78 burn victims reach hospitals in Islamabad, six die from Dec to date

Islamabad

After the setting in of winter, in last one-and-a-half months, as many as 78 burn victims have been reported in public and private healthcare facilities in the federal capital of which six died of the critical injury in result of burn.

It is important that the number of burn cases increases every year in winter due to improper use of heating systems particularly at domestic level.

From December 2016 to date, 78 patients reach private and public healthcare facilities, however, as many as 18 patients requiring hospitalisation were refused admission to hospitals because all the beds for burn victims were already dedicated to patients with critical burn injury.

A victim from Sector G-9 of Islamabad told that he was checking a leak from gas cylinder with flame of cigarette lighter when his clothes caught fire. He had 80 per cent of total body surface area burns. Luckily he had asked his wife and son to leave the room so they were saved. However, the patient is in a critical condition in ICU on ventilator, said Medical Specialist at Intensive Care Unit of Pakistan Institute of Medical Sciences Dr. Muhammad Haroon while talking to ‘The News’ on Saturday.

It is worth mentioning here that burn care can be termed as the most neglected area in health sector in Pakistan and none of the governments ever gave due attention to develop equipped burn care centres as per requirements even in major cities of the country that resulted in extreme increase in mortality rate in critical burn victims.

Dr. Haroon said as many as six burn victims have died of the injury in last 45 days or so in the federal capital. The management of burns should start immediately at the time of injury. All burned victims of over 30% TBSA (total body surface area) should be considered as critical and should be managed inside a dedicated burn unit, he said.

He added the first-aid should start with rescuing victim from fire and removal of all clothing immediately. The victim should be kept in a warm temperature room ideally at around 25 degree centigrade. In cases of burns, the victim has usually hypothermia (The fall in core body temperature) and cooling a burn victim with cold water, sponging or using air conditioner can result in devastating consequences, he said.

Talking of inhalation injury that is caused mostly in winter because of accidents involving fuel based heating systems, Dr. Haroon said it is a mixture of heat injury with burn injury of airways and toxic gases inhalation that occurs when carbon monoxide and cyanide gases enter lungs through smoke. Heat causes damage of airways from nose to lungs. The nose shows singeing of hair and soot. The sputum turns grey or black due to carbonaceous particles. The most frightening and dangerous complication of burns is air pipe swelling or laryngedema. The inner mucous lining of trachea swells so much that air passage is blocked and burn victim with inhalation injury choke to death, he said.

He added that carbon monoxide poisoning causes headache, altered mental state, delirium, agitation, shortness of breath, hypoxemic respiratory failure, fits, fever, paralysis, coma and death if untreated. Cyanide toxicity once a major concern in past but latest evidence shows that cyanide toxicity occurs very rare in burned patients, he explained.

He added that the initial phase immediately after burns is Ebb or hypodynamic phase in which patient has severe dehydration, low blood pressure, cool hands and feet, pain, low body temperature and restlessness. “The patient should be given large amounts of fluids during the hypodynamic Ebb phase that lasts for 24 hours.”

He suggested that a patient with severe burns should be given at least three to four litres of Ringer Lactate immediately. The fluid should be of normal temperature. Only concern is in patients who have heart or kidney diseases in which fluids are given with slower speed and invasive monitoring. However degree of capillary leakage warrants fluids resuscitation in all patients, he said.

After first 24 to 36 hours, flow or hyperdynamic phase starts. Patients are kept in warm dry rooms. Daily assessment of all organs is vital and cornerstone of burn critical care. At this stage, fluid requirements decrease and judicious amounts should be given, said Dr. Haroon.

He explained that as the burned tissues swell up, the surrounding blood vessels are constricted causing high blood pressure. Also, complete occlusion of blood vessels can block blood flow causing compartment syndrome. To relieve it, urgent surgery is required. The hyperdynamic phase lasts for one to two weeks. If patient is saved from sepsis and infections and adequate nutrition and organ support are provided, the final recovery phase starts. The recovery occurs by scarring and necrosis of burned dead tissue, he said.

Dr. Haroon said burned patients need aggressive nutrition and regular follow-up. All patients with burns need medical and surgical support that is usually provided but the most neglected is psychological support and rehabilitation, he said.

He said prevention, however, is the best remedy to avoid burn. When checking leaks, instead of using flame or match, it is better to use washing powder solution that is sprinkled over suspicious areas so bubbling will occur and leak will be confirmed. Children should never be allowed to ignite or control heaters or other fuel-based heating systems, he said.

If gas is leaked in a room, just move away and open windows and doors. Never switch on the fan or light in a room where gas leak is suspected as spark in electric switch or appliance can cause immediate fire, he said.

Check geysers, gas cylinders, heaters and other heating systems on regular basis for any malfunctioning or leakage, said Dr. Haroon.