Burns : journal of the International Society for Burn Injuries
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Bitumen burns while comprising a small percentage of all types of burns are troublesome. They affect persons engaged in gainful employment which the burns then curtail, as well as requiring special attention because the substance adheres to the skin and is therefore difficult to remove. Ninety-two consecutive patients with such burns who were admitted as in-patients over a 10-year period (1985-1995) have been reviewed. ⋯ Roofing tars and asphalts are usually heated to temperatures of 232 degrees C to achieve desirable viscosities (e.g. for spraying), whereas lower temperatures are required for the manageable form to pave roads. Notable localities for asphaltum are the island of Trinidad and the Dead Sea region where lake asphaltums were long known to the ancient. Ironically, none of the 92 patients who were treated for bitumen injuries in the 'Soroka' (Beer-Sheba, Israel) and 'Barzilai' (Ashkelon, Israel) Medical Centres (80 and 150 km from the lake respectively) had anything to do with the Dead Sea area.
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Opiates remain the most common form of analgesic therapy in the burn patient today. Because of increased opiate requirements, optimal relief of burn pain continues to be a problem for these patients. The purpose of this article is to summarize those alternative pain control methods that appear in the literature. ⋯ Ketamine has been extensively used during burn dressing changes but its psychological side-effects have limited its use. Clonidine, however, has shown promise in reducing pain without causing pruritus or respiratory depression. Other forms such as transcutaneous electrical nerve stimulation (TENS), psychological techniques, topical and systemic local anaesthetics are also useful adjuncts.
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Rhabdomyolysis due to flame burns is not well described. A case of fatal rhabdomyolysis in an epileptic patient who sustained 65 per cent body surface area, very deep, flame burns is described. It appears as if the sustained muscle compression from the restrictive, circumferential eschar was the major factor in the aetiology of the rhabdomyolysis. ⋯ It would seem as if rhabdomyolysis following extensive full thickness burns may be more common than previously suggested. Fluid requirements are in excess of those proposed by traditional protocols. Rhabdomyolysis in flame burn patients indicates a poor prognosis.
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Hot air burns resulting from hairdriers held against the skin are rare. The largest published clinical series relates to burns in children injured by the use of hairdriers at home. Adults are assumed not to be at risk because the pain associated with thermal injury would normally stimulate acute action to prevent further skin damage. ⋯ There was loss of consciousness resulting from an epileptic fit in one case, and the local absence of sensation in a flap used to reconstruct a breast after mastectomy, in the other. The temperatures generated by hairdriers were experimentally assessed and the results are reviewed. We emphasize that hairdriers are a potentially dangerous source of hot air and can cause burns.
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Hot tar burns compose a unique class of thermal injury, because removal of this highly sticky compound may be very difficult without inflicting additional tissue damage. Early removal of tar facilitates assessment of the burn and improves patient comfort. Although the use of many substances for the painless removal of tar has been described, we used sunflower oil effectively in the treatment of four tar burn patients. This first report describes the practical and successful use of sunflower oil which was easily obtained from the hospital kitchen.