The purpose of this video is to provide general information and education about the care of
a critically ill child.
It is in no way a substitute for the independent decision-making and judgment by a qualified
health care professional.
The information contained in this video should not be used to make a diagnosis or to overrule
the advice of a qualified health care provider, nor should it be used to provide advice for
emergency medical treatment.
Introduction to Burn Care by Dr. Robert Sheridan.
Please note that in this video we will be following the guidelines used at Shriner's
Hospitals for Children, Boston.
Some of this information may need to be modified based on the equipment, guidelines, and practices
in place in your institution.
Hello.
My name is Rob Sheridan, and I work in the Burn Unit at the Shriner's Hospital in Boston.
What I'd like to talk about is the history of burn care briefly, a little bit about the
epidemiology, something about how burn care is organized at the patient level and at the
system level, a little bit about the role of burn care in disasters, and then finally
long-term outcomes.
History of Burn Care I'd like to very briefly talk about some important aspects of history
of burn care.
This is a woman, Zora Janzekovic who ran a burn unit in Eastern Europe in the '60s and
'70s.
And she wrote a very influential paper in the 1970 issue of the Journal of Trauma in
which she described early excision of burns in her experience.
The traditional treatment of burns at that time was simply supporting the natural history,
the natural history being progressive colonization, infection of eschar, and then liquefaction
and separation, leaving a bed of granulating tissue, which was then grafted, that process
taking two to six weeks typically.
She was one of the early people who recognized that this process could be dramatically shortened
by acknowledging when a wound is full thickness, cutting away the dead tissue, and immediately
grafting the resulting wound.
And she did this in a series of patients in her unit and reported it in the 1970 issue
of the Journal of Trauma and demonstrated that she had very short hospital stays, much
happier patients, much better long-term functional outcomes.
People that really started the early excision trend in burn care, and this is one of my
favorite quotes from her-- "The patients in the wards presented the usual clinical picture
of large exposed burn wounds covered by broken down eschars with infected granulating areas
on anemic, exhausted, and frightened individuals."
And this really is true, and if you have the opportunity to visit units where traditional
burn care is provided, supporting the natural history of progressive liquefaction and separation,
this really is the rule.
And to spare patients that experience is really a good thing.
Epidemiology Briefly, a little bit about the epidemiology of burns.
In the pediatric group it's a lot of scalds, a lot of cooking and bathing related incidents.
And this is true worldwide.
As people get into the young working age range they tend to be injured in more industrial
accidents, high voltage injuries, flame injuries.
And once again, as people get older, they tend to be injured more with scalding, and
kitchen accidents.
An unfortunate reality is that the patients who are more likely to have bad long term
sequela of their injuries are those in the developing world where it's more difficult
to survive with those sequela.
In other words, a disability related to a burn injury is better tolerated in someone
in a developed environment than it is in undeveloped environment.
And so it's very important, I think, to try to optimize the functional outcome of patients
who have suffered injuries so that they can do well, and be happy and productive, in the
world in which they find themselves.
Burn Care Organization How is burn care organized?
At the patient level, burn care initially comprises a resuscitation over the first day
or two, followed by an initial excision, and biologic closure of the wounds over the first
week or so, followed by definitive wound closure, and addressing small areas of high functional
importance, like the face and hands, over the succeeding one to five weeks, followed
by long term reconstruction and reintegration, which can be a very brief experience, or can
last many years depending on the severity of the injury.
On the system level it's optimal if the people, equipment, and resources that are required
to take care of the patients are concentrated, so the expertise stays well rehearsed.
And in the United States, there are burn units that are dedicated to that purpose.
In the developing world, there are programs, like in Nicaragua, and Honduras, where some
very sophisticated programs have been developed to optimize care in a central location for
their patients.
Unfortunately that's not the reality in most parts of the world.
Most parts of the world, burn patients are taken care of in the local hospital nearest
to where they're injured.
Another benefit of developing a centralized cadre of people skilled with wound and burn
care is in addressing natural and man made disasters.
Very frequently patients suffering injuries in earthquakes, and terrorist scenarios, and
bombing incidents, have injuries that are very --either are burns or are very similar
to burns-- big soft tissue injuries.
And having that expertise in the medical system is very, very useful.
This is also true in wartime, unfortunately, with blast and fragment injuries being so
common.
And this skill set that you evolve in a burn unit from the nursing side, and the physician
side is very useful to caring for those patients as well.
Long-term Outcome Very briefly, as regards to long-term outcomes, what I'd say is, it's
just a large body of data-- the data gets more robust every year-- that says that patients
with burns, if they're managed in an organized way, will do very well, over the long haul.
They'll become happy taxpayers, and it does require attention to get the wounds excised
and closed, as early as possible, to avoid the septic morbidity, and it does require
that the patients have access to reconstructive and rehabilitative services, ideally, very
early, to optimize their functional outcomes, so they can become independent and become
quickly employable.
That concludes our video on Introduction to Burn Care.
Thank you.
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