The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1989
Randomized Controlled Trial Clinical TrialA randomized trial of plasma exchange in the treatment of burn shock.
Hypovolemia following major thermal injury results from increased capillary permeability with subsequent loss of fluid into the interstitium. Investigations of burn shock have demonstrated the release of circulating factors that effect these fluid shifts. Previous studies have suggested that this process can be altered by the performance of plasma exchange in patients who fail to respond to conventional resuscitation. ⋯ There was no difference in the total amount of fluid required to achieve resuscitation. The mean urine output during resuscitation was greater for the plasma exchange group (p less than 0.01). Performance of plasma exchange during the second 8-hour period after the burn did not alter the course of burn shock in this study group.
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J Burn Care Rehabil · Jan 1989
Comparative StudyHetastarch: an alternative colloid in burn shock management.
Hetastarch is a synthetic polysaccharide colloid that has been used clinically in the management of multiple trauma, hypovolemic shock, and postoperative cardiac patients. Our objective was to determine whether hetastarch is a safe alternative to blood products in burn shock resuscitation. Twenty-six patients received hetastarch during the colloid phase of resuscitation and were compared to matched historical controls who received either albumin or fresh frozen plasma. ⋯ There was no significant difference in hemodynamics, respiratory status, incidence of bleeding, or renal or liver function among the three colloid groups. The advantages of hetastarch include immediate availability, no dependence on human blood donor population, no risk of serum-transmitted diseases, and lower cost. It can be safely recommended for those patients who object to blood products for resuscitation, in those situations where human donors are few, and when cost is a consideration.
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J Burn Care Rehabil · Jan 1989
The use of the bone curet in debridement of the burn wound and graft recipient sites.
We describe the use of the simple bone curet for the purpose of scraping and debriding partial-thickness burn wounds and other chronic wounds encountered by the burn surgeon before autograft placement. In our experience the instrument allows more efficient and safer operating room debridement than does the standard scalpel blade.
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J Burn Care Rehabil · Jan 1989
Registered nurses and burn care facilities. Factors associated with turnover rates.
The health care system in the United States is suffering from a severe shortage of registered nurses. Burn treatment facilities are no exception to this phenomenon. ⋯ The purpose of this paper is to determine the magnitude of the registered nurse shortage in burn care facilities. A second purpose is to identify factors associated with high turnover rates and to document the reasons why registered burn nurses are leaving their positions.
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J Burn Care Rehabil · Nov 1988
The epidemiology of methicillin-resistant Staphylococcus aureus in a burn center.
The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in a critical care facility creates a multifaceted epidemiological problem in uncovering the source of infection. This study was undertaken to determine the true etiology of MRSA burn wound infections. Patients with a 30% or greater TBSA burn had both burned and unburned skin surface cultured upon admission, using RODAC plates. ⋯ However, the remaining 42.9% of the patients had methicillin-sensitive, B-lactamase positive staphylococci present on admission. Isolates of group D streptococci resistant to methicillin were isolated in 35.7% of the patients. This data suggests that burn wound infections caused by MRSA very likely arise from the endogenous flora present at the time of injury through conferring the resistant plasmid by conjugational transfer.