Burn injury

Figure 13.5 Initial procedures for dealing with burn injuries...

Early restrictive lung disease Infection Pneumothorax Pulmonary edema Pulmonary embolism Tissue hypoxia Burn injury Excessive mechanical ventilation Fever... 

There have been three randomized clinical trials and multiple case reports and open-label trials with the tricyclic antidepressants (TCAs) in PTSD, although only one study of childhood PTSD (Southwick et al., 1994) has been reported. Robert et al. (1999) reported the use of low-dose imipramine (1 mg/kg) to treat symptoms of ASD in children with burn injuries. In this study, 25 children ages 2 to 19 years were randomized to receive either chloral hydrate or imipramine for 7 days. Ten of 12 subjects receiving imipramine experienced from half to full remission of ASD symptoms, whereas 5 of 13 subjects responded to chloral hydrate. Sleep-related flashbacks and insomnia appeared to be particularly responsive to treatment. 

It is indicated in subjects already sensitised with serums of animal origin, existence of prior or present allergic manifestations (asthma, eczema, etc.), burns, injuries, open and compound fractures unimmunized or inadequately immunised mothers. 

Wood FM, Kolybaba ML, AUen P (2006) The use of cultured epithelial autograft in the treatment of major burn injuries a critical review of the hterature. Burns 32(4) 395-401... 

Burke JF, Yannas IV, Quinby WC Jr, Bondoc CC, Jung WK (1981) Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Ann Surg 194(4) 413-428... 

Demling RH. Comparison of the anabolic effects and complications of human growth hormone and the testosterone analogue, oxandrolone, after severe burn injury. Burns 1999 25(3) 215-21. 

Ferrara, J.J. et al., Increased hyaluronan flux from skin following burn injury, J. Surg. Res., 50, 240, 1991. 

Exposure to toxic fire effluents can lead to a combination of physiological and behavioral effects of which physical incapacitation, loss of motor coordination, disorientation are only a few. Furthermore, survivors of a fire may experience postexposure effects, complications, and burn injuries, leading to death or long-term impairment. The major effects, such as incapacitation or death, may be predicted using existing rat lethality data, as described in ISO 1334431 or more recently, based on the best available estimates of human toxicity thresholds as described in ISO 13571,5 by quantifying the fire effluents in different fire conditions in small-scale tests, using only chemical analysis, without animal exposure. 

ASTM F 2703 Standard Test Method for Unsteady-State Heat Transfer Evaluation of Flame Resistant Materials for Clothing with Burn Injury Prediction... 

A volunteer who worked at a nearby plant died from burns received while helping to spray fire-water during the emergency. Four people suffered major burn injuries when the initial vapor cloud ignited. Many spectators who stood on an earthen mound on that warm early Sunday afternoon suffered intense radiation burns from the BLEVEs. [10]. 

Total direct damages were about 5 million (1977 dollars). One emergency responder from a neighboring plant died as a result of burns and four individuals suffered major burn injuries when the ignition of the cloud took place. 

Galeano M, Deodato B, Altavilla D, Squadrito G, Seminara P, Marini H, et al. Effect of recombinant adeno-associated virus vector-mediated vascular endothelial growth factor gene transfer on wound healing after burn injury. Crit Care Med 2003 31 1017-1025. 

A four-year-old girl took fluoxetine for symptoms of post-traumatic stress disorder after a severe burn injury and 2 days after the addition of linezolid developed agitation, mydriasis, and abnormal movements in her limbs (106). Linezolid was withdrawn, and the symptoms resolved after 2 days. 

Historically, traumatic mass casualty incidents are likely to involve burn injuries. Burn care is highly specialized. 

Describe the etiology, basic pathophysiology, and initial management of burn injury. 

Although burns are cutaneous injuries, the effects can influence nearly all systems of the body. The overall morbidity associated with a burn injury will be determined by burn depth, percentage total body surface area (TBSA) involved, patient age, and presence of inhalation injury. Children and older adults have thinner skin and are more likely to sustain a deeper burn injury. Patients at the age extremes are also less likely to tolerate the stress of burn shock. The presence of an inhalation in-... 

Extensive burn injuries produce a systemic response that pulls fluid from the vascular system into the interstitial space. This is exacerbated in burns greater than 20% TBSA by a significant capillary leak into the microvasculature and generalized edema. Without proper treatment, intravascular fluid loss and hypovolemic burn shock result. This is why immediate initiation of fluid resuscitation is important. A successful fluid resuscitation will maintain intravascular volume and organ perfusion until capillary membrane integrity is restored (approximately 24 to 48 hours postinjury). 

Burn Injuries Are Common in Mass Disasters and Terrorist Acts. In general, in most traumatic events, approximately 25 % to 30 % of the injured will require burn care treatment. Approximately one third of those hospitalized in New York City on 9/11 had severe burn injuries the Pentagon attack resulted in 11 burn patients, again a high percentage of those injured. 

Burn Center Care Is the Most Efficient and Cost-Effective Care for Burn Injuries. Burn injuries are not like other trauma injuries burn injuries often require a lengthy course of treatment as compared with simple or even complex trauma patients. For example, for burn patients with 50% body surface area burn, the average length of stay in the intensive care unit is 50 days. In a mass casualty, the average burn is typically greater than 50% body surface area. 

Burn Centers Are a Unique National Resource. Given the unique nature of burn care and the nationwide availability of highly specialized burn care systems established to address the complex nature of burn injuries, burn centers have been specifically recognized in federal bioterrorism legislation, with subsequent action of the U.S. Department of Health and Human Services (HHS) to incorporate burn centers in state and local disaster plans. Furthermore, although most burn surgeons have the expertise and training to treat burn—as well as trauma— victims in the event of a mass casualty, the reverse is not necessarily so, which supports the need for unique benchmarks to ensure that the needs of the burn-injured are met in the event of a terrorist incident. 

Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality... 

Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols. 

Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention... 

An earthquake struck Duzce, Turkey, at 7 p.m. on November 12, 1999, a time when families were preparing dinner, washing their children, and heating their homes (Ad-El, Engelhard, Beer, Dudkevitz, Benedeck, 2001). Consequently, 27 adults and 13 pediatric patients were treated for burn injuries, most of which were deep and deep partial thickness burns to the lower extremities due to hot liquids, usually water, spilled during the quake (Ad-El et al., 2001). Two of the pediatric patients sustained 30% and 40% total body surface area burns and were transferred to a burn unit the remaining patients were treated as outpatients, as the local hospital was destroyed in the earthquake (Ad-El et al., 2001). 

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