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Book Details
Abstract
Recent advances in research have resulted in tremendous changes in burn management. Stay fully up to date with the new edition of Total Burn Care, by leading authority Dr. David N. Herndon. Detailed procedural guidelines walk you through every step of the process, from resuscitation through reconstruction and rehabilitation. Everyone on the burn care team, including general and plastic surgeons, intensivists, anesthestists, and nurses, will benefit from this integrated, multidisciplinary guide to safe and effective burn management.
- Discusses infection control, early burn coverage, occupational physical exercise, respiratory therapy, and ventilator management.
- Summarizes key points at the beginning of each chapter for quick reference.
- Uses an integrated, team approach to help you meet the clinical, physical, psychological, and social needs of every patient.
- Offers expert guidance on early reconstructive surgery and rehabilitation, with new content on improved surgical techniques.
- Covers special populations such as elderly and pediatric patients, and includes a new chapter on burns in pregnancy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Total Burn Care | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | viii | ||
| In Memorium of Ted Huang, MD | ix | ||
| List of Contributors | x | ||
| Video Table of Contents | xviii | ||
| List of Video Contributors | xix | ||
| 1 A Brief History of Acute Burn Care Management | 1 | ||
| Early Excision | 1 | ||
| Skin Grafting | 3 | ||
| Topical Control of Infection | 4 | ||
| Nutritional Support | 4 | ||
| Fluid Resuscitation | 5 | ||
| Inhalation Injury | 6 | ||
| Hypermetabolic Response to Trauma | 7 | ||
| Conclusion | 7 | ||
| Further Reading | 7 | ||
| References | 7.e1 | ||
| 2 Teamwork for Total Burn Care | 8 | ||
| Introduction | 8 | ||
| Members of a Burn Team | 9 | ||
| Burn Surgeons | 9 | ||
| Plastic Surgeons | 10 | ||
| Anesthesiologists | 10 | ||
| Nurses | 10 | ||
| Physical and Occupational Therapists | 10 | ||
| Respiratory Therapists | 11 | ||
| Exercise Physiologist | 11 | ||
| Nutritionists | 11 | ||
| Psychosocial Experts | 11 | ||
| Spiritual Therapists | 11 | ||
| Music Therapists | 11 | ||
| Students, Residents, and Fellows | 11 | ||
| Dynamics and Functioning of the Burn Team | 12 | ||
| Summary | 13 | ||
| References | 13.e1 | ||
| 3 Epidemiological, Demographic and Outcome Characteristics of Burns | 14 | ||
| Introduction | 14 | ||
| Demography | 18 | ||
| High-Risk Populations | 19 | ||
| Children | 19 | ||
| Elderly | 19 | ||
| Disabled | 20 | ||
| Military Personnel | 20 | ||
| Burn Etiologies | 20 | ||
| Fire/Flame | 20 | ||
| Scald | 21 | ||
| Contact | 21 | ||
| Work-Related Burns | 21 | ||
| Chemical Burns | 21 | ||
| Electrical Current Injury | 22 | ||
| Lightning Burns | 22 | ||
| Fireworks | 22 | ||
| Intentional Burns | 22 | ||
| Hospital Burns | 23 | ||
| Burn Patient Transport and Transfer | 23 | ||
| Mass Casualties | 24 | ||
| Outcome Analysis in Burns | 24 | ||
| Conclusion | 27 | ||
| References | 27.e1 | ||
| 4 Prevention of Burn Injuries | 28 | ||
| Introduction | 28 | ||
| Injury Prevention Models | 28 | ||
| Burn Intervention Strategy | 28 | ||
| Epidemiology | 29 | ||
| Overview of Burn Injuries in the United States | 29 | ||
| Common Mechanisms of Injury | 30 | ||
| High-Risk Populations | 30 | ||
| Engineering and Enforcement | 31 | ||
| Smoke Alarms | 31 | ||
| Fire Sprinklers | 32 | ||
| Fabric Flammability | 32 | ||
| Fire-Safe Cigarettes | 32 | ||
| Water Temperature Regulations | 33 | ||
| Fireworks Regulation | 33 | ||
| Education | 33 | ||
| Evaluation | 34 | ||
| Global Burn Prevention | 34 | ||
| Future | 35 | ||
| References | 35.e1 | ||
| 5 Burn Management in Disasters and Humanitarian Crises | 36 | ||
| Introduction | 36 | ||
| Definitions | 36 | ||
| The Historical Record | 37 | ||
| Terrorist Attacks | 37 | ||
| New York City—September 11, 2001 | 37 | ||
| Kuta, Bali, Indonesia—October 12, 2002 | 38 | ||
| Madrid, Spain—March 11, 2004 | 38 | ||
| London, England—July 7, 2005 | 38 | ||
| Indoor Fires | 38 | ||
| Gothenburg, Sweden—October 30, 1998 | 38 | ||
| Volendam, the Netherlands—January 1, 2001 | 39 | ||
| Warwick, Rhode Island—February 20, 2003 | 39 | ||
| Buenos Aires, Argentina—December 30, 2004 | 39 | ||
| Kiss Nightclub Fire, Santa Maria, Rio Grande do Sul, Brazil—January 27, 2013 | 39 | ||
| Colectiv Nightclub Fire, Bucharest, Romania— October 30, 2015 | 39 | ||
| Transportation Crashes | 40 | ||
| Alcanar, Spain—July 11, 1978 | 40 | ||
| Lyce Diyarbakir, Turkey—July 21, 2014 | 40 | ||
| Ramstein, West Germany—August 28, 1988 | 40 | ||
| Pope Air Force Base, North Carolina—March 23, 1994 | 41 | ||
| Explosions | 41 | ||
| San Juanico, Mexico—November 19, 1984 | 41 | ||
| Piper Alpha, North Sea—July 6, 1988 | 41 | ||
| Bashkir Autonomous Soviet Socialist Republic— June 4, 1989 | 41 | ||
| Phases of Mass Casualty Events | 42 | ||
| Chaos and Alarm | 42 | ||
| Organization | 42 | ||
| Search and Rescue | 42 | ||
| Triage and First Aid | 42 | ||
| Initial Transport | 43 | ||
| Burn Center Referral | 43 | ||
| Evacuation to Other Burn Centers | 43 | ||
| Secondary Transport | 44 | ||
| Transport Home | 44 | ||
| Long-Term Follow-Up and Rehabilitation | 44 | ||
| Debriefing | 44 | ||
| Emergency Care: Special Considerations in Disasters | 44 | ||
| First Aid | 44 | ||
| Fluid Resuscitation | 44 | ||
| Oral Resuscitation | 45 | ||
| Airway Management | 45 | ||
| Oxygen | 45 | ||
| Anesthesia | 46 | ||
| Blood | 46 | ||
| Wound Care and Escharotomies | 46 | ||
| Communication | 46 | ||
| Means of Communication | 47 | ||
| Cellular Telephone | 47 | ||
| Conventional Telephone | 47 | ||
| Voice over Internet Protocol | 47 | ||
| Two-Way Radio | 47 | ||
| Trunked Radio System | 47 | ||
| Satellite Telephone | 47 | ||
| Internet | 47 | ||
| Electronic News Media | 47 | ||
| Communication With News Media | 47 | ||
| Communication With Relatives and Friends | 47 | ||
| Strategies for Distribution of Patients and Resources | 48 | ||
| The Role of Burn Centers | 48 | ||
| The Role of Trauma Centers | 48 | ||
| The Role of Burn-Bed Databases | 48 | ||
| The Role of International Cooperation | 48 | ||
| Humanitarian Crises | 48 | ||
| Conclusions | 49 | ||
| References | 49.e1 | ||
| 6 Care of Outpatient Burns | 50 | ||
| Introduction | 50 | ||
| Who Can Be Managed as an Outpatient? | 50 | ||
| Percent of the Burn | 50 | ||
| Depth of the Burn | 50 | ||
| Distribution of the Burn | 51 | ||
| Injuring Agent | 51 | ||
| Electricity | 51 | ||
| Chemicals | 52 | ||
| Respiratory Complications | 52 | ||
| Associated Trauma | 52 | ||
| Comorbid Disorders | 52 | ||
| Social Circumstances | 52 | ||
| Hospital Resources | 53 | ||
| Management of Minor Burns | 53 | ||
| Cooling the Burn | 53 | ||
| Pain Control | 53 | ||
| Blisters | 53 | ||
| Cleansing the Wound | 54 | ||
| Topical Agents | 54 | ||
| Dressing the Wound | 54 | ||
| Synthetic Wound Dressings | 54 | ||
| Mepitel | 55 | ||
| Mepilex AG | 55 | ||
| Acticoat | 55 | ||
| TheraBond 3D | 55 | ||
| Silverlon | 55 | ||
| Suprathel | 55 | ||
| Hydrocolloid Dressings | 55 | ||
| Synthetic Tissue-Engineered Wound Dressings | 55 | ||
| Biobrane | 55 | ||
| Biologic Wound Dressings | 56 | ||
| Allogenic Amnion | 56 | ||
| Xenograft | 56 | ||
| Allograft | 56 | ||
| Elevation of the Burned Part | 56 | ||
| Infection and Use of Systemic Antibiotics | 56 | ||
| Vaccinations | 56 | ||
| Instructions and Follow-Up Care | 56 | ||
| Definitive Wound Closure | 56 | ||
| Pruritus | 56 | ||
| Traumatic Blisters in Reepithelialized Wounds | 57 | ||
| Rehabilitative Physical Care | 57 | ||
| Outpatient Treatment of Moderate and Major Burns | 57 | ||
| Conclusion | 57 | ||
| References | 57.e1 | ||
| 7 Prehospital Management, Transportation, and Emergency Care | 58 | ||
| Introduction | 58 | ||
| Prehospital Care | 58 | ||
| Onsite Assessment of a Burned Patient | 58 | ||
| Primary Assessment | 58 | ||
| Secondary Assessment | 59 | ||
| Transport to Hospital Emergency Department | 59 | ||
| Keeping the Patient Warm and Dry | 59 | ||
| Pain Control | 59 | ||
| Transferring a Burn Patient | 60 | ||
| Privacy and Security Issues | 60 | ||
| Transportation Guidelines | 61 | ||
| Transport Team Composition | 62 | ||
| Training and Selection | 62 | ||
| Modes of Transportation | 62 | ||
| Ground Transport | 62 | ||
| Air Transport | 62 | ||
| Helicopters and Fixed-Wing Aircraft. | 63 | ||
| Equipment | 63 | ||
| Portable Monitor | 64 | ||
| Infusion Pump | 64 | ||
| Ventilator | 64 | ||
| Stabilization | 64 | ||
| Patient Assessment Prior to Transport to a Specialized Burn Care Unit From a Referring Hospital | 64 | ||
| Summary | 65 | ||
| Further Reading | 65 | ||
| References | 65.e1 | ||
| 8 Pathophysiology of Burn Shock and Burn Edema | 66 | ||
| Introduction and Historical Notes | 66 | ||
| Hypovolemia and Rapid Edema Formation | 66 | ||
| Normal Microcirculatory Fluid Exchange | 67 | ||
| Mechanisms of Burn Edema | 68 | ||
| Capillary Filtration Coefficient (Kf) | 68 | ||
| Capillary Pressure (Pc) | 68 | ||
| Interstitial Hydrostatic Pressure (Pif) | 68 | ||
| Osmotic Reflection Coefficient (σ) | 68 | ||
| Plasma Colloid Osmotic Pressure (πp) | 69 | ||
| Interstitial Colloid Osmotic Pressure (πif) | 69 | ||
| Endothelial Dysfunction and the Glycocalyx | 69 | ||
| Unburned Tissue | 70 | ||
| Altered Cellular Membranes and Cellular Edema | 70 | ||
| Inflammatory Mediators of Burn Injury | 71 | ||
| Histamine | 71 | ||
| Prostaglandins | 71 | ||
| Thromboxane | 71 | ||
| Kinins | 72 | ||
| Serotonin | 72 | ||
| Catecholamines | 72 | ||
| Reactive Oxygen Species | 73 | ||
| Nitric Oxide | 73 | ||
| Platelet Aggregation Factor | 73 | ||
| Angiotensin II and Vasopressin | 74 | ||
| Other Mediators | 74 | ||
| Hemodynamic Consequences | 74 | ||
| Myocardial Dysfunction | 74 | ||
| Increased Systemic Vascular Resistance and Organ Ischemia | 75 | ||
| Pulmonary Circulation and Lung Edema | 75 | ||
| Fluid Overload and Abdominal Compartment Syndrome | 75 | ||
| Conclusion | 76 | ||
| Further Reading | 76 | ||
| References | 76.e1 | ||
| 9 Burn Resuscitation | 77 | ||
| Introduction | 77 | ||
| Early Approaches to Fluid Resuscitation | 77 | ||
| Brooke and Parkland Formulas | 79 | ||
| Children | 79 | ||
| Choice of Fluid | 80 | ||
| Route of Administration | 81 | ||
| Patients at Increased Risk During Resuscitation | 81 | ||
| Monitoring Resuscitation | 81 | ||
| Fluid Creep and Edema Management | 82 | ||
| Pharmacologic and Extracorporeal Adjuncts | 83 | ||
| Protocol-Driven and Computerized Resuscitation | 84 | ||
| Conclusion | 86 | ||
| References | 86.e1 | ||
| 10 Evaluation of the Burn Wound | 87 | ||
| Introduction | 87 | ||
| Pathophysiology of the Burn Wound | 87 | ||
| Skin Biology | 87 | ||
| Pathophysiological Changes of Thermal Injury | 88 | ||
| Assessment of Burn Depth | 88 | ||
| Clinical Observation | 88 | ||
| Adjuncts to Clinical Evaluation | 89 | ||
| Mechanisms of Thermal Injury | 89 | ||
| Flash and Flame Burns | 89 | ||
| Scalds | 90 | ||
| Contact Burns | 91 | ||
| Chemical Burns | 91 | ||
| Electrical Burns | 92 | ||
| Further Reading | 92 | ||
| References | 92.e1 | ||
| 11 Treatment of Infection in Burn Patients | 93 | ||
| Introduction | 93 | ||
| Prevention of Infection | 93 | ||
| Diagnosis of Burn Wound Infection | 93 | ||
| Treatment of Burn Wound Infections | 96 | ||
| Topical Antimicrobial Compounds | 96 | ||
| Systemic Antimicrobials in Burn Patients | 100 | ||
| Specific Pathogens in Burn Wounds | 103 | ||
| Infections From Sources Other Than Wounds in the Burn Patient | 109 | ||
| Conclusion | 112 | ||
| References | 113.e1 | ||
| 12 Operative Wound Management | 114 | ||
| Introduction | 114 | ||
| Advantages of Operative Wound Management | 114 | ||
| Techniques of Burn Wound Excision | 115 | ||
| Excision of a Small Burn | 115 | ||
| Tangential Excision | 115 | ||
| Fascial Excision | 117 | ||
| Controlling Blood Loss During Burn Excision | 117 | ||
| Techniques of Wound Closure | 118 | ||
| Advances in Wound Closure | 119 | ||
| Dermal Replacement | 119 | ||
| Cultured Epidermal Autografts | 119 | ||
| Skin Procurement | 121 | ||
| Management of Donor Site | 121 | ||
| Dressings | 121 | ||
| Temporary Skin Substitutes | 121 | ||
| Management of Specific Types of Burns | 122 | ||
| Scald Burns | 122 | ||
| Extensive Burns | 122 | ||
| The Operating Room | 122 | ||
| The Operation | 123 | ||
| Operative Management of Burns Involving Special Areas | 123 | ||
| The Hand | 123 | ||
| Escharotomy and Fasciotomy | 124 | ||
| Techniques of Excision and Grafting | 125 | ||
| Techniques to Salvage Length in Fourth-Degree Hand Burns | 126 | ||
| The Scalp | 128 | ||
| The Face | 128 | ||
| Eyelids | 129 | ||
| Genital Burns | 129 | ||
| The Breast | 129 | ||
| Conclusion | 129 | ||
| Further Reading | 130 | ||
| References | 130.e1 | ||
| 13 Anesthesia for Burned Patients | 131 | ||
| Introduction | 131 | ||
| Preoperative Evaluation | 131 | ||
| Initial Evaluation of Burn Injury | 132 | ||
| Airway and Pulmonary Function | 133 | ||
| Effect of Burn Injury on Circulation | 136 | ||
| Effect of Burn Injury on Renal Function | 140 | ||
| Metabolic Changes Associated With Burn Injury | 141 | ||
| Thermoregulation in Burn Patients | 141 | ||
| Pharmacological Considerations | 143 | ||
| Airway Management | 145 | ||
| Monitors | 147 | ||
| Vascular Access | 148 | ||
| Patient Transport | 150 | ||
| Selection of Anesthetic Agents | 150 | ||
| Fluid Management | 151 | ||
| Blood Transfusion | 152 | ||
| Blood Components | 152 | ||
| Whole Blood | 153 | ||
| Packed Red Blood Cells | 153 | ||
| Fresh Frozen Plasma | 153 | ||
| Platelets | 153 | ||
| Cryoprecipitate | 154 | ||
| Complications of Massive Blood Transfusion | 154 | ||
| Coagulopathy | 154 | ||
| Citrate Toxicity | 154 | ||
| Potassium Abnormalities | 154 | ||
| Acid–Base Abnormalities | 155 | ||
| Altered Oxygen Transport | 155 | ||
| Hypothermia | 155 | ||
| Pulmonary Complications | 155 | ||
| Transfusion Reactions | 155 | ||
| Infection | 156 | ||
| Postoperative Care | 156 | ||
| Conclusion | 157 | ||
| References | 157.e1 | ||
| 14 The Skin Bank | 158 | ||
| History | 158 | ||
| The Growth of Skin Banking | 158 | ||
| Role of the American Association of Tissue Banks | 159 | ||
| Clinical Uses of Allograft Skin | 159 | ||
| Coverage of Extensive Full-Thickness Wounds | 159 | ||
| Coverage of Widely Meshed zSkin Autografts and Partial- Thickness Wounds | 160 | ||
| Template for Delayed Application of Keratinocytes | 160 | ||
| Acellular Dermal Matrix | 161 | ||
| Potential Disadvantages of Allograft Use | 161 | ||
| Infection | 161 | ||
| Rejection | 162 | ||
| Technical Aspects of Skin Banking | 162 | ||
| Donor Screening | 162 | ||
| Skin Recovery | 162 | ||
| Skin Processing | 163 | ||
| Processing Environment | 163 | ||
| Microbiologic Testing | 163 | ||
| Maintenance of Viability | 164 | ||
| Refrigeration | 164 | ||
| Cryopreservation | 164 | ||
| Lyophilization | 165 | ||
| Irradiation | 165 | ||
| Transport | 165 | ||
| Rewarming | 165 | ||
| FDA Regulation of Human Skin Banking | 165 | ||
| Amnion Processing | 165 | ||
| The Future of Skin Banking | 165 | ||
| References | 166.e1 | ||
| 15 Skin Substitutes and ‘the next level’ | 167 | ||
| Introduction | 167 | ||
| Structure and Function of the Skin | 167 | ||
| Consequences of Loss of Barrier Function | 167 | ||
| Temporary Skin Substitutes and Dressings | 167 | ||
| Biological Tissues | 167 | ||
| Allograft | 167 | ||
| Human Amnion | 168 | ||
| Xenograft | 168 | ||
| Synthetic Materials | 168 | ||
| Permanent Skin Substitutes | 169 | ||
| Epidermal Cells and Constructs | 170 | ||
| Dermal Constructs | 170 | ||
| Tissues | 170 | ||
| Dermal Scaffolds | 171 | ||
| Cellular Dermal Substitutes | 171 | ||
| Subcutaneous Fat | 172 | ||
| Full Skin Substitutes | 173 | ||
| Regulatory Issues | 173 | ||
| Conclusion | 173 | ||
| References | 173.e1 | ||
| 16 The Pathophysiology of Inhalation Injury | 174 | ||
| Introduction and Epidemiology | 174 | ||
| Pathophysiology | 174 | ||
| Injury to the Oropharynx | 174 | ||
| Injury to the Tracheobronchial Area | 175 | ||
| Injury to the Lung Parenchyma | 178 | ||
| Long-Term Effects of Inhalation Injury | 180 | ||
| The Fire Environment and Toxic Smoke Compounds | 180 | ||
| Carbon Monoxide | 180 | ||
| Symptoms and Diagnosis of Carbon Monoxide Poisoning | 181 | ||
| Hydrogen Cyanide | 182 | ||
| Symptoms and Diagnosis of Cyanide Poisoning | 182 | ||
| Other Toxic Chemicals | 183 | ||
| References | 183.e1 | ||
| 17 Diagnosis and Treatment of Inhalation Injury | 184 | ||
| Introduction | 184 | ||
| Diagnosis | 184 | ||
| Pathophysiology of Pulmonary Insufficiency with Inhalation Injury | 187 | ||
| Treatment | 188 | ||
| Potential Future Therapeutic Strategies | 193 | ||
| Long-Term Changes in Pulmonary Function | 193 | ||
| References | 194.e1 | ||
| 18 Respiratory Care | 195 | ||
| Introduction | 195 | ||
| Bronchial Hygiene Therapy | 195 | ||
| Therapeutic Coughing | 195 | ||
| Series of Three Coughs | 195 | ||
| Tracheal Tickle | 195 | ||
| Cough Stimulation | 195 | ||
| Chest Physiotherapy | 195 | ||
| Bronchial Drainage/Positioning | 195 | ||
| Percussion | 196 | ||
| Vibration/Shaking | 196 | ||
| Early Ambulation | 196 | ||
| Airway Suctioning | 197 | ||
| Therapeutic Bronchoscopy | 197 | ||
| Pharmacologic Adjuncts | 197 | ||
| Mechanical Ventilation | 198 | ||
| Modes of Ventilation | 199 | ||
| Control Mode | 199 | ||
| Assist-Control Mode | 199 | ||
| Synchronized Intermittent Mandatory Ventilation | 199 | ||
| Pressure Control Mode | 199 | ||
| Pressure Support Ventilation | 199 | ||
| Alternate Modes of Ventilation | 199 | ||
| High-Frequency Ventilation | 199 | ||
| Airway Pressure Release Ventilation | 200 | ||
| Volumetric Diffusive Ventilation | 200 | ||
| Ventilator Settings | 200 | ||
| Tidal Volumes | 201 | ||
| Respiratory Rate | 201 | ||
| Flow Rates | 201 | ||
| Inspiratory/Expiratory (I:E) Ratio | 201 | ||
| Inspired Oxygen Concentration | 201 | ||
| Positive End-Expiratory Pressure | 201 | ||
| Extubation Criteria | 202 | ||
| Infection Control of Respiratory Equipment | 202 | ||
| Handwashing | 202 | ||
| Chemical Agents for Sterilization/Disinfection | 202 | ||
| Aldehydes | 203 | ||
| Alcohols | 203 | ||
| Late Complications of Inhalation Injury | 203 | ||
| Tracheal Stenosis | 203 | ||
| Obstructive/Restrictive Disease | 203 | ||
| Summary | 203 | ||
| Further Reading | 203 | ||
| References | 204.e1 | ||
| 19 The Systemic Inflammatory Response Syndrome | 205 | ||
| Introduction | 205 | ||
| Definition of SIRS | 205 | ||
| The Initiating Event | 206 | ||
| SIRS and Immunological Perturbations | 207 | ||
| The Two-Hit Hypothesis | 208 | ||
| Cytokine and Noncytokine Mediators of SIRS | 209 | ||
| Circulating Cytokines as Markers of SIRS and Predictors of Outcome | 213 | ||
| Anti-Inflammatory Therapy for SIRS | 214 | ||
| Activation of the Coagulation Cascade During Inflammation | 215 | ||
| The Hemodynamic Response | 217 | ||
| Changes in Endothelial Permeability | 217 | ||
| Increased Epithelial Permeability | 219 | ||
| The Hyperdynamic State | 219 | ||
| Conclusion | 220 | ||
| Further Reading | 220 | ||
| References | 220.e1 | ||
| 20 Host Defense Antibacterial Effector Cells Influenced by Massive Burns | 221 | ||
| Introduction | 221 | ||
| Neutrophils | 222 | ||
| Impaired Neutrophil Recruitment | 222 | ||
| Impaired Neutrophil Killing | 222 | ||
| Pro- and Antiinflammatory Neutrophils | 223 | ||
| Role of Damage-Associated Molecular Patterns in Inducing Antiinflammatory Neutrophils Postburn Injury | 224 | ||
| Suppressing Adaptive Immunity | 226 | ||
| Macrophages | 226 | ||
| Tissue Macrophages and Infiltrating Monocyte-Derived Macrophages | 226 | ||
| M1 Macrophages as an Antibacterial Effector Cell | 226 | ||
| M2 Macrophages as Inhibitors for Macrophage Polarization From Quiescence to the M1 Phenotype | 226 | ||
| Plasticity of Various Phenotypes of Macrophages | 227 | ||
| Innate Lymphoid Cells | 227 | ||
| Impaired ILC1 Generation Due to Impaired IL-12 Production After Burn Injury | 228 | ||
| Type 2 Immune Responses Induced by Activated ILC2s | 229 | ||
| Intestinal ILC3s | 230 | ||
| Dendritic Cells | 230 | ||
| Summary | 231 | ||
| References | 231.e1 | ||
| 21 Biomarkers in Burn Patient Care | 232 | ||
| Introduction | 232 | ||
| Prediction of Sepsis and Infection | 232 | ||
| TNF-α | 232 | ||
| IL-8 | 232 | ||
| IL-6 | 233 | ||
| C-Reactive Protein | 233 | ||
| Procalcitonin | 233 | ||
| Leptin | 233 | ||
| Combined Panels | 233 | ||
| Prediction of Patient Survival with Clinical Characteristics | 233 | ||
| Inhalation Injury and Mechanical Ventilation | 234 | ||
| Resuscitation and Kidney Function | 234 | ||
| Wound Healing | 235 | ||
| Conclusion | 235 | ||
| Further Reading | 235 | ||
| References | 235.e1 | ||
| 22 Hematology, Hemostasis, Thromboprophylaxis, and Transfusion Medicine in Burn Patients | 236 | ||
| Introduction | 236 | ||
| Etiology of Anemia in Burn Patients | 236 | ||
| Hemostasis in Burn Patients | 236 | ||
| Coagulopathy in Burn Patients | 237 | ||
| Transfusion of Blood Cells | 240 | ||
| Venothromboembolic Prophylaxis | 242 | ||
| Hematopoiesis | 243 | ||
| Myeloid Growth Factors | 244 | ||
| Granulocyte Colony-Stimulating Factor | 244 | ||
| CSF-1 | 246 | ||
| GM-CSF | 246 | ||
| Lymphoid Growth Factors | 247 | ||
| Megakaryocyte Growth Factors | 247 | ||
| Transcription Factors | 247 | ||
| Conclusion | 247 | ||
| References | 247.e1 | ||
| 23 Significance of the Hormonal, Adrenal, and Sympathetic Responses to Burn Injury | 248 | ||
| Introduction | 248 | ||
| Normal Hypothalamic- Pituitary-Adrenal Axis | 248 | ||
| Strong Sympathetic Activation Following Burn Trauma | 248 | ||
| Cardiovascular Response | 248 | ||
| Catecholamine Resistance | 249 | ||
| Catecholamines and Hypermetabolism | 250 | ||
| β-Blockade | 250 | ||
| Sympathetic Influences on Immune Function | 251 | ||
| Sympathetic Response to Sepsis | 251 | ||
| Role of Thyroid Function | 251 | ||
| Sex Steroids Following Burn Trauma | 252 | ||
| Androgens | 252 | ||
| Release of C19 Steroids. | 252 | ||
| Estrogens | 253 | ||
| Adrenal Cortical Steroids Following Burn Trauma | 253 | ||
| Free versus Total Cortisol | 255 | ||
| Substrate Cycling | 255 | ||
| Influence on Metabolic Pathways | 255 | ||
| Hormonal Determinants of Glucose Utilization | 255 | ||
| Glucocorticoids Following Burn Injury | 256 | ||
| Glucocorticoids and Carbohydrate Metabolism | 256 | ||
| Glucocorticoids and Protein Metabolism | 256 | ||
| Glucocorticoids on Bone Metabolism | 257 | ||
| Glucocorticoids on Immune Suppression | 257 | ||
| Further Reading | 258 | ||
| References | 258.e1 | ||
| 24 The Hepatic Response to Thermal Injury | 259 | ||
| Introduction | 259 | ||
| Anatomy and Physiology of the Liver | 259 | ||
| Anatomy | 259 | ||
| Physiology | 259 | ||
| The Hepatic Response to a Severe Thermal Injury | 260 | ||
| Liver Damage and Morphological Changes | 260 | ||
| Underlying Molecular Mechanisms | 262 | ||
| Effects on the Biliary System | 262 | ||
| Mononuclear Phagocyte System (MPS) | 262 | ||
| Glucose, Protein, and Lipid Metabolism | 262 | ||
| Acute-Phase Response | 264 | ||
| Vitamin Metabolism | 265 | ||
| Coagulation and Clotting Factors | 265 | ||
| Hormones | 265 | ||
| Importance of the Liver for Postburn Outcomes | 266 | ||
| Conclusion | 266 | ||
| Acknowledgments | 266 | ||
| Further Reading | 267 | ||
| References | 267.e1 | ||
| 25 Importance of Mineral and Bone Metabolism after Burn | 268 | ||
| Metabolic Actions of Calcium, Phosphate, and Magnesium | 268 | ||
| 26 Micronutrient Homeostasis | 276 | ||
| Importance of Vitamins and Trace Elements | 276 | ||
| Vitamins | 276 | ||
| Vitamin C | 276 | ||
| Vitamin D | 276 | ||
| Vitamin E | 277 | ||
| Vitamin K | 277 | ||
| Trace Elements | 277 | ||
| Blood Concentrations | 277 | ||
| Exudative and Urinary Losses | 278 | ||
| Role of Trace Elements in Inflammation and Antioxidant Defenses | 279 | ||
| Trace Element Therapy | 279 | ||
| Conclusion | 279 | ||
| Further Reading | 279 | ||
| References | 279.e1 | ||
| 27 Hypophosphatemia | 280 | ||
| Etiology of Postburn Hypophosphatemia | 280 | ||
| Stress Response | 280 | ||
| Resuscitation and Topical Therapy | 280 | ||
| Ulcer Prophylaxis | 281 | ||
| Hyperventilation | 281 | ||
| Metabolic Support | 281 | ||
| Burn Wound Physiology | 282 | ||
| Acute-Phase Response and Sepsis | 282 | ||
| Other Electrolytes | 282 | ||
| Summary | 283 | ||
| Consequences of Hypophosphatemia | 283 | ||
| Cardiac Dysfunction | 283 | ||
| Neuromuscular Dysfunction | 283 | ||
| Hematologic Dysfunction | 284 | ||
| Summary | 284 | ||
| Prevention and Treatment of Hypophosphatemia | 284 | ||
| Summary | 285 | ||
| Further Reading | 286 | ||
| References | 286.e1 | ||
| 28 Nutritional Needs and Support for the Burned Patient | 287 | ||
| Introduction | 287 | ||
| Metabolic Pathology Associated With Burn Injury | 287 | ||
| Nutritional Demand and Substrate Metabolism in Burn Patients | 288 | ||
| Increased Total Caloric Demand | 288 | ||
| Substrate-Specific Requirements | 288 | ||
| Carbohydrates | 288 | ||
| Fats | 289 | ||
| Protein | 290 | ||
| Nutritional Support | 290 | ||
| Enteral Nutrition | 290 | ||
| Benefits of Enteral Nutrition | 290 | ||
| Initiation of Feeds | 290 | ||
| Early Initiation. | 290 | ||
| Delivering Enteral Feeds | 291 | ||
| PO Feeding | 291 | ||
| Enteral Access for Feeding | 291 | ||
| Diet Composition and Enteral Feed Formulas | 292 | ||
| Immunonutrition | 292 | ||
| Parenteral Nutrition | 292 | ||
| Meeting Prescribed Feeding Goals | 294 | ||
| Complications of Nutritional Support | 295 | ||
| Nutritional Assessment and Monitoring | 297 | ||
| Total Caloric Requirements | 297 | ||
| Body Composition | 298 | ||
| Total Body Weight | 298 | ||
| Muscle and Lean Body Mass | 298 | ||
| Obesity | 298 | ||
| Ideal Body Weight | 298 | ||
| Clinical Imaging | 299 | ||
| Dual-Energy X-Ray Absorptiometry. | 299 | ||
| Computed Tomography and Ultrasound. | 299 | ||
| Albumin and Serum Markers for Nutrition | 299 | ||
| Conclusion | 299 | ||
| Further Reading | 300 | ||
| References | 300.e1 | ||
| 29 Modulation of the Hypermetabolic Response after Burn Injury | 301 | ||
| Introduction | 301 | ||
| Cardiovascular Dysfunction | 301 | ||
| Skeletal Muscle Catabolism and Regeneration | 301 | ||
| Insulin Resistance and Hyperglycemia | 302 | ||
| Alterations in Lipid Metabolism and Fat Composition | 302 | ||
| Nonpharmacological Modulation of the Hypermetabolic Response | 303 | ||
| Environmental Support | 303 | ||
| Early Wound Excision and Closure | 303 | ||
| Nutritional Support | 303 | ||
| Exercise | 303 | ||
| Pharmacological Modulation of the Hypermetabolic Response | 304 | ||
| Recombinant Human Growth Hormone (rhGH) | 304 | ||
| Insulin-Like Growth Factor-1 | 304 | ||
| Oxandrolone | 304 | ||
| Propranolol | 304 | ||
| Insulin | 305 | ||
| Metformin | 305 | ||
| Alternative Therapeutic Options | 305 | ||
| Conclusion | 305 | ||
| References | 306.e1 | ||
| 30 Etiology and Prevention of Multisystem Organ Failure | 307 | ||
| Introduction | 307 | ||
| Etiology and Cellular Response | 307 | ||
| Common Ground: Humoral Mediators | 311 | ||
| Organ-Specific Failure and Prevention | 312 | ||
| Hypermetabolism | 312 | ||
| Cardiovascular | 312 | ||
| Lungs | 313 | ||
| Gastrointestinal Dysfunction | 314 | ||
| Renal | 315 | ||
| Prevention of Sepsis | 315 | ||
| Ensuring Adequate Oxygen Delivery | 316 | ||
| The Potential Role of Nutritional and Specific Immunomodulators | 316 | ||
| Nutritional Immunomodulation | 316 | ||
| Nonspecific and Specific Immunomodulation | 316 | ||
| References | 317.e1 | ||
| 31 Acute Renal Failure in Association with Thermal Injury | 318 | ||
| Introduction | 318 | ||
| Definition | 318 | ||
| Etiology | 318 | ||
| Early | 318 | ||
| Hypovolemia | 318 | ||
| Overresuscitation and Abdominal Compartment Syndrome | 320 | ||
| Rhabdomyolysis | 320 | ||
| Cardiac Dysfunction | 320 | ||
| Late | 321 | ||
| Sepsis | 321 | ||
| Toxins | 321 | ||
| Antibiotics | 321 | ||
| Diagnosis | 322 | ||
| Urine Volume | 322 | ||
| Urinalysis | 322 | ||
| Creatinine Clearance | 322 | ||
| FeNa | 322 | ||
| Microscopy | 322 | ||
| Serum Biomarkers | 323 | ||
| Creatinine | 323 | ||
| NGAL | 323 | ||
| Others | 323 | ||
| Treatment | 323 | ||
| Renal Protection in the Early Phase of Acute Burn Care | 323 | ||
| Resuscitation | 323 | ||
| Other Acute Issues | 324 | ||
| Heart. | 324 | ||
| Remove Nephrotoxins. | 324 | ||
| Late | 325 | ||
| Workup. | 325 | ||
| Sepsis Treatment. | 325 | ||
| Medical Therapy: Fenoldopam. | 325 | ||
| Renal Replacement Therapy | 325 | ||
| Modalities. | 326 | ||
| Conclusion | 327 | ||
| References | 327.e1 | ||
| 32 Critical Care in the Severely Burned | 328 | ||
| Introduction | 328 | ||
| Burn Intensive Care Unit Organization | 328 | ||
| Physical Plant | 328 | ||
| Personnel | 329 | ||
| Equipment | 329 | ||
| Hemodynamic Monitoring in the Burn Intensive Care Unit | 330 | ||
| Cardiovascular Monitoring | 330 | ||
| Arterial Lines | 330 | ||
| Cardiac Output Measurement | 331 | ||
| Arterial Waveform Analysis | 331 | ||
| Echocardiography | 331 | ||
| Laboratory Estimates of Perfusion | 332 | ||
| Multisystem Organ Failure | 332 | ||
| Humoral Mediators | 332 | ||
| Course of Organ Failure | 333 | ||
| Critical Care Interventions | 333 | ||
| Toxicological Burn Critical Care | 334 | ||
| Neurological Burn Critical Care | 334 | ||
| Cardiovascular Burn Critical Care | 335 | ||
| Preload | 335 | ||
| Cardiac Contractility | 335 | ||
| Afterload | 335 | ||
| Heart Rate and Rhythm | 336 | ||
| Effects of Burn on Cardiac Performance | 336 | ||
| Hemodynamic Therapy: Preload Augmentation. | 336 | ||
| Hemodynamic Therapy: Inotropes and Vasopressors. | 336 | ||
| Effects of β-Blockade on Cardiac Performance After Severe Burn | 337 | ||
| Pulmonary Burn Critical Care | 337 | ||
| Indications for Intubation | 337 | ||
| Pulmonary Physiology | 338 | ||
| Ventilation. | 338 | ||
| Oxygenation. | 339 | ||
| Expectoration. | 340 | ||
| Mechanical Ventilation | 340 | ||
| Ventilator Modes. | 340 | ||
| Weaning From Mechanical Ventilation. | 345 | ||
| Monitoring of Mechanical Ventilation. | 345 | ||
| limiting ventilator-induced lung injury. | 345 | ||
| Epidemiology, Pathophysiology, and Treatment of ARDS. | 346 | ||
| Treatment of ARDS. | 347 | ||
| Gastrointestinal System Burn Critical Care | 348 | ||
| Pathophysiologic Changes in the Gut After Burn | 348 | ||
| Clinical Changes in the Gut After Burn | 348 | ||
| Renal Burn Critical Care | 349 | ||
| Pathophysiology | 349 | ||
| Hematologic Burn Critical Care | 351 | ||
| Endocrine Burn Critical Care | 352 | ||
| Infectious Disease Burn Critical Care | 353 | ||
| Prevention of Organ Failure | 353 | ||
| Conclusion | 353 | ||
| Further Reading | 354 | ||
| References | 354.e1 | ||
| 33 Burn Nursing | 355 | ||
| Introduction | 355 | ||
| Emergency Needs: Resuscitation and Pulmonary Priorities | 355 | ||
| Acute Care of the Burn Wound | 356 | ||
| Surgical Care | 357 | ||
| Nutrition and Metabolic Changes | 358 | ||
| Pain and Anxiety Assessment and Management | 358 | ||
| Patient and Family Education | 359 | ||
| Rehabilitation of the Burn Patient | 359 | ||
| Work-Hardening Programs for Adults | 360 | ||
| 34 Care of the Burned Pregnant Patient | 364 | ||
| Introduction | 364 | ||
| Mortality Factors | 364 | ||
| Fetal Viability | 365 | ||
| Practical Management Algorithm | 365 | ||
| Treatment | 366 | ||
| Additional Considerations | 370 | ||
| Hematology and Coagulopathy | 370 | ||
| Psychological Issues | 370 | ||
| Nonsevere Burns | 370 | ||
| Conclusion | 371 | ||
| Further Readings | 371 | ||
| References | 371.e1 | ||
| 35 Special Considerations of Age | 372 | ||
| Introduction | 372 | ||
| Initial Evaluation | 372 | ||
| Resuscitation | 373 | ||
| Assessment of Resuscitation | 375 | ||
| Evaluation and Management of Airways | 377 | ||
| Inhalation Injury | 377 | ||
| Hypermetabolism | 377 | ||
| Thermoregulation | 378 | ||
| Nutritional Support | 378 | ||
| Growth Delay | 378 | ||
| Management of Burn Wound | 378 | ||
| Pain Management | 380 | ||
| Rehabilitation | 380 | ||
| Prevention | 380 | ||
| Further Reading | 380 | ||
| References | 380.e1 | ||
| 36 Care of Geriatric Patients | 381 | ||
| Introduction | 381 | ||
| Epidemiology | 381 | ||
| Outcome | 381 | ||
| Risk Factors | 381 | ||
| Decreased Cardiopulmonary Reserve | 382 | ||
| Infections | 382 | ||
| Malnutrition and Decreased Lean Body Mass | 382 | ||
| Aging Skin and Wound Healing | 382 | ||
| Immune Response | 382 | ||
| Treatment | 382 | ||
| Initial Resuscitation | 383 | ||
| Wound Management | 383 | ||
| Metabolic and Nutritional Support | 383 | ||
| Pain, Sedation, and Comfort Care | 383 | ||
| Perioperative Optimization | 384 | ||
| Rehabilitation | 384 | ||
| Intentional Burns in Older Adults | 384 | ||
| Conclusion | 385 | ||
| Further Reading | 385 | ||
| References | 385.e1 | ||
| 37 Surgical Management of Complications of Burn Injury | 386 | ||
| Introduction | 386 | ||
| Burns and Trauma | 386 | ||
| Primary Assessment | 386 | ||
| Associated Injuries | 387 | ||
| Gastrointestinal Tract Complications | 387 | ||
| Paralytic Ileus | 388 | ||
| Ogilvie’s Syndrome | 388 | ||
| Abdominal Compartment Syndrome | 389 | ||
| Complications Associated With Feeding Tubes | 389 | ||
| Stress Gastritis | 389 | ||
| Acalculous Cholecystitis | 390 | ||
| Pancreatitis | 390 | ||
| Superior Mesenteric Artery Syndrome | 391 | ||
| Necrotizing Enterocolitis | 391 | ||
| Clostridium difficile Infection | 391 | ||
| Vascular Complications | 392 | ||
| Suppurative Thrombophlebitis | 392 | ||
| Complications Related to Central Venous Access | 393 | ||
| Distal Limb Ischemia | 393 | ||
| Thoracic Complications | 393 | ||
| Pneumothorax | 393 | ||
| Empyema | 394 | ||
| Urologic Complications | 394 | ||
| Conclusion | 395 | ||
| Further Reading | 395 | ||
| References | 395.e1 | ||
| 38 Electrical Injuries | 396 | ||
| Introduction | 396 | ||
| Pathophysiology | 396 | ||
| Acute Care | 398 | ||
| Electrocardiographic Monitoring | 398 | ||
| Myoglobinuria | 398 | ||
| Compartment Syndrome and Initial Operative Intervention | 399 | ||
| Further Surgical and Wound Considerations | 399 | ||
| Problem Areas | 400 | ||
| Lightning Injury | 401 | ||
| Low-Voltage Injuries | 401 | ||
| Complications | 402 | ||
| References | 402.e1 | ||
| 39 Cold-Induced Injury | 403 | ||
| History of Frostbite | 403 | ||
| Pathophysiology and Classification of Frostbite | 403 | ||
| Clinical Findings and Classification of Frostbite Injury | 404 | ||
| Initial Management of Freezing Cold Injury | 405 | ||
| Post-Thaw Evaluation and Management | 405 | ||
| Nonsurgical Therapies | 405 | ||
| Imaging and Surgical Management | 406 | ||
| Conclusion | 407 | ||
| Further Reading | 407 | ||
| References | 407.e1 | ||
| 40 Chemical Burns | 408 | ||
| Introduction | 408 | ||
| Pathophysiology | 408 | ||
| General Principles of Management | 409 | ||
| Specific Agents | 409 | ||
| Acids | 409 | ||
| Acetic Acid | 409 | ||
| Carbolic Acid (Phenol) | 409 | ||
| Chromic Acid | 409 | ||
| Epichlorohydrin Acid | 410 | ||
| Formic Acid | 410 | ||
| Hydrochloric Acid, Muriatic Acid, and Sulfuric Acid | 410 | ||
| Hydrofluoric Acid | 411 | ||
| Nitric Acid | 411 | ||
| Oxalic Acid | 411 | ||
| Phosphoric Acid | 411 | ||
| Alkalis | 411 | ||
| Cement | 412 | ||
| Metals | 412 | ||
| Hydrocarbons | 412 | ||
| Hypochlorite Solutions | 412 | ||
| Alkyl Mercuric Compounds | 412 | ||
| Tar | 412 | ||
| Vesicant Chemical Warfare Agents (Mustard, Lewisite, Nitrogen) | 412 | ||
| Conclusion | 413 | ||
| Further Reading | 413 | ||
| References | 413.e1 | ||
| 41 Radiation Injuries and Vesicant Burns | 414 | ||
| Radiation Injury: Introduction | 414 | ||
| Terminology | 414 | ||
| Incidence | 414 | ||
| Pathophysiology | 416 | ||
| Thermal Effects | 416 | ||
| Radiation Effect | 416 | ||
| Localized Injury | 416 | ||
| The Acute Radiation Syndrome | 417 | ||
| Hematopoietic Syndrome | 417 | ||
| Gastrointestinal Syndrome | 417 | ||
| Neurovascular Syndrome | 417 | ||
| Triage | 417 | ||
| Treatment | 417 | ||
| First Aid | 417 | ||
| Assessment | 418 | ||
| General Care of Irradiated Patients | 418 | ||
| Oral Resuscitation | 418 | ||
| Care of Burn Wounds | 418 | ||
| Treatment of Complications | 419 | ||
| Hematologic | 419 | ||
| Infection | 419 | ||
| Summary | 419 | ||
| Vesicant Burns | 419 | ||
| Introduction | 419 | ||
| Mechanisms of Action | 420 | ||
| Clinical Features | 420 | ||
| Acute Treatment for Exposure to a Vesicant Agent | 420 | ||
| Long-Term Effects of Acute Exposure | 421 | ||
| Summary | 421 | ||
| Further Reading | 421 | ||
| References | 421.e1 | ||
| 42 Exfoliative Diseases of the Integument and Soft Tissue Necrotizing Infections | 422 | ||
| Introduction | 422 | ||
| Severe Exfoliative Disorders | 422 | ||
| Toxic Epidermal Necrolysis | 422 | ||
| Epidemiology | 422 | ||
| Prognosis, Morbidity, Mortality | 422 | ||
| Etiology | 423 | ||
| Triggers and Risk Factors | 423 | ||
| Genetics | 425 | ||
| Immunopathology | 425 | ||
| Clinical Presentation | 425 | ||
| Diagnosis and Prognostic Evaluation | 426 | ||
| Histopathology | 426 | ||
| Complications | 427 | ||
| Systemic and Other Nonmucocutaneous Complications | 428 | ||
| Management | 428 | ||
| General Management and Resuscitation | 428 | ||
| Immunomodulation Therapy | 428 | ||
| Corticosteroid Therapy. | 428 | ||
| Cyclosporine A. | 428 | ||
| Intravenous Immunoglobulin. | 429 | ||
| TNF-α Inhibitors, Thalidomide. | 429 | ||
| Surgical Approach. | 429 | ||
| Topical Therapy. | 429 | ||
| Nutritional Support | 430 | ||
| Soft-Tissue Infections and Other Acute Skin Disorders | 430 | ||
| Staphylococcal Scalded Skin Syndrome | 430 | ||
| Pathology | 431 | ||
| Presentation | 431 | ||
| Diagnosis | 431 | ||
| Management | 431 | ||
| Necrotizing Fasciitis and Bacterial Myonecrosis | 431 | ||
| Diagnosis | 432 | ||
| Management | 432 | ||
| Purpura Fulminans | 433 | ||
| Calciphylaxis | 433 | ||
| Conclusion | 434 | ||
| Further Reading | 434 | ||
| References | 434.e1 | ||
| 43 Burn Injuries of the Eye | 435 | ||
| Introduction | 435 | ||
| Selected Anatomy | 435 | ||
| Examination | 436 | ||
| Applied Pathology | 436 | ||
| Electrical Injury | 438 | ||
| Exposure Keratitis and Eyelid Burns | 438 | ||
| Epithelial Defects | 438 | ||
| Corneal Ulcer | 438 | ||
| Bacterial Keratitis | 439 | ||
| Fungal Keratitis | 439 | ||
| Viral (Herpetic) Keratitis | 439 | ||
| Orbital Compartment Syndrome | 439 | ||
| Amblyopia | 440 | ||
| Descemetocele, Corneal Perforation, and Open Globe | 440 | ||
| Interventions | 440 | ||
| Bandage Contact Lens | 441 | ||
| Lateral Canthotomy | 441 | ||
| Eyelid Closure and Reconstruction | 441 | ||
| Conjunctival (Gundersen) Flaps | 443 | ||
| Reconstruction of the Lacrimal Apparatus | 444 | ||
| Corneal Transplantation | 444 | ||
| References | 444.e1 | ||
| 44 The Burn Problem | 445 | ||
| Introduction | 445 | ||
| Systemic Reactions to Burns | 445 | ||
| Hypoxia and Ischemia | 445 | ||
| Infection | 445 | ||
| Coagulopathy | 447 | ||
| Review of Organ Systems Affected by Burns | 448 | ||
| Integumentary System | 448 | ||
| Respiratory System | 448 | ||
| Cardiovascular System | 451 | ||
| Urinary System | 451 | ||
| Digestive System and Hepatobiliary Tract | 451 | ||
| Lymphoid System | 452 | ||
| Endocrine System | 453 | ||
| Musculoskeletal System | 453 | ||
| Central Nervous System | 453 | ||
| The Burn Autopsy | 453 | ||
| Further Reading | 454 | ||
| References | 454.e1 | ||
| 45 Molecular and Cellular Basis of Hypertrophic Scarring | 455 | ||
| Introduction | 455 | ||
| Extracellular Matrix | 455 | ||
| Collagen | 455 | ||
| Proteoglycans and Glycoproteins | 455 | ||
| Cellular Contributions to Hypertrophic Scar | 457 | ||
| Hypertrophic Scar Fibroblasts | 457 | ||
| Role of Myofibroblasts in Normal and Pathological Situations | 457 | ||
| Role of Mechanical Stress and Myofibroblasts | 458 | ||
| Pathological Repair (Hypertrophic Scars and Keloids) | 458 | ||
| Origin of (Myo)Fibroblasts | 460 | ||
| The Role of Fibrocytes in Hypertrophic Scar | 461 | ||
| Hypertrophic Scar Keratinocytes | 462 | ||
| The Role of Cytokines in Hypertrophic Scar | 462 | ||
| TGF-β | 462 | ||
| CTGF/CCN2 | 463 | ||
| Platelet-Derived Growth Factor | 463 | ||
| Insulin-Like Growth Factor 1 | 463 | ||
| Interferons | 463 | ||
| The Immune System Regulates Wound Healing | 464 | ||
| Conclusion | 465 | ||
| Further Reading | 465 | ||
| References | 465.e1 | ||
| 46 Pathophysiology of the Burn Scar | 466 | ||
| Introduction | 466 | ||
| Prehistoric and Historic Perspectives | 466 | ||
| Incisional Wounds With Primary Closure | 466 | ||
| Delayed Wound Closure “by Second Intention” and Wound Contraction | 466 | ||
| First-Degree or Superficial Injury of Skin | 467 | ||
| Second-Degree or Partial- Thickness Injury | 467 | ||
| Third-Degree or Full-Thickness Injury | 467 | ||
| Biology of Wound Healing | 467 | ||
| Changes in Vascular Permeability | 467 | ||
| Granulation Tissue and the Proliferative Phase of Wound Healing | 467 | ||
| Influx of Circulating Cells | 468 | ||
| Migration of Keratinocytes to Cover the Wound (Epiboly) | 468 | ||
| Collagen Matrix Formation and Maturation | 468 | ||
| Cytokines and Growth Factors | 468 | ||
| Biophysics of Thermal Injury | 468 | ||
| Factors That Alter Wound Healing | 470 | ||
| Changes in Blood Supply and Perfusion | 470 | ||
| Compromised Wound Healing: Requirements for Optimal Wound Healing | 470 | ||
| Biologic Responses to Wound Excision and Grafting | 470 | ||
| Wound Infection | 470 | ||
| Hypertrophic Wound Healing | 470 | ||
| Histologic Features of Hypertrophic Scars | 471 | ||
| Experimental Models of Hypertrophic Healing | 473 | ||
| Phenotypic Abnormalities of Hypertrophic Scar Fibroblasts | 474 | ||
| Gene Expression in Hypertrophic Scars | 474 | ||
| Interplay of Systemic and Local Inflammatory Responses | 474 | ||
| Pathogenic Concepts | 474 | ||
| Conclusion | 475 | ||
| Further Reading | 475 | ||
| References | 475.e1 | ||
| 47 Burn Rehabilitation Along the Continuum of Care | 476 | ||
| Introduction | 476 | ||
| Evaluation of the Burn Patient | 476 | ||
| Positioning and Splinting of the Burn Patient | 476 | ||
| Head | 478 | ||
| Neck | 478 | ||
| Spine | 479 | ||
| Shoulder Girdle/Axilla | 480 | ||
| Elbow/Forearm | 481 | ||
| Wrist/Hand | 481 | ||
| Hip | 484 | ||
| Knee | 484 | ||
| Foot/Ankle | 484 | ||
| Orthotic Treatment of the Lower Extremity | 485 | ||
| Serial Casting | 486 | ||
| Prosthetic Interventions | 488 | ||
| Burn Scar Management | 490 | ||
| Historical Review | 490 | ||
| The Scar | 490 | ||
| Scar Assessment | 490 | ||
| Treatment of Hypertrophic Scars | 492 | ||
| Pressure Therapy | 492 | ||
| Inserts | 494 | ||
| Burn Scar Massage | 495 | ||
| Therapeutic Exercise | 496 | ||
| Exercise During the Acute Rehabilitation Phase | 496 | ||
| Exercise During the Intermediate Rehabilitation Phase | 498 | ||
| Long-Term Rehabilitation Phase | 498 | ||
| The Role of Exercise Physiology in Burn Rehabilitation | 499 | ||
| Exercise for the Outpatient | 499 | ||
| Exercise Evaluation | 499 | ||
| Subjective Data | 499 | ||
| Objective Data | 499 | ||
| Exercise Testing | 500 | ||
| Three-Repetition Maximum Test (3RM) | 500 | ||
| Body Composition Measurement | 500 | ||
| When to Implement an Exercise Program | 501 | ||
| Components of an Exercise Program | 501 | ||
| Warm-Up Stage | 501 | ||
| Endurance Stage | 501 | ||
| Recreational Activities | 501 | ||
| Cool-Down Stage | 501 | ||
| Exercise Prescription | 501 | ||
| Aerobic Training | 502 | ||
| Intensity | 502 | ||
| Duration | 502 | ||
| Frequency | 502 | ||
| Mode | 503 | ||
| Progression of Exercise | 503 | ||
| Initial Conditioning Stage. | 503 | ||
| Improvement Stage. | 504 | ||
| Maintenance Stage. | 504 | ||
| Resistive Training | 504 | ||
| Exercise Type | 504 | ||
| Training Frequency | 504 | ||
| Type of Contraction | 505 | ||
| Amount of Load Lifted | 505 | ||
| Number of Repetitions | 505 | ||
| Number of Sets | 505 | ||
| Exercise Order | 505 | ||
| Rest Periods | 505 | ||
| Progressive Overload | 505 | ||
| Example of an Exercise Program | 505 | ||
| Important Considerations | 507 | ||
| Patient and Caregiver Education | 507 | ||
| Conclusion | 507 | ||
| Further Reading | 508 | ||
| References | 508.e1 | ||
| 48 Musculoskeletal Changes Secondary to Thermal Burns | 509 | ||
| Acknowledgment | 509 | ||
| Introduction | 509 | ||
| Changes Confined to Bone | 509 | ||
| Osteoporosis | 509 | ||
| Osteomyelitis | 510 | ||
| Fractures | 512 | ||
| Changes Involving Pericapsular Structures | 514 | ||
| Heterotopic Ossification | 514 | ||
| Pathogenesis of Heterotopic Ossification | 514 | ||
| Percentage of Burn Effect on Heterotopic Ossification | 514 | ||
| Location of Burn Effect on Heterotopic Ossification | 514 | ||
| Period of Confinement Effect on Heterotopic Ossification | 514 | ||
| Osteoporosis and Heterotopic Ossification | 515 | ||
| Superimposed Trauma on Heterotopic Ossification | 515 | ||
| Genetic Predisposition to Heterotopic Bone | 515 | ||
| Characteristics and Behavior of Heterotopic Bone | 516 | ||
| Prevention and Treatment of Heterotopic Bone | 516 | ||
| Changes Involving the Joints | 519 | ||
| Dislocation | 519 | ||
| Septic Arthritis | 520 | ||
| Amputations | 521 | ||
| Alterations in Growth | 521 | ||
| Further Reading | 522 | ||
| References | 522.e1 | ||
| 49 Reconstruction of Bodily Deformities in Burn Patients | 523 | ||
| Reconstruction of Burn Deformities | 523 | ||
| General Principles | 523 | ||
| Early Treatment of Deformity and Timing of Surgical Intervention | 523 | ||
| The Techniques of Reconstruction | 525 | ||
| Primary Wound Closure Technique | 525 | ||
| Skin Grafting Technique | 525 | ||
| Free Skin Graft Without Incorporating a Dermal Template. | 525 | ||
| Free Skin Graft With Prior Incorporation of a Dermal Regenerative Template. | 526 | ||
| Skin Flap Technique | 526 | ||
| The Axial Skin Flap. | 527 | ||
| The Z-Plasty Technique. | 527 | ||
| The Modified Z-Plasty Technique; Alias Three-Quarters Z-Plasty Technique. | 527 | ||
| Musculocutaneous or Fasciocutaneous Flap Technique | 527 | ||
| Musculocutaneous Z-Plasty Technique. | 527 | ||
| Fasciocutaneous Z-Plasty Technique. | 527 | ||
| Three-Quarter Fasciocutaneous Z-Plasty Technique. | 527 | ||
| Paratenon Cutaneous Z-Plasty and Three-Quarter Paratenon Cutaneous Z-Plasty Techniques. | 527 | ||
| Tissue Expansion Technique | 529 | ||
| Free Composite Tissue Transfer via Microsurgical Technique | 529 | ||
| Fat Grafting Technique | 531 | ||
| Allotransplantation: Facial Transplantation | 531 | ||
| Comments | 531 | ||
| Further Reading | 531 | ||
| References | 531.e1 | ||
| 50 Reconstruction of the Head and Neck after Burns | 532 | ||
| Introduction | 532 | ||
| Acute Management | 533 | ||
| Pathogenesis | 534 | ||
| Evaluation of Facial Burn Deformities | 536 | ||
| Fundamental Principles and Techniques | 540 | ||
| Contractures | 540 | ||
| Aesthetic Units | 542 | ||
| Z-plasty | 542 | ||
| Laser Therapy | 542 | ||
| Grafts | 542 | ||
| Flaps | 542 | ||
| Tissue Expansion | 543 | ||
| Timing of Reconstructive Surgery | 543 | ||
| Acute-Phase Reconstruction | 543 | ||
| Eyelids | 543 | ||
| Perioral Deformities | 543 | ||
| Cervical Deformities | 544 | ||
| Intermediate-Phase Reconstruction | 544 | ||
| Late-Phase Reconstruction | 545 | ||
| Reconstruction of Specific Areas of the Head and Neck | 547 | ||
| Scalp | 547 | ||
| Eyebrows | 548 | ||
| Eyelids | 548 | ||
| Lower Lip and Chin | 550 | ||
| Upper Lip Deformities | 550 | ||
| Electrical Burns of the Oral Commissure | 550 | ||
| Nasal Deformities | 550 | ||
| Ear Deformities | 550 | ||
| Burn Neck Contractures | 550 | ||
| Prevention | 550 | ||
| Release and Grafting | 554 | ||
| Local Flap Reconstruction | 554 | ||
| Distant Flap Reconstruction | 554 | ||
| Further Reading | 554 | ||
| References | 554.e1 | ||
| 51 Management of Postburn Alopecia | 555 | ||
| Introduction | 555 | ||
| Spectrum of Postburn Alopecia | 555 | ||
| Classification of Scalp Burns | 555 | ||
| Surgical Correction of Alopecia | 555 | ||
| Serial Excision | 555 | ||
| Bipedicle Flaps | 556 | ||
| Local Flaps and the Rotation Flap Template | 556 | ||
| Tissue Expansion | 559 | ||
| Hair Follicle Grafting | 561 | ||
| Conflict of Interest | 561 | ||
| References | 561.e1 | ||
| 52 Trunk Deformity Reconstruction | 562 | ||
| Introduction | 562 | ||
| Reconstruction of the Trunk Soft Tissue Layers | 563 | ||
| Acute Reconstructive Management of the Trunk Soft Tissue Layers | 563 | ||
| Late Reconstructive Management of the Trunk Soft Tissue Layers | 565 | ||
| Reconstruction of the Trunk Boundaries | 566 | ||
| Reconstruction of the Breast | 568 | ||
| Principles of Breast Reconstruction | 569 | ||
| Release and Scar Resurfacing | 569 | ||
| Replacement of Missing Parts: Breast Mound Reconstruction | 569 | ||
| Nipple-Areola Complex Reconstruction | 571 | ||
| Asymmetry | 571 | ||
| Conclusion | 572 | ||
| References | 572.e1 | ||
| 53 Management of Contractural Deformities Involving the Shoulder (Axilla), Elbow, Hip, and Knee Joints in Burned Patients | 573 | ||
| Introduction | 573 | ||
| Contractural Deformities of the Shoulder (Axilla), Elbow, Hip, and Knee Observed in a Burned Patient | 573 | ||
| The Factors Leading to Formation of Contractural Deformities | 573 | ||
| Incidence of Burn Contracture Involving the Shoulder (Axilla), Elbow, and Knee Joints | 573 | ||
| Efficacy of Splinting in Controlling Burn Contractures of Shoulder (Axilla), Elbow, and Knee Joints | 573 | ||
| Management During the Acute Phase of Recovery | 574 | ||
| Body Positioning and Joint Splinting | 574 | ||
| Body Position | 574 | ||
| Shoulder (Axillary) Joint. | 575 | ||
| Elbow Joint. | 575 | ||
| Wrist Joint. | 575 | ||
| Hip Joint. | 575 | ||
| Knee Joint. | 575 | ||
| Exercise | 575 | ||
| Management During the Intermediate Phase of Recovery | 576 | ||
| Body Positioning and Joint Splinting | 576 | ||
| Pressure Dressing | 576 | ||
| Management of Established Contractural Deformities | 577 | ||
| Patient Evaluation | 577 | ||
| Nonoperative or Minimally Invasive Approach to Correct a Contracted and/or Stiff Joint | 577 | ||
| Shoulder (Axillary) Contracture | 577 | ||
| Figure-of-Eight Compression Dressing. | 577 | ||
| Airplane Splint. | 577 | ||
| Elbow and Knee Contracture | 577 | ||
| Three-Point Extension Splint. | 577 | ||
| Skeletal Traction Technique. | 578 | ||
| Surgical Treatment of a Contracted Joint | 579 | ||
| Presurgical Evaluation | 579 | ||
| Techniques of Joint Contracture Release | 580 | ||
| Release of Joint Contracture by Incising the Scarred Tissue. | 580 | ||
| Z-Plasty Technique. | 580 | ||
| Wound Coverage | 580 | ||
| Primary Closure of the Wound. | 580 | ||
| Skin Grafting Technique. | 580 | ||
| operative technique. | 580 | ||
| after-care. | 580 | ||
| Interposition Flap Technique. | 580 | ||
| operative technique. | 581 | ||
| after-care. | 581 | ||
| Muscle Flap or Skin-Muscle Flap Technique. | 581 | ||
| Use of a Free Flap or Muscle Flap. | 581 | ||
| Conclusion | 586 | ||
| Further Reading | 588 | ||
| References | 588.e1 | ||
| 54 Acute and Reconstructive Care of the Burned Hand | 589 | ||
| Introduction | 589 | ||
| Initial Assessment and First Aid | 589 | ||
| Acute Care of the Burned Hand | 589 | ||
| Occupational Therapy of the Burned Hand | 593 | ||
| Management of Established Burned Hand Deformities | 595 | ||
| Reconstructive Methods | 595 | ||
| Reconstruction of Phalangeal Deformities | 596 | ||
| Flexion Contracture Deformities | 596 | ||
| Extension Contracture Deformities | 598 | ||
| Web Space Contracture | 601 | ||
| First Web Space Contracture | 601 | ||
| Reconstruction of a Deformed Thumb | 603 | ||
| Reconstruction of a Claw Hand | 605 | ||
| Electrical Injuries Involving the Upper Limb | 606 | ||
| Decompressive Escharotomy and Fasciotomy | 606 | ||
| Early Débridement | 606 | ||
| Wound Management | 607 | ||
| Functional Reconstruction of Limb Deformities | 607 | ||
| Conclusion | 608 | ||
| Further Reading | 608 | ||
| References | 608.e1 | ||
| 55 Management of Burn Injuries of the Perineum | 609 | ||
| Introduction | 609 | ||
| Management During the Acute Phase of Injury | 609 | ||
| Burns of the Penis | 609 | ||
| Skin Loss Over the Penile Shaft and Scrotum | 609 | ||
| Burns of Labia Majora | 609 | ||
| Perineal Wound Coverage | 609 | ||
| Anal Burns | 610 | ||
| Rectal Prolapse | 610 | ||
| Reconstruction of Established Deformities of the Perineum and Perineal Structures | 611 | ||
| Reconstruction of Penile Deformity | 611 | ||
| Reconstruction of Scrotal Deformities | 613 | ||
| Reconstruction of Labial Deformity | 613 | ||
| Reconstruction of Band Deformity Around the Perineum | 613 | ||
| The Technique of Multiple Z-Plasties | 615 | ||
| Reconstruction of Anal Strictures | 615 | ||
| Reconstruction of Rectal Prolapse | 615 | ||
| Conclusion | 617 | ||
| Further Reading | 617 | ||
| References | 617.e1 | ||
| 56 Reconstruction of Burn Deformities of the Lower Extremity | 618 | ||
| Assessment of Salvage Potential | 618 | ||
| Amputations | 618 | ||
| Early Reconstruction | 619 | ||
| Late Reconstruction | 619 | ||
| Grafts and Flaps | 623 | ||
| Conclusion | 624 | ||
| References | 624.e1 | ||
| 57 Electrical Injury | 625 | ||
| Introduction | 625 | ||
| Physiological Basis of Tissue Destruction | 625 | ||
| Diagnosis and Acute Treatment | 626 | ||
| Assessment of Tissue Damage | 626 | ||
| Rhabdomyolysis and Myoglobinuria | 626 | ||
| Renal Failure | 626 | ||
| Cardiac Monitoring | 627 | ||
| Surgical Debridement | 627 | ||
| Compartment Syndrome | 627 | ||
| Head: Scalp, Skull, and Mouth | 628 | ||
| Thorax and Abdomen | 629 | ||
| Extremities | 630 | ||
| Amputations | 630 | ||
| Peripheral Nerve Injury | 631 | ||
| Complications | 631 | ||
| Central Nervous System | 631 | ||
| Ocular Manifestations of Electrical Injury | 632 | ||
| Skeletal Injury | 632 | ||
| Conclusion | 632 | ||
| Further Reading | 632 | ||
| References | 632.e1 | ||
| 58 The Role of Alternative Wound Substitutes in Major Burn Wounds and Burn Scar Resurfacing | 633 | ||
| Introduction | 633 | ||
| Classification of Alternative Wound Substitutes | 633 | ||
| Clinical Applications of Alternative Wound Substitutes in Major Burn Wounds | 633 | ||
| Clinical Applications of Alternative Wound Substitutes in Burn Scar Resurfacing | 636 | ||
| Future Directions | 639 | ||
| References | 639.e1 | ||
| 59 Aesthetic Reconstruction in Burn Patients | 640 | ||
| Introduction | 640 | ||
| Timing of Reconstruction | 640 | ||
| Patient–Surgeon Relationship | 641 | ||
| Pre- and Postoperative Care in Burn Reconstruction | 642 | ||
| Surgical Approach to the Burn Reconstructive Patient: The Role of the Reconstructive Ladder | 643 | ||
| Aesthetic Reconstruction of Burned Patients | 644 | ||
| Head and Neck | 644 | ||
| Burn Alopecia | 645 | ||
| Upper Extremity | 646 | ||
| Breasts | 646 | ||
| Lower Extremity | 646 | ||
| References | 647.e1 | ||
| 60 Laser for Burn Scar Treatment | 648 | ||
| History of Laser and Intense Pulse Light | 648 | ||
| Physics of Laser | 648 | ||
| Overview of Lasers in Hypertrophic Burn Scar | 649 | ||
| General Considerations | 649 | ||
| Pulsed Dye Laser Therapy | 649 | ||
| Ablative/Nonablative Fractional Lasers | 650 | ||
| Erbium-YAG Laser | 650 | ||
| CO2 Laser | 650 | ||
| Lasers to Target Pigment | 650 | ||
| Intense Pulsed Light | 650 | ||
| Treatment of Specific Post Burn Scar Conditions | 652 | ||
| Four-Year Review | 652 | ||
| Vascular and Hypertrophic Scars | 652 | ||
| Folliculitis | 652 | ||
| Scar Contracture | 652 | ||
| Hyperpigmentation | 652 | ||
| Laser Complications and Laser Safety | 653 | ||
| Laser Complications | 653 | ||
| Laser Safety | 653 | ||
| Logistical and Financial Considerations | 654 | ||
| Future Investigations | 654 | ||
| Conclusion | 654 | ||
| References | 654.e1 | ||
| 61 The Ethical Dimension of Burn Care | 655 | ||
| Introduction | 655 | ||
| What Is an Ethical Problem? | 655 | ||
| How Should Clinical Ethics Problems Be Managed? | 656 | ||
| The Role of the Care-Provider in Ethical Dialogue | 656 | ||
| The Role of the Patient or Surrogate in Ethical Dialogue | 658 | ||
| How Should Persistent Ethical Conflict Be Managed? | 658 | ||
| The Patient Without Decision-Making Capacity, Surrogate, or Advance Directive | 658 | ||
| How Should Organizational Ethics Problems Be Managed? | 659 | ||
| Conclusion | 659 | ||
| Further Reading | 659 | ||
| References | 659.e1 | ||
| 62 Intentional Burn Injuries | 660 | ||
| Introduction | 660 | ||
| Prevalence Rates of Intentional Burn Injuries | 661 | ||
| Prevalence of Childhood Burns | 661 | ||
| Prevalence in Elderly | 662 | ||
| Distinctive Characteristics of Perpetrators and Families | 662 | ||
| Indicators of Intentional Injuries | 664 | ||
| Self-Inflicted Burn Injuries | 666 | ||
| Clinical Evaluation of Suspicious Injury With Pediatric Patient and Family | 666 | ||
| Physician Assessment | 667 | ||
| Types of Burn | 668 | ||
| Scald | 668 | ||
| Contact | 668 | ||
| Chemical Burns | 670 | ||
| Psychosocial Assessment | 670 | ||
| Reporting Suspected Intentional Burn Injury | 670 | ||
| Clinical Interviewing With Other Vulnerable Populations | 671 | ||
| Maintaining Professional Relationships With Patient and Family | 671 | ||
| Future Burn Prevention and Child Safety | 671 | ||
| Further Reading | 672 | ||
| References | 672.e1 | ||
| 63 Functional Sequelae and Disability Assessment | 673 | ||
| Introduction | 673 | ||
| Postburn System-Based Disability Assessment | 673 | ||
| Constitutional | 673 | ||
| Skin/Integument | 674 | ||
| Facial Injuries, Scars, and Ear/Nose/Throat Problems | 674 | ||
| Musculoskeletal | 675 | ||
| Hand Function | 675 | ||
| Neurological | 676 | ||
| Cardiovascular/Metabolic | 676 | ||
| Respiratory | 676 | ||
| Eyes/Vision | 677 | ||
| Renal/Genitourinary | 677 | ||
| Gastrointestinal | 677 | ||
| Endocrine | 677 | ||
| Hematological and Lymphatic | 678 | ||
| Psychological | 678 | ||
| Overall Quality of Life | 678 | ||
| References | 678.e1 | ||
| 64 Management of Pain and Other Discomforts in Burned Patients | 679 | ||
| Introduction | 679 | ||
| Pathology of a Burn Injury Pain and Pain-Generating Mechanisms | 679 | ||
| Additional Factors Contributing to Pain Generation | 679 | ||
| Pain as a Function of the Healing Process | 680 | ||
| Tolerance to Opiates and Opiate-Induced Hyperalgesia | 680 | ||
| Measurement of Pain in Burned Patients | 680 | ||
| Pain Measurement Techniques for Adult Burned Patients | 681 | ||
| Pain Measurement Techniques for Pediatric Burned Patients | 681 | ||
| Measurement of Anxiety | 683 | ||
| Measurement of Itching | 683 | ||
| Treatment Considerations | 683 | ||
| Surgical Treatment of Pain | 684 | ||
| Topical Agents | 684 | ||
| Pharmacological Treatment of Burn Pain | 684 | ||
| Opioids | 685 | ||
| Morphine | 685 | ||
| Fentanyl | 685 | ||
| Remifentanil | 686 | ||
| Alfentanil | 686 | ||
| Methadone | 686 | ||
| Benzodiazepines | 686 | ||
| Nonopiate Analgesics | 686 | ||
| Anticonvulsants | 686 | ||
| Ketamine | 687 | ||
| α2 Agonists | 687 | ||
| Propofol | 687 | ||
| Nitrous Oxide | 688 | ||
| Initial Injury | 688 | ||
| Background and Breakthrough Pain | 688 | ||
| Analgesia for Procedures | 689 | ||
| Itch Medications | 691 | ||
| Development of Protocols for Comfort | 693 | ||
| Nonpharmacologic Therapies in Burned Patients | 693 | ||
| Classical Conditioning | 693 | ||
| Operant Conditioning | 695 | ||
| Cognitive Interventions | 696 | ||
| Augmented Reality | 696 | ||
| Hypnosis | 697 | ||
| Virtual Reality Hypnosis | 697 | ||
| Other Approaches | 697 | ||
| Empirical Support | 697 | ||
| Conclusion | 698 | ||
| References | 699.e1 | ||
| 65 Psychiatric Disorders Associated With Burn Injury | 700 | ||
| Introduction | 700 | ||
| Preexisting Factors | 700 | ||
| Disorders in Children and Adolescents | 700 | ||
| Social Considerations in Pediatric Burns | 701 | ||
| Self-Inflicted Burns and Suicide Attempts | 701 | ||
| In-Hospital Contributing Factors and Disorders | 701 | ||
| In-Hospital Disorders | 702 | ||
| Delirium | 702 | ||
| Acute Stress Disorder and Posttraumatic Stress Disorder | 702 | ||
| Long-Term Postburn Disorders | 703 | ||
| General Anxiety Disorder | 703 | ||
| Major Depressive Disorder | 704 | ||
| Persistent Depressive Disorder | 704 | ||
| Substance-Related and Addictive Disorders | 704 | ||
| Comorbidity and Problems Beyond Psychiatric Illness | 704 | ||
| Adjustment in Children After Burns | 704 | ||
| Diagnosis (Screening Instruments, SCID) | 705 | ||
| Treatment | 705 | ||
| Delirium and Agitation | 705 | ||
| ASD and PTSD | 705 | ||
| Other Anxiety Disorders | 706 | ||
| Major Depression | 706 | ||
| Sleep Disturbances | 706 | ||
| Special Aspects in Pediatric Treatment | 706 | ||
| Nonpharmacological Prevention of PTSD | 707 | ||
| Resilience, Posttraumatic Growth | 707 | ||
| Interventions to Foster PTG | 707 | ||
| Conclusion | 707 | ||
| References | 708.e1 | ||
| 66 Psychosocial Recovery and Reintegration of Patients With Burn Injuries | 709 | ||
| Introduction | 709 | ||
| Integrating Psychological Treatment With Physical Treatment | 709 | ||
| Preinjury Adjustment | 709 | ||
| Admission Crisis | 709 | ||
| Critical Care Phase | 710 | ||
| In-Hospital Recuperation Phase | 711 | ||
| Reintegration Phase | 711 | ||
| Rehabilitation Phase, Postdischarge | 713 | ||
| Assisting With Grief Following Trauma | 713 | ||
| Cultural Sensitivity | 714 | ||
| Postburn Psychological Distress and Long-Term Outcome | 714 | ||
| Acute and Posttrauma Distress | 714 | ||
| Chronicity of Postburn Psychological Distress: From In-Hospital Through Long-Term Follow-Up | 715 | ||
| Theory-Guided Research as the Next Step in Enhancing Psychological and Social Adjustment | 715 | ||
| Formulating Psychological Distress Following Burn Injury: Using Posttrauma Distress as an Illustration | 716 | ||
| Resilience and Recovery | 716 | ||
| Body Image, Stigmatization, and Social Integration | 716 | ||
| Social Belongingness as Core Survival Need | 716 | ||
| Appearance, Social Stigmatization, and Social Exclusion | 717 | ||
| Factors Affecting Body Image Dissatisfaction and Social Discomfort | 718 | ||
| Distress of Families of Burn Survivors | 718 | ||
| Long-Term Outcome: Quality of Life | 719 | ||
| Interventions for Burn Survivors Beyond Acute Care | 719 | ||
| Summary | 720 | ||
| Acknowldgments | 720 | ||
| References | 720.e1 | ||
| Index | 721 | ||
| A | 721 | ||
| B | 723 | ||
| C | 724 | ||
| D | 726 | ||
| E | 727 | ||
| F | 728 | ||
| G | 729 | ||
| H | 730 | ||
| I | 731 | ||
| J | 732 | ||
| K | 732 | ||
| L | 733 | ||
| M | 733 | ||
| N | 735 | ||
| O | 735 | ||
| P | 736 | ||
| Q | 738 | ||
| R | 738 | ||
| S | 739 | ||
| T | 741 | ||
| U | 743 | ||
| V | 743 | ||
| W | 743 | ||
| X | 744 | ||
| Y | 744 | ||
| Z | 744 |