Burn victims need inner, outer healing

Burn victims need inner, outer healing

Maria Endah Hulupi, The Jakarta Post, Jakarta

The image of the resort island of Bali as the last safe haven for
tourists in Indonesia was shattered by bomb explosions that
destroyed two crowded nightspots in Kuta beach, claiming the
lives of at least 184 people and injuring more than 300 others,
mostly foreign vacationers.

Most of the surviving victims suffered burns and other trauma
caused by debris thrown by the strong explosion.

A dermatologist with Siloam Gleneagles hospital in Tangerang,
Hannah K. Damar, said that people with burn injuries should be
rushed to burns units at hospitals to receive proper care under
the supervision of experts, including dermatologists, surgeons,
nutritionists and internists.

Burns cause intense pain and severe burns cases can be life
threatening because of dehydration (that can lead to renal
failure and in turn multi-organ failure), respiratory problems,
shock and possible infection.

She said burn wounds, which can also be triggered by corrosive
chemicals, electricity and radiation (like sunburn), can be
divided into three degrees.

First degree burns were characterized by a reddish or grayish
color in the burn area and some blistering. The pain could be
eased by cooling off the burn area, she said.

Second degree burns usually affected the dermis, a deeper skin
layer, and damage hair follicles, sweat and sebum glands. It
caused blisters and intense pain as the nerve endings were left
exposed.

Third degree burns also affected the underlying tissue but
damaged the nerves so the victims did not experience pain. It
required longer periods to heal and usually skin grafts.

"The degree of the burn, however, can increase because of a
failure to cool off the affected area, enabling the heat to
further damage the surrounding or the underlying tissue," she
said.

Hannah said the area of the burn was assessed using the "rule
of 9" for adults and "rule of 10" for children. Under these
rules, each part of the body, like hands and legs, were given a
specific percentage. The percentages of the affected areas were
then added to count the total area of the wound.

She said giving first aid was important. People could help by:
* Moving the victims to a safer place away from smoke and a
panicked crowd to prevent other possible injuries like broken
bones;
* Take off removable clothing so the wound could be cleansed, and
jewelry before a wound began to swell.
* Try to cool the burn by dousing it with copious amounts of
water for 10 to 20 minutes. Milk or other liquids at room
temperature or colder can be used but don't use ice as it can
lead to vaso constriction.
* Cover the wound with a clean cloth (make sure the fabric's
thread or fiber will not cling to the wound) or clean plastic. If
the affected area involves the fingers, separate each finger.

"Do not use butter or toothpaste to cover the wound as it may
trigger infection and delay further treatment because doctors
will have to clean the wound first," Hannah warned.

She explained that serious fluid loss could occur because when
the skin layer was damaged, body fluids evaporated quickly.

This condition, she added could also lead to infection because
skin layers that protected the body were damaged and it prompted
exudation of highly nutritious fluids for the wound's healing
process, which also made the affected area a conducive living
environment for bacteria like Staphylococcus aureus and
Pseudomonas.

Other experts said that up to 75 percent of the patients that
survived the initial period of treatment, but develop a wound
infection, die as a result of sepsis.

Separately, a nutritionist with the Endang Darmoutomo Hospital
said that burn victims needed immediate infusion to replace the
loss of fluids and electrolytes.

Enteral feedings (given directly to the intestine) of high
protein food to replace protein loss increased the patients'
immune responses and supported the recovery process. "Enteral
feeding also helps prevent translocation of bacteria in the
intestines to the blood circulation," she said.

Superficial burn wounds could heal but Hannah said the
blister, was best left the way it was, although in some cases
doctors do remove it.

"The blister is a natural protection against infections and it
helps hold the highly nutritious fluid for the reepithelization
(the healing of the wound) in the next seven to 10 days."

But for deep burn wounds, she added, skin grafting from other
body parts, from other people or cadavers could be performed.

Scarring may occur depend on the depth of the wound. The
possibilities are keloid (thick, raised tissues that grow beyond
the edges of the wound), hypertrophic (raised, red, thick scars
that remain within the injury area) and atrophic scars.

Contracture, a permanent tightening of muscle, tendons,
ligaments and skin that reduce the range of motion, can develop
but it can be prevented by physical therapy.

Apart from leaving physical scars, the traumatic incident
itself can also leave a psychological scar on victims.

This is why the hospital's psychiatrist, W.M. Roan, advised
that vulnerable burn victims need calming words, consolation,
attention and warmth to ease their confusion, panic or anxiety,
while providing them with the initial treatment.

Physical damage after the incident can make them withdraw
themselves from the public and to overcome this, cosmetic surgery
could be performed, not only to improve the scar but also to help
boost self-confidence, relieve depression and encourage victims
to socialize.

"After the traumatic experience, survivors can also develop
deep sadness, some may become angry and even seek revenge and
some others may be grateful to be alive. It depends on the
victim's personality," Roan said.

If consolation fails, he added, it was advisable to seek
professional help to restore independency and improve their self-
image. "The patients may be given anti-anxiety or anti-depression
medication to help relieve their problem."