treatments, what he will look like when he is healed, and his social life. Encourage him to keep up with his friends and to keep up with school work. Teenagers may need to talk about what happened and how they feel. A child psychologist is available for children on the Burn Center and their parents. What is a Family Spokesperson? A spokesperson is someone you and your family choose to be in charge of getting information about the patient and giving it to the rest of your family and friends. This allows the Burn Center Team to do patient care rather than spend time on the phone talking to every family member. The spokesperson may call the Burn Center with questions at any time; the phone number is 612-873-2915. The spokesperson s name and phone number is kept on the patient s chart. If there are updates or changes in plans, the Burn Center calls the spokesperson. 25
Pain Management At Hennepin County Medical Center you can expect: - A concerned staff who will help you manage your pain. - Your expressions of pain will be believed and promptly acted on. How Can Pain Management Help You? Pain management is an important part of your care. Being in pain or uncomfortable can affect the way you feel physically and emotionally. When your pain is managed, you: - Heal faster. - Are more comfortable to walk and do breathing exercises. - Regain your strength faster. - Have less chance of having problems, such as pneumonia or blood clots. Facts about pain: - Pain is different for everyone. - Your pain is real. - You have the right to ask for pain relief. - You should have adequate pain control to allow you to care for yourself or to do your therapy. - Addiction to pain medicine is rare. 26
How can you help manage your pain? Talk to your health care provider and your family about your pain. Describe: - Where the pain is located. - How bad the pain is: - Rate it on a scale of 0-10. - 0 is no pain, 10 is the worst pain possible. - Or see the face picture scale. You will be asked to evaluate your pain based on the following pain scale: 27
- What the pain feels like (burn, ache, throb, sharp, etc.). - What pain medicines you are taking now. - What makes the pain feel better or worse. - What allergies or side effects you have had to pain medicine. Work together to find the best treatment to manage your pain. Let your health care provider know: - What personal, cultural, or spiritual beliefs you have about pain. - Any questions or concerns you have. Feeling anxious makes your pain worse. Ask your health care provider: - What can I do to help my pain? - What will you give me for pain? - How should I take it? - When should I take it? - How long should I take it? - What are the side effects? - What should I do if the medicine is not working? 28
Ask for your pain medicine when the pain starts. The longer pain goes without treatment, the harder it is to manage. Let your health care provider know how the treatment is working. - Tell your health care provider your goals for pain management. - You may not be totally pain free. Types of pain medicine 1. OPIOIDS (for example, morphine, codeine, Percocet, oxycodone, Dilaudid, Vicodin ): - Used for moderate to severe pain. - Possible side effects are drowsiness, nausea, constipation, itching or trouble breathing or urinating. You may need to take stool softeners and laxatives to help with constipation. 2. NON-NARCOTIC MEDICINE (for example, aspirin, ibuprofen, Tylenol, Toradol ): - Used for mild to moderate pain. - Can be combined with narcotics to manage severe pain. - Possible side effects are nausea, stomach bleeding, or kidney problems. There are other medicines available for specific types of pain. 29
Other Ways to Manage Pain Along with medicine, there are many ways to manage pain. Ask your health care provider for more information about: - Relaxation techniques - Heat or cold treatments - Music - Massage - Distraction - Changing position (elevation or support) - Imagery - Accupuncture/accupressure 30
Glossary ANTIBIOTIC Medication used to prevent or treat infection. AUTOGRAFT A permanent graft using skin from a non-burn area and transferring it to a burn area. BACITRACIN Antibiotic ointment used to treat burns. CALORIE COUNT A record of the amount of food you eat and drink. This is evaluated to see if you are getting enough calories and protein for healing. CONTRACTURE A tightening or pulling of the skin that causes a decrease in movement. CADAVER The body of a deceased person who has donated body organs or tissue. DEBRIDE To remove dead or burned skin. DERMIS Second layer skin which contains blood vessels, nerves, hair follicles, oil and sweat glands. DONOR SITE Area where healthy or non-burned skin is removed and used to cover a burn area. EDEMA Swelling caused by fluid that leaks into a burn area. EPIDERMIS Outer layer of skin which produces the melanin (color). 31
EPITHELIAL SKIN BUDS Small buds that grow from the remaining skin tissue of a second degree burn. They develop as the wound heals. This phase of healing is very painful due to nerves growing back before skin buds cover them. ESCHAR Burned, dead tissue (skin). ESCHAROTOMY The process of cutting through the burned skin to allow normal circulation or blood flow to return. EXCISION A surgery to remove burned tissue. FULL THICKNESS BURN A burn that involves both the epidermis and the dermis. This burn requires grafting to heal. May also be called deep second degree or third degree burn. GRAFTING A surgery covering a burn with skin to help it heal. GRANULATION TISSUE Irregular, red, bumpy new skin growth. HYPERTROPHIC SCARRING Red, raised scars that develop on healed burned areas or skin grafts. HOMOGRAFT A temporary graft using skin from a cadaver. HYDROTHERAPY Using water therapy to clean burns. INTRAVENOUS FLUIDS Fluids given through a small tube that has been placed in the vein. 32
ISOLATION Special procedures used to prevent the spread of germs or infection. JOBST A custom-made pressure garment used to decrease scarring. MASSAGE A gentle pressure placed over healed skin to improve the texture of the skin and circulation. MELANIN The part of the skin that gives it color. MESH GRAFT A thin layer of skin with small slits which has a fish-net appearance. This helps the graft spread out and over a larger area. NYSTATIN A topical antibiotic cream or ointment used to treat fungal infections. OXIMETER A machine to measure oxygen in the blood. It is attached by a probe connected to the patient s finger, toe, or ear. PARTIAL THICKNESS BURN A first to second degree burn which does not need grafting to heal. PERCENT OF BURN (TBSA total body surface area) A calculated number used to describe how large an area of the body is burned. PRIMARY CLOSURE A surgery where the dead skin is removed, then the skin is pulled together or closed with staples or stitches. Only small burns are treated this way. 33
REHABILITATION (rehab) A time after the burn heals, spent recovering and preparing to return to a normal life. It may take many months. RESPIRATOR (ventilator or vent) A machine that helps a patient breathe. SEPTIC Infection due to germs in the blood. Antibiotics are given to treat this. SHEET GRAFT A thin solid layer of skin graft used mostly on hands, face, and neck burns. SHOWER TROLLEY A portable cart used to shower patients while laying down. SPLINT Plastic, plaster, or foam pieces used to keep burn areas in a special position best for healing and or gaining motion. SILVADENE, SSD, SILVER SULFADIAZINE A white antibiotic cream used to treat a burn; feels cool when applied. SULFAMYLON A white antibiotic cream used to treat ear burns. TUBIGRIP Special generic-sized pressure garment used to decrease scarring. TUBROOM A room where burns are cleansed and dressings changed. Each member of the Burn Team wears a hat, mask, gown, goggles, and gloves to help prevent infection. 34 VITAL SIGNS Measurements of temperature, heart rate, breathing rate, and blood pressure.
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Hennepin Burn Center (612) 873-5479 (888) 873-5479 Location 716 South 7th Street R4 Minneapolis, MN 55415 Mailing Address 701 Park Avenue Mail Code O9 Minneapolis, MN 55415 Hennepin County Medical Center provides services without regard to race, color, creed, religion, age, sex, disability, marital status, sexual orientation, public assistance or national origin. 12/09