The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Mar 1998
Reliability of photographic analysis in determining change in scar appearance.
Photographs frequently are used to document change in the management of hypertrophic scars. The purpose of this study was to design a scale for the analysis of photographs of hypertrophic scars and to test its reliability. The subjects were four occupational and physical therapists, (two novices and two experts), in scar management. ⋯ The test-retest reliability ranged between 0.73 and 0.89 for all items. The new scale had substantial reliability (using a single rater) and was at least as reliable when used by novice therapists. This indicated that training had no effect.
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The pain associated with burn injury and treatment often is managed poorly. The purpose of this article is to describe available pain-management guidelines and to explain how burn pain can be enhanced by using a guideline-based approach. Data from a retrospective audit are used to highlight several of the common causes of pain mismanagement: including inadequate pain assessment, analgesic-knowledge deficits, and incomplete documentation. ⋯ Guidelines for burn-pain management must be broad in scope to allow for variations in analgesic needs across all patient populations and phases of burn recovery. Guidelines are necessary because studies show that information and education alone have little effect on the quality of pain management. What is effective are guideline-based initiatives that make pain visible and care providers accountable.
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After frostbite injury, the phases of rewarming and progressive injury may cause intense pain for the patient. Although parenteral narcotic agents are the usual method of pain relief, they have well-described adverse effects such as heavy sedation, respiratory depression, and nausea and vomiting. In frostbite injury of the lower extremities, epidural blockade has the potential to provide good pain relief with fewer of those complications. ⋯ The technique provided effective pain control, and no complications occurred. To our knowledge, use of continuous epidural morphine after frostbite injury has not been reported previously. Further use of this technique will be required to clarify its efficacy.
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J Burn Care Rehabil · Mar 1998
Extracorporeal membrane oxygenation in the treatment of respiratory failure in pediatric patients with burns.
Extracorporeal membrane oxygenation (ECMO) as a treatment for pulmonary failure from postshock respiratory distress in burned children recently has been shown to salvage patients who were thought to have more than a 90% chance of dying. We describe five burned children in whom severe respiratory failure--not responsive to medical management and maximal ventilatory support--developed, and who underwent ECMO treatment. ⋯ Outcome was poor for those burned children who received ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Children who experience perfusion/reperfusion shock injury to the lungs as a result of delayed resuscitation of scald burns may have an improved chance of survival with short courses of ECMO regardless of the burn size.
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I had the good fortune to initially present the thoughts written here at the Psychosocial Interest Group of the American Burn Association Annual Meeting in New York City in 1997. The paper begins with a personal introduction and proceeds to describe how Frances Cooke Macgregor's work inspired my colleagues and myself to develop a series of programs to address the rehabilitation challenges inherent in living with any kind of facial disfigurement. It is our sincere hope that the programs developed by our organization, Changing Faces (based in the United Kingdom) will contribute to the rehabilitation of people living with disfigurement throughout the world. We especially look forward to learning how what we have learned can be adapted to and disseminated in the United States as we establish collaborative relationships with the dedicated group of burn professionals there.