The Journal of burn care & rehabilitation
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J Burn Care Rehabil · May 1998
Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/N-acetylcystine [correction of acetylcystine] therapy.
Smoke-inhalation injury causes a destruction of the ciliated epithelium that lines the tracheobronchial tree. Casts produced from these cells, polymorphonuclear leukocytes and mucus, can cause upper-airway obstruction, contributing to pulmonary failure. We have reported that a combination of aerosolized heparin and a mucolytic agent, N-acetylcystine [corrected], can ameliorate cast formation and reduce pulmonary failure secondary to smoke inhalation. ⋯ The number of patients requiring reintubation for successive pulmonary failure was recorded, as was mortality. The results indicate a significant decrease in reintubation rates, in incidence of atelectasis, and in mortality for patients treated with the regimen of heparin and N-acetylcystine [corrected] when compared with controls. Heparin/N-acetylcystine [corrected] nebulization in children with massive burn injury and smoke-inhalation injury results in a significant decrease in incidence of reintubation for progressive pulmonary failure and a reduction in mortality.
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J Burn Care Rehabil · May 1998
Reconstitution of basement membrane after 'sandwich-technique' skin grafting for severe burns demonstrated by immunohistochemistry.
Reconstitution of basement membrane structures after "sandwich-technique" grafting of severe deep burns is demonstrated with use of immunohistochemical techniques. Cryosections of human skin after epifascial burn wound excision and sandwich grafting were stained with monoclonal antibodies against type IV and VII collagen, polyvalent antiserum against type VI collagen, and polyvalent antibody against laminin. Standard hematoxylin and eosin histologies were performed for morphologic correlation. ⋯ To our knowledge this is the first report of the expression of type VI collagen in these types of wounds. The findings are compared with the expression of type VI collagen in healthy skin. The results indicate that the modified sandwich-grafting technique is an adequate means for early burn wound closure and resurfacing of third-degree burn wounds and leads to the reconstitution of dermal qualities.
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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.