The incidence of burn injuries due to hot water increases with age. This study retrospectively investigated reports of elderly patients who sustained burn injuries in the bathtub at their home and discussed potential prevention methods. Reports of hospitalized patients (80 years old or older) who received treatment at our hospital for burn injuries were selected. Among the selected reports, there were 22 of patients who sustained burn injuries within their home and 4 of burn injuries sustained while bathing. Three cases had a common faucet structure, two-steering faucets (the device has two independent controlling flow-devices such as orifice, tap, or cock) . All three cases ranged between superficial dermal burn (SDB) and deep burn (DB) on pelvis and lower extremities. As contributory factors, this study suggested cognitive deficiency due to changes in blood pressure, physical decline, such as muscular decrement, and the possible danger of the two-steering faucet due to its design. Considering these factors, the faucet issue is preventable by changing it. This study suggests preventative methods by cooperating with the local government and surveying potential factors in the home.
We investigated the effects of pressure garments for burn scars used in our hospital. We used pressure garments on 28 areas in 25 burn patients between August 2013 and October 2017. The most common sites were the upper and lower arms, and the most common burn depth was DDB. The start was 9.8 days on average after wound closure, and the duration of use ranged from 2 weeks to 3 years and 7 months, with the average being 1 year and 1 month. Based on the Vancouver Scar Scale, pressure garments were effective in 80%. Complications were itching, discomfort, contact dermatitis, and equipment breakage.
Our garment is advantageous in that it can be used regardless of age and area because different forms can be created according to the scar. It can also be combined with other therapies, such as topical agents, enabling more complex treatments, and it costs less. On the other hand, there were some problems such as discomfort, itching, reduction of pressure effects, and breakage. In the future, it is necessary to improve the material to be comfortable and durable, and to further examine the effective forms and mounting methods suitable for each body part.
An 81-year-old man rolled down a slope with a crawler transporter during agricultural work under the scorching sun. His left lower leg was crushed under the car body in the prone position until he was rescued approximately 3 hours later. Gasoline contamination was observed on his pants and black rubber boots. He was transported to our hospital and hospitalized with a diagnosis of chemical burn on the left leg and heel（7%TBSA）, hypertonic dehydration, and rhabdomyolysis. Dehydration and rhabdomyolysis improved in a week by fluid treatment. The wound was washed and treated with ointment, and the lower leg was epithelialized in a month.
However, the heel remained necrotic and was debrided 50 days after the injury, followed by reconstruction using a medial plantar flap. The postoperative course was uneventful. The photos taken by the fire department provided us detailed information of the injury circumstances, and the deep burn on his heel was considered to be a low-temperature burn due to wearing black rubber boots for a few hours under the scorching sun. This case emphasizes the importance of information sharing with emergency services in prehospital care.
Pain has a negative effect on patients’ physical activities. Patients with burns (aged 75 years and older) who were treated at Ina Central Hospital over the past 10 years were recruited in this retrospective study. Fifteen patients (60%) reported severe pain during body movement. Analgesics were administered to 7 (47%) patients. The average length of hospital stay of patients with pain was 35.4 days and that of those without pain was 31.0 days. There was no significant difference in the length of hospital stay between the two groups according to pain (p = 0.97) ; however, that of patients who received analgesics and that of those who did not was 47.6 days and 24.8 days, respectively, being significantly different (p < 0.05) .
In conclusion, insufficient pain control during patient mobilization may be one of the factors delaying discharge of elderly patients with burns. Burn nurses should objectively assess pain and encourage early team intervention to reduce the length of hospital stay of elderly patients with burns.