Annals of Burns and Fire Disasters - vol. XII - n. 1 - March 1999

MBC NEWS

A Message from Toulouse

Burn Unit, Rangueil Hospital, Toulouse, France
26 February 1998

Dear Colleagues working in burn management,
If you don't know French it is difficult to ask - in French -how can an 83% burn patient live? It is easier to find the answer by using two senses: your eyes and your ears!
At the Toulouse Burn Unit they told me that a few years ago they had had a patient with an 83% TBSA burn they had succeeded in keeping alive. With the help of my adequate French and my own two senses I found out how and discovered that it was a highly qualified centre.
In Toulouse I saw many things and learned many techniques, but all the time I was making a mental comparison between what was happening there and what happened in my burn centre back home.
In Toulouse, once a patient is received they observe him hourly and the data are collected in a 24-hour sheet. They use the Evans formula for haermodynamic resuscitation as they have a cold climate, and there is no need for the large quantities of Parkland fluid that we use in the hot climate of Assiut.
All types of haematological and bacteriological investigations for the patient are performed daily, after stabilization of the patient - it depends.
I was impressed by their use of routine painkillers and antacids. I was told that antibiotic administration depends on the wound, body temperature, and white blood cell count, and that every patient with a burn in over 60% TBSA must receive systemic antibiotics for both gram-positive and gram-negative micro-organisms. They prefer clavulanate-potentiated amoxicillin, piperacilin, kenolones, and ceftazidime because, like everywhere else, their commonest organisms are Staphylococci and Pseudomonas sp.
It is very nice to know that in Toulouse there are specialized dieticians who monitor the burn patients nutritional support. They use standard nutritional formulae, but for the last month they have had Deltatrack, which is an apparatus capable of calculating the required amounts of fats, carbohydrates, and proteins in relation to the carbon dioxide and oxygen consumption of patients with good pulmonary conditions.
What happens with patients suffering from inhalation injury is magic, and this is the aspect that is most different from our home unit. Bronchoscopy and X-rays are the investigative tools of inhalation injury. The bronchoscope is used for visualization of the mucosal status and to take swabs for bacteriological tests.
If there is a laryngeal oedema or any other sign of inhalation injury, the patient is intubated for mechanical ventilation and X-ray studies are performed daily. Steroids are never indicated except in cases of ARDS, which is diagnosed by a correlation between blood gases and the white blood cell count.
In Toulouse, patients with mild inhalation injuries can survive, although with aggressive injuries the mortality rate is 100%. At Assiut we are sorry to say that we lose patients with minor inhalation injuries because we still do not have facilities for mechanical ventilation and we try to manage tachypnoea symptomatically on the basis of the original aetiology.
Patients with mechanical ventilation receive nutritional support by the nasogastric and parenteral routes. All vital signs are assessed peripherally and centrally.
The principle here in Toulouse is to have a clean wound. All dressing manoeuvres are performed under general anaesthesia, which reflects great humanity. First- and second-degree burns are dressed by broad-spectrum antiseptic- or fibrinolysin-containing ointments. Third-degree burns receive special care: all dry eschars in this type of burn should be surgically excised, and the resultant underlying raw areas are dressed and if possible covered by autografts. I was told that skin substitutes are too expensive to be used routinely and that homografts are acutely difficult to obtain from volunteers.
At Assiut, although homograft donation is not difficult, we cannot perform surgical excision and grafting routinely as they do in Toulouse. This may be due to the lack of the much indicated perioperative intensive care management.
It was very nice and also very surprising for me to see that all the above jobs I saw in Toulouse are performed by anaesthesiologists - the role of the plastic and burn surgeon is just to follow and supervise. At the Assiut Burn Centre, plastic surgeons do all the jobs and anaesthesiologists are just consulted and that is the main difference.
For me, February 1998 was a very nice month. I discovered a lot and learned a lot, and for you, my colleagues, if you want to develop your knowledge about burns, you can visit any of the burn centres in France, but first of all:

S'iI vous plaIt vous devriez apprendre la langue franyaise!

Dr Mohamed Mahmoud EI-Sharly M.Sc.
Plastic Surgery Unit, Assiut University Hospital, Assiut, Egypt
Tel.: 0020 88347373 - Fax: 0020 88333327
E-mail: elshazly@aun.eun.eg

RESOLUTION
ON THE SAFETY OF BUTANE GAS DISPENSERS IN DOMESTIC USE
THE MEDITERRANEAN CLUB FOR BURNS AND FIRE DISASTERS,
AT ITS
10' ANNUAL MEETING IN ATHENS, GREECE, OCTOBER 29-31,1998

noting
these implements are a health hazard, as a frequent and major cause of extensive burns among these populations,

and calls upon
Governments, national and local authorities, industry and intergovernmental organizations to initiate and strengthen legislation concerning the manufacture and safe use of these products.

INFORMATIC UPDATE

Informatic Update is a new feature that we shall be publishing regularly in Annals. Our aim is to create a space where we can inform our readers about new developments in information technology and review any new products which they may wish to submit to our attention.
Information science has taken on an ever more important role in the medical field in the last few years and the computer is now an irreplaceable work tool, especially for data storing and processing. However, our years of experience with computerization at the Department of Plastic Surgery and Burns Therapy in Palermo have led us to believe that the computer can also be applied more specifically in the clinical field.
At present not many such clinical application exist, mainly because medical software can only be developed by persons who are competent in the two fields of medical and information science.
Another purpose of this feature is to stimulate collaboration among all those who - like us - believe in the future development of the clinical application of the computer and to attract the attention of people who are not yet fully aware of the computer's potential. Relevant articles and actual applications can be sent to the address below:

Annals of Mediterranean Club for Burns and Fire Disasters (MBC)
Informatic News
Divisione di Chirurgia Plastica e Terapia delle Ustioni.
Ospedale Civico, Via Carmelo Lazzaro, 90127 Palermo, Italy
E-mail: mbcpa@cres.it

MBC - PREVENTION CAMPAIGNS

The MBC, in the context of the activities laid down in its Statute and intended to promote burn prevention campaigns, has produced the following videotapes:

• The Prevention of Burns in Children

• The Prevention of Electrical Burns in Everyday Life

• The Prevention of Electrical Burns at Work

• The Prevention of Industrial Disasters

• How to Defend ourselves from Fire

• How to Defend ourselves from Forest Fire

The tapes have been dubbed in English, French, Arabic, Italian, Spanish, Greek and Turkish and come in two versions, U-MATIC and VHS.
All the tapes are available entirely free of charge to MBC Members who apply in writing to receive them explaining their reasons and undertaking to use them exclusively to promote a burn prevention campaign in their respective countries.
For non-members of MBC the tapes are available at a cost of US$ 25 each, including postal charge.

Please address requests to:
Annals of Burns and Fire Disasters
Divisione di Chirurgia Plastica e Terapia delle Ustioni
Ospedale Civico, Via C. Lazzaro, 90127 Palermo, Italy
Tel.: + 39 091 6663631 - Fax: + 39 091 596404.