Treatment of Burns
Springer Berlin (Verlag)
978-3-642-68102-8 (ISBN)
Introductory Remarks.- I Early Management of Burn Patients.- 1 Emergency Care and Transportation.- 1.1 Eradication of the Cause of Burn.- 1.2 Resuscitation of Critically 111 Patients.- 1.3 Relief of Pain.- 1.4 Protection of the Wound Surface.- 1.5 Transportation.- 2 Estimation of BSA Burned; Assessment and Classification of Depth of the Burn Wound.- 2.1 Estimation of BSA Burned.- 2.2 Assessment of Depth of the Burn Wound.- 2.3 Classification of Burn Wounds.- 3 Early Care of Burns.- 3.1 Maintaining the Patency of the Respiratory Tract.- 3.2 Ascertaining Concomitant Traumas and Poisonings.- 3.3 Establishment of Intravenous Lines.- 3.4 Use of Analgesics.- 3.5 Use of Urinary Retention Catheter.- 3.6 Debridement.- 3.7 Prevention of Tetanus and Hemolytic Streptococcus Infection.- II Burn Shock.- 1 Method of Fluid Therapy.- 1.1 Estimation of Amount of Fluid Required.- 1.2 Points to Note in Fluid Therapy.- 1.3 Clinical Guidelines for Adjustment of Fluid Volume Administered.- 1.3.1 Main Guidelines.- 1.3.2 Criteria for Reference.- 2 The Clinical Significance and Management of Common Symptoms in the Shock Stage.- 3 Administration of Artificial Hibernation Drugs.- 3.1 Pharmacologic Actions and Composition.- 3.2 Methods of Administration and Precautions.- 4 Administration of Diuretics.- 4.1 Indications for the Use of Diuretics.- 4.2 Choice of Drugs and Methods of Use.- III Management of the Burn Wound.- 1 Principles of Management.- 2 Methods and Choice of Treatment.- 2.1 Treatment by Bandaging.- 2.1.1 Purpose.- 2.1.2 Method.- 2.1.3 Indications.- 2.1.4 Points for Attention.- 2.2 Treatment by Exposure.- 2.2.1 Purpose.- 2.2.2 Method.- 2.2.3 Indications.- 2.2.4 Points for Attention.- 2.3 Treatment by Semiexposure.- 2.3.1 Purpose.- 2.3.2 Method.- 2.3.3 Indications.- 2.3.4 Points for Attention.- 2.4 Treatment with Wet Dressing.- 2.4.1 Purpose.- 2.4.2 Method.- 2.4.3 Indications.- 2.4.4 Points for Attention.- 2.5 Treatment by Immersion.- 2.5.1 Purpose.- 2.5.2 Method.- 2.5.3 Indications.- 2.5.4 Points for Attention.- 3 Application and Choice of Chinese Herb Medicine.- 3.1 Crust-Forming Drugs.- 3.1.1 Purpose.- 3.1.2 Points for Attention.- 3.1.3 Choice of Drug.- 3.2 Eschar Removal Drugs.- 3.2.1 Purpose.- 3.2.2 Points for Attention.- 3.2.3 Choice of Drug.- 3.2.3.1 Wound Healing Ointment No. 10.- 3.2.3.2 Burn and Scald Ointment.- 3.3 Wound-Healing Drugs.- 3.3.1 Purpose.- 3.3.2 Points for Attention.- 3.3.3 Choice of Drugs.- 3.3.3.1 Lacca Ointment.- 3.3.3.2 "Duet Ointment".- 4 Treatment of Third Degree Eschar.- 4.1 Spontaneous Separation (or Withering Away) of Eschar by "Silkworm Bite".- 4.2 Surgical Removal of Eschar.- 4.2.1 Indications for Tangential Excision.- 4.2.2 Eschar Excision.- 4.2.2.1 Indications.- 4.2.2.2 Timing.- 4.2.2.3 Size and Location of Excision.- 4.2.2.4 The Interval Between Two Excisions.- 4.2.2.5 Preparation for Excision.- 4.2.2.6 Anesthesia.- 4.2.2.7 Method.- 4.2.2.8 Use of CO2 Laser.- 4.2.2.9 Excision of Eschar of Extensive Third Degree Burns.- 5 Skin Grafting.- 5.1 Requirements for the Take of Skin Grafts.- 5.2 Preoperative Preparation for Skin Grafting.- 5.2.1 General Preparation.- 5.2.2 Preparation of the Surfaces to Receive Grafts.- 5.2.3 Harvesting the Skin.- 5.2.3.1 Simple Method.- 5.2.3.2 Cropping with a Drum Dermatome.- 5.2.3.3 Harvesting of Full-Thickness Graft.- 5.2.4 Harvesting Skin from Unusual Parts of the Body.- 5.2.5 Care of the Donor Site.- 5.2.6 Methods of Grafting.- 5.2.6.1 Transplantation of Large Sheets of Graft.- 5.2.6.2 Transplantation of Mesh Graft.- 5.2.6.3 Transplantation of Small Autografts.- 5.2.6.4 Transplantation of Postage Stamp-Sized Grafts.- 5.2.6.5 Full-Thickness Skin Transplantation.- 6 Allografts, Xenografts, and Intermingled Transplantation.- 6.1 Allografts.- 6.2 Xenografts.- 6.3 Intermingled Transplantation of Autograft and Allograft.- 6.3.1 Method of Intermingled Transplantation.- 6.3.2 Histologic Observations.- 6.4 Intermingled Transplantation of Porcine Skin and Autograft.- 6.5 Artificial Skin.- IV Infection of the Burn.- 1 The Onset of Septicemia.- 1.1 Early Stage.- 1.2 Stage of Eschar Separation.- 1.3 Late Stage.- 2 Symptoms of Septicemia.- 2.1 Systemic Symptoms.- 2.2 Changes in the Appearance of the Wound.- 2.3 Changes in the Appearance of the Tongue.- 2.4 Laboratory Findings.- 2.5 Summary.- 2.6 Erythema Gangrenosa.- 3 Early Diagnosis of Septicemia.- 4 The Prevention and Treatment of Septicemia.- 4.1 Ameliorate the Host Resistance.- 4.1.1 Ami-Pseudomonas Hyperimmune Globulin.- 4.1.2 Convalescent Blood or Plasma.- 4.2 Proper Management of the Wound.- 4.2.1 10% Sulfamylon Cream.- 4.2.2 Silver Sulfadiazine Cream.- 4.2.3 Gentamicin Cream.- 4.2.4 Combinations of Drugs.- 4.2.5 Surgical Removal or Drainage of Infective Foci.- 4.3 Reasonable Use of Antibiotics.- 4.3.1 Indications for Systemic Administration of Antibiotics in Burns.- 4.3.2 Plan for the Systemic Administration of Antibiotics.- 4.3.3 Choice of Antibiotics in the Light of Past Experience.- 5 Fungal Infection.- 5.1 Fungal Infection of Burn Wounds.- 5.2 Invasive Fungal Infection of the Mucous Membranes and Disseminated Fungal Infection.- 5.3 Treatment.- V Traditional Chinese Treatment of Burns.- 1 Treatment Following Discrimination of Symptoms and Signs in Burns.- 2 Methods of Treatment and Medication.- 3 Diagnostic Significance of "Pulse Picture" and "Tongue Picture".- VI Water-Electrolyte and Acid-Base Balances.- 1 Water-Electrolyte Balance.- 1.1 Introduction.- 1.1.1 Calculating Units.- 1.1.2 Method of Unit Transformation.- 1.2 Sodium Balance.- 1.2.1 Hypernatremia.- 1.2.1.1 Tube-Feeding Syndrome.- 1.2.1.2 Hypernatremia Induced by Uncontrolled Diabetes.- 1.2.2 Hyponatremia.- 1.2.2.1 Sodium-Deficient Hyponatremia.- 1.2.2.2 Dilutional Hyponatremia and Water Intoxication.- 1.2.2.3 Hyponatremia During the Shock Stage After Extensive Burns.- 1.3 Potassium Balance.- 1.3.1 Hypokalemia.- 1.3.2 Hyperkalemia.- 2 Acid-Base Balance.- 2.1 Introduction.- 2.1.1 Biologic Oxidation and Hydrogen Ions.- 2.1.2 Pulmonary and Renal Compensation and Buffer Systems.- 2.1.2.1 Lungs.- 2.1.2.2 Kidneys.- 2.1.2.3 Buffer System.- 2.2 Symbols and Terms of Importance in the Expression of Acid-Base Changes.- 2.3 Signs and Symptoms of Acid-Base Imbalance.- 2.4 Methods of Calculation.- 2.5 Frequently Used Solutions.- 2.5.1 Sodium Bicarbonate Solution.- 2.5.2 Sodium Lactate Solution.- 2.5.3 Sodium Lactate-Physiologic Saline or Sodium Bicarbonate-Physiologic Saline Solution.- 2.5.4 Tromethamine (THAM).- 2.5.5 Ammonium Chloride (NH4Cl).- 2.6 Frequent Postburn Acid-Base Disturbances.- 2.6.1 Metabolic Acidosis.- 2.6.2 Respiratory Acidosis.- 2.6.3 Acute Hypokalemic Alkalosis.- VII Burns of Special Sites.- 1 Burns of the Head and Face.- 1.1 Characteristics.- 1.2 Problems Requiring Attention During Management in the Early Stage.- 1.3 Local Management.- 2 Burns of the Respiratory Tract.- 2.1 Classification.- 2.2 Pathologic Changes.- 2.2.1 Pulmonary Edema.- 2.2.2 Sloughing of the Necrotic Mucosa.- 2.2.3 Pulmonary Infection.- 2.3 Early Diagnosis.- 2.4 Management.- 2.4.1 Burns of the Upper Respiratory Tract.- 2.4.2 Burns of the Lower Respiratory Tract.- 3 Burns of the Eye.- 3.1 Symptoms.- 3.2 Management.- 4 Burns of the External Ear.- 4.1 Characteristics.- 4.2 Management.- 4.3 Symptoms and Management of Auricular Chondritis.- 5 Burns of the Hand.- 5.1 Characteristics.- 5.2 Management.- 5.2.1 Superficial Second Degree Burns.- 5.2.2 Deep Second Degree Burns.- 5.2.3 Third Degree Burns.- 6 Burns of the Perineum.- 7 Burns of the Bones and Joints.- 7.1 Management.- 7.1.1 Tubular Bones.- 7.1.2 Cranial Bones.- 7.1.3 Joints.- VIII Electric Injury.- 1 Pathologic Features.- 2 Treatment.- 2.1 Early Care.- 2.1.1 Resuscitation.- 2.1.2 Fluid Replacement in the Shock Stage.- 2.1.3 Prevention of Tetanus and Other Anaerobic Infections.- 2.1.4 Early Decompression Incision of the Deep Fascia.- 2.2 Management of the Wound.- 2.2.1 Electric Injuries of the Hand.- 2.2.2 Electric Injuries of the Limbs.- 2.2.3 Electric Injuries of the Thoracic and Abdominal Walls.- 2.2.4 Electric Injuries of the Cranium.- 2.2.5 Electric Injuries of the Joints.- 3 Complications.- 3.1 Complications Involving the Central Nervous System.- 3.2 Secondary Hemorrhage.- 3.3 Peripheral Nerve Injuries.- 3.4 Anaerobic Infection.- 3.5 Cardiac Arrest and Arrhythmia.- 3.6 Ileus and Perforation of the Intestines.- 3.7 Acute Renal Failure.- 3.8 Severe Anemia.- 3.9 Cataract.- IX Chemical Burns.- 1 Acid Burns.- 1.1 Sulfuric Acid, Nitric Acid, and Hydrochloric Acid.- 1.2 Hydrofluoric Acid.- 1.3 Oxalic Acid.- 1.4 Chromic Acid.- 1.5 Chlorosulfonic Acid.- 2 Alkali Burns.- 2.1 Caustic Alkali.- 2.2 Lime.- 2.3 Ammonia Water.- 3 Agents Causing Chemical Burns Associated with Systemic Poisoning.- 3.1 Phenol.- 3.2 Yellow Phosphorus.- 3.3 Organic Phosphorus.- 3.4 Cyanides.- 3.5 Carbon Disulfide.- 3.6 Mercury.- 4 Other Chemical Burns.- 4.1 Magnesium.- 4.2 Tar.- 5 Chemical Burns of the Eye.- X Burns Complicated by Trauma.- 1 Blast and Gas Explosion Injuries.- 1.1 Blast Injuries.- 1.2 Gas Explosion Injuries.- 2 Craniocerebral and Spinal Injuries.- 2.1 Diagnosis of Craniocerebral Injuries.- 2.2 Treatment of Craniocerebral Injuries.- 2.2.1 Early Treatment.- 2.2.2 Principles of Treatment of Various Craniocerebral Injuries.- 2.3 Spinal Cord Injuries.- 3 Fractures.- 3.1 Closed Fractures of the Extremities.- 3.2 Open Fractures of the Extremities.- 4 Soft Tissue Injuries.- 5 Hot Roller Burns of the Hand (Hot Roller Hand).- 6 Trauma of the Chest and Abdomen.- 6.1 Rib Fractures.- 6.2 Pneumothorax.- 6.3 Hemothorax.- 6.4 Abdominal Injuries.- XI Systemic Complications of Burns.- 1 Pneumonia.- 1.1 Clinical Manifestations.- 1.2 Management.- 2 Cardiac Complications.- 3 Deep Venous Thrombosis-Including Pulmonary Embolism.- 3.1 Clinical Manifestations.- 3.2 Management.- 4 Acute Postburn Ulcerative Bleeding.- 5 Diarrhea.- 6 Jaundice.- 6.1 Hemolytic Jaundice.- 6.2 Serum Hepatitis.- 6.3 Wound Sepsis (or Septicemia)-Induced Jaundice.- 7 Stress Diabetes.- 7.1 Clinical Characteristics.- 7.2 Management.- 8 Acute Renal Failure (ARF).- 8.1 General Considerations.- 8.2 Prevention and Early Diagnosis of ARF of the Shock Stage.- 8.3 Peritoneal Dialysis in Postburn ARF.- 8.3.1 Timing.- 8.3.2 Preparation and Instructions.- 8.4 Other Managements of Postburn ARF.- 8.4.1 Nutrition.- 8.4.2 Fluid Intake.- 8.4.3 Management of Hyperkalemia.- 8.4.4 Management of Dilutional Hyponatremia.- 8.4.5 Management of Metabolic Acidosis.- 9 Bone and Joint Complications.- 9.1 Bone Destruction.- 9.2 Joint Destruction.- 9.3 Hyperplastic Periostitis.- 9.4 Osteoporosis.- 9.5 Ectopic Calcification and Ossification.- 9.6 Osteophytes Formation.- XII Nursing Care in Burns.- 1 Sources of Infection, Disinfection, and Isolation.- 1.1 Sources of Cross Infection.- 1.2 Measures of Disinfection and Isolation.- 1.2.1 Final Disinfection of the Wards.- 1.2.2 Regulations Concerning Disinfection and Isolation in the Wards.- 1.3 Problems and Prospect of Improvement.- 2 Nutrition.- 2.1 Nutrient Requirements.- 2.2 The Nitrogen-Calorie Ratio.- 2.3 Routes of Administration of Nutrients.- 2.3.1 Enteral Administration.- 2.3.1.1 Oral Feeding.- 2.3.1.2 Nasal Feeding.- 2.3.1.3 "Element Diet".- 2.3.2 Intravenous Alimentation.- 2.3.2.1 Composition of Intravenous Aliments.- 2.3.2.2 Preparations of Intravenous Aliments.- 2.3.2.3 Adiminstration of Parenteral Nutriments.- 2.3.2.4 Important Points in Parenteral Nutrition.- 2.3.2.5 Complications and Their Prevention.- 3 Intravenous Fluid Administration.- 3.1 Venipuncture of Veins of Unusual Sites.- 3.1.1 Superficial Veins of the Trunk.- 3.1.2 Veins of the Scalp.- 3.1.3 Veins of the Fingers and Toes.- 3.1.4 External Jugular Vein.- 3.1.5 Internal Jugular Vein.- 3.1.6 Femoral Vein.- 3.1.7 Superficial Veins Beneath the Healed Wound Surface.- 3.1.8 Popliteal Vein.- 3.1.9 Subclavian Vein.- 3.1.10 Axillary Vein.- 3.2 Intravenous Catheterization Through Puncture.- 4 Basic Nursing Care.- 4.1 Turning Over the Patient by Means of the Turning Bed.- 4.1.1 Advantages.- 4.1.2 Procedure.- 4.1.3 Important Points to Note.- 4.2 Nursing Care of Defecation and Urination in Extensively Burned Patients.- 4.2.1 Defecation.- 4.2.2 Urination.- XIII Pathologic Anatomy of Burns.- 1 Local Pathologic Changes.- 1.1 Cutaneous Burns.- 1.2 Burns of the Respiratory Tract.- 2 Systemic Disturbances Caused by Cutaneous Burns.- 2.1 Lung, Trachea, and Bronchi.- 2.2 Wound Sepsis and Septicemia.- 2.3 Kidneys.- 2.4 Heart.- 2.5 Liver.- 2.6 Spleen.- 2.7 Stomach and Duodenum.- 2.8 Adrenal Glands.- 2.9 Central Nervous System.- 2.10 Bladder.- 2.11 Serosa and Mucosa.- 2.12 Thrombosis of the Femoral Vein.- XIV Plastic Surgery in Burns.- 1 General Considerations.- 1.1 Classification of Scars.- 1.1.1 Atrophic Scar.- 1.1.2 Hypertrophic Scar.- 1.2 Scar Contraction.- 1.2.1 Timing of Surgery.- 1.2.2 Principles of Surgery.- 1.2.2.1 Formulating the Operative Plan.- 1.2.2.2 Release of Contraction.- 1.2.2.3 Wound Care.- 1.3 Cutting of Skin Graft.- 1.3.1 Partial-Thickness Grafts.- 1.3.2 Full-Thickness Grafts.- 1.4 Z-plasty.- 1.5 Skin Tubes.- 1.5.1 Indications.- 1.5.2 Complications of Design and Transfer.- 1.6 Free Flaps.- 2 Cicatricial Contraction of the Face.- 2.1 Dysfunction Caused by Facial Cicatricial Contraction and Its Repair.- 2.1.1 Repair with a Large Sheet of Skin Graft.- 2.1.2 Repair with a Tube Flap.- 2.2 Ectropion of the Eyelids.- 2.3 Microstomia.- 2.4 Nostril Atresia.- 2.5 Partial or Total Loss of the Nose.- 2.5.1 Alar Defects.- 2.5.2 Subtotal and Total Loss.- 2.6 Defects of the Ear.- 2.6.1 Repair of Ear Defects.- 2.6.2 Scar Adhesion Between the Ear and the Mastoid Region.- 3 Cicatricial Contraction of the Neck.- 3.1 Classification.- 3.2 Surgical Treatment.- 3.2.1 Z-plasty.- 3.2.2 Free Skin Graft.- 3.2.3 Tubes or Flaps for Repair of the Neck.- 4 Cicatricial Contraction of the Axilla.- 4.1 Classification.- 4.2 Infection.- 4.3 Surgical Treatment.- 4.3.1 Z-plasty.- 4.3.2 Transplantation of Free Skin Graft.- 4.3.3 Repair with a Pedicle Flap.- 5 Cicatricial Contraction of the Elbow.- 6 Cicatricial Contraction of the Hand.- 6.1 Classification of Burn Cicatricial Contraction on the Dorsum of the Hand.- 6.1.1 Mild Form.- 6.1.2 Moderate Form.- 6.1.3 Severe Form.- 6.2 Treatment.- 6.2.1 Reduction of the MP Joint.- 6.2.1.1 Reduction by Manipulation.- 6.2.1.2 Excision of the Collateral Ligament.- 6.2.1.3 Handling of Extensors.- 6.2.1.4 Arthroplasty.- 6.2.2 Arthrodesis of IP Joints.- 6.2.3 Adduction Deformity of the Thumb.- 7 Cicatricial Contraction over the Perineum.- 7.1 Deformities.- 7.2 Principles of Treatment.- 7.3 Operative Procedure and Pre- and Postoperative Care.- 8 Cicatricial Contraction of the Popliteal Fossa and Chronic Ulcer of the Leg.- 8.1 Cicatricial Contraction of the Popliteal Fossa.- 8.1.1 Treatment.- 8.2 Chronic Ulcer of the Leg.- 8.2.1 Treatment.- 9 Cicatricial Contraction of the Foot.- 9.1 Signs.- 9.2 Principles of Treatment.- 10 Cicatricial Contraction After Very Extensive Third Degree Burns.- 10.1 Use of a Large Piece of Allograft with "Punched Windows" for Autologous Skin Inlays.- 10.1.1 Preoperative Preparation.- 10.1.2 Operative Procedure.- 10.1.3 Postoperative Management.- 10.2 Distant Transplantation of Cicatricial Skin Tube.- 10.3 Harvesting Free Cicatricial Skin Grafts.- 11 Skin Lesions Following Radiation Burn.- 11.1 Clinical Manifestations.- 11.2 Principles of Treatment.- 11.2.1 General Treatment.- 11.2.2 Local Treatment.- 11.2.3 Surgical Treatment.- 12 Transplantation of Free Skin Flaps.- 12.1 Advantages of the Free Skin Flap.- 12.2 Requirements of the Donor Area.- 12.3 Requirements of the Recipient Area.- 12.4 Free Transplantation of the Thoracodorsal Axillary Flap for the Repair of Postburn Cicatricial Contraction.- 12.4.1 Advantages of Thoracodorsal Axillary Flaps.- 12.4.2 Regional Anatomy.- 12.4.3 Surgical Procedure.- XV Anesthetization of Burn Patients.- 1 Preparation for Anesthesia.- 2 Premedication.- 3 Choice of Anesthesia.- 3.1 Regional Anesthesia.- 3.2 General Anesthesia.- 3.2.1 Lytic Cocktail.- 3.2.2 Sodium ?-Hydroxybutyrate (?-OH).- 3.2.3 Thiopental Sodium.- 3.3 Neuroleptanalgesia.- 3.4 Ketamine.- 4 Anesthetic Management.- 4.1 Measurement of Blood Pressure.- 4.2 Clearance of Secretions from the Respiratory Tract.- 4.3 Maintenance of Ventilation.- 4.4 Restoration of Blood Volume Deficit.- 4.5 Changes in Body Temperature.- 4.6 Postural Hypotension.- 4.7 Use of Muscle Relaxants.- 5 Anesthesia for Plastic and Reconstructive Surgery.- Appendix I The Subeschar Bacterial Count.- Appendix II Preparation and Deep-freeze Storage of Allografts and Xenografts.
Erscheint lt. Verlag | 7.12.2011 |
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Übersetzer | Pao-Chun Nyi |
Zusatzinfo | XXIV, 404 p. |
Verlagsort | Berlin |
Sprache | englisch |
Maße | 170 x 244 mm |
Gewicht | 740 g |
Themenwelt | Medizinische Fachgebiete ► Chirurgie ► Ästhetische und Plastische Chirurgie |
Schlagworte | Burns • Verbrennungskrankheit |
ISBN-10 | 3-642-68102-6 / 3642681026 |
ISBN-13 | 978-3-642-68102-8 / 9783642681028 |
Zustand | Neuware |
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