Clinics in plastic surgery
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A successful outcome to the management of the significantly burned patient requires a team approach. Although at one time survival alone was considered a sufficient indicator of success, the quality of that survival now must be closely assessed prior to self-congratulations. The burn team, in addition to the usual medical personnel, requires occupational and physical therapy, as well as rehabilitation medical specialists, whose goals are to preserve function and restore independence. Burn care that does not emphasize these goals from the first day of injury, and extended well beyond initial discharge from the hospital, does not match contemporary standards of excellent care.
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The key to successful fluid resuscitation of the thermally injured patient is close monitoring of the clinical response. Individualized resuscitation based on the parameters described allows for approximation of this goal. ⋯ The goals of fluid resuscitation have been summarized and a variety of formulas have been described. We anticipate that our understanding of patient subsets outlined in this paper will undergo further evolution.
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The vast majority of respiratory disorders in thermally injured patients arise from associated inhalation injuries. The major forms of these injuries are carbon monoxide poisoning, injury to the upper airway, and pulmonary parenchymal damage. One hundred per cent oxygen, initiated at the scene of the accident, is the single most effective treatment of carbon monoxide toxicity, which must be assessed by carboxyhemoglobin determinations. ⋯ The compromised airway is protected by tracheal intubation, and respiratory failure is treated with assisted ventilation and supplemental oxygen. Pulmonary infection requires specific antibiotics based on isolated organisms and their sensitivities to antimicrobials. The upper respiratory tract of patients requiring long-term intubation should be assessed by fiberoptic bronchoscopy and other modalities to prevent fatal late airway occlusion.
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Burn injuries are common in children. In this article, the epidemiology, initial resuscitation, nutritional management, and wound management of pediatric burn injuries are reviewed with emphasis on the special problems of children.
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Burn wounds require coverage for healing to occur. Many techniques have been utilized to achieve such a closed wound, including biologic dressings, autologous skin, and skin substitutes. These and other methods are discussed.