CLINICIANS BULLETIN March 2021, Issue 23

TABLE OF CONTENTS:

THE BATES-JENSEN WOUND ASSESSMENT TOOL

BURNS

THE UNFRIENDLY CROUP

SIMPLE. PROVEN. QUALITY. INNOVATIVE. SOLUTIONS.

Bringing you the latest news and updates regarding Pressure Ulcers/Injury/Beds sores and Woundcare. Delivered right to your inbox

DARREL R. LATVA, DPM, F.A.C.F.A.S

• 30+ years private practice experience.• Associate Professor in the Department of Podiatric Surgery &Applied Biomechanics; Dr. Wm. M. Scholl College of Podiatric Medicine;since 1992.• Only current faculty member having been nominated by hisdepartment chair to the prestigious Harvard-Macy Program forEducators in Health Professions.• Diplomate: ABFAS and ABPM.• Founded the podiatry service, the podiatry residency program, andfive student clerkships dedicated to student education at Mt. SinaiHospital Medical Center in Chicago, and served as its’ first residencydirector and podiatry section chief.• Consultant: Walgreen Health Solutions.

FEATURED ARTICLE

THE BATES-JENSEN WOUND ASSESSMENT TOOL DARREL R. LATVA, DPM, F.A.C.F. A.S

Last month, I described the PUSH 3.0 wound assessment tool. Here’s another one you might find interesting.

Increased costs of wound care can be attributed to variability in wound assessment and inconsistency in documentation. The Bates-Jensen Wound Assessment Tool [BWAT] uses thirteen items to track and evaluate wound care therapy and progress, in a language common to all wound care providers.

Barbara Bates-Jensen developed the Pressure Sore Status Tool [PSST]. Following a revision to that system, it was renamed the BWAT in 2001.

Each item is given a score of 1-5; 1 is the best and 5 is the worst. A final sum is determined. The higher the score, the more severe the wound.

Is the BWAT reliable and useful? From Wound Repair Regen. 2019 Jul: 27[4]. 386-395:“We demonstrate that adequate to good reliability can be obtained when persons with limited to no experience with wounds [such as non-healthcare research staff or beginning nursing students] use the BWAT with adequate training. The average time to complete the BWAT was only 1.6 minutes with 95% of assessments completed within 5 minutes. The use by persons with limited to no experience in wound care and the quick assessment times suggest the tool is practical for clinical use.” It is further suggested that experienced wound care providers would raise the reliability estimates.

I have attached examples of the BWAT for your perusal.

DARREL R. LATVA, DPM, F.A.C.F.A.S

DARREL R. LATVA, DPM, F.A.C.F.A.S

DARREL R. LATVA, DPM, F.A.C.F.A.S

DARREL R. LATVA, DPM, F.A.C.F.A.S

SAKEENA I. HAQ, DPM

• Chief Medical Officer and Managing Partner Walgreen HealthSolutions.• Graduate from the Dr. William M. Scholl College of Podiatric Medicine.• Residency completed in podiatric medicine and surgery at MountSinai Hospital. Medical Center, Level 1 trauma center, in Chicago, IL.• Podiatric Physician and Surgeon Edward-Elmhurst Health System.• Professional affiliations include the American Podiatric MedicalAssociation, the Illinois Podiatric Medical Association, the AmericanDiabetes Association, and the American Professional Wound CareAssociation, American Board of Podiatric Medicine.• Member of the NPIAP Corporate Advisory Council.• Board Certified American Board of Podiatric Medicine.

MANAGING PARTNER ARTICLE BURNS

Sakeena I. Haq, DPM, Board Certified by the American Board of Podiatric Medicine (ABPM), M.Ed.

IMAGE SOURCE: SHUTTERSTOCK.COM

Burns are caused by thermal, electrical, radiation, or chemical injury to the skin. Burns cause extreme skin damage to the area of exposure therefor leading to a skin wound. These wounds are often very painful and deep. They can extend deep through the soft tissue to bone. The 3 most important factors which influence the course of fate of a burn are age, location, and percentage of the body’s surface area affected by the burn. Severe burns are often debilitating. They can cause scarring, disfigurement, infection, and even a loss of a limb or limbs.

There are 6 different types of burns. Thermal burns are the most common type of burns these are caused by extreme heat. Cold burns, or frostbite, are due to prolonged exposure of the skin too extreme cold. Radiation burns are due to excessive exposure of the skin to UV rays from the sun. They can also be caused from x-rays. Chemical burns are due to contact of the skin with powerful chemical agents such as strong acids, alkalis, detergents, solvents, paint thinner, and gasoline. Friction burns caused by rubbing of the skin across a roughened surface. Finally, electrical burns are caused by electrical current. Many of these types of burns can be due to child or elderly abuse.

Burns can occur in 4 stages. Each stage is classified as a degree. The higher the degree the more serious the tissue injury. 1st degree burns are superficial. They are localized to the level of the epidermis. They present with the skin red and painful in the area such as with a sunburn.

SAKEENA I. HAQ, DPM

2nd degree burns are partial thickness burns. These burns extend from the epidermis partially into the dermis. They present with the skin red, white, and splotchy with the area dry and swollen with blisters present. 2nd degree burns are often caused by hot liquids or flash fires. 3rd degree burns are full thickness burns. These burns extend from the epidermis through the entire dermis to the level of adipose tissue. The tissue is often white, leathery, waxy, charred, and hyperpigmented which is commonly accompanied by numbness in the area. Blisters may or may not be present. 3rd degree burns are often caused by hot grease, electricity, tar, hot coals, and flames from a burning fire. 4th degree burns cause injury from the epidermis, through the entire dermis and additionally cause injury to underlying adipose tissue, nerves, muscles, tendons, ligaments, and bone. These burns are highly debilitating. 1st and 2nd degree burns often heal uneventfully on their own in contrast to 3rd and 4th degree burns which often require extensive medical attention.

The level of treatment required to treat a burn depends upon its stage. 1st degree burns are commonly treated with topical over the counter skin products such as aloe vera cream or triple antibiotic ointment. 2nd degree burns are often treated with topical prescription antibiotic ointment and/or creams such as Silvadene (Silver Sulfadiazine) and with the addition of an oral antibiotic at times. Severely burned victims require treatment in special burn units or centers and require extensive rehabilitation and psychological treatment. 3rd and 4th degree burns commonly require treatment with IV fluids, IV antibiotics, extensive wound care, debridement, multiple surgeries along with skin grafting, and in some cases loss of a limb by amputation or in extremely severe cases loss of life. Pain management is required at some level for each degree of burns. Higher degree burns can be life threatening and require immediate medical attention especially if they occur in combination with inhalation injury or chronic comorbidities (such as diabetes, heart disease, asthma, COPD, kidney disease, or neurological conditions such as MS etc.) and/or if they involve a surface area of greater than 10% of the body, the face, the groin, the buttocks, the upper and/or lower extremities, a major joint, individuals in the 3rd through 5th decades, children under 5 years of age, and/or seniors over 60 years of age. 3rd and 4th degree burns frequently lead to such complications as extensive scar tissue, disfigurement, severe contractures, shock, sepsis, osteomyelitis, tetanus, hypovolemia, hypothermia, and respiratory distress. They can also lead to such psychological conditions as severe depression and PTSD. Often, unfortunately, abuse is found to be the main culprit. As a result, social workers and authorities can be involved in the burn victim’s case.

Patients with severe burns require a long duration of care. They are generally more susceptible to infection. The more sever the burn and the longer the burn takes to heal, the higher the risk of infection.

SAKEENA I. HAQ, DPM

1. Kahn, April. “Burns: Types, Treatments, and More”. Healthline. March 7, 2019. https://www.healthline.com/health/burns.2. Kumar, Shalab, MCh et al. “Burns and COVID-19 – Initial Experience and Challenges”. Journalof Burn Care and Research. Oxford Academic. December 23, 2020. https://academic.oup.com/jbcr/advance-article/doi/10.1093/jbcr/iraa217/6046190.3. Pathak, Neha, MD. “Burns”. WebMD. September 15, 2020. https://www.webmd.com/pain-management/guide/pain-caused-by-burns.4. Saha, Shivangi, MBBS, MS et al. “Managing Burns During COVID-19 Outbreak”. Journal ofBurn Care & Research. Oxford Academic. May 30, 2020. https://academic.oup.com/jbcr/article/41/5/1033/5849079.5. “Burns”. Brigham Health. Brigham and Women’s Hospital. http://healthlibrary.brighamandwomens.org/Search/85,P01146.6. “Burns”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/burns/symptoms-causes/syc-20370539 .7. “About Burns”. UC San Diego Health. https://health.ucsd.edu/specialties/burn-center/Pages/about-burns.aspx .

References:

During the COVID pandemic it has been a significantly large challenge for medical providers to provide burn patients with the appropriate care safely as well as to maintain the safety of the healthcare providers on the burn team so as to preserve the quality and integrity of care administered to patients given the high risk of viral transmission of the COVID virus.

DATA ANALYST'S ARTICLE THE UNFRIENDLY CROUP

Michael Wolper, Data Analyst Walgreen Health Solutions

Respiratory diseases affect any person of any age, whether it is the common cold, the flu, or croup. These diseases have affected people for a long time, way before COVID-19 appeared. Because there are so many respiratory diseases to count, I am going to focus this article on croup, also known as laryngotracheobronchitis.

Croup is a respiratory disease that is commonly found in children, usually infants and toddlers. Croup occurs as a result of an infection by the parainfluenza virus or by bacteria. The larynx, trachea and bronchi become swollen during croup, hence the term “laryngotracheobronchitis.” Common symptoms of croup include hoarseness, a barking cough that sounds like a sea lion, and stridor (wheezing). X-ray photos of the neck reveal a distinct “steeple sign,” which shows narrowing of the trachea due to swelling. Croup can be treated by drinking fluids, using humidifiers, or by remaining calm and not agitated. Hospital admission may be necessary if the croup is severe.

Severity of croup is calculated using the Westley croup score. This system checks for chest wall retractions, stridor, cyanosis, air entry, and level of consciousness. The Westley score ranges from 0 to 17, with 0 being mild croup and 17 being imminent respiratory failure.

Most cases of croup in children are mild, with very few cases being serious. Infants and toddlers between the ages of three months and six years are more likely to get croup. But croup can occur in older children, although not very often. Even adolescents can get croup, as it happened to me one fateful night several years ago.

In the springtime back when I was young, I started coughing very frequently, sometimes nonstop. I had to use a bronchodilator to temporarily ease my cough. Three days later, my coughing continued and gradually became more seal-like, and my voice became hoarse from all the coughing. Not only did my croup symptoms continue, but they also worsened. One night, my croup symptoms reached their peak when I started experiencing stridor. I was coughing loudly, accompanied by noisy rapid stridor and hoarseness. I tried drinking fluids and using humidifiers, but they had no effect in treating my symptoms. I felt like my trachea was closing up on me, possibly in danger of suffocation. Because of the severity of my croup symptoms, I was immediately rushed to the hospital.

I arrived at the hospital to have my croup taken care of. Fortunately, my stridor subsided, but my voice was still hoarse. The doctor took an x-ray photo of my neck and found the steeple sign in my trachea. Then the doctor proceeded to give me a vaccine, which would make me immune to croup. The next day, my voice became better and my coughing was less frequent, and it no longer sounded like a seal. I also stopped using my bronchodilator. I was back to normal by the following day. Thank goodness for the vaccine.

The article you have just read is one of many possible scenarios one might experience with croup. More children have been diagnosed with croup than any other respiratory disease. Treatment is simple as described earlier. So if you are concerned you may have croup, seek medical assistance.

REFERENCES

1. “Croup in Children,” https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/c/croup-in-children.html, Cedars Sinai2. Thomas, Liji. “Croup – Acute Laryngotracheobronchitis.” https://www.news-medical.net/health/Croup-Acute-Laryngotracheobronchitis.aspx, News-Medical3. “Croup,” https://www.statpearls.com/ArticleLibrary/viewarticle/20142, Stat Pearls4. Nichols, Hannah. “What is croup and how is it treated?.” https://www.medicalnewstoday.com/articles/155932, Medical News Today, January 15, 20185. “Westley Croup Score,” https://www.pediatriconcall.com/calculators/westley-croup-score-calculator, Pediatric Oncall6. “What’s the Treatment for Croup?,” https://www.webmd.com/children/understanding-croup-treatment, WebMD

IMAGE REFERENCES1. Sobolewski, Brad. “The Reading Room: Airway Films.” https://pemcincinnati.com/blog/the-reading-room-airway-films/, PEMBlog, January 17, 20192. Lee, Doo Ri et al. “Clinical characteristics of children and adolescents with croup andepiglottitis who visited 146 Emergency Departments in Korea.” https://www.researchgate.net/publication/283758406_Clinical_characteristics_of_children_and_adolescents_with_croup_and_epiglottitis_who_visited_146_Emergency_Departments_in_Korea/citation/download, KoreanJournal of Pediatrics, October 2015

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