The Journal of burn care & rehabilitation
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J Burn Care Rehabil · May 1992
Reconstructive goals for children with burns: are our goals the same?
It is often difficult if not impossible to include a pediatric patient in the planning of burn reconstruction. To give the patient greater input into his or her reconstructive plan, we developed a survey tool to evaluate the different reconstructive goals of the patient, the parent, and the physician. Each patient, parent, and physician were requested to complete a separate goal form. ⋯ Patients indicated fewer and different desired reconstruction sites than the physicians or the parents. Before reconstruction is planned, the patient should be consulted. The desires of the parents and the physician may differ significantly from those of the patient.
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J Burn Care Rehabil · May 1992
The effect of dopamine on pulmonary hemodynamics and tissue damage after inhalation injury in an ovine model.
Hypoxic pulmonary vasoconstriction and reduced blood flow occur as a result of smoke inhalation. The aim of this study was to investigate how the amelioration of blood flow reduction by the vasodilator dopamine affects histopathologic outcome. We exposed the left lungs of chronically instrumented sheep (n = 12) to smoke, awakened them, and studied them for 24 hours. ⋯ The histologic evaluation of the injured lungs showed epithelial necrosis and cast formation in both groups in addition to an increased wet/dry ratio. No difference in lung injury between the groups could be distinguished. We conclude that the amelioration of blood flow reduction by treatment with dopamine in the lungs that were exposed to smoke did not affect pulmonary damage after inhalation injury.
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J Burn Care Rehabil · May 1992
Reorganization of a burn unit in response to underutilization: a critical assessment.
The incidence of burn injury in the United States has declined over the past few years, resulting in a dramatic decrease in the number of admissions to burn centers. This decrease has generated considerable concern, leading to a variety of proposals to modify burn units to control the cost of inpatient care. In 1986 Albany Medical Center Hospital, a 654-bed regional academic health sciences center, closed its burn unit and implemented a program to manage thermally injured patients in the intensive and progressive care areas of the medical center. ⋯ The relationship between burn severity and length of stay was unaltered by the burn program change. A comparison of data collected just after the change to those collected 2 years later again showed no difference, except that the annual census had dropped more than 50%. The results suggest that burn units can be converted to integrated burn programs without compromising patient care outcomes, although the lack of a cohesive burn team and the unavailability of beds designated for patients with burns ultimately resulted in a deemphasis of the burn program and consequent marked reduction in the number of patients with burns seen in the institution.
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The purposes of this study were (1) to identify the percentage of patients with burns or intergenerational family members who have had previous burn injuries that required hospitalization and (2) to assess the need for an inpatient burn prevention program for patients and families. This study revealed an increase from 8% to 19% "burn repeaters," with a yearly average of 13% in a 5-year census and a 20.1% etiologic fraction related to the marker of increased risk (previous burn injury). These results strongly substantiate the necessity for an inpatient prevention program for patients and families to promote injury control by reduction of subsequent burn injury and thus break the burn injury cycle.
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J Burn Care Rehabil · May 1992
Improvements in rheologic properties of blood by fluid resuscitation after burn injury in rats.
Severe burn injury impairs tissue perfusion both by adversely altering the rheologic properties of blood and by decreasing circulating blood volume. Although resuscitation is known to improve perfusion by increasing whole blood volume, it is possible that it may also improve blood flow. To assess these latter effects of resuscitation after burn injury, we studied several determinants of blood flow. ⋯ Finally, the decrease in red blood cell membrane deformability that is associated with burn injury was improved by resuscitation, although it never completely returned to normal. These results demonstrate beneficial effects of fluid resuscitation on rheologic properties of blood after burn injury. Restoration of blood flow to tissue by resuscitation after burn injury may be due to improved blood rheology as well as to intravascular volume loading.