Tampa General Hospital is one of just four burn centers in Florida and has earned Verification by
the American Burn Association/American College of Surgeons. This distinction means the center has
met stringent guidelines for patient care procedures, facilities, and staffing.
The center treats critically burned patients from emergency admission through rehabilitation. This
13-bed specialty unit includes a six-bed intensive care unit, a seven-bed wound care unit, and
state-of-the art treatment rooms conveniently located within the unit. Our burn program has received
disease specific certification from The Joint Commission.
Realizing that pediatric burn patients have special needs, these patients are treated in the Children's Medical Center by specially trained pediatric staff.
Child life therapists help children and their families cope with the hospital experience and provide honest information at the child's level of understanding. Age-appropriate play and activities are organized and children are encouraged to participate at their own pace.
TGH is fortunate to have a certified Hillsborough County school teacher at the hospital who enables children to catch up on their schoolwork while hospitalized.
Furnished by a generous donation from the Tampa Bay Lightning, the Lightning Playroom gives kids a stress-free place to play and socialize with other kids. No medical procedures are permitted in the playroom!
TGH is a proud sponsor of Camp Hopetake along with the Tampa Firefighters and Paramedics. Children from throughout Florida who have been burned spend this special week together.
The severity of burns is determined by depth. There are three levels of burns:
First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.
Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.
Burns are also classified by size in relation to the entire body. There are formulas used to determine the percentage of the body burned. The table below roughly generalizes the 'rule of nines' for adults where the body is divided into areas equaling multiples of 9% of the body area.
ADULT
CHILD
Arm:
9%
Arm:
9%
Head & Neck:
9%
Head & Neck:
18%
Anterior Trunk:
18%
Anterior Trunk:
18%
Posterior Trunk:
18%
Posterior Trunk:
18%
Leg:
18%
Leg:
14%
In an infant or child the 'rule' deviates because of the large surface area of the child's head and the smaller area of lower extremities.
The medical team must determine the total area burned in order to determine the amount of replacement fluids needed.
Burn victims need the support of family during this difficult time. They experience pain, fear and anxiety and have many questions about their treatment and healing. Having family members nearby is very comforting to the patient and beneficial in building a bond among the healthcare team, patient and their families. We ask that there is at least one family representative designated to serve as the contact person. This representative will meet with the burn team to help answer questions so that we can deliver the best possible care for your loved one.
Treatment of a burn injury begins by cleaning the skin and applying medicine and dressings over the burn(s). After the medical evaluation, cleaning, and dressing of the wounds, the patient is moved to a room.
The medical team's immediate concern is controlling physical dangers, starting intravenous lines to replace lost fluids, and actual wound care.
Burn patients require special treatment to replace bodily fluids, and are very susceptible to infections. The staff at TGH will do everything it can to make the patient as comfortable as possible.
Replacement Fluids
Skin allows us to be weatherproof while at the same time keeping our own bodily fluids inside. When the skin is burned, bodily fluids seep out. These lost fluids must be replaced. With large burns, the fluids are replaced with an IV. The IV machine feeds the replacement fluids into the body in carefully controlled amounts. For smaller burns, fluids may be replaced by drinking.
Edema
Edema is swelling. Swelling may occur just around the burned area or it may be systemic, meaning over the entire body. The larger the burn, the greater the swelling will be. Chances are that the first time you see your loved one after they have been burned, swelling will be present. The swelling can distort features to the point that you may no longer recognize them. This swelling should begin to lessen after a few days.
Breathing Assistance
It may be necessary to assist the patient's breathing. This may be done with a simple mask supplying oxygen or through a tube. Intubation is the insertion of a tube through the patient's mouth or nose, directly into the windpipe. The patient can breathe through this tube, but will not be able to speak because the tube is below the vocal cords. If necessary, a ventilator can be attached to the tube to further assist breathing.
Nutrition
A person who has sustained a burn requires a massive amount of calories as their body's metabolic rate goes into overdrive. The metabolism speeds up to compensate for the burn injury and to begin the healing process. A feeding tube may be inserted through the nose into the stomach. Liquid food is fed to the stomach around the clock.
Foley Catheter
The Foley catheter is used to help patients urinate. A small rubber tube is inserted into the bladder, and a small balloon is inflated with sterile water to keep the catheter in place. The catheter drains the fluid from the bladder into a bag that hangs on the bed. The bag is monitored to determine how much urine is being produced which helps the doctor determine if more or less fluid should be given to the patient.
X-rays
A burn patient may get a lot of x-rays. These x-rays check the placement of the various tubes, such as the feeding tube, to make sure they are where they need to be. The intubated patient usually gets daily x-rays of their lungs to watch for signs of infection and pneumonia.
Skin Grafts
Allograft or cadaver skin is used as a temporary biological dressing over a cleansed (excised) wound. These are held in place with surgical staples.
Autograft is the skin taken from an unburned area of the burn patient. It is a permanent replacement.
The autograft is removed with a tool called a dermatome, which actually slices an extremely thin layer of skin from the burned person's body. This layer is .010 to .012 of an inch in thickness.
The two types of autografts are 'sheet' and 'mesh'. Sheet grafts are taken from an unburned area of the person's body. The sheet graft contains no holes or stretching so it takes a larger donor site to cover the same amount of burned area. The advantage to sheet grafts is durability and less noticeable scarring. The disadvantage of sheet grafts is the possibility of loss due to fluid building up beneath the graft.
Mesh grafts cover more area. The skin is taken from the donor site, then perforated. These perforations allow the skin to be stretched, thereby covering more area. The advantages to mesh grafts are the perforations which allow drainage and, since it has been stretched, it covers more area. The disadvantages of the mesh grafts are that they are not as durable as sheet grafts and the perforations leave more noticeable scarring.
