The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 2001
Comparative StudyBarriers to employment among working-aged patients with major burn injury.
The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .001). ⋯ With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7-336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2-6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.
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J Burn Care Rehabil · Jan 2001
Comparative Study Clinical TrialTourniquet and subcutaneous epinephrine reduce blood loss during burn excision and immediate autografting.
Blood loss has been reduced using both tourniquets and epinephrine-injected subeschar during burn wound excision. This study quantified and compared blood loss in extremities distal to an inflated tourniquet with that after subeschar infusion of 1:1,000,000 epinephrine in saline into the trunk or proximal extremities. Tangential excision of eschar to viable dermis or fat was followed by immediate application of meshed autograft. ⋯ With tourniquets for limbs, 2.07 +/- 0.34% of circulating blood volume per 1% body surface excised was lost; whereas after epinephrine injection 3.42 +/- 0.39% of blood volume per 1% body surface excised was lost (P < 0.05). Both methods effectively reduced blood loss when compared with excision followed by delayed autograft application. Where there was a choice the tourniquet was more effective.
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J Burn Care Rehabil · Jan 2001
Case ReportsMusic therapy for assistance with pain and anxiety management in burn treatment.
The management of pain is one of the primary issues in burn care. Pain is not only a physiologic experience, but a psychological one as well. With this in mind, the treatment of burned patients must incorporate a holistic view of pain management and healing. ⋯ Studies, as well as clinical experience, have shown that musical intervention has been helpful in assisting patients with pain management in a variety of medical settings. Music is an element of normal life that can be easily adapted for the needs of individual patients and their current environment while providing a means for self expression and for normalizing the environment. This article examines the rationale for using music therapy with burned patients, describes several protocols that have been adapted to meet the specific needs of burned patients, and summarizes our preliminary findings, which demonstrate significant response to music therapy protocols employed on our patients.
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J Burn Care Rehabil · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of music-based imagery and musical alternate engagement on the burn debridement process.
Management of pain is a primary concern in the treatment of burn patients. The intent of this study was to test the efficacy of music-based imagery and musical alternate engagement in assisting burn patients in managing their pain and anxiety during debridement. Twenty-five patients, 7 years of age and older, who were admitted to the Comprehensive Burn Care Center were enrolled in the study, which used a repeated-measures design with subjects serving as their own control. ⋯ The measurements taken were pulse, patients' self-report of pain, patients' self-report of anxiety, and the nurse's observation of patients' tension. There was a significant reduction in the self-reporting of pain in those who received music therapy in contrast to those who did not receive music therapy (P < .03). Music therapy is a valuable noninvasive intervention for the treatment of pain after burn injury.
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J Burn Care Rehabil · Jan 2001
Comparative Study Clinical TrialThe optimal management of pediatric steam burn from electric rice-cooker: STSG or FTSG?
The steam burn caused by an electric rice-cooker is a unique mode of burn injury in Asian countries, especially Korea and Japan. This type of burn injury is characterized by 1) occurring most frequently on the volar aspect of the hand in toddlers younger than 2 years of age (92.8%); 2) the depth of burns are normally deep second-degree to third-degree (98%) and usually need surgery at the time of injury; 3) flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary full-thickness skin graft (FTSG) would give more reliable results and eliminate the late reconstructive procedures. ⋯ In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9 +/- 4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients (79.2%) received reconstructive procedure during a 5-year follow-up period. In this report, we introduce the nature of steam burn caused by electric rice-cooker and propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.