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Fig. 2. Decompressive incisions through the fuU thickness bum area may be needed to prevent ischemia of the limb. ^ Medio! and ^ Lateral and actively exercised to reduce edema. In some instances, edema formation may produce a rise in interstitial pressure sufficient to obstruct venous outflow and produce limb ischemia. When it is determined that blood flow to the extremity is impaired, a decompressive incision through the full thickness bum area should be performed (Fig. 2). Since this incision is only through the anesthetic third-degree bum areas, no anesthesia is required. TABLE 1. Classification of Burns MINOR BURNS MODERATE BURNS MAJOR BURNS Magnitude of injury Less than 15% TBS second degree Less than 10% TBS (children) Less than 2% TBS third degree (unless eyes, hands, feet or perineum involved) Treatment Outpatient Magnitude of Injury 15 to 30% TBS second degree (10-30% TBS-child) Less than 10% third degree (vital areas exempt) Treatment Inpatient — Community or general hospital Magnitude of Injury Greater than 30% TBS second degree Greater than 10% TBS third degree (or third degree involving face, eyes, hands, feet) Burns complicated by inhalation injury, extensive soft tissue injury, fractures or other major trauma Treatment Inpatient — Burn trauma center •TBS Total body surface. Initially, parenteral narcotics may be required to alleviate pain. These agents should be administered in moderate doses and intravenously as tissue perfusion is low immediately after the burn injury. Narcotics administered intramuscularly may be poorly absorbed and lead to intoxication. After the ileus abates, oral pain medication can be administered. Inhalation injuries may occur during any thermal injury burn, but they usually occur in closed space accidents such as house fires and are associated with very high mortality rates. Wheezing, hoarseness, bronchorrhea, bumed nares, intraoral soot and carbonaceous sputum are clinical signs of a respiratory burn. Intubation and ventilatory support may be necessary due to an obstruction and hypoxia. Initial stabilization and adequate preparation of the critically bumed patient before transfer to a burn center will prevent complications during transport. A large bore intravenous catheter, securely taped, will insure a route for resuscitation fluids. A Foley catheter should be inserted to monitor fluid requirements. A nasogastric tube should be placed into the stomach to prevent vomiting and aspiration during the transport period. The patient should be wrapped in sterile sheets to avoid further bacterial contamination and covered with sufficient blankets to prevent hypothermia. In each instance, a record of administered medications and fluids plus urinary output should accompany the patient to the referral center. SUMMARY Proper treatment of the bum injury includes estimation of the extent and depth of the thermal injury, initial fluid stabilization, proper wound care and triage based on the size of the injury. This approach to bum care can minimize mortality and morbidity. General References 1 Filston HC: The acute care of the severely burned child. Zeitschrift Fur Kinderchirurgje Und Grenzgebiete, VII. Verbrennungen. 1972, p 238. 2. Peters CR: Surgical management of the burned hand. Duke Plastic Surgery Residents' Conference, January, 1974. 3. Peters CR: Office and emergency care of injured hand. South Med J Vol 69, January, 1976. 4. FVuitt BA Jr, Moylan JA: Current management of thermal bums. Adv Surg 6:237-288. 1972. 257 Vol. 38, No. 10
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1977 |
Identifier | NCHH-17-038 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 38 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-038.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-038 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 596 (images) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1977 |
Identifier | NCHH-17-038-0256 |
Form General | Periodicals |
Page Type | all; all images; diagram; all images; chart/table; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed38v21977medi_0256.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 38 |
Issue Number | 10 |
Page Number | 596 |
Health Discipline | Medicine |
Full Text | Fig. 2. Decompressive incisions through the fuU thickness bum area may be needed to prevent ischemia of the limb. ^ Medio! and ^ Lateral and actively exercised to reduce edema. In some instances, edema formation may produce a rise in interstitial pressure sufficient to obstruct venous outflow and produce limb ischemia. When it is determined that blood flow to the extremity is impaired, a decompressive incision through the full thickness bum area should be performed (Fig. 2). Since this incision is only through the anesthetic third-degree bum areas, no anesthesia is required. TABLE 1. Classification of Burns MINOR BURNS MODERATE BURNS MAJOR BURNS Magnitude of injury Less than 15% TBS second degree Less than 10% TBS (children) Less than 2% TBS third degree (unless eyes, hands, feet or perineum involved) Treatment Outpatient Magnitude of Injury 15 to 30% TBS second degree (10-30% TBS-child) Less than 10% third degree (vital areas exempt) Treatment Inpatient — Community or general hospital Magnitude of Injury Greater than 30% TBS second degree Greater than 10% TBS third degree (or third degree involving face, eyes, hands, feet) Burns complicated by inhalation injury, extensive soft tissue injury, fractures or other major trauma Treatment Inpatient — Burn trauma center •TBS Total body surface. Initially, parenteral narcotics may be required to alleviate pain. These agents should be administered in moderate doses and intravenously as tissue perfusion is low immediately after the burn injury. Narcotics administered intramuscularly may be poorly absorbed and lead to intoxication. After the ileus abates, oral pain medication can be administered. Inhalation injuries may occur during any thermal injury burn, but they usually occur in closed space accidents such as house fires and are associated with very high mortality rates. Wheezing, hoarseness, bronchorrhea, bumed nares, intraoral soot and carbonaceous sputum are clinical signs of a respiratory burn. Intubation and ventilatory support may be necessary due to an obstruction and hypoxia. Initial stabilization and adequate preparation of the critically bumed patient before transfer to a burn center will prevent complications during transport. A large bore intravenous catheter, securely taped, will insure a route for resuscitation fluids. A Foley catheter should be inserted to monitor fluid requirements. A nasogastric tube should be placed into the stomach to prevent vomiting and aspiration during the transport period. The patient should be wrapped in sterile sheets to avoid further bacterial contamination and covered with sufficient blankets to prevent hypothermia. In each instance, a record of administered medications and fluids plus urinary output should accompany the patient to the referral center. SUMMARY Proper treatment of the bum injury includes estimation of the extent and depth of the thermal injury, initial fluid stabilization, proper wound care and triage based on the size of the injury. This approach to bum care can minimize mortality and morbidity. General References 1 Filston HC: The acute care of the severely burned child. Zeitschrift Fur Kinderchirurgje Und Grenzgebiete, VII. Verbrennungen. 1972, p 238. 2. Peters CR: Surgical management of the burned hand. Duke Plastic Surgery Residents' Conference, January, 1974. 3. Peters CR: Office and emergency care of injured hand. South Med J Vol 69, January, 1976. 4. FVuitt BA Jr, Moylan JA: Current management of thermal bums. Adv Surg 6:237-288. 1972. 257 Vol. 38, No. 10 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-038.pdf |
Document Sort | all; nchh-17 |
Article Title | Burn Therapy Updated |
Article Author | Joseph A. Moylan; Calvin R. Peters; Howard C. Filston |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-038 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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