The Journal of burn care & rehabilitation
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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.
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It is well recognized that child abuse is a common mechanism of injury to burned children. A profile of an abused burn child was constructed by analyzing 321 consecutive pediatric admissions to our burn center during a 24-month period starting in April 1993. ⋯ From the 93 reported cases, 26 were taken into temporary custody, 56 were indicated for abuse, but returned to the home, and 14 were "unfounded" cases. Our analysis indicated burned children aged 3 years and under, from single-parent, impoverished homes, admitted with a scald or thermal-contact burn are at highest risk for abuse or neglect and warrant careful assessment.
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J Burn Care Rehabil · Jan 1998
Comparative Study Clinical TrialA prospective analysis of serum vitamin K in severely burned pediatric patients.
Patients with burn injuries exhibit multiple risk factors for the development of vitamin K deficiency, including malabsorption, limited enteral intake, antibiotic therapy, and multiple surgical procedures. A prospective evaluation of 48 children was conducted to evaluate serum vitamin K values during the first 4 postburn weeks. Serum levels were analyzed in relation to clinical course. ⋯ Ninety-one percent of the children demonstrated serum values below expected norms. These data suggest a relationship between coagulopathy and an intact functioning gastrointestinal tract. However, the relative importance of dietary versus endogenous vitamin K produced by intestinal bacteria remains to be elucidated.