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BURN CARE

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Title: BURN CARE


1
BURN CARE
  • INMED CONFERENCE
  • JUNE 8, 2009
  • Mani M Mani MD
  • Maria Pena RN
  • Trina Schulz OTR

2
BURN CARE
  • What are the standards of burn care in the United
    States?
  • What are the standards of care in the country
    that you plan to work and serve?
  • How do the standards that you are used to work
    over there?

3
BURN CARE
  • My experience in Burn Care
  • in Kansas 1974 - 2007
  • in Malaysia 1986 1996
  • in Australia 1995 1999
  • in Kyrgyzstan 1997 2000
  • in India 1964 - 2009

4
BURN CARE
  • Burn care can be simple
  • or very complex.
  • One can spend a lot of time and resources to
    prolong the process of death in a severe case.
  • One can do a lot of good to the majority of cases
    which fall into the minor and moderate category.

5
BURN CARE
  • Our pattern.
  • Call 911, ambulance arrives.
  • Resuscitation initiated and the patient is
    transferred to E.R and burn center.
  • Protocols are put into effect.
  • Most patients survive and live happily ever after
    (?) wondering how to pay the bills.

6
BURN CARE
  • THEIR PATTERN.
  • No 911. Transfer by whatever mode available to
    the nearest hospital.
  • Major burn patients do not survive.
  • Minor burn cases survive but with deformities.
  • Patients turns around and asks you, why did you
    save me to live like this for the rest of my
    life?.

7
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8
BURN CARE
  • So what should one do?
  • Leave behind your rules, protocols and
    regulations.
  • Assess what they need, what they have and what
    can be done in the time and with the resources
    available to you.
  • Dont be satisfied with applying a band aid and
    giving them platitudes.

9
BURN CARE
  • What is the average size of burn treated in burn
    centers in the USA?
  • Most of the cases involve about 15 of body
    surface.
  • If the average is 15, then there are a few that
    are larger and many that are smaller.

10
BURN CARE.
  • On an international scene, when facilities
    (equipment, supplies, staff and finances) are not
    available, it is better not to spend available
    resources on cases that are major and whose
    chances of survival is minimal.

11
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12
BURN CARE
  • On an international scene it is smarter to manage
    smaller injuries that can be managed with locally
    available resources, to prevent deformities and
    make the person functional.

13
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14
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15
BURN CARE
  • Minor and Moderate burns.
  • These may not life threatening injuries.
  • The deformities could be prevented by using a
    simple splint during the healing period.
  • Once the deformity is established, it will
    require major procedures to create a functional
    person.

16
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17
BURN CARE.WHAT CAUSES DEFORMITIES?
18
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19
BURN CARE
  • Scars are an inevitable end result of wound
    healing.
  • Scars can be modulated to prevent deformities and
    provide full function.
  • Scars can be modulated to make appearance
    acceptable.

20
DEEP BURNS, GRAFTED.
21
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22
BURN CARE
  • Priorities in burn management.
  • Recognize life threatening issues.
  • Resuscitation.
  • Pain management.
  • Nutrition.
  • Wound management.

23
BURN CARE
  • Nursing care.
  • Rehabilitation
  • Occupational and Physical therapy.
  • Psychological care.
  • Family support.
  • Reentry into society.
  • Late reconstruction.

24
BURN CARE
  • Wound Management.
  • Recognize partial thickness injuries (first and
    second degree). These should heal
    within 7-10 days with adequate management.
  • Prevent these from becoming full thickness
    injuries due to lack of blood supply and
    infection.

25
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26
Partial thickness
27
BURN CARE
  • Full thickness skin loss will not heal without
    surgical intervention or they take months or
    years to heal with all the attended complications
    of infection, scar contracture and even death.

28
Full thickness skin loss
29
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30
BURN CARE
  • Wound Care.
  • Somehow we have come to a mind set that topical
    antimicrobials are necessary for wound healing.
  • We are the only specialty that will retain dead
    tissue on the body and expect healing with the
    use of creams and ointments.

31
WOUND CARE
  • Wound care.
  • In partial thickness injuries, the goal is to
    protect the injured tissues and allow the body to
    heal by epithelial growth.
  • Provide protection.
  • Provide nutrition.
  • Prevent infection.
  • Provide pain management.

32
BURN CARE
  • Wound care.
  • In full thickness skin loss, excise the dead
    tissue as soon as possible and feasible and
    provide epithelial coverage.
  • Prevent infection.
  • Provide nutrition.
  • Provide pain management.

33
Late reconstruction
34
BURN CARE
  • International burn care efforts should involve
    educating a team to provide care on a long term.
  • Band aid philosophy may make you feel good, but
    does very little for the patient.
  • Use locally available facilities, equipment,
    supplies and personnel.

35
INTERNATIONAL HEALTH CARE
  • Go to the people,
  • Live among them,
  • Love them.
  • Start with what they know,
  • Build on what they have.
  • But of the best leaders
  • When their task is accomplished,
  • The people will remark
  • Weve done it ourselves.
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