The Journal of burn care & rehabilitation
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Children younger than 4 years of age who have sustained deep palmar burns pose a significant challenge to the burn care team. Flexion contractures of the palm and digits are all too common because the hand is maintained in flexion when at rest and while engaged in functional activities. A splint that positions the wrist in extension and the metacarpophalangeal joints of digits 2 to 5 in some hyperextension was evaluated. Nine patients with acute burns and two patients who required palmar reconstruction were studied. (The total number of hands was 15.) With this splinting technique, we have successfully maintained the antideformity position in patients with acute injuries and in those who have undergone reconstructive procedures.
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Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. ⋯ One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.
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J Burn Care Rehabil · Jul 1992
Continuous enteral feeding and short fasting periods enhance perioperative nutrition in patients with burns.
Both retrospective and prospective analyses of the effects of various fasting regimens were carried out on the achievement of calculated caloric needs of patients with severe burns. The records of patients who received enteral feedings while undergoing burn debridements were divided into three groups and retrospectively analyzed to determine the effect that duration of fasting had an achievement of caloric needs and on the risks of aspiration. Patients in two other groups were prospectively studied to determine the safety and efficacy of stopping continuous enteral feedings 1 and 4 hours before surgery, respectively. ⋯ In the prospective portion of the study, patients who fasted for 1 hour before anesthesia was induced achieved 30% of their caloric needs, whereas those who fasted for 4 hours achieved 15% of their target nutritional needs (p = 0.0001). No patient had evidence of pulmonary aspiration. We conclude that controlled enteral feedings and shortened preoperative fasting periods can safely enhance nutritional support in patients with burns.
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J Burn Care Rehabil · Jul 1992
Case ReportsMajor thermal burn as a result of intraoperative heating blanket use.
A 72-year-old woman sustained a 30% full-thickness total body surface area burn as a result of a malfunction in a heating blanket during coronary artery bypass surgery. Early burn wound excision and wound closure with skin grafts were performed. The patient experienced wide swings in systolic blood pressure. ⋯ However, cardiac collapse occurred, and the patient died on the tenth day after burn injury. Previous case reports have discussed only minor burns that resulted from heating blanket use. The magnitude of this injury and the death that resulted from it highlight the importance of preoperative and intraoperative equipment checks and careful intraoperative core temperature monitoring.
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Thirty-eight individuals who had been previously hospitalized for burn injuries were interviewed about the problems that they had experienced as a result of their injuries, their rehabilitation goals, and factors that they believed had influenced either the rate or extent of their recovery. The problems that were most frequently mentioned by participants were compared with problem areas that are covered by the Burn-Specific Health scale, which is a standardized measure designed to assess the impact of burn injury. ⋯ In general, patients' rehabilitation goals reflected the types of problems they experienced. Support from health care providers was the most frequently mentioned facilitator to recovery, which emphasizes the importance of the patient-provider relationship.