The Surgical clinics of North America
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Burn injury affects all facets of life. Burn care has improved over time. ⋯ Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns based on their ability to reintegrate into their normal physical, social, psychological, and functional activities. Burn outcomes will continue to develop on the foundation that has been built and will generate evidence-based best practices in the future.
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Surg. Clin. North Am. · Aug 2014
ReviewInitial assessment and fluid resuscitation of burn patients.
For the physician or surgeon practicing outside the confines of a burn center, initial assessment and fluid resuscitation will encompass most of his or her exposure to patients with severe burns. The importance of this phase of care should not be underestimated. This article provides a review of how to perform initial resuscitation of patients with significant burns and/or inhalation injury, while arranging for transfer to a regional burn center.
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Marked expansion of physiologic understanding and the improvement of burn patient outcomes have resulted from multidisciplinary clinical/laboratory research programs at burn centers in the United States and elsewhere.
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Surg. Clin. North Am. · Aug 2014
ReviewBiology and principles of scar management and burn reconstruction.
Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. ⋯ All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program.
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Burn patients provide numerous challenges to the anesthesiologist. It is important to understand the multiple physiologic disruptions that follow a burn injury as well as the alterations in pharmacokinetics and pharmacodynamics of commonly used anesthetics. Thought must be given to surgery during initial fluid resuscitation and the airway challenges many of these patients present. Finally, the central role of pain management through all phases of care is a constant concern.