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Chapter 1: What historical advancements have improved burn care?
This is exactly right. Will Ferrell's Big Money Players and iHeart Podcast presents Soccer Moms. So I'm Leanne. Yeah. This is my best friend Janet. Hey. And we have been joined at the hip since high school. A redacted amount of years later, we're still joined at the hip. Just a little bit bigger hips.
This is a podcast, we're recording it as we tailgate our youth soccer games in the back of my Honda Odyssey. With all the snacks and drinks. Why did you get hard seltzer instead of beer? Oh, they had a BOGO. Well, then you got it. Listen to Soccer Moms on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, it's us, the Jonas Brothers, and guess what?
We have some big news. What's the news, Nate? Huge news. We created our own podcast called Hey Jonas. How did we actually come up with the name Hey Jonas, guys? I honestly don't remember. We were talking about a bit for the podcast where people could call in and say Hey Jonas, and then I wrote down on my little notepad Hey Jonas and offered it up as a potential title for the podcast. Oh, wow.
But thanks for remembering that, guys. Listen to Hey Jonas on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Just listen. We don't care where you hear it. When you feel uncomfortable, what do you put on? Biggie. You put on Biggie when you feel uncomfortable? Because I want to get confident.
This is DJ Hester Prynne's Music is Therapy, a weekly podcast from me, a DJ and licensed therapist. It's Mental Health Month. Let's figure out what actually works. I didn't care about my life circumstance when I listened to that stuff. It didn't matter to me. This isn't just a podcast. It's unconventional therapy for you every day.
Open your free iHeartRadio app, search DJ Hester Prynne's Music is Therapy and start listening now. This episode features descriptions that some listeners might find upsetting. Please listen with discretion. Hi, I'm Emma.
In May of 2020, I was working at my job as a bookbinder when a machine error caused my dominant hand to be crushed and burned inside a machine used for stamping foil designs onto book covers. That day, I went to the ER for treatment where I also got to have my first COVID test. About a week later, I had my first surgery.
The first procedure was extensive wound debridement that couldn't have been achieved while I was awake. and the application of homograft, which is essentially a very fancy band-aid that's cadaver skin.
A couple of days later, after allowing the wound site to calm down a little bit, the homograft was removed and something called BTM, or biodegradable temporizing matrix, was placed on the burn sites. BTM is an incredible innovation. It's basically a sort of foam that acts as a structure for the body to rebuild tissue into over time.
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Chapter 2: How did skin grafting evolve over time?
Anyways. Before we can do any of that, it's quarantini time. It is. We're drinking the same thing that we drank last week, which is a non-alcoholic bee's knees that we're calling... By degrees. And listen, we're not equipped to create a new cocktail recipe every week. We're in the hundreds of episodes now. Listen, just drink it.
We're making, we're borrowing from established knowledge, which is bee's knees. It's delicious. You can find the full recipe on our website, thispodcastwillkillyou.com and on all of our social media channels. You can. We didn't mention this, but it is honey and lemon and non-alcoholic gin. And it's great. And on our website, which is also great, you can find lots of things like transcripts.
You can find links to merch, links to our bookshop.org affiliate page, our Goodreads list, music by Bloodmobile, first-hand account form, contact us form. And an About Us page that hasn't seen an update in a number of years and doesn't have that much information anyway. So to see what information is provided, check it out. You really sold that About Us page there, Erin.
Do we even have like the start date of the podcast? Which still blows my mind that we are in our ninth year of doing this. I know. No, we don't have that on there. It might say that we're still in grad school, which is quite out of date. No, we graduated in 2018. Yeah, listen. Anyways. Anyways. Let's get to the episode itself. Let us. Right after this break.
Your husband is not who you think he is.
Your body is not what you thought it was. Your identity is formed by a secret history. I'm Dani Shapiro, and these are just a few of the stunning stories I'll be exploring on the 14th season of Family Secrets. Just then, we felt the plane turn in the air, so much so that the bags that were under people's seats just kind of flew into the aisle.
Each week, we dive headfirst into the complex power of secrecy. how it shapes our identities and relationships, and how it ultimately can reveal to us our truest selves.
My daughter, she's pretending she doesn't know, but is trying to cook and feed me and keep me alive because I wasn't eating anything, and me pretending like everything was fine. He kind of shoved me out of the way and said, move. And he went out the front door and he jumped in a car and drove off. And that was the last time I saw him.
Listen to season 14 of Family Secrets on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.
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Chapter 3: What role did antiseptic techniques play in burn treatment?
50 years later, 1950, nearly 70% survived. Wow. So the mortality had gone down to 30 percent, from 100 percent to 30 percent. That's huge. That's huge. It's unfathomable. Yeah. Yeah. Wow. In those 50 years, burn care had undergone a profound revolution, and we've continued to make tremendous strides up through the present day. And I'm going to leave those present-day strides to you, Erin.
And what I want to focus on instead is those 50 or so years. Okay. What changed in medicine to drive such a transformation? There was no single moment or breakthrough, but there were many. There was skin grafting, antiseptic technique, fluid balance and nutritional support, antibiotics, and airway management.
Really, it was through integrating all of these medical advancements through the formation of burn care as a specialized approach that the scales finally tipped. The survival rates that this integrated management could now achieve were beyond the imagination of any physician in past centuries. I imagine someone...
Trying to treat someone with a burn in like 1500 and then coming today to a burn center and just just like chills that it's amazing to think about how much the opposite of Outlander. Yes. Yeah. Here's some moldy bread. We'll try that out. Yeah. Yeah.
Yeah.
But so what I want to do today is take us through how that happened piece by piece. Skin grafts and burn excision. Okay. So these approaches date back to ancient times.
For instance, in the 5th century CE, Sushruta, the famous surgeon from ancient India, described how he treated amputated noses by taking a flap of skin from the forehead and then later the butt and then grafting it over the nose wound. Fascinating. Yeah. So skin grafting in that way has very, very deep roots. Wow.
And from this point until the 1800s, a few physicians had tried their hand at grafting over the centuries with varying rates of success. Allegedly, the first rhinoplasty, I think, was performed in the 1600s or 16th century. I can't remember. Okay. Like a while ago. Yeah. A while ago. Yeah. Yeah. But still, it was very much touch and go, not very. It was definitely more of an art than a science.
And things turned around in the 1800s. The early part of the century saw a few surgeons experimenting with skin grafting in animals, which showed some promise. But more importantly, those experiments helped to clarify science. some crucial concepts about tissue death, circulation, and immune rejection.
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Chapter 4: How important is fluid balance in burn recovery?
And you haven't rinsed your hands once? That's what I want in a surgeon. No. No, thank you. Please. No, no, no. Thankfully, Joseph Lister, see our sepsis episode, revolutionized surgery in the 1850s with his recognition that if you operated with clean surgical tools and you cleaned the wound, your patients were less likely to die.
His solution of choice, his antiseptic solution of choice was carbolic acid, often mixed with Vaseline for use in burn patients to reduce the pain of having acid rubbed into your wound. Yeah. Okay. Later during World War I, other antiseptic solutions were developed like boric acid, acetic acid, and a 25% solution of sodium hypochlorite, also called Dakin solution. Still use that today.
Still use that today. Aniseptic technique was a major step forward in reducing infections and deaths following surgery, such as removing burn tissue or performing skin grafts. And the same principles were used for wound management in burn patients, even if they didn't have surgery. Because your skin, as you've talked about, is a barrier, right?
to infection, when that barrier is disrupted, it leaves it super vulnerable to infection. And so if you can find a way to decrease that vulnerability through antiseptic ointments, antimicrobial ointments, bandages that are infused with antiseptic components. Stuff. Stuff. These things are integral in improving outcomes for those who have burns, both minor and major.
By reducing infection through antiseptic technique and these specialized ointments, physicians could chip away at one major, major source of mortality for burns. But other threats remained. Fluid balance and nutritional support. Yeah. Yeah. This is a big one.
More than I realized, I think, despite having rewatched all of ER, I don't think it really hit home to me how important this part of it was. As though ER is a super, super accurate. Great. It's like I was saying, despite med school, despite ER. Same, same.
Over the centuries, a handful of physicians had noticed that providing a burn patient with lots of replenishing fluids and food seemed to help. But this was very much against the beliefs of the day. Things like bloodletting and purging were still the standard for centuries.
And it wasn't really until the late 1800s, the late 1800s, that doctors began to crack the code on fluid balance and nutritional support. Wow. And it started when a few doctors observed that the renal failure in burn patients looked very similar to that that they observed in cholera patients. Wow. Oh, yeah.
Or their bodies were extremely dehydrated and they just their fluid balance was not even in super imbalance, I guess. Right. They're losing tons of fluid and they're losing tons of electrolytes because they're pooping pure water meters at a time in cholera. And that totally makes sense because the same thing is happening.
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Chapter 5: What are the current challenges in burn care accessibility?
Okay. But yeah, so that was the first time that penicillin was used to see if it improved. And I don't think... I think that the data were not strong enough to see, did this actually help anything? Yeah, there was still a lot of other things that needed to be figured out.
But this tragedy also led to the refinement of fluid replacement calculations and the recognition of airway injuries after a fire. But since then, since this nightclub fire, antibiotics have often been employed in treating systemic infections that arise after a burn or used prophylactically to prevent infection in the first place. But their use in burn patients can be tricky.
So first, antibiotic resistance is a major problem, especially for certain types of bacteria found after burns like Pseudomonas. Yeah. And antibiotic use can also lead to other opportunistic pathogens taking over. So, for example, certain fungal species such as Candida albicans.
So it's a little bit of a mixed bag, or it's not the way that antiseptic technique or fluid replacement is the role that it plays in the history of burns. Especially because you're talking about systemic antibiotics. Right. Like IV antibiotics or oral antibiotics, like the kind that you would use to treat an infection. And yes.
And that and that makes sense because we don't really use them that much in burns today. Yeah. Unless we need to. Unless. Exactly.
So like having it there when needed.
Exactly. Exactly. Yeah. But yeah, like you said, I mean, the systemic part of it. And so having this knowledge of antimicrobial properties to then infuse bandages, I kind of lumped that in with the antiseptic technique. But like that was a huge part of it.
Yes.
Just like how do we topically treat this and prevent infection? Yeah. Right. And then last on the list is airway management. So this includes both the recognition of airway injury as well as ways to treat it.
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Chapter 6: How do modern technologies enhance burn treatment?
And each case is different. And. At the same time, as amazing, as incredible as these centers are, they can only help someone if someone has access to them, which is a pervasive issue across the globe that I know you'll talk about. And as transformative as burn treatment has been over the past century, continued improvement can only be achieved through funding for research.
And I know everyone who's listening has heard this all before, but it bears repeating. It bears repeating until we all... Internalize it forever until something changes. But with that, Erin, I'll turn it over to you now to fill us in on some of the incredible treatments out there for burn injuries that happened after those 50 years were up. Oh, I can't wait to do that, Erin.
Your husband is not who you think he is. Your body is not what you thought it was. Your identity is formed by a secret history.
I'm Dani Shapiro, and these are just a few of the stunning stories I'll be exploring on the 14th season of Family Secrets.
And just then, we felt the plane turn in the air. So much so that the bags that were under people's seats just kind of flew into the aisle. Each week, we dive headfirst into the complex power of secrecy. how it shapes our identities and relationships, and how it ultimately can reveal to us our truest selves.
My daughter, she's pretending she doesn't know, but is trying to cook and feed me and keep me alive because I wasn't eating anything. And me pretending like everything was fine. He kind of shoved me out of the way and said, move. And he went out the front door and he jumped in a car and drove off. And that was the last time I saw him.
Listen to season 14 of Family Secrets on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. How much you weigh, Wanda? Right now, I'm about 130. I'm at 183. We should race. No, I want to leave here with my original hips. On the podcast, The Matchup with Aaliyah, I pair prominent female athletes with unexpected guests.
On a recent episode, I sat down with undisputed boxing champ, Clarissa Shields, and comedian, Wanda Sykes, to talk about Wanda's new movie, Undercard, the art of trash talk, and what it really means to be ladylike. Open your free iHeartRadio app, search The Matchup with Aaliyah, and listen now. Brought to you by Novartis, founding partner of iHeart Women's Sports Network. Hi, I'm Chris Fairbanks.
And I'm Karen Kilgariff. We host Do You Need a Ride, the mobile comedy podcast that answers the question, what does it sound like when we drive our comedian friends around the wild streets of Los Angeles? Yes, every week we pick up a hilarious guest, maybe run some errands, share some laughs, and our dreams. Like when Martha Kelly shared her career pivot.
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Chapter 7: What psychological impacts do burn survivors face?
Like, there are way too many to count in terms of the types of dressings and antimicrobial dressings. A lot of the ones that we use in burns tend to be silver-infused dressings. And that's because silver is a good antimicrobial that is really only topical. So it's not penetrating deep. It's not going systemic, etc. But honey-based dressings, aloe vera-based dressings...
With all of these, the goal is to inhibit the growth of bacteria to reduce the chance of infection. IV antibiotics, like I mentioned, we don't tend to use unless there is an infection that leads to something like sepsis.
Because not only is it overboard to use IV antibiotics that might increase the risk of antibiotic resistance and other things, but also these wounds don't really have any blood flow. So IV antibiotics don't really work that effectively. That was sort of the conclusion of the coconut grove. They were like, we don't know if this did anything or not. Exactly.
Yeah.
And it might not have. It might not have. Maybe for some people it does. So the gold standard for treatment of any burn that had to have a surgical excision is still a skin graft, even though they're apparently as old as dirt. So old. So old. I had no idea. Yeah. The way that we do skin grafting today is mostly by what's called a split thickness skin graft.
So that means a skin graft that has both epidermis and a small amount, the very top of the dermis. For more sensitive areas or more cosmetically important areas, like say the face or maybe even the hands, you might use a full thickness skin graft. So that would be epidermis and the whole entirety of the dermis. And skin grafts are really fascinating.
You could probably talk in way more detail about them, but I will just give us all the basics of how these work. Essentially, you take a healthy, non-burned piece of skin and use that to cover the burned wound. You adhere it with staples or sutures or something. Ideally, the skin comes from you, right?
Because then your body recognizes it and there's much less risk of rejection or anything like that. There's two ways that we can do this depending on how important the cosmetic outcome is and how large the burn wound is. In some areas, you might take a piece of skin and just use it as is to cover, sort of just like a flap graft essentially. Okay.
In other cases, you might do what's called meshing, which means you take the skin that you're going to use as the graft and you run it through a machine that basically turns it into a mesh so that you can stretch it over a much larger area. Okay. Your face doesn't look like it appreciates that. I appreciate the technology, just not. It is so fascinating.
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Chapter 8: What future innovations are on the horizon for burn care?
Wow. So they blot and moisturize? Yes, yes, yes, yes. They blot and moisturize. There's also films, patches, sponges, nanofibers. There's a lot of interest in like nanomedicines for these dressings. But the goal of all of these things is to promote wound healing and reduce the amount of time that it takes for our body to actually grow new skin in and of itself. Mm-hmm.
They also serve to reduce the risk of infection. And the goal is to maintain a kind of optimal wound healing environment. And wounds heal best when they are moist but not too wet because too much fluid can actually impair wound healing. You need to be able to have oxygen flow in and out. So you need something that's semi-permeable like our skin is and prevents infection, right?
So something that's going to block other, either have antibiotics in it or can just block other microbes from getting in. And ideally, these dressings can also help to reduce pain, either because they have something in them that's analgesic or just because they're reducing the number of dressing changes and and the friction or anything that you might have from other dressings.
So, like I said, there's literally too many of these kinds that can go into these. One that I think is quite interesting is an acellular fish skin. Okay. Excuse me? Right. So you know how I said sometimes we can use like xenografts from like porcine skin, so pigs or something like that? There is a acellular fish skin that can be used now for wound healing, including burns. Okay.
But it can kind of act, again, as like a temporary skin. So you put it on, leave it on until your skin starts to re-epithelialize itself. My mind is blown by that. I know. Fish skin. It's really fish skin. That was, I think, one of the newest ones for me. But then there's also a lot of interest in things that are even more... They honestly sound like science fiction-y.
So there are things that are available commercially that are kind of like scaffolds that we actually can take some of our own cells, send them off to these companies who engineer them and then spray them or otherwise infuse them into these like films, these scaffolds that we then can use as a dressing. Right. I feel like I read about this in Replaceable You by Mary Roach.
It's possible.
It is that that totally blew my mind. Like basically kind of 3D printing your own cells. And that's even I would say a separate thing. Because 3D printed cells is a huge area of research and it's been done on animal models. I think there is actually some like clinical in human data from it, but it's all in the realm of research as far as I can tell right now.
But that's even like a step beyond what already does exist, which are these like these dressings that you can impregnate even with your own cells. So cool. I'm sorry. It's just like, what? I don't know. To me, it's a really interesting... trajectory of burn care because for millennia, the focus was on the wound itself, very topical, very isolated, the local treatments.
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