Burn Care Services at Blake Medical Center

(soft playful music) Hi, I’m Kelly Carlstein
from Blake Medical Center and this is Healthy Living. A show that brings you
the information you need to live a healthier, happier life. On today’s episode we’ll be
talking about the burn services at Blake Medical Center. I’m very happy to have
a special guest today. Plastic surgeon, Dr. Michael Van Vliet of Blake Medical Center. Thanks so much for joining us. Thanks for having me. Let’s start by you telling
us a bit about yourself. Sure, my name is Mike Van Vliet. I grew up in Burgon County,
New Jersey up north. I always sort of knew growing
up I wanted to be a doctor. I grew up just knowing that that was my like mission to be a doctor and to sort of help people and those sort of things. Right now I live in Florida. It’s a beautiful place to
live and I’m very happy to work at Blake and have
a great community here. And what inspired you to become a doctor? So it’s sort of one of those things I always knew growing up. I was always attracted
to the television shows like ER and Emergency
and the Rescue Squads and those sort of things. It just sort of was in my
blood that I knew I wanted to be in the medical field. I was very fortunate to
have very good guidance by my parents and sort of pushing me to the highest level of being a physician. And they were very much
motivational for me to fulfill that. As I went through high
school, I was a paramedic and a fireman as well. I had my fire rescue
and I just, nothing more than I enjoyed than to be on the ambulance and taking care of patients. And I quit the basketball
team just so I could ride in the ambulance. Whatever I did, I just wanted
to be in the medical field. Then I was a phlebotomist. I was a volunteer candy striper. Anything that I ever did just had to do with the medical field. So I just sort of always knew growing up that that was my calling. And then I was really
fortunate as I went along my medical training, I
was able to match into a program where a lot
of the emphasis was on underserved patients and volunteerism in the medical community. So this was out of high school. And during undergrad I had a
lot of opportunity to travel the developing nations and
to complete medical trips and just continue to peak
my interest as I went along. And can you tell us more
about your specialty and how you chose it? Sure. So I chose burn as a specialty. It’s kind of an interesting
choice for a plastic surgeon, but the way medical training
goes is you start out by doing general surgery first. And I really liked the
component of general surgery with critically injured patients. I liked caring for them. I liked the intensity of it. I like being in the ICU. I liked that management and
I spent about three years doing general surgery. As we transition as the
medical residency goes for plastic surgery, you
transition over to doing full plastics and I love
being a plastic surgeon. I loved the reconstructive side. I loved cosmetic, I loved
everything about it. I just thought it was such
a fascinating specialty because no case is the same. Every patient that you get is different. And it’s sort of unlike any
other surgical specialty because most surgical
specialties, our surgeons have done every operation
100 times in training and they know exactly what to expect. Plastic surgery is so
different because every patient is different and there’s
no really right answer. So however, having said that
I knew during plastic surgery that I really did miss
the critically ill patient and caring for that part of it. I had the opportunity to to a
small rotation in Los Angeles during my residency. We went out to L.A. to the
burn center and there was a plastic surgeon running it, Dr. Garner. And he was a plastic
surgeon is also boarded in critical care and I was at
the burn center and I was just in love because here I was
managing critically ill patients in the ICU that were burned. And then I had the
opportunity to go right over to the operating room
and do plastic surgery and reconstructive side
and everything else. And it was just really a great compliment. It sort of encompassed all
the components of medicine that I love and at that moment I knew that burn was the specialty for me. And what brought you to
Blake Medical Center? Well as I started off
in L.A. and then I had my first job in Memphis,
Tennessee and I was directing the burn ICU there and doing a lot of burn surgery. And I really enjoyed it. It was really a great,
great starting place. I learned a lot from a
pretty senior surgeon there. And it was just a great stepping stone. But Dr. Mullens who’s the chief of our program in
Acosta was developing a burn center here and he
had gotten in touch with me and my wife is from Hawaii
so for her living in Memphis, Tennessee land
locked was a little tough. And when we saw this opportunity
to come near the water and warm weather, it
was sort of a home run. So we took the leap and here we are. And at Blake Medical
Center, am I right that it’s only one of six burn centers
in the state of Florida? That’s true. We are one of six burn centers. And can you tell us some
of the types of burns that you see in the burn center? Sure. So most people think of a burn injury and they think of a thermal burn. So obviously a flame, fire,
heat, these sort of things are probably our most common burn and the most common things we see. Patients come in from
house fires, burning trash, using gasoline as accelerant,
all these sort of things. And they sustain a thermal burn. And that’s your most common
and the one most people think about. But there are two other
types of burns that we see commonly, electrical burns
and also chemical burns. And these types of burns,
while they’re not as common as thermal, they have the potential to be far more significant injuries. A chemical burn, obviously,
patients come in contact on the job with certain costic chemicals. Mostly alkalines and they have
sustains pretty costic burns. And then of course electrical burns, which arguably are your most devastating. And we see all spectrums. We have a lot of patients
that get caught in a 220 volt circuit, and while
that can be pretty painful, it’s not as damaging as the patient, as the workers that we see in our linemen. And these guys come in contact with an arc or some high voltage
greater than 1,000 volts. And these can be pretty
devastating injuries where patients come in with
immediate loss of limb or life. And these are pretty intense injuries. But also, the compliment
to burn is that we see a lot necrotizing infections. And a lot of other skin
disorders that other facilities are uncomfortable managing. And the main reason for
that is there’s a large component of this that
requires excising and grafting and certain things that
we do in burn surgery. And probably the necrotizing
soft tissue infections or flesh eating bacteria that we hear of is probably one of the most common things that we see and that we manage
also in the burn center. Great. We’re gonna take a short
break and then we’ll back with more on the burn care
services at Blake Medical Center. We are Blake Medical Center. We are leaders in surgical care. We are trained in minimally
invasive techniques. Such as da vinci phlebitic surgery. We are committed to give
you personalized options. Because to us, it’s all about you. Your health. Your wellbeing. Your quality of like. – [Woman] Blake Medical Center. Exceptional care for everyone. Hi my name is Spencer Faust and I currently go to SCF for college. I was a junior in high
school when I got in a car with one of my friends
and we were driving home from a friend’s house. And we had lost control, hit a tree. I got a phone call in 2013 from Blake Trauma Center
that my son Spencer was in a major car accident. He was the passenger in the car and he wasn’t supposed to make it. And he had several shattered bones. Well this arm completely shattered so they had to go in
right here and basically put the bones back together. Go in through the top and
put titanium rod in there and finish it off with a screw right here and two screws over here. Hold it in place and 14
screws right over here. Big titanium plate too. I had broke two ribs, punctured both my lungs, punctured kidney and a liver. My sternum and broke this
right shoulder blade. Broke my pelvis in five places. Blake Trauma Center is the one who even found out who my phone was. There was no ID or anything. All that was wrapped up in the car. They couldn’t even retrieve it. It took two days to find
out who he even was. And then I got a call from Blake Trauma Center. I wasn’t supposed to originally make it so Blake Medical Center called my family, that I have family in
Connecticut, Germany, Ohio and everything, they
just all flew down here to say their goodbyes. But you know, but Blake did a good job and I’m here so now I’m back to my
full potential that I was. There’s nothing that I can’t do. I can play my guitar just like I used to. Still kayak and canoe. I can do anything I want,
100%, 110% actually. The trauma center at Blake Medical Center was phenomenal. I mean that’s the whole reason
why my son is here today. They were hands on, did
everything they could to give me my son. Welcome back to Healthy Living. I’m Kelly Carlstein and joining
me now is Dr. Van Vliet. So I’ve heard a lot about
different degrees of burns. Can you tell us a bit about those? What is a first degree burn? Sure. So your first degree burn is a sun burn. Basically you’re hanging out in the sun, you come back, your skin is red. That’s your first degree burn. Interestingly, while the first degree burn is the least serious of a
burn or the least threatening to your overall health, it’s
arguably the most painful. And the reason for that is
most of the nerve endings live in the skin and the
deeper that you go in a burn, you burn more nerve endings. So while this first degree
burn is relatively superficial, it’s quite painful as you know
if you’ve gotten a sunburn. It can be pretty painful. The main thing about the first degree burn and what separates it
is that it doesn’t break the skin barrier. So while it hurts and it’s
annoying and it’s painful and all these things, it’s
not breaking the skin barrier has implications as far as
you’re not losing fluid. You’re not have risk of infections, you not have all these things
that we worry about in burn. So it really doesn’t require
treatment in a burn center this is something you put aloe on at home and deal with the pain and get through it. And how would you know if
you had a first degree burn? So basically it’s painful and it’s red. So you had some exposure to to some thermal insult
or the sun or whatever. And things are painful and they’re red and you know that you
have a first degree burn. And again, when we’re
calculating our percentage of body surface area of what’s burned, one thing that even a lot
of providers don’t realize that emergency rooms is a first
degree burns doesn’t count when you’re looking at a person. So if someone’s 20% burn and
18% of it is first degree, it’s really a two percent burn. It doesn’t have any physiological siquily. Okay. And then what is a second degree burn? So the second degree burn
is a little bit deeper, obviously, than the first degree. There’s different layers of the skin. You’ve gotten through now the
epidermis to the outer layer of the burn injury or of the skin into the what we call
the superficial-dermis. And the way to look at
this is by a blister. So if you’ve ever touched the stove or you’ve gotten something and you develop a little blister with fluid in it, that’s technically a second degree burn. And these are broken down into A and B or superficial and deep. The superficial ones, when
you break that blister and you look, there’s nice,
healthy, living red tissue underneath there. And again these should
probably be addressed in a burn center, however they generally do not require skin grafting. The difference is you go to
a deeper second degree burn or a deep partial thickness,
you get a little bit deeper into the skin and when
you break that blister and you look underneath it, it’s not quite as healthy and pink tissue
that you would expect as a superficial second degree burn. And these burns are really tough to tell what’s first, what’s second, what’s third. And people have developed
all sort of mechanisms for, they’ve looked at lasers and
ultrasound and everything to try to have a machine
that you put on there that tells you the degree. And unfortunately the only
thing that really stands the test of time is experience
and just having looked at enough of these and when you
fellow in a burn fellowship, that’s the largest part
of your fellowship. Is just looking at thousands
of burns and saying what degree is it. And what should somebody
do if they suspect that they might have a second degree burn? So probably if they suspect
they have a second degree burn would be to contact
your primary care doctor and referral to a burn center. Depending on where it is,
usually we see thing things on the hands, the face,
these sort of areas. And probably you’re gonna
have your pass result if you’re treated at
least as an outpatient in the burn clinic. If it’s a small little area on your arm or something, you know, not
necessarily jumping the gun and running to a burn center. But still having somebody
that’s at least trained to know how to manage the
blisters is probably helpful. Great. And then the next degree
would be third degree. Can you tell you us a bit about that? Sure. So a third degree by definition has burned all the way through the skin. And the main difference
with a third degree burn, first of all it’s actually
painless because all the nerve endings in the
skin have been destroyed. And people watching here may think, well how’s a third degree
burn, we know it hurts. And the reason it hurts
is because you never have just a pure third degree burn. There’s areas surrounding that are second and different components
of it that are still some skin cells that are alive,
that is what’s hurting you. But the major implication
of a third degree burn or why we even grade these
things is the treatments vary depending on the depth of the burn. So by definition, a third
degree burn will not heal without surgical
intervention and grafting. If it’s a small centimeter or something, sure the edges will contract, it’ll heal, but a larger third degree burn,
it’s relatively expeditious that the dead tissue be removed
so it doesn’t get infected. And then that it gets
grafted in a timely fashion. And we find that the quicker
that you get to that burn and the quicker you get the dead skin off, the better your outcome is gonna be. And I’ve been in burn
centers where you wait a week or more to excise the burn and patients have poorer outcomes. They become infected, they get sick. And here at Blake, we try to
get rid of all the dead tissue within 24 hours. So while that may have
implications on the surgeon’s life, we know that it’s better for our patients so pretty much when you come to Blake or any burn center in our
group, our goal is to get that dead tissue off
within the first 24 hours and that limits your risk of infection. It gets you out of the hospital quicker and back to your life a lot quicker. And you mentioned grafting
as a treatment option. Are there other treatment options? There are other treatment
options available. Grafting encompasses the whole spectrum of what we use to apply to a burn wound. So the skin graft or
your own skin is called an auto graft and that’s
the time honored treatment of a burn injury. And where I trained, we didn’t
have many other options. There were not a lot of
technology in a county facility and because of that a lot of patients did receive skin grafts. And it’s a great way to treat it. There’s nothing wrong with doing grafting. But time has passed since my fellowship and more technology has become available. And now we have a lot of
modalities available to patients as far as stem cells and growth factors and other products that
we apply to these burns. And we find that if we get
rid of the tissue right away and we start applying different stem cells and other products we can
get a lot of these to heal at least these deep partial thickness, or these deep second degree
burns where as probably ten years ago they were
require skin grafting and weeks in the hospital. Now we can get rid of
that tissue right away, apply a stem cell, and
get that patient healed without any grafting and that’s sort of revolutionized burn care. And let’s talk about
the burn care services at Blake Medical Center. What makes us unique,
different to an emergency room or a walk in clinic? So I think the thing that makes us unique is, number one, is our availability. Pretty much anytime you
come there’s a surgeon available and ready and
a lot of other places like an emergency room there’s a triage and then we call the doctor
and then we have to get an appointment and then
you have to get scheduled for surgery a few days later. And that’s disruptive to a patient’s life to have to go through multiple
visits to see the surgeon and then get scheduled. And then everything that comes with that. So what’s unique about
us is that the patients come into the clinic. They’re seen in a timely fashion. Usually by a mid level provider. If it’s deemed that
this is a surgical case or requires relatively
urgent surgical intervention, the surgeon that’s on
call that day is called and we have our own operating rooms and our own availability to those ORs. The patients are all
told to come not having eat or drink anything in
case they need surgery. And this way we take the
patients right from the clinic right back to the operating room. We get their treatment completed. They get excised, they get grafted with either a stem cell
or their own tissue. And then we have therapists in our clinic. And the therapists will see
them after their surgery, all that day and show them
what sort of therapies that they need to do
at home or the patients will get admitted
depending on the severity. But the unique aspect of
this is that the patient can come in at eight
o’clock in the morning and by two o’clock they
can have been triaged, seen by a surgeon, have
surgery, have therapy, have seen the therapist,
worked with therapist, and have a therapeutic
plan and by five o’clock they’re home with their
family having dinner and just having received
all their treatment. Wow. We’re gonna take one last
break and then we’ll be back with more on the burn care
services at Blake Medical Center. We are Blake Medical Center. We are leaders in orthopedic care. We are experts in
procedures like hip and knee replacement surgery. We have been recognized for
our clinical excellence. We are committed to
giving you the best care. Because to us, it’s all about you. Your health. Your wellbeing. Your quality of life. – [Woman] Blake Medical Center. Exceptional care for everyone. And yet I’m still here. I shouldn’t be alive, but I am. It wasn’t my time. I wasn’t supposed to survive, but I did because of the Blake
Medical Trauma Center. Welcome back to Healthy Living. I’m Kelly Carlstein and
I’m joined once again by Dr. Van Vliet. Can you talk to us about who’s at the most highest risk for burns? Sure, this is a common
question we get asked, but I would say that the
bottom line is really anyone is at risk. Of course people that are
engaging in daily activities around thermal sources and
whatnot are at a higher risk so we do see a lot of
patients that come through that are workers. Anyone working on high
power voltage lines, welders that we see a lot of. But the bottom line is that
really anyone can be burned. And I would say the largest
percentage of that population would be kids. So kids are at a extremely
high risk for burn injuries and usually for scalding. It’s a extremely common
way that kids get burned. Kids will commonly pull
glasses of water or hot tea or soup onto themselves from the counter. We see a high volume of
kids with burns on their face and their chest from
pulling water on them. So all in all, I’d say those
are the most common injuries. But of course with house
fires and everything else, really anyone can be burned. And what are some of the other
common causes that you see in maybe the older population? So you know, I think it’s
dependent on location and population. So elderly and kids are at very high risk and the common cause would be for scald. The older you get, the
thinner your skin becomes and the less inhibitions
you have to remove yourself from the water or the source. So the elderly are very high
risk for scald injuries. Kids also are very high risk. Obviously they don’t know
better to prevent the injury or to avoid it. And then obviously, the
other most common causes are really work related. And then I would say
depending on your location, more rural areas, people
are burning trash. People are heating their
homes with thermal sources. And all those are creating
very high risk situations. I think burning trash,
burning leaves and brush is very high risk especially
when winds are changing and shifting. It’s very easy to catch fire that way. And then I would say
that probably the most or one other common area
would be any type of alcohol and some activity that involves fire. So camp fires are very common. People are out in the evening drinking and trying to accelerate the fire and people for some
reason often use gasoline to try to accelerate fires
and just try to remind people that’s a terrible idea. Gasoline is a very poor accelerant. It is very dangerous and very explosive. And what about chemical burns? Living here in Florida, a
lot of people are dealing with pool chemicals. Is that something that you see often? We don’t see that too commonly. I think a lot of the
people are professionals and know to take the
appropriate precautions. But we do intermittently
see the chemical burns. Usually it’s like a hydrochloric acid or one of these and usually
they are work related injuries. But most people that are
professional are knowing to protect their hands and whatnot with gloves. And what are the common
electric burns that you see? So the common electric burns
would be really twofold. I would say number one,
anyone using high power voltage lines. So linemen are at
obviously, very high risk. What people don’t know is
that you really don’t need to even contact the source. There could be an arc of shift of energy. So anyone that’s working
around high power lines are at very high risk. And then another common
one is also children. Kids are obviously curious,
everything goes in the mouth and chewing on cords is a
very common thing that we see. And it causes some relatively
deep burns right around the mouth on a child
that’s chewing on a cord. So just something to always
be mindful of in the house. Okay. The other common ones we’ll see there are adults around the pools and
whatnot with extension cords. And although these are
relatively low voltage, generally in the 200s, they
can actually be more painful of an injury because
the electrical current doesn’t necessarily ground so
it gets caught in the patient and the alternating
current which is usually what’s coming out of the
wall is just stagnant in the patient and it’s
not necessarily grounding. And until they ground
themself, then that can sustain pretty decent muscle injury
and pain for the patient. And it can certainly
be a deadly phenomenon. So although low voltage is relatively safe in the 100 to 200, it can
also be a deadly encounter if you’re not appropriately grounded. And then anything over the 1,000 volt is always a life threatening event. So what would you say
the most rewarding part of your career is? I think probably the most rewarding part is to see somebody through from the moment that they come in and then
from the time they get back to work in their life. We see these patients that
come in and it’s sort of an eye opening experience for
someone that’s never seen it so the patient will usually come in, they’re 70, 80% burned and
everyone in the emergency room just kind of wants to see this. It’s just a horrific sight
to see someone so burned. And these patients get so critically ill and I’ve been in situations
where we call consultants and people really write them off. They’re like this is not survivable and these people are
really the sickest patients in the hospital that you have. And they go through
such a profound response to this burn injury. And they’re so near
death for so many months. And then to see them from that point and then to get them through their injury and obviously save their life. And then not only that,
to improve their function and get them back to their
work and their career is very rewarding. They come to us, we sort
of follow them through life because these injuries
require constant attention. And the scars and lasers
and everything else that we do for them. And just to see them
reintegrate back into society and their job and their career
and get their lives back and to think of that first
moment when they came in a rewarding component of it. Well thanks so much for joining us today. You’re welcome, thanks. That’s all the time we have for today. If you would like more
information on today’s guest, please visit us at blakemedicalcenter.com and click on the Healthy Living Talk Show. While you’re there, you can
also send me your comments or suggest a topic for
one of our upcoming shows. I’d love to hear from you. I’m Kelly Carlstein
wishing you healthy living. (soft playful music)

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