- •Preface
- •List of contributers
- •History, epidemiology, prevention and education
- •A history of burn care
- •“Black sheep in surgical wards”
- •Toxaemia, plasmarrhea, or infection?
- •The Guinea Pig Club
- •Burns and sulfa drugs at Pearl Harbor
- •Burn center concept
- •Shock and resuscitation
- •Wound care and infection
- •Burn surgery
- •Inhalation injury and pulmonary care
- •Nutrition and the “Universal Trauma Model”
- •Rehabilitation
- •Conclusions
- •References
- •Epidemiology and prevention of burns throughout the world
- •Introduction
- •Epidemiology
- •The inequitable distribution of burns
- •Cost by age
- •Cost by mechanism
- •Limitations of data
- •Risk factors
- •Socioeconomic factors
- •Race and ethnicity
- •Age-related factors: children
- •Age-related factors: the elderly
- •Regional factors
- •Gender-related factors
- •Intent
- •Comorbidity
- •Agents
- •Non-electric domestic appliances
- •War, mass casualties, and terrorism
- •Interventions
- •Smoke detectors
- •Residential sprinklers
- •Hot water temperature regulation
- •Lamps and stoves
- •Fireworks legislation
- •Fire-safe cigarettes
- •Children’s sleepwear
- •Acid assaults
- •Burn care systems
- •Role of the World Health Organization
- •Conclusions and recommendations
- •Surveillance
- •Smoke alarms
- •Gender inequality
- •Community surveys
- •Acknowledgements
- •References
- •Prevention of burn injuries
- •Introduction
- •Burns prevalence and relevance
- •Burn injury risk factors
- •WHERE?
- •Burn prevention types
- •Burn prevention: The basics to design a plan
- •Flame burns
- •Prevention of scald burns
- •Conclusions
- •References
- •Burns associated with wars and disasters
- •Introduction
- •Wartime burns
- •Epidemiology of burns sustained during combat operations
- •Fluid resuscitation and initial burn care in theater
- •Evacuation of thermally-injured combat casualties
- •Care of host-nation burn patients
- •Disaster-related burns
- •Epidemiology
- •Treatment of disaster-related burns
- •The American Burn Association (ABA) disaster management plan
- •Summary
- •References
- •Education in burns
- •Introduction
- •Surgical education
- •Background
- •Simulation
- •Education in the internet era
- •Rotations as courses
- •Mentorship
- •Peer mentorship
- •Hierarchical mentorship
- •What is a mentor
- •Implementation
- •Interprofessional education
- •What is interprofessional education
- •Approaches to interprofessional education
- •References
- •European practice guidelines for burn care: Minimum level of burn care provision in Europe
- •Foreword
- •Background
- •Introduction
- •Burn injury and burn care in general
- •Conclusion
- •References
- •Pre-hospital and initial management of burns
- •Introduction
- •Modern care
- •Early management
- •At the accident
- •At a local hospital – stabilization prior to transport to the Burn Center
- •Transportation
- •References
- •Medical documentation of burn injuries
- •Introduction
- •Medical documentation of burn injuries
- •Contents of an up-to-date burns registry
- •Shortcomings in existing documentation systems designs
- •Burn depth
- •Burn depth as a dynamic process
- •Non-clinical methods to classify burn depth
- •Burn extent
- •Basic principles of determining the burn extent
- •Methods to determine burn extent
- •Computer aided three-dimensional documentation systems
- •Methods used by BurnCase 3D
- •Creating a comparable international database
- •Results
- •Conclusion
- •Financing and accomplishment
- •References
- •Pathophysiology of burn injury
- •Introduction
- •Local changes
- •Burn depth
- •Burn size
- •Systemic changes
- •Hypovolemia and rapid edema formation
- •Altered cellular membranes and cellular edema
- •Mediators of burn injury
- •Hemodynamic consequences of acute burns
- •Hypermetabolic response to burn injury
- •Glucose metabolism
- •Myocardial dysfunction
- •Effects on the renal system
- •Effects on the gastrointestinal system
- •Effects on the immune system
- •Summary and conclusion
- •References
- •Anesthesia for patients with acute burn injuries
- •Introduction
- •Preoperative evaluation
- •Monitors
- •Pharmacology
- •Postoperative care
- •References
- •Diagnosis and management of inhalation injury
- •Introduction
- •Effects of inhaled gases
- •Carbon monoxide
- •Cyanide toxicity
- •Upper airway injury
- •Lower airway injury
- •Diagnosis
- •Resuscitation after inhalation injury
- •Other treatment issues
- •Prognosis
- •Conclusions
- •References
- •Respiratory management
- •Airway management
- •(a) Endotracheal intubation
- •(b) Elective tracheostomy
- •Chest escharotomy
- •Conventional mechanical ventilation
- •Introduction
- •Pathophysiological principles
- •Low tidal volume and limited plateau pressure approaches
- •Permissive hypercapnia
- •The open-lung approach
- •PEEP
- •Lung recruitment maneuvers
- •Unconventional mechanical ventilation strategies
- •High-frequency percussive ventilation (HFPV)
- •High-frequency oscillatory ventilation
- •Airway pressure release ventilation (APRV)
- •Ventilator associated pneumonia (VAP)
- •(a) Prevention
- •(b) Treatment
- •References
- •Organ responses and organ support
- •Introduction
- •Burn shock and resuscitation
- •Post-burn hypermetabolism
- •Individual organ systems
- •Central nervous system
- •Peripheral nervous system
- •Pulmonary
- •Cardiovascular
- •Renal
- •Gastrointestinal tract
- •Conclusion
- •References
- •Critical care of thermally injured patient
- •Introduction
- •Oxidative stress control strategies
- •Fluid and cardiovascular management beyond 24 hours
- •Other organ function/dysfunction and support
- •The nervous system
- •Respiratory system and inhalation injury
- •Renal failure and renal replacement therapy
- •Gastro-intestinal system
- •Glucose control
- •Endocrine changes
- •Stress response (Fig. 2)
- •Low T3 syndrome
- •Gonadal depression
- •Thermal regulation
- •Metabolic modulation
- •Propranolol
- •Oxandrolone
- •Recombinant human growth hormone
- •Insulin
- •Electrolyte disorders
- •Sodium
- •Chloride
- •Calcium, phosphate and magnesium
- •Calcium
- •Bone demineralization and osteoporosis
- •Micronutrients and antioxidants
- •Thrombosis prophylaxis
- •Conclusion
- •References
- •Treatment of infection in burns
- •Introduction
- •Clinical management strategies
- •Pathophysiology of the burn wound
- •Burn wound infection
- •Cellulitis
- •Impetigo
- •Catheter related infections
- •Urinary tract infection
- •Tracheobronchitis
- •Pneumonia
- •Sepsis in the burn patient
- •The microbiology of burn wound infection
- •Sources of organisms
- •Gram-positive organisms
- •Gram-negative organisms
- •Infection control
- •Pharmacological considerations in the treatment of burn infections
- •Topical antimicrobial treatment
- •Systemic antimicrobial treatment (Table 3)
- •Gram-positive bacterial infections
- •Enterococcal bacterial infections
- •Gram-negative bacterial infections
- •Treatment of yeast and fungal infections
- •The Polyenes (Amphotericin B)
- •Azole antifungals
- •Echinocandin antifungals
- •Nucleoside analog antifungal (Flucytosine)
- •Conclusion
- •References
- •Acute treatment of severely burned pediatric patients
- •Introduction
- •Initial management of the burned child
- •Fluid resuscitation
- •Sepsis
- •Inhalation injury
- •Burn wound excision
- •Burn wound coverage
- •Metabolic response and nutritional support
- •Modulation of the hormonal and endocrine response
- •Recombinant human growth hormone
- •Insulin-like growth factor
- •Oxandrolone
- •Propranolol
- •Glucose control
- •Insulin
- •Metformin
- •Novel therapeutic options
- •Long-term responses
- •Conclusion
- •References
- •Adult burn management
- •Introduction
- •Epidemiology and aetiology
- •Pathophysiology
- •Assessment of the burn wound
- •Depth of burn
- •Size of the burn
- •Initial management of the burn wound
- •First aid
- •Burn blisters
- •Escharotomy
- •General care of the adult burn patient
- •Biological/Semi biological dressings
- •Topical antimicrobials
- •Biological dressings
- •Other dressings
- •Exposure
- •Deep partial thickness wound
- •Total wound excision
- •Serial wound excision and conservative management
- •Full thickness burns
- •Excision and autografting
- •Topical antimicrobials
- •Large full thickness burns
- •Serial excision
- •Mixed depth burn
- •Donor sites
- •Techniques of wound excision
- •Blood loss
- •Antibiotics
- •Anatomical considerations
- •Skin replacement
- •Autograft
- •Allograft
- •Other skin replacements
- •Cultured skin substitutes
- •Skin graft take
- •Rehabilitation and outcome
- •Future care
- •References
- •Burns in older adults
- •Introduction
- •Burn injury epidemiology
- •Pathophysiologic changes and implications for burn therapy
- •Aging
- •Comorbidities
- •Acute management challenges
- •Fluid resuscitation
- •Burn excision
- •Pain and sedation
- •End of life decisions
- •Summary of key points and recommendations
- •References
- •Acute management of facial burns
- •Introduction
- •Anatomy and pathophysiology
- •Management
- •General approach
- •Airway management
- •Facial burn wound management
- •Initial wound care
- •Topical agents
- •Biological dressings
- •Surgical burn wound excision of the face
- •Wound closure
- •Special areas and adjacent of the face
- •Eyelids
- •Nose and ears
- •Lips
- •Scalp
- •The neck
- •Catastrophic injury
- •Post healing rehabilitation and scar management
- •Outcome and reconstruction
- •Summary
- •References
- •Hand burns
- •Introduction
- •Initial evaluation and history
- •Initial wound management
- •Escharotomy and fasciotomy
- •Surgical management: Early excision and grafting
- •Skin substitutes
- •Amputation
- •Hand therapy
- •Secondary reconstruction
- •References
- •Treatment of burns – established and novel technology
- •Introduction
- •Partial thickness burns
- •Biological membranes – amnion and others
- •Xenograft
- •Full thickness burns
- •Dermal analogs
- •Keratinocyte coverage
- •Facial transplantation
- •Tissue engineering and stem cells
- •Gene therapy and growth factors
- •Conclusion
- •References
- •Wound healing
- •History of wound care
- •Types of wounds
- •Mechanisms of wound healing
- •Hemostasis
- •Proliferation
- •Epithelialization
- •Remodeling
- •Fetal wound healing
- •Stem cells
- •Abnormal wound healing
- •Impaired wound healing
- •Hypertrophic scars and keloids
- •Chronic non-healing wounds
- •Conclusions
- •References
- •Pain management after burn trauma
- •Introduction
- •Pathophysiology of pain after burn injuries
- •Nociceptive pain
- •Neuropathic pain
- •Sympathetically Maintained Pain (SMP)
- •Pain rating and documentation
- •Pain management and analgesics
- •Pharmacokinetics in severe burns
- •Form of administration [21]
- •Non-opioids (Table 1)
- •Paracetamol
- •Metamizole
- •Non-steroidal antirheumatics (NSAID)
- •Selective cyclooxygenasis-2-inhibitors
- •Opioids (Table 2)
- •Weak opioids
- •Strong opioids
- •Other analgesics
- •Ketamine (see also intensive care unit and analgosedation)
- •Anticonvulsants (Gabapentin and Pregabalin)
- •Antidepressants with analgesic effects
- •Regional anesthesia
- •Pain management without analgesics
- •Adequate communication
- •Psychological techniques [65]
- •Transcutaneous electrical nerve stimulation (TENS)
- •Particularities of burn pain
- •Wound pain
- •Breakthrough pain
- •Intervention-induced pain
- •Necrosectomy and skin grafting
- •Dressing change of large burn wounds and removal of clamps in skin grafts
- •Dressing change in smaller burn wounds, baths and physical therapy
- •Postoperative pain
- •Mental aspects
- •Intensive care unit
- •Opioid-induced hyperalgesia and opioid tolerance
- •Hypermetabolism
- •Psychic stress factors
- •Risk of infection
- •Monitoring [92]
- •Sedation monitoring
- •Analgesia monitoring (see Fig. 2)
- •Analgosedation (Table 3)
- •Sedation
- •Analgesia
- •References
- •Nutrition support for the burn patient
- •Background
- •Case presentation
- •Patient selection: Timing and route of nutritional support
- •Determining nutritional demands
- •What is an appropriate initial nutrition plan for this patient?
- •Formulations for nutritional support
- •Monitoring nutrition support
- •Optimal monitoring of nutritional status
- •Problems and complications of nutritional support
- •Conclusion
- •References
- •HBO and burns
- •Historical development
- •Contraindications for the use of HBO
- •Conclusion
- •References
- •Nursing management of the burn-injured person
- •Introduction
- •Incidence
- •Prevention
- •Pathophysiology
- •Severity factors
- •Local damage
- •Fluid and electrolyte shifts
- •Cardiovascular, gastrointestinal and renal system manifestations
- •Types of burn injuries
- •Thermal
- •Chemical
- •Electrical
- •Smoke and inhalation injury
- •Clinical manifestations
- •Subjective symptoms
- •Possible complications
- •Clinical management
- •Non-surgical care
- •Surgical care
- •Coordination of care: Burn nursing’s unique role
- •Nursing interventions: Emergent phase
- •Nursing interventions: Acute phase
- •Nursing interventions: Rehabilitative phase
- •Ongoing care
- •Infection prevention and control
- •Rehabilitation medicine
- •Nutrition
- •Pharmacology
- •Conclusion
- •References
- •Outpatient burn care
- •Introduction
- •Epidemiology
- •Accident causes
- •Care structures
- •Indications for inpatient treatment
- •Patient age
- •Total burned body surface area (TBSA)
- •Depth of the burn
- •Pre-existing conditions
- •Accompanying injuries
- •Special injuries
- •Treatment
- •Initial treatment
- •Pain therapy
- •Local treatment
- •Course of treatment
- •Complications
- •Infections
- •Follow-up care
- •References
- •Non-thermal burns
- •Electrical injury
- •Introduction
- •Pathophysiology
- •Initial assessment and acute care
- •Wound care
- •Diagnosis
- •Low voltage injuries
- •Lightning injuries
- •Complications
- •References
- •Symptoms, diagnosis and treatment of chemical burns
- •Chemical burns
- •Decontamination
- •Affection of different organ systems
- •Respiratory tract
- •Gastrointestinal tract
- •Hematological signs
- •Nephrologic symptoms
- •Skin
- •Nitric acid
- •Sulfuric acid
- •Caustic soda
- •Phenol
- •Summary
- •References
- •Necrotizing and exfoliative diseases of the skin
- •Introduction
- •Necrotizing diseases of the skin
- •Cellulitis
- •Staphylococcal scalded skin syndrome
- •Autoimmune blistering diseases
- •Epidermolysis bullosa acquisita
- •Necrotizing fasciitis
- •Purpura fulminans
- •Exfoliative diseases of the skin
- •Stevens-Johnson syndrome
- •Toxic epidermal necrolysis
- •Conclusion
- •References
- •Frostbite
- •Mechanism
- •Risk factors
- •Causes
- •Diagnosis
- •Treatment
- •Rewarming
- •Surgery
- •Sympathectomy
- •Vasodilators
- •Escharotomy and fasciotomy
- •Prognosis
- •Research
- •References
- •Subject index
A. Arno, J. Knighton
Prevention of contact burns
Contact burns, as well as chemical burns, can be avoided by adopting appropriate preventive measures. In developed countries, contact burns from the use of gas-fire places, domestic central heating radiators, irons and ovens have been identified. The surface temperature of the glass front on gas fireplace units can reach 200 °C, on average 6.5 minutes after ignition. A full-thickness burn may occur in less than 1 second with this temperature, and these contact burns can occur in both adults and children (Table 12). In toddlers and preschool children, domestic heating devices located too close to their beds have been found to be responsible for many hand contact burns.
to the female end of the extension cord to prevent injuries.
In some developing and western-world countries, thieves can also suffer electrical burns during their attempts to steal the cupper wire.
In Korea, people eat using steel – not plastic or wood – chopsticks; children may insert the steel chopsticks into the wall socket, producing severe pediatric electrical burns. To prevent such injuries, they could be encouraged to use wooden chopsticks.
Lightning is a form of direct electrical current that kills approximately one hundred people each year in the US. Lightning injuries can be avoided by leaving the area or seeking shelter when a storm approaches.
Prevention of chemical burns |
Conclusions |
Chemicals, used in the home, should be locked away and rendered inaccessible to children. All chemicals should be stored in their original containers. The Occupational Safety and Health Administration (OSHA) regulations require eyewash stations and showers in all facilities that use potentially injurious chemical products to allow for instant and copious irrigation following exposure.
Prevention of electrical burns
Electrical injuries can be prevented by strict adherence to safety rules regarding household wiring, electrical outlets and appliance cords. The majority of high-voltage electrical injuries occur at work and may be fatal or lead to devastating sequelae such as amputations. In addition, bystanders are at risk for injury and should never touch someone, who is in direct contact with electricity until the current has been shut off. In the case of children, when the regional resistance (wet mouth) is low and the peripheral resistance is high (e. g. an ungrounded foot), then an oral burn results, but if this latter is also low (e. g. a grounded foot or hand), then electrocution results. Prevention must be directed to the female end of the extension cord. In 1976, the “Crikelair protective cuff” was described in the scientific literature; it consists of a plastic, transparent and non-conductive cuff which attacks
Although burns constitute a small number of casualties, they consume a disproportionate amount of resources and require specialized care. More importantly, burns are traumatic injuries with potentially chronic and devastating physical, mental and social sequelae, which occur in individuals who are less able to protect and care for themselves, such as children, the elderly or people under the effect of drugs or who have mental health concerns.
The vast majority of burns occur in the developing world, who do not have the same resources to care for these burn patients. Further, the victims in those countries are often amongst the poorest and most vulnerable. Most of the advances in burn prevention, care and recovery have been incompletely applied to the developing world. In order to ameliorate that, international support – such as that developed by the WHO (World Health Organization) and ISBI (International Society of Burn Injuries) – is strongly needed.
Burns are preventable and prevention should continue to be as important as proper treatment. Burn prevention campaigns should include active, as well as, passive tools, including education (with a focus on behavioural changes to be truly effective), product safety improvements and legislation. Prevention programmes should be population-specific and address the different risk factors, including age, gender, geography, comorbidities, culture and trad-
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Prevention of burn injuries
itions. More accurate worldwide epidemiologic registries would be helpful in tracking the efficacy of programmes, with a goal of reducing burn injuries to lower levels than exist at currently.
References
[1]Atiyeh BS, Costagliola M, Hayek SN (2009) Burn prevention mechanisms and outcomes: Pitfalls, failures and successes. Burns 35: 181–193
[2]Al-Quattan MM, Al-Zahrani K (2009) A review of burns related to traditions, social habits, religious activities, festivals and traditioal medicinal practices. Burns 35: 476–481
[3]Prasad Sarma B (2011) Prevention of burns: 13 years’ experience in Northeastern India. Burns 37: 257–264
[4]Patil SB, Anil Kahre N, Jaiswal S et al (2010) Changing patterns in electrical burn injuries in a developing country: Should prevention programs focus on the rural population? J Burn Care Res 31: 931–934
[5]Taira BR, Cassara G PA, Meng H et al (2011) Predictors of sustaining burn injury: Does the use of common prevention strategies matter? J Burn Care Res 32: 20–25
[6]Crickelair GF, Dhaliwal AS (1976) The cause and prevention of electrical burns of the mouth in children: A protective cuff. PRS 58(2): 206–209
[7]Rimmer RB, Weigand S, Foster KN et al (2008) Scald burns in young children: A review of Arizona burn center pediatric patients and a proposal for prevention in the Hispanic community. J Burn Care Res 29: 595–605
[8]Kendrick D, Smith S, Sutton AG et al (2009) The effect of education and home safety equipment on childhood thermal injury prevention: meta-analysis and metaregression. Inj Prev 15: 197–204
[9]Abeyasundara SL, Rajan V, Lam L et al (2011) The changing pattern of pediatric burns. J Burn Care Res
32:178–184
[10]Parbhoo A, Louw QA, Grimmer-Somers K (2010) Burn prevention programs for children in developing countries require urgent attention: A targeted literature review. Burns 36: 164–175
[11]ABA (2011) Fire and Burn prevention news. March; 6(1): 1–5
[12]Hunt JL, Arnoldo BD, Purdue GF (2007) Prevention of burn injuries. In: Herndon DN (ed) Total burn care. Saunders Elsevier, Galveston, pp 33–39
[13]Light TD, Latenser BA, Heinle JA et al (2009) Jaggery: An avoidable cause of severe, deadly pediatric burns. Burns 35: 430–432
[14]WHO (2008) A WHO plan for burn prevention and care. WHO, Geneva
[15]Roeder RA, Schulman CI (2010) An overview of warrelated thermal injuries. J Craniofac Surg 21(4): 971–75
[16]Brusselaers N, Monstrey S, Vogelaers D et al (2010) Severe burn injury in Europe: A systematic review of the incidence, etiology, morbidity and mortality. Crit Care
14:R188
[17]Wisee RPL, Bijlsma WE, Stilma JS (2010) Ocular fireworktrauma:Asystematicreviewonincidence,severity, outcome and prevention. Br J Ophthalmol 94: 1586–91
[18]Thompson RM, Carrougher GJ (1998) Burn prevention. In: Carrougher GJ (ed) Burn care and therapy. Mosby,St. Louis, pp 497–524
[19]Neaman KC, DO VH, Olenzek EK et al (2010) Outdoor recreational fires: A review of 329 adult and pediatric patients. J Burn Care Res 31: 926–930
Correspondence: A. Arno, M.D., Burn Unit and Plastic Surgery Department, Vall d’Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d’Hebron 119–129, 08035, Barcelona, Spain, E-mail: aiarno@vhebron.net
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