Burn injuries in firefighters.

The authors cover the care of burn injuries from start to finish, beginning with a discussion of immediate intervention and concluding with a look at psychosocial aspects of burns. Topics in the middle include early management, evaluation of the patient and classification of the burn's severity, burn resuscitation, the pathophysiology of smoke inhalation, dressing of burn wounds, escharotomies and fasciotomies, surgical management, and rehabilitation.

The effect of burn wound size on resting energy expenditure.

Numerous formulas have been used to estimate the calorie requirements of hypermetabolic burned patients. With the recent development of instrumentation for indirect calorimetric measurements, questions have been raised concerning the validity and accuracy of the early equations. Because metabolic rate decreases during the course of wound healing, we attempted to determine the magnitude of hypermetabolism and the accuracy of the Curreri formula in patients with various wound sizes. Twenty-eight patients with a mean initial burn size of 29% body surface area (BSA) had measurements of resting energy expenditure (REE) at regular intervals during their postburn course. Concomitantly, basal energy expenditure (BEE) was calculated from the Harris-Benedict equation; and the predicted energy needs were calculated using the Curreri formula adjusted for current wound size (ACEE). Three significantly different burn size (%BSA) groups were identified: Group 1, 1-10%; Group 2, 11-30%; and Group 3, 31-60% BSA. The measured REE was 27, 35, and 50% greater than the BEE in Groups 1, 2, and 3, respectively (p less than 0.001). The ACEE underestimated REE by 7% in Group 1, and overestimated REE by 13 and 35% in Groups 2 and 3, respectively (p less than 0.001). Resting energy expenditure should be measured at regular intervals in individuals with open burn wounds greater than 10% BSA in order to adjust nutritional support appropriately.

Acute electrical burns: a 10-year clinical experience.

We have reviewed 113 cases of electrical burns treated at the Cook County Hospital Burn Center during the past 10 years. There were 3265 acute burn admissions during this period. the incidence of electrical burns being 3.5 per cent. Low-voltage electrical burns occurred in 82 of the 113 patients (73 per cent). These were caused mostly by household electricity supplies, occurred in children, and were preventable. Arc burns of the perioral region were allowed to heal spontaneously. The surgical management of other arc burns and flash burns was similar to that for most deep burn wounds. The incidence of high-voltage electrical injuries was 27 per cent in our series. Over 50 per cent of these injuries were not work-related. These tended to occur outside the home in young adult males and were also frequently preventable. None of these patients developed acute renal failure. Early surgical debridement of devitalized tissue with allografting, followed by delayed definitive wound closure or amputation prevented septic complications. Early fasciotomy appeared to have little effect on complete limb salvage. Limb loss continues to be the major factor contributing to the high morbidity associated with these injuries. All 113 patients survived. We attribute this to early transfer of patients to our Burn Unit, aggressive fluid resuscitation, continuous haemodynamic and metabolic support, and early surgical intervention.