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Introduction to Burns

General Medicine Comments Off

Mar 172012

A major burn is a horrifying injury, necessitating painful treatment and a long period of rehabilitation. It’s often fatal or permanently disfiguring and incapacitating (emotionally and physically). In the United States, about 2.5 million people annually suffer burns. It’s the nation’s third leading cause of accidental death.

Causes

Thermal burns, the most common type, are caused by flame, flash, scald or contact with hot objects. Examples are residential fires, motor vehicle accidents, playing with matches, improperly stored gasoline, space heater or electrical malfunctions, or arson. Other causes include improper handling of firecrackers, scalding accidents, and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns in children are sometimes traced to parental abuse.

Chemical burns result from the contact, ingestion, inhalation, or injection of acids, alkalis, or vesicants that cause tissue injury and necrosis. Electrical burns result from coagulation necrosis caused by intense heat; they usually occur after contact with faulty electrical wiring or high-voltage power lines or when electric cords are chewed (by young children). Friction or abrasion burns happen when the skin is rubbed harshly against a coarse surface. Sunburn, of course, follows excessive exposure to sunlight.

Signs and symptoms

Symptoms will vary depending on the degree of burn. Suspect burn injury when the patient presents with blisters, pain, peeling skin, red skin, edema, white or charred skin, or signs of shock. Suspect an airway burn if you see charred mouth, burned lips, burns on the head, neck, or face; wheezing, change in voice, difficulty breathing and coughing; singed nose hairs or eyebrows; or dark carbon- Continue reading »

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Arterial occlusive disease

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Mar 162012

With arterial occlusive disease, the obstruction or narrowing of the lumen of the aorta and its major branches causes an interruption of blood flow, usually to the legs and feet. Arterial occlusive disease may affect the carotid, vertebral, innominate, subclavian, mesenteric, or celiac artery. Occlusions, which may be acute or chronic, often cause severe ischemia, skin ulceration, and gangrene.

Arterial occlusive disease is more common in males than in females. The prognosis depends on the location of the occlusion, the development of collateral circulation to counteract reduced blood flow and, if the patient has acute disease, the time elapsed between occlusion and its removal.

Causes

Arterial occlusive disease is a common complication of atherosclerosis. The occlusive mechanism may be endogenous, due to embolus formation or thrombosis, or exogenous, due to trauma or fracture. Predisposing factors include smoking; aging; conditions such as hypertension, hyperlipidemia, and diabetes; and a family history of vascular disorders, myocardial infarction, or stroke.

Signs and symptoms

Evidence of this disease varies widely, according to the occlusion site.

Clinical features of arterial occlusive disease Continue reading »

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Ménière’s disease

General Medicine, General Surgery Comments Off

Mar 102012

Also known as endolymphatic hydrops, Ménière’s disease is a labyrinthine dysfunction that produces severe vertigo, sensorineural hearing loss, and tinnitus. It usually affects adults, slightly more men than women, between ages 30 and 60. After multiple attacks over several years, this disorder leads to residual tinnitus and hearing loss.

Causes

Ménière’s disease may result from overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells.

This condition may stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. In some women, premenstrual edema may precipitate attacks of Ménière’s disease.

Signs and symptoms

Ménière’s disease produces three characteristic effects: severe vertigo, tinnitus, and sensorineural hearing loss. Fullness or blocked feeling in the ear is also quite common. Violent paroxysmal attacks last from 10 minutes to several hours. During an acute attack, other signs and symptoms include severe nausea, vomiting, sweating, giddiness, and nystagmus. Also, vertigo may cause loss of balance and falling to the affected side.

To lessen these signs and symptoms, the patient may assume a characteristic posture—lying on the unaffected ear and looking in the direction of the affected ear. Initially, the patient may be asymptomatic between attacks, except for residual tinnitus that worsens during an attack.

Diagnosis

The presence of all three typical symptoms suggests Ménière’s disease. Audiometric studies indicate a sensorineural hearing loss and loss of discrimination and recruitment. Electronystagmography, electrocochleography, a computed tomography scan, magnetic resonance imaging, and X-rays of Continue reading »

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