This booklet is a guide for parents of children who have received severe scalds or burns, most of whom have had skin grafts. The aim is to present practical information on the care of a child after leaving hospital and explanation of the continuing medical care which he or she will receive.

Mason S., Forshaw A. Bums, 12: 364-370, 1986.

Full thickness burns of the face can present numerous problems in the prevention and control of skin contractures. Burn microstomia can inhibit normal feeding, speech, dental care and it can pose problems during anaesthesia. The modified microstomia prevention splint presented here was designed to overcome bum microstomia which could not be treated with conventional devices. Further modifications eliminated problems of pressure on the oral mucosa.

Fowler D., Pegg S.P. Bums, 12: 371-373, 1986.

Experience in using the Moulinex Masterfry 800 deep fat fryer showed that it can easily cause scalds of the hand if used without especial care. It is suggested that such devices should be provided with a handle.

Butler-Manuel A.P., McLean N.R. Bums, 12: 374-375, 1986.

Part 1: demographic comparison with the population of origin.

The literature contains many studies on the epidemiology, aetiology and demography of bum injuries, but no study in the past has compared a burn population with detailed data regarding the general population from which it is derived. The US Census Reports of 1970 and 1980 have provided information making such a comparison possible. The paper examines, with reference to the 6-year period 1973-1979, the age, sex, ethnic origin, level of education, gross family income and occupation in a bum population of 585 patients residing in the Standard Metropolitan Area of San Diego. Children and males were found to be the most liable to burn injuries. Blacks were at high risk from bum injury. There was an inverse relationship between risk of bum injury and both income and education level. Craftsmen, labourers and service-workers are at high risk. Burn prevention information should be directed at blacks, those with only an elementary education and the poor.

Darko D.F., Wachtel T.L., Ward H.W., Frank H.A.

Bums, 12: 384-390, 1986,

Part II: aetiological data.

Various factors contributing to the occurrence of burn injuries are examined in a population of 585 patients from a well-defined population, the San Diego Metropolitan area, over a 6-year period. The following were considered: scene of bum; patient's activity at time of accident; contribution of appliances and materials; influence of clothing on the extent of injury. Of all bum agents the most frequent was found to be flame. Flammable liquids ranked high among the causes of bums. The home was the commonest scene of the bum accidents. Clothing was found to be either protective or a cause of increased severity in the case of bum accidents.

Darko, D.F., Wachtel T.L., Ward H.W., Frank H.A. Bums, 12: 391-394, 1986.

Part III: psychosocial data.

An analysis is made of the physical and psychosocial aberrations in a series of 585 burn patients from a well-defined urban population, the San Diego Metropolitan area, over a 6-year period. The survey shows that the risk of bum injury is increased and the likelihood of survival is reduced in persons who have a history of psychiatric illness, poor social adjustment or self-destructive behaviour. Tobacco smoking and the abuse of alcohol are major risk factors. Active symptomatic disease in any of a number of organ systems is also a significant risk factor in the occurrence of bum injury and the failure to survive it. These data have implications that may help in the identification of persons at high risk from burn injury, and thus in forming a psychosocial profile for the evaluation of burned patients.

Darko D.F., Wachtel T.L., Ward H.W., Frank H.A. Bums, 12: 395-401, 1986.

A PROSPECTIVE ANALYSIS OF HYPERTONIC LACTATED SALINE V. RINGER'S LACTATE-COLLOID FOR THE RESUSCITATION OF SEVERELY BURNED CHILDREN

A prospective study comparing the resuscitative efficacy of hypertonic lactated saline (HLS) and Ringer's lactate-colloid (RL-collold) was carried out in children and young people (from 5 months to 21 years old) with 30 per cent or more BSA burns. The 24- and 48-h fluid requirements of children resuscitated with RL-colloid were significantly greater than those resuscitated with HLS. Urine output in the two groups was not significantly different. The haematocrits were equally maintained. The RL-colloid group patients gained significantly more weight at 48 h. There was no significant difference in sodium requirements and resulting sodium balances. The desired and significant elevation of serum sodium in the HLS group was maintained for the 5 days of the study. No significant difference was detected until 48 h post-burn in colloid oncotic pressures, serum albumin and albumin/globulin (A/G) ratios. The RL-collold group received plasmanate in the second 24-h period. The significant increase in serum albumin, A/G ratio and colloid oncotic pressure persisted only for the first 48 h; after 96 h these values were not significantly different. The two techniques were equally effective in the resuscitation of children although there was decreased morbidity associated with oedema in the case of HLS. The RL-colloid group required 45 per cent more fluid volume at 24 h and 51 per cent more at 48 h. Costwise the RL-colloid resuscitation technique was more expensive, working out for example at 8.5 times as much as I-ISL in a 60-kg patient with 60 per cent BSA burns. The HLS protocol is therefore recommended, both in terms of direct and indirect savings of expense and morbidity.

Bowser-Wallace B.H., Caldwell F.T. Burns, 12: 402-409, 1986.

In bum patients with inhalation injuries who require ventilatory support the most pressing therapeutic problem is the difficulty of reducing excessive carbon dioxide levels. Hypercarbia may be fatal to these patients even if arterial oxygen saturations are maintained. Standard mechanical ventilators may not be adequate in the face~'-of the increased metabolic demands and the altered pulmonary pathology following inhalation injury, as they are unable to provide the minute volume requirements necessary to reduce hypercarbia. In order to achieve this maximum minute volume, two Siemens-Elema 900C ventilators with a bilateral ventilation cable were used to provide synchronized ventilatory support in 8 paediatric bum patients, for the removal of carbon dioxide levels above 50 mm Hg. The levels were decreased by as much as 32%. When hypercarbia is under control, conventional ventilatory techniques can be resumed. Independent lung ventilation is also possible by means of the bilateral ventilation cable.

Milcak R., Richardson J., Potter C., Hemdon D.N. J. Burn Care Rehabil., 7: 109-111, 1986.

Endogenous opiates have been implicated since the mid-1970s in the cardiovascular pathophysiology of a number of shock states, including those caused by bacterial endotoxins. It has been found in various animal trials, and in a limited number of human trials, that haemodynamic values in septic shock can be improved by naloxone, either given alone or in combination with methylprednisone. A case is described of low-dose naloxone therapy in a patient with septic shock, and a review is made of the current literature.

Christensen M.A., Gresch J.J. J. Bum Care Rehabil., 7: 122-126, 1986.

Patterns of scald injuries show considerable consistency both within Brisbane over a 5-year period and with results obtained in other studies. The great majority of childhood scald accidents occur to children between I and 2 years of age, between 4 p.m. and 7 p.m., and when both parents are present. Most of these scalds are suffered in the kitchen and the bathroom, the commonest bum agent being a hot cup of tea.

Phillips W., Mahairas E., Hunt D., Pegg S.P. Bums, 12: 343-350, 1986.

A comparative assessment was made of three hydrogels (Geliperm and Strathclyde Hydrogels 1 and 2) in respect of water-vapour transmission and conformability. The materials were tested alone and as part of a bilaminate dressing incorporating an adhesive top layer. The adhesive layer used was a compliant adhesive bandage marketed as Mefix. This layer reduced the normally high water-vapour water transmission rates of the hydrogels to much lower and clinically more acceptable levels. Mechanically, the Mefix layer protects the underlying hydrogel and prevents tearing and puncturing. It also decreases conformability by elastic restraint.

Queen D., Evans J.H., Gaylor J.D.S., Courtney J.M., Reid W.H. Bums, 12: 351-356, 1986.

RESPIRATORY INJURY IN CHILDREN: THE HISTOLOGY OF HEALING

Three children burned in the same fire, in which they suffered smoke inhalation injuries, died at varying times after the incident, one almost immediately, one after 2 days and the third after 24 days. The histological findings from the large airways are presented and compared with reference to the stages in the healing process that they represent. The various implications are discussed.

Judkins K.C., Brander W.L. Burns, 12: 357-359, 1986.

CIRCUMFERENTIAL BURNS TO THE FINGERS ASSOCIATED WITH GOLD AND PLATINUM RINGS

Two cases are described of bums to the fingers associated with metal rings. One of these involved burning caused by molten zinc and was treated by early bum excision and split skin grafting. The second was an electrical bum caused by a car battery and was treated conservatively.

Regan M.W., Moss A.L.H. Bums, 12: 360-363, 1986.