|KNOW YOUR BURN UNIT
|Year : 2015 | Volume
| Issue : 1 | Page : 9-11
Our burns ward
Smitha Sriram Segu
Department of Plastic Surgery and Burns, Bangalore Medical College and Research Center, Bengaluru, Karnataka, India
|Date of Web Publication||11-Dec-2015|
Dr. Smitha Sriram Segu
Department of Plastic Surgery and Burns, Bangalore Medical College and Research Center, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Segu SS. Our burns ward. Indian J Burns 2015;23:9-11
Mahabodhi Burns Center, under the care of Department of Plastic Surgery and Burns, affiliated to Bangalore Medical College and Research Institute, had its modest beginning in 1964. Dr. V A Ram (American Board Certified Plastic Surgeon) was instrumental in starting the burns center in 1968.
In 1969, Acharya Buddha Rakhita Thera, during the Governorship of Dharmaveer, raised donations from philanthropists and was instrumental in building the burns and casualty center. The present center is built with the help of Mahabodhi trust thus, named as Mahabodhi Burns Center. The burn unit occupies the first floor of this Mahabodhi Burns Center and Casualty.
It has undergone multiple facelifts over the years orchestrated by Heads of the Plastic Surgery Department such as Dr. K S Shekar, Dr. Sadashivmurthy, Dr. Gurumurthy, and Dr. B G Tilak and others.
In 1983, Dr. CSR and Dr. K S Shekar inspected the department on behalf of MCI and granted permission to start the MCh program with 2 seats/year. In 1986, under Dr. Vyasa Rao as Head of the department, the first batch of MCh was started.
Dr. Gurumurthy was instrumental in upgrading the burn unit with newer instruments and also revived the MCh program (which was derecognized by MCI in 1997) with 2 seats in 2001.
Under the able leadership of Dr. B G Tilak, the department and the burn unit underwent a major revamp of infrastructure to get well-equipped wards and state of the art operating theaters and equipment. Definitive protocols were put in place. The MCh seats were increased from 2 to 4.
It is currently the tertiary center of choice for the people of Karnataka and also people from the neighboring states catering to more than 3000 burn victims every year. The center sees an average of 6 admissions per day apart from patients treated on an outpatient basis. It is totally funded by the Government of Karnataka, and all treatment is given free of cost. On an average, about 800 surgeries are performed every year.
The burn unit has 54 beds with 21 beds each for male and female patients, respectively, 9 beds for pediatric patients and 3 Intensive Care Unit (ICU) beds. The burn unit is under expansion now with a skin bank and better intensive care and rehabilitation facilities to be added to the services provided in near future.
Our workforce consists of 7 consultants, 12 super specialty (MCh) postgraduate students, specialty (MS) general surgery, and ENT postgraduate students from BMCRI and other medical colleges who are posted as part of their peripheral postings for 2 months and house surgeons who are posted for 15 days as part of their 1 year Compulsory Rotatory Internship Programme. Fellows in dermatosurgery are posted for 2 months training with the unit. Thus, the unit enjoys a strong interdisciplinary support.
Our current nurse to patient ratio is 1:7, and we intend to work toward improving this skewed ratio. We follow a standard protocol for every patient. On arrival at the burn unit, all patients are given hydrotherapy by a trained person at the entrance of the unit and shifted to a treatment room where they are evaluated for total body surface area (TBSA), depth assessment, and subjected to a primary survey. If the patient fulfills criteria for admission, he/she will be shifted to an appropriate ward. Each patient is nursed in a separate cubicle. Intravenous access is established by placing central lines for resuscitation. We follow crystalloid only regimen for the first 24 h as per Modified Parkland formula. Colloids are used after 24 h.
We use bovine collagen sheets in superficial and deep partial-thickness burns in children and adults with <30% TBSA. Patients who do not belong to this category are treated with silver sulfadiazine (SSD) impregnated dressings. This is unless the patient is enrolled as part of a study using heparin spray for the first 5 days, or in studies using any other dressing materials. We routinely give a proton pump inhibitor to all patients. Morphine/Pethidine is used as pain alleviator along with intravenous paracetamol. Nonsteroidal anti-inflammatory drugs are used sparingly. Antibiotics (cephalosporins) are started for all patients on admission and according to culture and sensitivity reports eventually.
Presently, we lack a dedicated ICU for burn patients which has been a major setback for us in the treatment of patients with inhalational burns. The management of such patients presently is to give these patients oxygen, nebulization with heparin, chest physiotherapy, incentive spirometry, and use of steroids. Ventilators are shifted from the general ICU when indicated.
For all patients with electrical burns, apart from standard treatment protocol, emergency surgical procedures are undertaken with careful monitoring to reduce morbidity and mortality.
Every patient with burns over 20%, children with burns, patients with comorbid conditions, and all electrical burn victims are catheterized for monitoring the adequacy of resuscitation, and patients are encouraged to take an oral diet. Routine investigations such as complete hemogram (CBC), random blood sugar, serum electrolytes (SE), renal and liver function tests (RFT and LFT), urine routine examination, and viral markers are done on the day of admission, and CBC, RFT, and SE are repeated for every 3 rd day. Wound swabs for culture and sensitivity are sent on the 3 rd , 5 th , and 10 th day of admission, and blood and urine cultures are sent when indicated. The intravenous lines and catheters are changed according to NABH guidelines.
Analgesics, antacids, antibiotics, antiemetics, and other adjuncts such as calcium, Vitamin C, hematinics, multivitamins, and trace elements are given as needed. We also start patients on amino acids, both essential and nonessential and protease inhibitors such as ulinastatin which have been shown to have a beneficiary role in cases of acute inflammation from day 2 postinjury. Intravenous glutamin is a constant addition to the treatment regimen. Improving the patient's nutrition is stressed on during the counseling sessions with the patients and relatives other dressing materials that are available for use in the unit include silk protein dressings, polyurethane foam dressings, sodium hyaluronate cream, and silicon-based dressings. SSD cream, however, remains the mainstay for burns dressings for most patients. Patients with deep burns involving the neck, upper limbs, and fingers are given cervical collars, cock-up splints, and finger splints, respectively, to prevent contractures. Dressing assistants help in preparation of the SSD impregnated dressings in a sterile manner in the sterilization room attached to the operation theater (OT).
The OT is attached to the wards on the first floor and comprises a minor OT which is open every day for procedures and a major OT operational on 3 days a week for acute burns. Postburn deformity surgeries are carried out in the elective plastic surgery OT in the super specialty block. The establishment of the skin bank by December 2015 as part of the burns ward expansion program will boost our morale by reducing mortality and morbidity rates. With this valuable adjunct, we also hope to make early excision and grafting which is presently rarely feasible as our standard of care. The awareness programs for skin donation are in full swing.
Currently, we are associated with Non-Governmental Organizations who help in the postrecovery rehabilitation of the patients in the form of helping adult patients find jobs and children attend school by paying their fees among other activities. A psychologist is available during working hours to counsel and motivate patients. A public relations officer and clerical staff help patients with documentation work during the course of their stay. This helps patients in availing benefits of Government Insurance Policies for patients with below poverty line cards such as travel allowance and money for drugs bought outside the hospital.
Various research projects have been undertaken over the years which were presented at conferences or published as papers. Some of the research presentations and publications have been on:
- Complex defects following electric burns,
- Pattern of burns in suicidal, homicidal, and accidental burns,
- Rescuer burns,
- Systematic study of trends in depression in burns patients,
- Neck contractures in burns patients,
- Postburn ear reconstruction,
- Domestic mass burn casualties,
- Modulation of acute phase post burn hypermetabolic response with propranolol,
- Review of 5 years' experience in electrical burns,
- Persistent paradigm of pediatric burns in India, etc., to name a few.
The department is also very actively involved in prevention programs. We have booklets about prevention, safety measures, and first aid which are distributed to all government schools, and the same is circulated to all the parents through the website of private schools. We have regular programs on radio and television about burns and first aid and during the festival of Diwali for safe usage of crackers. Our staff give regular talks in schools and various industries about prevention and first aid. We distribute fliers with instructions for safe usage of gas cylinders, crackers, electric equipment regularly. We conduct CME's for the Karnataka State Power Corporation and electrical departments, cable workers, and construction site worker to impress upon them the dangers of electrical injuries and their right to protective gear and safety measures.
Our department is recognized by the Government of Karnataka to train district surgeons in treating and managing acute burns before referral to a higher center. It is also recognized as a center for training for traveling fellowship in burn care by the National Association of Burns India. The department has also been identified as a center for reconstruction of Hansen's deformities-a central initiative started in 2010. Our consultants are visiting surgeons at Nimhans, Kidwai Institute of Oncology, Institute of Nephro Urology, SDS Sanitorium for Chest Diseases, Sanjay Gandhi Institute for Trauma and Orthopedics, Regional Institute of Ophthalmology MINTO, and Jayadeva Institute of Cardiology.
The existing burns ward is due for a major revamp shortly. The casualty center which is presently hosted in the ground floor of this Mahabodhi Burns Center and Casualty is being shifted to the new trauma block, and the whole building will be converted to a center dedicated to burns care. This new expansion will host 24/7 OT facilities for early excision and grafting, effective implementation of barrier nursing, 10-bedded state of the art ICU, psychiatry and counseling center, a physiotherapy unit, orthotic limb center, rehabilitation center, skin bank, laboratory facilities, and adequate manpower.
Our vision is to provide consistent and comprehensive care for the burn patient at the highest possible level of excellence with innovative technologies and interventions.
Our mission will be to serve as a resource center for both referring facilities and the community, providing outreach programs for prevention and first aid, continuing education, and encompassing research to maintain a state-of-the-art care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.