Critical care clinics
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1. With improvements in treatment of burn shock and wound sepsis, inhalation injury has emerged as the number one cause of fatality in the burn patient; it accounts for 20 to 84 per cent of burn mortality. 2. Only steam is capable of inflicting direct thermal damage; most injury is caused by incomplete products of combustion, the most important being aldehydes. 3. ⋯ Prophylactic antibiotics or steroids are not of benefit. Further care is only supportive and includes CPAP, PEEP, vigorous pulmonary toilet, humidification of inspired air, and antibiotics for documented infection. 7. Further advances await the development of pharmacologic methods of affecting the lung's response to injury, which includes altered capillary permeability and decreased immune function.
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Fluid resuscitation of the burn victim has evolved into a sophisticated science based on sound physiologic principles. This article presents these new developments in the context of the physiology of burn injury.
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The burned child requires a management that is different from that employed in the burned adult because of physiologic and psychological dissimilarities, although basic principles of management are the same. Particular problems and treatment of the burned child are highlighted.
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Pain management in burned patients is a controversial topic. Early effective pain management in these patients requires that the physician and nurse be aware of the advantages and disadvantages of various pharmacologic and nonpharmacologic measures that may be used. Newer approaches to assessing and managing pain in these patients must be explored.
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The pathophysiology of the burn injury and treatment factors that influence burn depth are explained. Details of burn wound care, including indications for early excision, topical antimicrobials, and the most recent advances in skin substitutes, are described. Burn wound sepsis, the most common and serious complication, is discussed in regard to diagnosis and treatment.