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Essential
Burn Care
forNon-Burn
Specialists
JongO.Lee
Editor
123
Essential Burn Care
for Non- Burn Specialists
Jong O. Lee
Editor
Essential Burn Care
for Non-Burn Specialists
Editor
Jong O. Lee
Department of Surgery
University of Texas Medical Branch
Galveston, TX, USA
ISBN 978-3-031-28897-5 ISBN 978-3-031-28898-2 (eBook)
https://doi.org/10.1007/978-3-031-28898-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by
the Publisher, whether the whole or part of the material is concerned, specically
the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microlms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or
by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specic
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral
with regard to jurisdictional claims in published maps and institutional
afliations.
This Springer imprint is published by the registered company Springer
Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To my mom and dad, Kwang
and Ik.
To my sister, Amanda, and
nephews, Trent and Andrew.
For their love and support.
To my mentors Drs. Richard
Moore and David Herndon.
For their encouragement.
Contents
1 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Barclay T. Stewart
2 Pathophysiology and Hypermetabolic
Response to Burn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Roohi Vinaik, Dalia Barayan,
and Marc G. Jeschke
3 Initial Assessment of Burn Patient . . . . . . . . . . . . . . . . 85
Matthew A. DePamphilis and Robert L. Sheridan
4 Initial Management and Resuscitation . . . . . . . . . . . . 113
Leopoldo C. Cancio and Jill M. Cancio
5 Inhalation Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Axel Rodriguez and Alexis McQuitty
6 Burn Wound Management . . . . . . . . . . . . . . . . . . . . . . 167
Paige J. South, Deepak K. Ozhathil,
Amina El Ayadi, and Steven E. Wolf
7 Treatment of Facial Burns . . . . . . . . . . . . . . . . . . . . . . . 181
Alen Palackic, Robert P. Duggan, Rahul Shah,
Jong O. Lee, and Ludwik K. Branski
8 Treatment of Hand Burns . . . . . . . . . . . . . . . . . . . . . . . 197
Tina L. Palmieri
9 Burn Wound Infection . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Joseph E. Marcus, Kevin K. Chung,
and Dana M. Blyth
viii
Contents
10 Pediatric Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Eric S. Ruff, Nikhil R. Shah,
Ramon L. Zapata-Sirvent, and Jong O. Lee
11 Elderly Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Robyn Richmond and Sharmila Dissanaike
12 Electrical Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267
Manrique Guerrero, Casey Kohler,
and Brett Arnoldo
13 Chemical Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285
Henry B. Huson and Herb A. Phelan
14 ICU Care of Burn Patients . . . . . . . . . . . . . . . . . . . . . .301
Molly Hunter and David T. Harrington
15 Pain Management in Burn Patients . . . . . . . . . . . . . . . 315
Jordan B. Starr, Paul I. Bhalla, and Sam R. Sharar
16 Outpatient Burn Care . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Barclay T. Stewart and Nicole S. Gibran
17 Telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Lauren B. Nosanov and Amalia Cochran
18 Burn Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383
Wendy Y. Rockne, Victor C. Joe,
and James C. Jeng
19 Exfoliative Skin Diseases: Stevens-Johnson
Syndrome and Toxic Epidermal Necrolysis . . . . . . . . .405
Felicia N. Williams and Jong O. Lee
20 Burn Scar and Contracture Management . . . . . . . . . . 415
Jorge Leon-Villapalos, David Zergaran,
and Tom Calderbank
21 Burn Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Lynne Benavides, Betsey Ferreira,
Oscar E. Suman, and Jeffrey C. Schneider
22 Anesthesia for Burn Patients . . . . . . . . . . . . . . . . . . . . 449
Jamie L. Sparling and J. A. Jeevendra Martyn
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479
Chapter 1
Epidemiology
BarclayT.Stewart
Burden ofDisease
In the absence of systematic injury data collection and
minimal burn injury surveillance activities, much of the data
available to estimate the burden of burn injuries or temporal
trends has been gathered through hospital registries, police
and fire service reports, mortuary reports, and isolated representative, community-based surveys. Each of these modalities
for data collection has specific strengths and limitations
regarding ability to detect injuries and fatalities, bias related
to differential abilities to access care, and infrastructure
requirements. As a result, the patchwork of data available
makes it difficult to accurately, comprehensively, and
longitudinally describe the burden of burn injuries globally.
Several key definitions and concepts provided in Table 1.1
might be useful prior to reading this chapter and considering
how you might use epidemiological information to reduce the
burden of burn injuries in your region.
B. T. Stewart (*)
Division of Trauma, Burn and Critical Care Surgery, UW Medicine
Regional Burn Center, University of Washington, Harborview
Medical Center, Seattle, WA, USA
e-mail: barclays@uw.edu
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
J. O. Lee (ed.), Essential Burn Care for Non-Burn Specialists,
https://doi.org/10.1007/978-3-031-28898-2_1
1
2
B. T. Stewart
T .
Key denitions and concepts to promote understanding
and use of epidemiological data to reduce the burden of burn injuries locally and regionally
Term Definition or concept
Incidence Rate of occurrence of a condition or injury (e.g.,
new cases) measured as number per numberat- risk per unit time (e.g., 10 burns per 1,000
children per year).
Prevalence Proportion of a population who have a specific
characteristic in a given time period.
Active
surveillance
A system that tasks staff members to regularly
contact emergency care systems, health care
providers, or populations to seek information
about burns. Active surveillance provides more
accurate and timely information, but it is also
expensive and resource intensive.
Passive
surveillance
A system by which a health jurisdiction receives
reports submitted from emergency care services,
hospitals, clinics, public health units, mortuaries, or
other sources. Passive surveillance is a relatively
inexpensive strategy to cover large areas, and it
provides critical information for monitoring a
community's health. However, because passive
surveillance depends on people in different
institutions to provide data, data quality and
timeliness are difficult to control. Additionally, the
data are skewed toward populations with fewer
barriers to care.
Integrated
surveillance
A combination of active and passive systems that
use a single infrastructure to gather information
about multiple conditions, injuries, or behaviors.
(continued)
Chapter 1. Epidemiology
T . (continued)
Term Definition or concept
Syndromic
surveillance
Communitybased survey
An active and/or passive system that uses case
definitions that are based entirely on clinical
features without any clinical or laboratory
diagnosis (e.g., burn injuries rather than flame,
scald, electrical). Because syndromic surveillance
is inexpensive and simple, it is often the first kind
of surveillance begun in a low-resource setting.
Representative sampling of a population,
typically through household surveys, in order to
gain information about risk factors, conditions,
and deaths within a preceding time period.
Community-based surveys are the most accurate
method for determining injury epidemiology and
mitigate some of the selection bias associated with
barriers to care in passive surveillance systems but
are also the most costly and time consuming.
3
Incidence
It is estimated that there are between 7 and 12million people
who sustain burn injuries that require medical care, cause
prolonged absence from work or school, or result in death
each year [1]. As a result, burns from fire, heat, and hot substances are the fourth most common etiology of injury globally behind road traffic incidents, falls, and violence. For
comparison, the incidence of burn injuries is greater than that
of HIV/AIDS and tuberculosis combined and approaches the
incidence of all malignant neoplasms [2].
Using highly modeled data from varied sources (e.g.,
passive surveillance systems, burn center registries, mortuaries,
fire services) and with some rare exceptions, there is evidence
that the age-standardized incidence rate has not changed
significantly for most countries except the most wealthy,
where it has likely decreased by about 10% [1]. These
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