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Clinical assessment of burn depth
Abstracts
1. That all the 13 injured riders who were dragged along the ground with one foot in the stirrup recewed severe injuries It is suggested that specml safety stnrrups which automatically release the foot under these circumstances should be more widely used. 2 That among the injured riders who sustained head injuries (11 per cent of the total), the presence or absence of a helmet d~d not seem to affect the seventy of the injury. It is suggested that the current means of head protectnon are inadequate and that there is a case for the development of more effective and acceptable headgear Gierup J., Larson M. and Lennquist S. (1976) Incidence and nature of horse-riding injuries. Acta Ctnr Scand. 142, 57 Burns T r e a t m e n t of contractures Gains of from 2 to 20: (mean 8 ) in movement were achieved by passLve stretching of contractures whde the affected part was encased in a m~xture of paraffin and mineral oil at temperatures of 33 j C for adults and 29-30~C for children. Although the gain m movement lasted for only a few hours after the first treatment, improvement was progressnve and cumulative with successive periods of treatment. Head M D and Helm P. A (1977) Paraffin and sustained stretching in the treatment of burn contractures. Burns 4, 136.
Diagnosis of burn depth The author compares chmcal estimates wnth the study of serial bzopsy specimens in 42 experimental burns in animals and 8 accidental burns in humans Using three degrees of burning, based on appearance, he found a 60 per cent error in the first-degree, 73 per cent m the second-degree and 36 per cent in the thirddegree experimental burns. In the case of the human burns there was a 33 per cent error in the seconddegree burns and no error in the third-degree burns. The author dnd not compare other chnlcal tests with the results of histological examination Giarsu K G. (1977) An experimental study for diagnosis of burn depth. Burns 4, 97.
Clinical a s s e s s m e n t of burn depth The authors rehed on a combination of the colour changes resulting from pressure, perception of proprick, appearance and healing time to categorize burns into four depths: epidermal, superficial dermal, deep dermal and subdermal. They followed the course of healing by marking the outlines of the &fferent burned areas on transparent sheets at different times after the injury. Deep dermal burns increased slightly in area for the first few days and then became rapidly smaller; subdermal burns began the contracting process at once. Although the two deeper sorts of burn healed without grafting, the authors found that delayed primary excision and grafting gave a better scar and earlier healing. They found that the
81 speed of heahng was influenced by the width of raw surface that had to be covered and used the ratios between the raw area and its circumference (the 'configuration index') as a guide to the rate of healing. They regarded clinical assessment of the depth of burning as being rehable. Godma M., Derganc M. and Br~nE A. (1977) The rehabdnty of chnical assessment of the depth of burns Burns 4, 92. I n h a l a t i o n injury Although nn 10 years the incidence of inhalation injury rose from 5 2 to 8 2 per cent and the mortality rate fell from 79 to 58 per cent these changes are not statlstucally significant. Pulmonary insufficiency usually began to become evident 5-10 days after burning but sometimes occurred without evidence of inhalation of flame or smoke. Treatment was in either case aimed at keeping the air passages clear and the Pao2 at an acceptable level. The dnstmctzon between laryngeal oedema and bronchoconstnctnon ~s xmportant and can be made by means of fibreoptlc endoscopy. Obstruction and reduced compliance at least double the work of breathing and may increase ~t nearly tenfold. Deep burns round the nose and mouth were fatal, either because of the severity of the burn or because of inhalation injury Pulmonary oedema tended to accompany renal fadure but was not of itself serious. Other radiolog~cal changes include some congestnon as early as the first day in 30 per cent of cases and 25 per cent had areas of consohdatmn at various tumes, lnfectnon of the lungs occurred m two-thirds of the ventilated and one-thnrd of the non-ventdated patients. Thirteen of the 19 that died showed clear evidence at post mortem of inhalation injury but survival depended more upon the area of skin burned than upon the occurrence of harmful inhalation. Brown J. M. (1977) Inhalation injury and progressive pulmonary msuffcnency in a British burns umt. Burns 4, 32.
Respiratory burns In retrospect, clinical recognition of burns of the respiratory tract is rehable, but signs and symptoms during the first few hours cannot be relied on to indicate whether or not such burns have occurred. In 56 cases fibreoptnc bronchoscopy and scintlgraphy carried out after breathing 133Xe did not always gwe consistent results, but the method was much more reliable for early diagnosis of inhalation burn. Pegg S. P., Hinckley V. M. and Adtseshan N. (1977) Adjunct role of scmtigraphy and bronchoscopy in the early diagnosis of respnratory burns. Burns 4, 86. T r e a t m e n t of burns of the hand Preliminary treatment included cooling, after whnch the hands were twice washed for 5 rain using sterile cold water and sterile soap. Of the 140 hands treated 55 per cent were put into polythene gloves after being
1. That all the 13 injured riders who were dragged along the ground with one foot in the stirrup recewed severe injuries It is suggested that specml safety stnrrups which automatically release the foot under these circumstances should be more widely used. 2 That among the injured riders who sustained head injuries (11 per cent of the total), the presence or absence of a helmet d~d not seem to affect the seventy of the injury. It is suggested that the current means of head protectnon are inadequate and that there is a case for the development of more effective and acceptable headgear Gierup J., Larson M. and Lennquist S. (1976) Incidence and nature of horse-riding injuries. Acta Ctnr Scand. 142, 57 Burns T r e a t m e n t of contractures Gains of from 2 to 20: (mean 8 ) in movement were achieved by passLve stretching of contractures whde the affected part was encased in a m~xture of paraffin and mineral oil at temperatures of 33 j C for adults and 29-30~C for children. Although the gain m movement lasted for only a few hours after the first treatment, improvement was progressnve and cumulative with successive periods of treatment. Head M D and Helm P. A (1977) Paraffin and sustained stretching in the treatment of burn contractures. Burns 4, 136.
Diagnosis of burn depth The author compares chmcal estimates wnth the study of serial bzopsy specimens in 42 experimental burns in animals and 8 accidental burns in humans Using three degrees of burning, based on appearance, he found a 60 per cent error in the first-degree, 73 per cent m the second-degree and 36 per cent in the thirddegree experimental burns. In the case of the human burns there was a 33 per cent error in the seconddegree burns and no error in the third-degree burns. The author dnd not compare other chnlcal tests with the results of histological examination Giarsu K G. (1977) An experimental study for diagnosis of burn depth. Burns 4, 97.
Clinical a s s e s s m e n t of burn depth The authors rehed on a combination of the colour changes resulting from pressure, perception of proprick, appearance and healing time to categorize burns into four depths: epidermal, superficial dermal, deep dermal and subdermal. They followed the course of healing by marking the outlines of the &fferent burned areas on transparent sheets at different times after the injury. Deep dermal burns increased slightly in area for the first few days and then became rapidly smaller; subdermal burns began the contracting process at once. Although the two deeper sorts of burn healed without grafting, the authors found that delayed primary excision and grafting gave a better scar and earlier healing. They found that the
81 speed of heahng was influenced by the width of raw surface that had to be covered and used the ratios between the raw area and its circumference (the 'configuration index') as a guide to the rate of healing. They regarded clinical assessment of the depth of burning as being rehable. Godma M., Derganc M. and Br~nE A. (1977) The rehabdnty of chnical assessment of the depth of burns Burns 4, 92. I n h a l a t i o n injury Although nn 10 years the incidence of inhalation injury rose from 5 2 to 8 2 per cent and the mortality rate fell from 79 to 58 per cent these changes are not statlstucally significant. Pulmonary insufficiency usually began to become evident 5-10 days after burning but sometimes occurred without evidence of inhalation of flame or smoke. Treatment was in either case aimed at keeping the air passages clear and the Pao2 at an acceptable level. The dnstmctzon between laryngeal oedema and bronchoconstnctnon ~s xmportant and can be made by means of fibreoptlc endoscopy. Obstruction and reduced compliance at least double the work of breathing and may increase ~t nearly tenfold. Deep burns round the nose and mouth were fatal, either because of the severity of the burn or because of inhalation injury Pulmonary oedema tended to accompany renal fadure but was not of itself serious. Other radiolog~cal changes include some congestnon as early as the first day in 30 per cent of cases and 25 per cent had areas of consohdatmn at various tumes, lnfectnon of the lungs occurred m two-thirds of the ventilated and one-thnrd of the non-ventdated patients. Thirteen of the 19 that died showed clear evidence at post mortem of inhalation injury but survival depended more upon the area of skin burned than upon the occurrence of harmful inhalation. Brown J. M. (1977) Inhalation injury and progressive pulmonary msuffcnency in a British burns umt. Burns 4, 32.
Respiratory burns In retrospect, clinical recognition of burns of the respiratory tract is rehable, but signs and symptoms during the first few hours cannot be relied on to indicate whether or not such burns have occurred. In 56 cases fibreoptnc bronchoscopy and scintlgraphy carried out after breathing 133Xe did not always gwe consistent results, but the method was much more reliable for early diagnosis of inhalation burn. Pegg S. P., Hinckley V. M. and Adtseshan N. (1977) Adjunct role of scmtigraphy and bronchoscopy in the early diagnosis of respnratory burns. Burns 4, 86. T r e a t m e n t of burns of the hand Preliminary treatment included cooling, after whnch the hands were twice washed for 5 rain using sterile cold water and sterile soap. Of the 140 hands treated 55 per cent were put into polythene gloves after being