Critical care nursing clinics of North America
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Ideally, in a burn-traumatized patient, nonviable skin and tissues should be excised early in the course of treatment and replaced with a graftable material that mimics the properties of normal skin in function,texture, sensation, and appearance. The difficulty in identifying indeterminate-depth dermal injuries requires further studies to establish the line between extending injury and delaying the progressive excision of nonviable tissue. ⋯ Therefore, greater emphasis must be placed on improving the overall treatment process and the quality of the end result for these patients. Surgically directed and laboratory-based investigations into the cellular components of wound repair and the development of alternative methods of final wound closure are continuing to evolve, and bum specialists are,optimistic that new alternatives will become available for their patients.
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Crit Care Nurs Clin North Am · Mar 2004
ReviewTrends in burn resuscitation: shifting the focus from fluids to adequate endpoint monitoring, edema control, and adjuvant therapies.
Bum shock is a complex process involving a series of intertwined physiologic responses to injury that require more rigorous intervention than simply a change in fluid tonicity, fluid composition, or fluid resuscitation volume. Controversy ensues over monitoring techniques and resuscitation goals, in part because the identification of true markers of perfusion is clouded by intradependence of endpoints on other metabolic processes. The persistence of cellular hypoperfusion in patients who have been deemed adequately resuscitated by global indices supports the growing realization that failure of conventional endpoint-monitoring strategies to detect compensated bum shock can lead to significant organ injury from SIRS or MODS. ⋯ Present standards and monitoring guidelines for bum shock resuscitation should be critically evaluated and based on true, scientifically validated data rather than on observational studies or personal beliefs. Thus the continuing challenge for clinicians and researchers:burn centers must collaborate to perform large, multi-center studies to evaluate critically and to prove resuscitation endpoints and therapies. Future technologies targeted at microcirculatory perfusion and cellular oxygenation offer an exciting promise for less invasive, easily accessible, more accurate endpoints and treatments for bum shock resuscitation.
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Data from the National Burn Repository 2002 report indicate that most burns are minor and that 80%, to 90% of burn injuries can be treated on an outpatient basis. This article discusses the assessment and outpatient management of burn injuries, the role of specialized burn centers, and the reimbursement for outpatient burn care.
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Traumatic bum injuries and the associated treatments are a tremendous pain management challenge. The degree of tissue damage in severe burns can initiate physiologic changes in nociceptive pathways that place the patient at risk for undertreatment. ⋯ Medications, especially opioids, should be regularly evaluated and adjusted to achieve maximum effect and minimal side effect. Nursing's role is perhaps the most important in the essential focused surveillance of bum pain and it's successful treatment.
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Patients who survive to hospital admission after bums with inhalation injury face a difficult and potentially prolonged course of treatment in the burn center. Continuing survival and especially functional outcome hinges on the patient's receiving comprehensive, well-coordinated care from an interdisciplinary team of skilled health care providers. ⋯ Those who do may face prolonged and painful therapies on the way to recovery. The expert nurse managing and caring for this unfortunate population faces tremendous clinical challenges but also has the opportunity and satisfaction of helping each patient achieve the best possible outcome.