Emergency medicine clinics of North America
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The burned patient is a challenging problem to the emergency physician. The vast majority of burns are minor and can be managed effectively on an outpatient basis. There are many therapeutic options, and specific burn care must be based on an understanding of the pathophysiology, tailoring it to the patient's needs. ⋯ Close monitoring of the patient and accurate record keeping is essential, as thermal injury is a dynamic process. Transfer to burn center often will be necessary and requires early contact with the center to ensure appropriate treatment and transfer arrangement. Certain other injuries require close follow-up care by physicians experienced in burn care.
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Hypothermia continues to be a major public health problem and a challenge to health care providers. The very young, the very old, and the poor are at greatest risk. ⋯ Numerous rewarming methods have been described in the literature; the decision to use any of the methods available depends on the degree of hypothermia present, the condition of the patient, and the rewarming rate possible with the method chosen. Cardiopulmonary bypass, if available, is the optimal method for rewarming the severely hypothermic patient.
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Many thousands of individuals are near drowning victims each year in this country. The majority of these will be young, previously healthy people. The key to their successful outcome and return to productive, full lives is aggressive resuscitation by emergency physicians and prehospital care providers. ⋯ Attention should be focused on immediate institution of resuscitative measures at the earliest possible opportunity, and the basic principles of both ACLS and ATLS. Finally, most of these near drownings should never take place. Emergency physicians must take the lead in public education on prevention of drowning and near drowning.