The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1992
Mixing inpatient with outpatient care: establishing an outpatient clinic on a burn unit.
Outpatient care of patients with burns is an important aspect of a total health care plan. Changes in the health care system, which focuses on cost containment, force reevaluation of the methods used for delivery of high-tech care, particularly in areas such as burn care. Great advances that have taken place over the past decade in the field of burn care have enabled health care providers to treat more patients with burns as outpatients. ⋯ Several obstacles needed to be overcome before an outpatient clinic could be established on the burn unit itself. Wound care is now provided by burn unit nurses, which leads to better results and more consistent follow-up. Patient satisfaction is increased, patient teaching is provided by experienced staff, unnecessary admissions are prevented, and patients are able to be discharged from the hospital earlier or to be followed as outpatients even if surgery is eventually required.
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J Burn Care Rehabil · Sep 1992
How long do we need to give antioxidant therapy during resuscitation when its administration is delayed for two hours?
Twenty-four guinea pigs with third-degree burns over 70% of the body surface area were divided equally into four groups. All animals received Ringer's lactate (R/L) beginning 30 minutes after burn injury. Group 1 received R/L without vitamin C beginning 2 hours after burn injury. ⋯ Groups 1 and 2 demonstrated higher hematocrit and lower cardiac output values as compared with those values for group 3, indicating hypovolemia and hemoconcentration in these groups. Group 3 showed hematocrit and cardiac output values equivalent to those values for group 4. We conclude that high-dose vitamin C must be given until 8 hours after burn injury to maintain adequate hemodynamic stability in the presence of a reduced resuscitation fluid volume.
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Children younger than 4 years of age who have sustained deep palmar burns pose a significant challenge to the burn care team. Flexion contractures of the palm and digits are all too common because the hand is maintained in flexion when at rest and while engaged in functional activities. A splint that positions the wrist in extension and the metacarpophalangeal joints of digits 2 to 5 in some hyperextension was evaluated. Nine patients with acute burns and two patients who required palmar reconstruction were studied. (The total number of hands was 15.) With this splinting technique, we have successfully maintained the antideformity position in patients with acute injuries and in those who have undergone reconstructive procedures.
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Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. ⋯ One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.