Technical and Medical Aspects of Burn Size Assessment and Documentation

Approach to burn treatment in the rural emergency department

OBJECTIVE

To outline an approach to the assessment and initial management of patients with burns in the rural emergency department setting. Three mnemonics are presented that can be used for both the assessment and the initial management of patients with burns in rural settings.

QUALITY OF EVIDENCE

Current and local guidelines compiled by a plastic surgeon were reviewed to develop a systematic approach to the treatment of patients with burns. PubMed and other databases were also searched for current literature on emergency care of patients with burns.

MAIN MESSAGE

Burn injuries are a common reason for presentation to the emergency department. However, the care of patients with these injuries can vary substantially depending on geographic location, provider training, and hospital resources. Classification of burns, fluid resuscitation guidelines, dressings and wound care, indications for referral, and pain management are discussed.

CONCLUSION

Using a systematic approach may help improve burn injury outcomes for patients and provide practitioners with a step-by-step framework for the management of patients with burns in rural settings.

The impact of subject positioning on body composition assessments by air displacement plethysmography evaluated in a heterogeneous sample

Introduction

This study sought to evaluate the impact of subject positioning on body composition assessments by air displacement plethysmography using the BOD POD®.

Methods

Eighty-two adults (42 men and 40 women), aged 26.1 ± 8.4 y (mean ± standard deviation), body mass index = 23.6 ± 4.8 kg/m2, were assessed by repeated measurements in two different positions: relaxed (legs apart, back away from the rear) and compact (legs together, arms near the body, back touching the rear). We relied on Bland-Altman analysis to quantify the agreement between results recorded in the two positions. Using body surface charts, we tested the hypothesis that posture-induced variability stems from differences in exposed skin area.

Results

Switching from compact to relaxed position resulted in a bias of -197 mL for body volume, -1.53% for percent body fat, and 1.085 kg for fat-free mass. The body surface area in contact with air was larger in relaxed position by 3632 ± 522 cm2. When body volume was expressed in terms of the actual area of exposed skin in the compact position, the percent body fat bias became 0.08%, with a 95% confidence interval of (-0.14, 0.29)%.

Conclusions

Subject posture is a source of significant variability in air displacement plethysmography. The disagreement between results obtained in different positions can be eliminated by adjusting the surface area artifact, suggesting that subject positioning in the BOD POD® should be controlled to avoid changes in the amount of air maintained under isothermal conditions by the body.

Expert consensus on the prevention and first-aid management of burns in children

Burns are the second leading cause of unintentional injuries in children and are one of the major causes of disability in children. Timely and effective first-aid management of burns can have a major impact on the prognosis, but there is still a lack of the knowledge on burn management in the general public. With reference to expert opinions and related literature, this consensus summarizes the causes of burns, preventive measures, first-aid methods for common types of burns, and the prevention and treatment of serious complications of burns. It also provides recommendations on the most appropriate pre-hospital treatment. This consensus aims to emphasize the importance of burn prevention, improve the ability of first-aid treatment among witnesses and rescuers, avoid further injury caused by inappropriate treatment, and reduce the mortality and disability rates of burns and the harm to family and society. It can be used as guidance for pre-hospital treatment of childhood burns by first responders, parents, and passers-by.