The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Mar 1990
Smoke inhalation and airway management at a regional burn unit: 1974 to 1983. II. Airway management.
According to criteria established to define patients with smoke inhalation, the airway management of all victims of smoke and burns (1974 to 1984; n = 805) was reviewed. Fourteen percent of all patients were intubated (n = 117); patients intubated on the day of injury (n = 41) were more likely to extubate themselves or have technical problems with the endotracheal tube. Twelve percent of patients with smoke inhalation without burns required endotracheal intubation versus 62% of those with burns. ⋯ The prolonged length of stay for patients with a tracheotomy relates to the severity of the burn. Tracheotomy was not the cause of death in any patient. The strategy of grafting the neck before tracheotomy was used successfully in eight patients.
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One hundred burn care facilities in the United States were surveyed to determine the present use of hydrotherapy in burn care. It was found that 92% of the burn units that were polled practice this treatment in some form. ⋯ In most of these facilities, nurses perform the procedure. Although immersion therapy continues to play an important role in most burn care facilities, spray or shower techniques are also incorporated into many programs.
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Obesity is seldom recognized as a risk factor for the patient with burns. However, the overweight patient with burns presents major problems for the burn team, especially in the areas of wound care, pulmonary care, and general nursing care. One-hundred eighty adults (9.1% weighed more than 45 kg above ideal body weight or more than 100 kg in total weight. ⋯ The obese patient presents problems disproportionate to burn size, burn location, and age. The obese patient's problems are related to weight. Care is often compromised by the physical constraints of a patient's size.
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J Burn Care Rehabil · Jan 1990
Review Case ReportsBranhamella catarrhalis pneumonia with bacteremia in a pediatric patient with smoke inhalation.
Branhamella catarrhalis, a common inhabitant of the upper respiratory tract, has been identified recently as a cause of lower airway infection. In this report we present a case of B. catarrhalis pneumonia and bacteremia in a child with smoke inhalation as the first description of invasive disease involving this organism in a traumatized airway. In addition, other pediatric cases of B. catarrhalis bacteremia are reviewed, suggesting immunocompromise as a risk factor.
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A review of 1987 patients treated during the years 1981 to 1986 was conducted to answer the following questions about perineal burns: (1) Are Foley catheters necessary for all patients? (2) Is there any advantage to early excision of the perineal burn wound? (3) What are the complications of perineal wounds? One hundred three patients with perineal burns were identified; mean burn size was 36% of total body surface area. There were 29 deaths in this group but none were related to the perineal burns. Of the 74 survivors 36 (49%) needed Foley catheters. ⋯ In conclusion, we found no genitourinary complications associated with perineal burns. Almost all perineal and genital burns were managed without indwelling catheters. Early excision of the perineal burn wound is not necessary, and most of these wounds will heal satisfactorily without grafting.