A f t e r l o a d D e c . R e n a l b l o o d f l o w R i s k o f i l e u s D e c .
T i s s u e p e r f
The skin is one of the most important components of the human body. Its primary function is to serve as a protective envelope for all the underlying tissues. A secondary function is to serve as an organ of excretion, regulating the body temperature through evaporation and radiation.' he three classifications of burns are as follows: Thermal burns, due to heat Chemical burns, due to acids and alkalis Electrical burns, due to electrical current passing through the body.2 Despite the many technological advances made in the diagnosis of burn depth; most commonly, however, burn depth is determined based on the clinical judgement of the burn surgeon.3 Thermal burns cause approximately 9,000 deaths annually in the United States. Clinical presentation of direct thermal injury is dependent on the degree of damage, a direct function of the intensity and duration of exposure to skin. First-degree burns are painful, red, swollen, and they blanch with pressure. The most common causes are ultra-violet radiation, scalding, low-intensity exposure to steam, or contact with a hot object. Second-degree burns create painful red blisters or broken epidermis, exposing a weeping edematous surface. They are most often caused by sca ds or brief exposure to a flame. Third-degree burns usually result from prolonged contact with steam, hot objects, or flames. They create ulceration, tissue necrosis, and are often painless because nerve tissue in the area has been destroyed.4 Many complications occur during the healing phase of burns. Infection remains the major cause of morbidity and mortality. Measures to reduce the risk of wound infection and subsequent sepsis include early excision, where possible, and the use of topical antimicrobial creams, such as Silver Sulphadiazine.s Mechanisms of reepithelialization, reattachment (skin grafting) and remodeling may result in skin prone to blistering, dryness, itching, contact dermatitis, photosensitivity, and hypertrophic changes in the relatively early course of healing.6 Noxious pain and thermal stimuli are carried by small myelinated fibers (delta) and unmyelinated fibers (G fibers). The diameter of these fibers differs greatly. Therefore, the speed with which stimuli travel varies, creating a consequence known as "double pain." The stimulus carried by the delta fibers is faster and causes a sharp pain that rises to a crescendo. This is the fast pain or first pain. The second pain, or slow pain, is poorly localized and particularly unpleasant.7 Burn-related pain is often severe and intermittently excruciating for months after the initial injury as a result of the multiple interventions necessary. While procedure-induced pain is untreated, general pain management is usually integrated into the overall patient care plan. In the case presented here, thermoreceptors had responded to noxious thermal stimuli, lowering their thresholds. Therefore, the thermoreceptors were responsive to relatively mild stimuli.8 When this patient presented for chiropractic management of her back and leg pain, the choice of an effective, yet non-invasive technique was necessary. Activator Methods (AM)* adjusting technique was selected because it is a standardized system of chiropractic analysis and low-force spinal adjusting technique. The Activator instrument was developed, and is currently used, to increase control of speed, force and direction of adjustive thrusts and reduce physical stress on clinicians. The modern Activator adjusting instrument is the product of many modifications and makes use of a hammeranvil effect to produce safe, reliable, and controlled force to osseous misaligned or subluxated structures.10
but no other opthamalogic abnormalities were noted. T-3 (body left with rotation and right laterality). on an outpatient basis. The burns came about when a hot steamer fell on her while she was attempting to remove wall paper in January. and the inability to sleep without medication. There was no tenderness. the topical treatment was changed to Silvadene. with instructions to continue skinsoftening KeriAide soaks. K. Postadjustment checks. and Petroleum.Case Report
Ms. At that time. and C-6 (body right with rotation and no laterality). headaches. the ointment was once again changed to "Scarlet Red Dressing" (See Photo 3. in Davenport. she underwent debridement under general anesthesia. a 61-year-old white female. another antimicrobial. The following spinal segments were found to be subluxated and were corrected. Ten days into treatment. The patient sustained burns on the lower back.
The patient was placed in the prone position on a Thule portable adjusting table. There was an eight percent whole body burn noted on the lumbar spine. she was released from the outpatient burn clinic. Ifi/L-5 (body right with right rotation. Within 72 hours. she experienced pain in the lower thoracic and lumbar regions that interrupted her sleep and daily activities. rigidity. Examination of the head and neck revealed no abnormalities.9
. and there were no open wounds or vesicles. In due course. T-7 (body left with rotation and right laterality). Ms. Daily hydrotherapy debridement continued until Ms. New skin growth appeared normal. Four days after the initial injury. Olive Oil. and posterior lower extremities.. which is a combination of 5 percent Scarlet Red. This dressing is used to promote epithelial cell growth. and right foot that was in various stages of healing. for one week. followed by the application of Silver Sulfadiazine dressing. Her chief complaints were moderate constant pain in the low back and buttocks region. During the entire period following her injury. Activator checks revealed a right Pelvic Deficiency (PD). Four months after the initial injury. Lanolin. buttocks. sustained second. 1996. according to AM protocol. Illinois. with the exception of tenderness and palpatory pain in the posterior inferior occipital region on the left. Iowa.
On her first visit back to the outpatient burn clinic. Orthopedic and neurological testing were deferred. then referred to Trinity Medical Center Burn
Treatment Unit in Moline. were negative and the Pelvic Deficiency appeared to be corrected. buttocks. specific isolation tests revealed no laterality). or palpable masses noted in the abdomen. (See Photo 1) She was treated by her private medical physician for four days.and third-degree burns over eight percent of her body. K requested care at the Palmer College of Chiropractic Community Outreach Clinic. She resumed care with her personal physician. She was subsequently admitted to Trinity Medical Center Burn Unit and given parenteral medication for pain and itching. she began outpatient treatments of hydrotherapy debridement. post application). using AM protocol as outlined in the Activator Methods Chiropractic Technique Basic ManualS: right Ilium (posterior / superior / lateral). K experienced a progressive disabling pain and itching. There was a slight congenital convergence of the right eye. Vital signs were well within normal limits.
Physical examination revealed a well-nourished 61-yearold female in a mild antalgic position. located at the Center for Aging Services Inc. the patient improved considerably and was discharged with instructions to return to the outpatient burn facility." This course was followed daily. Nose and throat were unremarkable. legs bilaterally.