The pain suffered by burn victims is considerable and in many cases intractable. In paediatric burn patients, even the most advanced pharmacological treatment is unable to control pain, especially procedure-related pain, and it is therefore also important to use non-pharmacological techniques to alleviate suffering. A detailed account is presented of the implementation of such strategies. Precise pain measurement techniques are of extreme importance and a review of these is presented in order to indicate ways of developing interventions and evaluating their efficiency. Suggestions are also given for adjusting interventions for specific patient needs, and there is a practical discussion of the implementation of the techniques involved.
Martin-Herz S.P., Thurber C.T., Patterson D.R
J. Burn Care Rehabil., 21: 458-72
This three-year prospective study considered all infections observed in a university hospital burns unit and registered in a special database. Altogether 230 adult patients were reviewed. Of these, 83 presented a total of 176 infections, thus giving an infection rate of 48 per 1000 patient days, including both nosocomial and community-acquired infections. Thirty-five blood-stream infections (BSI) were observed in 22 patients. The commonest micro-organisms were coagulase-negative staphylococci and methicillin-sensitive Staphylococcus aureus. The device-specific BSI rate was 6 per 1000 central venous catheter days and the pneumonia rate was 41 per 1000 ventilator days. Seventy-two patients presented a total of 107 burn wound infections. Only 50% of the patients received antibiotics, including 96% of those with infections and 26% of those without. The antimicrobials used most frequently were cloxacillin, penicillin, and gentamicin. Resistance to antibiotics was low, and multi-resistant bacteria and fungi were rare. It is possible to use this database to assess the effects of changes in burn treatment, staffing, and design of burn units, as well as the development of antimicrobial resistance related to use of antibiotics.
Appelgren P., Björnhagen V., Bragderyd K., Jonsson C.E., Ransjö U.
Burns, 28: 39-46, 2002
This investigation is a descriptive study with a retrospective, ex-post facto design. The aim was to characterize body image changes in patients with burns sequelae, using the critical incident technique, and to identify and categorize critical incidents, comparing them with characteristics defined by the Taxonomy of the North American Nursing Diagnoses Association (NANDA) for body image disturbance nursing diagnosis. Thirty-five patients were interviewed and two types of critical incident were identified: “facing the mirror” - when patients looking at themselves notice the changes in their body; and “facing other people” - when they realize that they may attract other people’s attention. Together with their perception of change in their bodies, the patients reported feelings of fear, rebellion, and shame. They also presented coping mechanisms of denial, rationalization, minimization, and repression. All patients were diagnosed as having the NANDA body image disturbance.
Burns, 28: 47-72, 2002
Bergamasco E.C., Rossi L.A., da C.G. Amâncio A., de Carvallho E.C.
The normal technique today for determining the extent of capillary leakage after injury is to measure the leakage of dye-labelled foreign albumin. However, it has recently been reported that albumin leakage depends on the type of fluorescent dye used for labelling. This paper describes how a technique was developed and tested for determining the extent of vascular albumin leakage post-burn without the use of dyes. Skin and blood samples were harvested 3 h and 7 days after burn injury in mice. An analysis of total skin lysates and extracts was made for albumin leakage. It was revealed by Coomassie staining and Western blot analyses of skin preparations, followed by densitometric measurement, that there were increased levels of albumin, which suggested that serum albumin leakage started within 3 h of burn injury. The use of SDS-polyacrylamide gel electrophoresis of tissue extracts followed by Coomassie staining, rather than that of foreign albumin, should permit simple and direct quantification of burn-related autologous albumin leakage, as also in other types of injury.
Cho K., Adamson L.K., Hobson K.G., Greenhalgh D.G.
Burns, 28: 53-6, 2002
In Finland, burns related to sauna bathing are not uncommon, although there do not appear to be any systematic reports in the literature. This seven-year retrospective analysis of 598 burn patients treated in Kuopio University Hospital Burn Unit revealed that one-quarter of all burns treated in the unit were sauna-related (154 cases). The majority of the burns were minor, but 54% required operative treatment. Seventy-one per cent of the patients were male and 40% of all patients had been under the influence of alcohol. The incidence of sauna-related burns in Finland, on the basis of the findings, is 7/100,000, giving a total of 357 patients, which is equivalent to approximately one sauna-related burn per day requiring hospitalization.
Papp A.
Burns, 28: 57-9, 2002
The enteral feeding normally recommended in burn patients leads to an increase in intestinal oxygen demand, the extent of which depends on the amount administered. Intestinal perfusion decreases after major burns, and the objective of this study was to assess whether duodenal feeding could be a contributory factor in the development of splanchnic O2-imbalance. In 15 severely burned patients receiving duodenal feeding initiated within 6 h post-burn, an assessment was made of the CO2-gap between arterial and gastric CO2 as a parameter for the measurement of intestinal O2 balance. Before commencement of enteral nutrition, CO2-gap measurements were performed with a view to indicating when the CO2-gap increased above 30 mm Hg during the patients’ whole critical illness phase. When the CO2-gap increased above 30 mm Hg, enteral nutrition decreased by 50% and the CO2-gap was measured 1 h later. The gap did not increase in any patient during the increase of enteral nutrition. It was found in seven patients that the CO2-gap increased between day 6 and day 13 above 30 mm Hg and dropped significantly 1 h after enteral nutrition was reduced. Unlike what is observed in the early post-burn phase, enteral feeding might have adverse affects on the intestine’s oxygen balance in later stages of the critical illness phase.
Andel H., Rab M., Andel D., Hörauf K., Felfernig D., Scramm W., Zimpfer M.
Burns, 28: 60-4, 2002
This paper presents the author’s personal experience in a burns centre in a developing country, Yemen, where local difficulties in burns management continue to lead to unsatisfactory morbidity and mortality rates. Between 1996 and 1999, sponsored surgical teams made four visits to four Yemen cities, and the patients considered in the article constitute a consecutive series of the plastic surgery operations performed by the teams. All together 406 plastic surgery operations were performed, of which 139 were for post-burn contracture release, and these form the focus of the paper. The victims were mostly children and the hand was the commonest site. The operations included release and split-skin graft, excision and full-thickness skin graft, release and local flap, and multiple Z-plasty. The author’s experience suggests that, given initiative and efficient organization of available resources, developing countries such as the Republic of Yemen can achieve better burns management. The solutions for such problems include: the determination of local health needs; on-site conferences, symposia, and training programmes; local personnel to visit burn centres overseas; burn research and prevention activities; and epidemiological surveys.
Fadaak H.
Burns, 28: 65-9, 2002
An analysis was made of 437 consecutive acute burn patients transported to a burn centre in Pittsburgh USA. Of these, 339 were transported overland and 98 by helicopter. Eighteen air transport patients came from within a 25-mile-radius, while 80 were flown further than 25 miles. The age range of the patients was from three months to 97 yr. Three per cent of the ground transport patients and 28% of the helicopter patients presented inhalation injury. In patients with co-existent inhalation injury, the mean TBSA burned was significantly larger than the TBSA of patients without inhalation injury. Among the air transport patients there were some whose status was not in fact critical and they could have been transferred by ground transport. Certain non-clinical factors, such as insurance status, the wish to keep ground ambulances in their home community, and competing helicopter services unwilling to refuse transport, appeared to be factors leading to the choice of air ambulance transportation. Regional single helicopter services and regional co-operative ambulance services should ensure that helicopters are not used indiscriminately but when their use is clinically indicated.
Slater H., O’Mara M.S., Goldfarb I.W.
Burns, 28: 70-2, 2002
The incidence of burn injuries in the Prefecture of Akita in northeast Japan was investigated by a research regarding data on patients transported to hospital by ambulance. Between 1996 and 2000, 342 patients were transported by ambulance to emergency facilities in this area. The research revealed that fire was the most frequent cause of burn injury and that winter was the season with the highest incidence of cases (40.6%). The suicide rate was high: the percentage of burn patients who had attempted suicide was 7.9%. The mean time between burn injury and hospitalization was significantly longer in patients who later died (44.6 ± 35.3 min) than in those survived (33.0 ± 22.5 min). Severely burned patients were not always transported directly to a core emergency facility and an unacceptable number of patients (5.8%) died in tertiary hospitals. This relatively high death rate is attributable to the fact that the tertiary hospitals possess limited facilities for treating burns, as also to the comparatively long distance to core facilities, which makes it difficult for the Prefecture to reduce transport time to the Regional Trauma Centre and thus enable more patients to benefit from specialized treatment at an earlier injury stage. Also, tertiary facilities should improve their level of burn care (e.g. with the creation of a burn unit and a skin bank).
Nakae H., Wada H.
Burns, 28: 73-9, 2002
This paper presents a case of severe flame burns involving both upper and lower eyelids, bilaterally, treated with repeated full- and split-thickness skin grafting, and discusses the indications and problems associated with this therapeutic modality. The patient was first operated on two years post-burn, and over a period of five years a total of five operations were necessary to deal with recurrent ectropion of both upper and lower eyelids.
Burns, 28: 80-8, 2002
Apostolos D. Mandrekas A.D., Zambacos G.J., Anastasopoulos A.