Recent concepts regarding the resuscitation of the burned patient

The role of a 'satellite-service' in the national organisation of burn care in the Sultanate of Oman

Khoula hospital, one of the major tertiary care hospitals, situated in the capital city, is the national trauma centre of the Sultanate of Oman. The burns-unit at Khoula hospital has developed an unique collaborative service of active participation in the initial management of burns patients admitted to the peripheral hospitals of the country. The description 'Satellite-service' is used in this paper to describe this 'remote-control service' offered by the main burns center, for the management of burned patients admitted the various peripheral hospitals (the 'satellites') throughout the country, during the shock-period of the first 36 hour post-burn. Thereafter the patients are transferred to the main center for further management. This system was instigated with a common protocol for the initial management of burns all over the country in 1981. Central registration of burns patients from peripheral hospitals was started in 1994. Retrospective analysis of the statistics and records of 151 burns patients transferred from 19 peripheral hospitals to Khoula burns center during a 3 year period from September 1994 to August 1997, showed that the satellite service is very effective in the initial management of patients during the shock period, as there was no mortality due to hypovolemia. The advantages of this service include uniform and appropriate 'initial' management of all the burns patients admitted to any of the hospitals of the country. The major disadvantages of the system were the increased work-load of the main center and poor patient-compliance with post-discharge instructions. This paper also describes how the Satellite service works in practice.

Epidemiology of burns in the Tel Aviv area

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.

Effects of enriched lactate solution (ELS) for resuscitation after burn injury

Full skin thickness burns covering 35 per cent of the total body surface of rabbits were followed by measurements of Na-K ATPase and arterial blood gas analyses, before and after the burn injury. Studies of the effects of intravenous fluids with different compositions showed that the active transport of the cell membrane was depressed in vivo immediately after a burn injury, mainly due to acidosis. This phenomenon was not completely corrected by the Baxter formula which uses conventional lactated Ringer's solution. However, an improvement was observed in those groups given the 'Enriched Lactate Solution' (ELS) containing large quantities of lactate as the base source. These results suggest that ELS, which positively corrected acidosis in accordance with its concentration, is very effective and more appropriate than the conventional lactated Ringer's solution for early burn resuscitation.

Successful treatment of a 95 per cent body surface area burn

Survival after sustaining a 95 per cent body surface area burn is uncommon. We report the successful treatment of a 21-year-old patient who sustained such an extensive burn injury. This report stresses the importance of early aggressive excision of the burn eschar and early coverage with allografts (homografts) and later coverage with autogenous keratinocytes.