Download Burns In The Nursing Home Population Pose A Serious Threat Of

Burns In The Nursing Home Population
Pose A Serious Threat Of Injury &
Further Medical Complications
Posted by Jonathan Rosenfeld on April 21, 2010
A hot cup of soup, a radiator, an uncalibrated water thermostat or a fire can all pose
serious burn risks for nursing home patients. Your skin is necessary for your body’s
regulation of fluid and temperature; it also acts as a barrier against bacteria and
viruses. When you burn your skin, you put yourself at risk for infection, tetanus, scarring,
permanent injury, and even death depending on the severity of the burn.
Stages of Burns
Burns are categorized as first degree, second degree, or third degree based upon the depth
of the burn and the percentage of total body area affected.
First-Degree Burn
A first-degree burn is the least serious type of burn where only the outer layer of skin
(dermis) is burned. Symptoms include: redness, mild swelling, and skin that is tender to
the touch.
Second-Degree Burn
A second-degree burn occurs when the first and second layer of the skin is
burned. Symptoms include: blisters, reddened and splotchy skin, swelling, and pain.
Third-Degree Burn
A third-degree burn is the most serious type of burn and occurs when all layers of the skin are burned. This
causes permanent tissue damage and may affect fat, muscle, and even bone. Third-degree burns damage the
nerves and blood vessels, which can lead to a white and leathery appearance of the skin. Symptoms
include: severe pain, areas of charred black skin, or skin may appear white or dry.
If you suffer a burn (second or third-degree) that covers more than 15-20% of your body,
you are at risk for significant fluid loss, which could lead to shock if fluids are not
replaced intravenously. If you suffer a burn affecting over 50% of your body, then you
have a significant mortality risk, especially if compounded by underlying medical
conditions and advanced age.
Burn Treatment
In order to properly treat a burn, it is important to first determine the extent of tissue
damage. Minor first-degree burns and second-degree burns that are no larger than 3
inches in diameter require different treatment than third-degree burns. It is important that
burns are properly and thoroughly cleaned in order to prevent infection because your
body’s barrier against germs.
For minor burns, you should:
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Cool the burn (hold burn under cool running water or immerse in cool water for
10-15 minutes)
Cover the burn with a sterile gauze bandage (wrap gauze loosely)
Take an over-the-counter pain reliever (aspirin, ibuprofen, naproxen, or
acetaminophen)
It is important that you do not use ice directly on the burn (which could cause further
damage to the wound), do not apply ointments to the burn (which could cause infection),
and do not break blisters (which makes them more vulnerable to infection). As the burn
heals, watch for signs of infection, symptoms include: increased pain, fever, redness,
swelling, or oozing.
For major burns, which are third-degree burns or large second-degree burns, you should
contact emergency medical help and follow the following steps:
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Do not remove burned clothing
Do not immerse burns in cold water (which could cause hypothermia and shock)
Check for signs of circulation (breathing, coughing, or movement)
Elevate the burned body part or parts
Cover the area of the burn
Also, for severe burns, it is important to get a tetanus shot or make sure you have had one
in the last ten years because burns are susceptible to tetanus.
For major burns, doctors can use skin grafts to improve the function and appearance for
large burn areas. A skin graft is a surgical procedure where a piece of skin from the donor
area of the patient’s body (usually the buttocks or upper thighs) is transplanted to the
damaged area of the patient’s body. The graft can help reduce fluid loss, protect the burn
from infection, reduce pain, allow tissues underneath to heal, and improve the appearance
of burned skin. In order to prepare the burned area for the skin graft, doctors remove
(excise or debride) the burned skin. There are also skin banks, which store donor skin
from organ donors, which provide donor skin that can be used for temporary skin grafts.
Preventing Burns in Nursing Homes
Older adults (≥ 60 years) are at increased risk for burn accidents, second only to young
children. The National Fire Prevention Agency reported that adults age 75 and older are
the age group most likely to die in house fires. Older adults also suffer larger size burns
on average than any other age group. The most common type of burn injury for older
adults is usually a scald (a type of burn injury caused by hot liquids or steam). Also,
elderly burn victims have a higher mortality rate than younger burn victims.
As you age, so does your skin, and the skin of older adults is dry, wrinkled, loose, and
less elastic because the dermis layer of the skin becomes thinner over time. This makes
the skin more susceptible to the absorption of heat, which means that even moderate heat
sources (warm water, electric blankets, radiators) can cause serious physical
damage. Also, older adults are more susceptible to fluid loss and shock after suffering
from a burn, which requires proper fluid replenishment.
Elderly nursing home residents are more susceptible to dangerous burns because of their
advanced age, prevalence of mental illness, reduced mobility, and underlying medical
conditions. Many elderly nursing home residents are weak and vulnerable because of
disease and illness, which makes any additional illness or injury all the more dangerous.
Therefore, it is important that nursing home staff members take steps to reduce burn
risks. This includes monitoring the temperature of the water in resident bathrooms to
prevent scalding, monitor the temperature of food served to residents, not allowing
candles or other open flames, covering radiators, and complying with proper fire
prevention and safety standards.
If you or a loved one suffer a serious burn while living in a nursing home, you may be
entitled to collect damages. Nursing homes must provide safe environments for their
residents and monitor residents to ensure that there are not any burn risks and that all
injuries are properly treated. When nursing homes fail to meet this duty, they can be
liable for negligence.
Thank you to Heather Keil, J.D. for her assistance with this important topic.
Resources:
Burn Survivor Resource Center: Medical Care Guide
The Mediterranean Council for Burns and Fire Disasters: Annals of Burns and Fire
Disasters: Considerations on Intensive Care in Elderly Burn Patients
Burn Recovery: Skin Grafts for Burn Treatment
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Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put
Out The Fire?
Unsupervised Nursing Home Resident Dies From Burns
Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper
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Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient