The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1989
Smoke inhalation and airway management at a regional burn unit: 1974-1983. Part I: Diagnosis and consequences of smoke inhalation.
Victims of smoke inhalation with and without burns and burn patients with respiratory insufficiency for reasons other than smoke at a regional burn unit are profiled in terms of age, burn size, length of stay, and mortality. The diagnostic characteristics of patients with an inhalation injury (N = 108) are listed; 7% of all patients (N = 52) have known smoke exposure with equivocal evidence for injury to the airway or pulmonary parenchyma. ⋯ Many of the clues to this diagnosis are indirect and not always related to the severity of pulmonary injury. Timing and degree of visceral failure control the severity of the injury, which increases progressively from that in patients with a burn only (parietal injury) through those with a visceral injury only (smoke without burn), those with both smoke and burn, to those with a burn and uniformly severe respiratory failure on the basis of sepsis.
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Hypothesizing that reduced blood flow to various levels in thermally damaged dermis is related to the depth of burn, we studied 59 burns in 41 patients, with an age range of 18 months to 67 years, with improved laser Doppler blood flow technology to determine burn depth on admission. Two hundred and sixty-eight laser Doppler measurements were made in 59 burn wounds in 41 patients. ⋯ Therefore predictive value of a positive result (i.e., laser Doppler value less than 1.4) on admission was 98.4% using laser Doppler measurements. Clinical estimation did not correlate as well with the depth of injury.
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J Burn Care Rehabil · Jan 1989
Randomized Controlled Trial Clinical TrialA randomized trial of plasma exchange in the treatment of burn shock.
Hypovolemia following major thermal injury results from increased capillary permeability with subsequent loss of fluid into the interstitium. Investigations of burn shock have demonstrated the release of circulating factors that effect these fluid shifts. Previous studies have suggested that this process can be altered by the performance of plasma exchange in patients who fail to respond to conventional resuscitation. ⋯ There was no difference in the total amount of fluid required to achieve resuscitation. The mean urine output during resuscitation was greater for the plasma exchange group (p less than 0.01). Performance of plasma exchange during the second 8-hour period after the burn did not alter the course of burn shock in this study group.
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J Burn Care Rehabil · Jan 1989
Comparative StudyHetastarch: an alternative colloid in burn shock management.
Hetastarch is a synthetic polysaccharide colloid that has been used clinically in the management of multiple trauma, hypovolemic shock, and postoperative cardiac patients. Our objective was to determine whether hetastarch is a safe alternative to blood products in burn shock resuscitation. Twenty-six patients received hetastarch during the colloid phase of resuscitation and were compared to matched historical controls who received either albumin or fresh frozen plasma. ⋯ There was no significant difference in hemodynamics, respiratory status, incidence of bleeding, or renal or liver function among the three colloid groups. The advantages of hetastarch include immediate availability, no dependence on human blood donor population, no risk of serum-transmitted diseases, and lower cost. It can be safely recommended for those patients who object to blood products for resuscitation, in those situations where human donors are few, and when cost is a consideration.
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J Burn Care Rehabil · Jan 1989
The use of the bone curet in debridement of the burn wound and graft recipient sites.
We describe the use of the simple bone curet for the purpose of scraping and debriding partial-thickness burn wounds and other chronic wounds encountered by the burn surgeon before autograft placement. In our experience the instrument allows more efficient and safer operating room debridement than does the standard scalpel blade.