Bum patients

Daily protein needs 1.5-2 g/kg (>2 g/kg for bum patients >30% body surface area)... 

A 7-year retrospective Australian study of 182 industrial bums found that 5.5% were ocular bums due to chemicals, gas explosions, and electric flashes (percentages not specified) [13]. In another Australian study of 159 cases of hospital-admitted alkali ocular bum patients from 1972-1981, the majority of bums were Grade 1 or 2 and none of these resulted in vision loss [14]. 

Branday et al. [28] reported that 562 patients with acute chemical injuries were admitted to 8 regional hospitals in Jamaica during a 10-year period from 1981-1990 [28]. Chemical bums comprised 13.3% of all bum patients admitted during this time period. Nearly half (236 cases 42%) of these chemical bums resulted from deliberate assault, while only 10 of the total chemical bum cases (1.8%) were the result of work-related accidents. In one of the smdy hospitals, 38% of bum admissions were due to chemical bums and 2/3 of these were due to deliberate chemical assaults. Assailants were more likely to be female and victims were either male or other women over disputes involving a relationship with a male partner [28]. 

Of the overall chemical bum patients, the most common sites involved were the face, neck, and upper body (87%), and the eyes or eyelids were involved in 19% of overall cases [28]. In deliberate chemical assault victims, the face and neck were commonly injured, but the genital area was also involved in many victims. Acids, such as sulfuric acid, can be obtained at low cost in Jamaica. These authors note that many of the chemical assault injuries were devastating with facial destruction and blindness. Less than half of the victims decontaminated tliemselves with copious water inigation before presenting to hospital [28]. 

Asaria et al. [29] reported a retrospective review of 125 bum patients admitted to a hospital in Kampala, Uganda over an 18-month period in 2001-2002 [29]. Of these, 15 patients (17%) were victims of deliberate acid assault. The male/female ratio was 1 1. The average total body surface area (TBSA) involved was 14.1% and the most common bum sites were the face (86.7%), head and neck (66.7%), chest (53.5%), and upper limbs (60%). The eyes were commonly involved... 

At last, the examination of an eye bum patient aims to search and eliminate any concretion, particularly at the level of the conjunctival sacs. These concretions may help a continuation of the bum, because they are due to precipitations of either the chemical (for instance, lime) or dust projected with the chemical. These concretions result in the gradual decomposition of the compound at the level of the eye. 

Renal Effects. Evidence of renal damage was observed in individuals burned once with white phosphorus. Increased blood urea nitrogen (Summerlin et al. 1967), increased urinary levels of protein and urea nitrogen (Walker et al. 1947), and signs of acute renal failure (Songetal. 1985) have been observed. No longer term human studies were identified. Some of the blood/serum chemical changes are also found in thermal bum patients and cannot necessarily be ascribed to white phosphorus toxicity. However, controlled animal studies (discussed below) have shown similar effects that have been attributed to white phosphorus. 

Iwasaki S, Yoshimura A, Ideura T, Koshikawa S, Sudo M. Ehmination study of silver in a hemodialyzed bum patient treated with silver sulfadiazine cream. Am J Kidney Dis 1997 30(2) 287-90. 

An adverse effect of the BCG vaccine includes a positivr TB skin test. A red bli.sicr forms within 7 lo 10 days. Ihni ulcerates and. scars within 6 months. BCG is a live vaccine so it cannot he administered lo immunosuppressed palicnu bum patients, or pregnant women unless exposed (andeicn then not in Ihc first trimester). 

Circulating HA in the human organism occurs at very low levels, approximately 15 pg/liter, with a range of 4-40 pg/1 [43]. Elevated levels of plasma HA have been observed in a remarkable variety of diseases, including malignancies, arthritis, scleroderma, psoriasis, septicaemia, shock, in bum patients, and in liver and kidney diseases, particularly in liver or kidney failure (for review see [44]). 

Recovery from these symptoms was also facilitated by pyridoxine treatment. Several months after the incident the latter worker developed polyneuritis. The Endings from these studies are limited because the subjects were bum patients. The trauma from the bums may have played a role in some of the neurological effects observed. In addition, pyridoxine is also known to produce neurological effects at high doses, and may have been partially responsible for the delayed polyneuritis. 

Still, J. Law, E. Belcher, K. Spencer, S. "A Comparison of Susceptibility to Five Antifungal Agents of Yeast Cultures from Bum Patients", in Burns, Elsevier Science, Ltd. Great Britain, 1995,21(3) 167-170. 

Gentamicin is absorbed slowly when it is applied topically in an ointment and somewhat more rapidly when it is applied as a cream. When the antibiotic is applied to large areas of denuded body surface (e.g., in bum patients), plasma concentrations can reach 4 pg/mL, and 2-5% of the drug may appear in the urine. 

Mafenide This sulfonamide is also used topically to treat/prevent infections in bum patients. It is absorbed deeper into the skin than silver sulfadiazine and may cause painful rash and acidosis. 

Hetastarch is a non-antigenic used to treat or prevent shock following serious injury, surgery, or for bum patients when blood is not available for transfusion. This too isn t a substitute for whole blood. In an isotonic solution (310 mOsm/L), hetastarch decreases platelet and hematocrit counts and must not be used for patients who have bleeding disorders, congestive heart failure (CHF), and renal dysfunction. 

Third-degree burns are treated by first removing the charred skin (eschar) which is called debridement. This is a painful procedure. The patient is then given multiple antibiotics to prevent infections. The patient is also at risk for fluid and electrolyte imbalances (see Chapter 10) and at high risk for stress ulcers (see Chapter 18). Bum patients must be assessed for possible smoke inhalation. If it exists, the patient is treated with respiratory medications (see Chapter 14). 

The most common skin injuries are abrasions and lacerations that are the result of accidents such as road rash. This is caused by the body scraping along the roadway such as in a motorcycle accident. Patients who receive an abrasion or laceration are exposed to the same risk as a bum patient. 

Sawchuk, R. J- and Zaske, D. E., Pharmacokinetics of dosing regimens which utilize multiple intravenous infusions gentamicin in bum patients, J. Pharmacokinet. Bio-pharm., 4(2) 183-195, 1976. 

Chitnis D, Dickerson C, Munster AM, Winchurch RA Inhibition of apoptosis in polymorphonuclear neutrophils from bum patients. J Leukoc Biol 1996 59 835-838. 

Chuang S-S. Finger ischemia secondary to the synergistic agonist effect of norepinephrine and ergonovine and in a bum patient. Bums (2003) 29, 92-4. 

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