First-aid measures for the treatment of burns and scalds

QUANTIFICATION AND THE UNDERLYING MECHANISM OF SKIN THERMAL DAMAGE: A REVIEW

Skin thermal damage is the most common thermal trauma in civilian and military communities. Besides, advances in laser, microwave, and similar technologies have led to recent developments of thermal treatments for diseases involving skin tissue aiming at inducing damage precisely within targeted tissue structures without affecting the surrounding healthy tissue. Pain sensation accompanying thermal damage is also a serious problem for burn patients. Therefore, it is of great importance to quantify the thermal damage in skin tissue. In this review, we detail the progress of the state-of-the-art mathematical models and experimental methods for the quantification of thermal damage (both heat damage and cold damage) and the general development of thermal treatments in tissue engineering. This could enable better understanding of the underlying mechanisms of skin thermal damage and the optimization of clinical thermal therapies.

A five-year review of burn injuries in Irrua

Background

The management of burns remains a challenge in developing countries. Few data exist to document the extent of the problem. This study provides data from a suburban setting by documenting the epidemiology of burn injury and ascertaining outcome of management. This will help in planning strategies for prevention of burns and reducing severity of complications.

Methods

A total of 72 patients admitted for burns between January 1st, 2002 and December 31st, 2006 at the Irrua specialist teaching hospital were studied retrospectively. Sources of information were the case notes and operation registers. Data extracted included demographics as well as treatment methods and outcome

Results

The results revealed male to female ratio of 2.1:1. Over 50% of the injuries occurred at home. There was a seasonal variation with over 40% of injuries occurring between November and January. The commonest etiologic agent was flame burn from kerosene explosion. There were 7 deaths in the series.

Conclusion

Burns are preventable. We recommend adequate supply of unadulterated petroleum products and establishment of burn centers.

Consensus on the prehospital approach to burns patient management

Burns patients form a large group of trauma patients cared for by first aiders, ambulance staff, nurses, and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the prehospital environment based on current available evidence and a consensus of specialists from all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.

Consensus on the pre-hospital approach to burns patient management

Burns patients form a large group of trauma patients cared for by first-aiders, ambulance staff, nurses and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the pre-hospital environment based on current available evidence and a consensus of specialists all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.

Consensus on the pre-hospital approach to burns patient management

Burns patients form a large group of trauma patients cared for by first aiders, ambulance staff, nurses and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the pre-hospital environment based on current available evidence and a consensus of specialists from all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.

Consensus on the prehospital approach to burns patient management

Burns patients form a large group of trauma patients cared for by rst-aiders, ambulance staff, nurses and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the prehospital environment based on current available evidence and a consensus of specialists of all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.

The importance of immediate cooling--a case series of childhood burns in Vietnam

Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55-0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children.

The UK pre-hospital management of burn patients: current practice and the need for a standard approach

INTRODUCTION

In any system of burn care, first-aid, packaging and transportation of the burn injured patient from outside of hospital is a most important contribution to the successful management and outcome. This study aimed to assess the current initial care of burn patients given by the statutory ambulance services and then compare this to a survey of opinions among the plastic surgery and burns consultants in the United Kingdom (UK).

METHODS

In 1999, each of the UK ambulance services was contacted via a postal questionnaire. A similar survey was sent to all of the plastic surgery consultants within the UK (taken from the specialist register) therefore, canvassing the plastic surgeons who deal less commonly with burn patients as well as the burns units.

RESULTS

A total of 58% of ambulance services said that they had no treatment policy for burns patients; 97% sent patients to their nearest A&E department; 84% of services employed cooling; 12 different types of dressing were used for burn patients; 74% of services used nalbuphine hydrochloride and 97% used entonox; 74% services gave oxygen to all burn patients; 90% cannulated patients, with or without fluid administration. Plastic surgical opinion indicated that the most important aspects of basic first-aid should include: stopping the burning process; cooling (15 min (median)); airway, breathing and circulation assessment; clothing removal and dressings (clingfilm). Oxygen need not be given to all patients, but they should be kept warm and administered entonox and/or intravenous morphine. Most surgeons felt that patients should be taken to the nearest A&E and the majority of surgeons caring for this large group of patients did not have good and regular liaison with their local ambulance service.

CONCLUSIONS

There seems to be a wide variation in the basic approach to the first-aid and pre-hospital care of burns patients. A significant improvement in management for this large and important group of patients is achievable, if a standard approach across all ambulance services could be achieved.

Management of skin trauma

The majority of skin trauma incidents cause minor injury that can be treated effectively in the outpatient setting. A new approach to the closure of skin lacerations using tissue adhesive is presented and the current management of abrasions, blisters, burns, skin tears, and subungual hematomas are reviewed. An overview of wound dressings is provided to assist in obtaining the optimal wound-healing environment.