Management of fluid and electrolyte balance in thermal injuries: implications for perioperative nursing practice.

Thermal injury results in damage to the skin and underlying subcutaneous tissues. Extensive cutaneous injuries result in loss of water and electrolytes, and a disturbance in the homeostatic balance. The purpose of this article is to describe the pathophysiological changes that occur following extensive thermal injury and the common fluid-management challenges they provide.

Improved burn scar assessment with use of a new scar-rating scale.

The subjective assessment of scar appearance is a widely used method in the evaluation of burn outcomes and the efficacy of treatment methods. The purpose of this study is to design a numeric scar-rating scale with better interrater reliability than has previously been reported. The rating scale assesses scar surface, thickness, border height, and color differences between a scar and the adjacent normal skin.

Do custom-fitted pressure garments provide adequate pressure?

Pressure garment therapy has become the worldwide standard of care for the prevention and treatment of hypertrophic scars. There are many reports in the literature on pressure garment therapy but few studies state the amount of pressure actually provided. The purpose of our study was to determine the amount of pressure applied to the scar/garment interface by custom-fitted pressure garments.

A new tool to measure pressure under burn garments.

This article introduces a new tool to measure the pressure that is under pressure garments. The Iscan (Tekscan, Inc.) system uses a patented ultra-thin (0.

Substance P has a role in neurogenic mediation of human burn wound healing.

Knowledge of biochemical and molecular events during burn wound healing may optimize treatment of patients with thermal injuries. Substance P (SP), a neuropeptide present in C fibers of the skin, has been implicated as a mediator of inflammation and wound healing. This neuropeptide induces vasodilitation and vascular permeability by stimulating endothelial cells to round up, vascular smooth cells to relax, and mast cells to release histamine.

Changes in transfusion practices in burn patients.

In 1980 patients with burns greater than 10% of total body surface area (TBSA) received a mean of 8 units of blood (range, 0-42 units) during hospitalization in our burn center. Concern about the risks of blood transfusion caused us to reassess our transfusion practices and to question the need to maintain hematocrits above 30%. We compared the quantity of blood given to burn patients at Harborview Medical Center in 1980 with that given in 1990.

Engine block burns: Dupuytren's fourth-, fifth-, and sixth-degree burns.

We recently treated two patients with engine block-muffler contact burns and greatly underestimated the devastating injuries to bone, deep fascia, and muscle. As a result, each patient required multiple procedures to close their burn wounds. Ten-year data from the University of Washington Burn Unit confirmed our observation that these burns tend to be considerably deeper than suspected.

Mediators in thermal injury.

The combined goal of each of the mediators discussed here is homeostasis in a stressful situation. The associated immunosuppression and immunohyperactivity are unfortunate sequelae of massive upregulation of mediators normally produced in miniscule quantities. Perhaps they were once necessary to regulate survival of severely injured patients.

A nonuser's questions about cultured epidermal autograft.

Clinical experience assumes major importance as the source of data on cultured epidermal autograft (CEA), since a large controlled study is probably not forthcoming. Among the general questions to be answered are: Which patients are candidates for grafting with CEA? Do selection criteria specify size of total body surface area burn or age? Is CEA more suitable for certain body areas than others? Does CEA close the wound as quickly, as well, and as safely as other available methods of coverage? Fresh or frozen allograft, the gold standard, is presumed to be safe, but the current concern about transmission of viral diseases raises doubts. Presumably, CEA would be safe.

Burn depth: a review.

Despite the plethora of technologic advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. It is clear that this assessment is accurate for very deep and very shallow burns. But since clinical judgment is not precise in telling whether a dermal burn will heal in 3 weeks, efforts to develop a burn depth indicator are certainly warranted to accurately determine which dermal burns to excise and graft.

Research priorities for burn nursing. Report of the Wound Care and Infection Control Group.

This study was designed to identify research priorities in burn nursing. The Delphi technique of sequential questionnaires was used for data collection. Ninety-four participants completed four rounds of questionnaires.

Alcohol use and burn injury.

Charts of 108 consecutive adult patients with flame burns of 20% to 70% total body surface area were reviewed to determine the incidence of acute alcohol intoxication and the likelihood that intoxicated patients were chronic alcohol abusers, to assess morbidity and mortality in the alcoholic patient with burns, and to characterize the intervention used in postdischarge treatment of the alcoholic patient with burns who survives. Twenty-seven percent of patients were acutely intoxicated at the time of injury. Evidence for chronic alcohol abuse was apparent in 90% of intoxicated patients, compared to only 11% of nonintoxicated patients (p = 0.

Determinants of donor site infections in small burn grafts.

Studies indicate no advantage to the early use of systemic antibiotics in patients with burns, but the use of prophylactic antibiotics during excision is still being questioned. The records of 213 patients who required excision and who had less than 20% total body surface area burned were reviewed. We investigated risk factors associated with donor- and graft-site infections and whether or not perioperative antibiotics influenced the incidence of infections.

Effectiveness of nalbuphine for relief of burn debridement pain.

A prospective double-blind study was undertaken to compare the effectiveness of the agonist-antagonist nalbuphine hydrochloride with morphine sulfate in relieving pain from burn debridement. The study consisted of two groups in which each was given a preprocedure dose of the study medication followed by administration of incremental doses up to one half the initial dose as requested. After reviewing the literature, we set the ratio of nalbuphine hydrochloride/morphine sulfate at 2:1 mg, respectively.

Does early excision of burn wounds change the pattern of mortality?

Ninety-five patients died at the University of Washington Burn Center from 1980 to 1985. Fifty-seven patients (60%) survived more than 3 days. Thirty-five of these patients underwent excision and grafting.

Inhalation injuries.

Inhalation injuries occur in approximately one-third of all major burns and account for a significant number of deaths in those burn patients each year. Victims die as a result of carbon monoxide poisoning, hypoxia, and smoke inhalation. These deaths can occur without thermal wounds as well as with burn injuries.

Use of 5% sulfamylon (mafenide) solution after excision and grafting of burns.

In previous reports, 5% sulfamylon solution has been utilized on unexcised burns and granulation tissue. We prospectively evaluated 67 burn patients to determine graft take and the incidence of side effects with use of sulfamylon solution dressings after excision and grafting. Of patients excised and grafted, the mean graft take for a total of 100 procedures was 86%.

Efficacy of continuous passive motion (CPM) devices with hand burns.

Ten patients with bilateral (deep second-degree and/or third-degree) hand burns requiring excision and grafting were included in a prospective randomized study to evaluate the efficacy of continuous passive motion (CPM) with burned hands. The purpose of the study was to evaluate: 1) if CPM is a useful alternative to supervised OT/PT for burned hands; 2) which patient populations benefit from CPM intervention; 3) if CPM use has deleterious effects on new grafts; and 4) what effect CPM has on hand pain. Eight hands in the control group and eight hands in the experimental group regained normal total active motion (TAMs) in an average of nine days (range three to 22 days).