|Annals of Burns
and Fire Disasters - vol. XII - n. 1 - March 1999
A Message from Toulouse
Burn Unit, Rangueil Hospital, Toulouse,
26 February 1998
Dear Colleagues working in burn
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
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
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
Dr Mohamed Mahmoud EI-Sharly M.Sc.
Plastic Surgery Unit, Assiut University Hospital, Assiut, Egypt
Tel.: 0020 88347373 - Fax: 0020 88333327
ON THE SAFETY OF BUTANE GAS DISPENSERS IN DOMESTIC USE
THE MEDITERRANEAN CLUB FOR BURNS AND FIRE DISASTERS,
10' ANNUAL MEETING IN ATHENS, GREECE, OCTOBER 29-31,1998
Butane gas dispensing containers are very common in domestic use in several
countries of the Mediterranean Basin,
these implements are a health hazard, as a frequent and major cause of extensive burns
among these populations,
and considering that
there is inadequate legislation and insufficient information on their risks and safe
use by the consumer,
the Mediterranean Club for Burns and
Fire Disasters resolves to
initiate, study and promote prevention and improved treatment of burns and fire
disasters caused by these dispensers,
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.
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
Annals of Mediterranean Club for Burns and Fire Disasters (MBC)
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
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:
Divisione di Chirurgia Plastica e Terapia delle Ustioni.
Ospedale Civico, Via Carmelo Lazzaro, 90127 Palermo, Italy
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:
of Burns in Children
of Electrical Burns in Everyday Life
of Electrical Burns at Work
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
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.