La Revue du praticien
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Burn rehabilitation main goal is to minimize the consequences of hypertrophic scars and concomitant contractures. The treatment principles rely on the association of joint posture, continuous pressure completed with range of motion to prevent joint fusion (which happens to adults but not to children). Throughout the different treatment phases and wound evolution, reassessment is necessary to review rehabilitation goals and activities. ⋯ The treatment consists mainly on active/passive range of motion, scar massage, strengthening exercise and endurance retraining. Also modalities (such as thermal bath and high pressure water spray) are used to address itching problems and for scar softening. Finally, reconstructive surgery can be performed to correct excessive scarring or joint contracture for better functional or cosmetic outcome.
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Severely burned patients are at high risk for developing respiratory failure at any time during their treatment. The lung of a thermally injured patient may sustain many injuries such as smoke inhalation, physical forces, inflammation and infection. ⋯ The respiratory injuries are one of the main factors responsible for high mortality in burned patients. Better understanding of the pathophysiology and inflammatory response will lead to future therapeutic advances.
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First cares of burned patients depend of an accurate evaluation of the injury severity. Total body surface area burned can be estimated taking into account the fact that the area of one hand face is equivalent to 1% of the total body surface (TBS) of the individual. Second-degree burns are characterized by the occurrence of phlyctena, third-degree burns appear like adhering necrosis without any sensibility. ⋯ The emergency medical care consists in securing respiratory function, and, as early as possible, in beginning perfusions of Ringer Lactate Lavoisier exceeding 20 mL/kg during the first post-burn hours for patient suffering of burns exceeding 10% of the total body area. Pain must be controlled using preferentially morphine or related products. Transport to the specialized unit, in case of severe injury, will be performed assuring thermal comfort, wound protection and vital function monitoring.
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In 2002, the organisation of burn care is confronted to a great deficiency in burn epidemiological datas. The main mechanisms of hospitalized burns are somehow wellknown in industrialized countries: about 60% scalds and 30% flame burns; as well as the place of occurrence (60% at home, and 20% at work), and the risk groups (3 times more important for the age group 0-4 years old). ⋯ The statistics of Diagnosis Related Groups (DRG), for hospitalized patients will allow in France very shortly to know more about the most rational ways of dispatching and treating them. They already show that only 30% of hospitalized burned patients are treated in specialized facilities.