The Journal of burn care & rehabilitation
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Early aggressive fluid resuscitation has significantly decreased the morbidity and mortality associated with volume losses from large burns. Although most patients are adequately resuscitated using the Parkland formula, we noted increased fluid requirements for shock resuscitation in patients involved in methamphetamine laboratory explosions. ⋯ A 2-year retrospective study of 30 patients (15 methamphetamine users, 15 controls) revealed that the methamphetamine burn patient requires two to three times the standard Parkland formula resuscitation. In this study, methamphetamine burns larger than 40% TBSA had a 100% mortality.
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J Burn Care Rehabil · Sep 2003
Case ReportsThe rehabilitation/school matrix: a model for accommodating the noncompliant child with severe burns.
Some children with severe burns may have difficulty following therapeutic recommendations after discharge from a burn center. Noncompliance may result in complications that affect function, surgical management, community reintegration, and successful reentry into school. We present a case study in which a child with significant compliance issues was managed in a coordinated interdisciplinary model. ⋯ Educational reentry was facilitated by including a transitional period in a special-needs classroom in a freestanding special-needs school. Requirements for using educational resources to which some children are legally entitled are reviewed. Rehabilitation services that interface with the educational system for children with burns may improve outcomes as these children reintegrate into the community.
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In Turkey, burns represent a relatively small number of injuries overall, but they continue to be a major public health problem. Our aim in this study was to identify risk factors that affect outcome in burn patients hospitalized in the southern part of our country, with special emphasis on electrical burns. The database for 109 burn patients who were admitted to our burn center from April, 2000, through August, 2001, was retrospectively analyzed. ⋯ The mortality rate for the electrical burn group was lower than the rate for the rest of the burn patients (1/23 vs 17/86, respectively; P <.001); however, the opposite was true for complication rate (10/23 vs 5/86, respectively; P <.001), cost of treatment (8351 US dollars vs 5122 US dollars, respectively; P =.009), and length of hospital stay (39.9 vs 26.2 days, respectively; P < 0.001). The rate of electrical burn injury in Turkey has changed very little in the past two decades. This underlines the need for stronger efforts aimed at prevention, such as better public education and strict regulations regarding the distribution and use of electricity.
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J Burn Care Rehabil · Jul 2003
Noncontact laser Doppler imaging in burn depth analysis of the extremities.
The purpose of this study was to determine the accuracy and practical utility of a noncontact laser Doppler imager (PIM-II, Lisca Development AB, Linköping, Sweden) in the estimation of burn depth in the upper and lower extremities. At 48 hours after burn injury, we performed scans of 35 burns in 22 patients and obtained histological samples for burn determination with hematoxylin and eosin and vimentin immunohistochemical staining. Additionally, sequential scans and tissue specimens were obtained on 10 burns at 24, 48, and 72 hours. ⋯ Superficial dermal burns exhibited increased perfusion in the early burn period. Wounds showed a progressive decline in perfusion and a progressive increase in the depth of injury during a 72-hour period. This study demonstrates the advantage and accuracy of using a noncontact laser Doppler to differentiate deep dermal from superficial partial thickness burns in the extremities.
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J Burn Care Rehabil · Jul 2003
Serial measurements increase the accuracy of laser Doppler assessment of burn wounds.
Traditional methods of judging burn depth by clinical evaluation of the wound based on appearance and sensation remain in wide use but are subject to individual variation by examiner. In addition to the clinical difficulties with burn wound management, observer dependency of wound assessment complicates clinical trials of burn wound therapy. ⋯ Serial measurement with laser Doppler flowmetry had an 88% specificity and a positive predictive value of 81% for identifying nonhealing wounds. These results suggest that laser Doppler flowmetry is a potentially useful tool for burn wound assessment.