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Emergent care of the burn victim
The iournai of Emergency Medcine, Vol 2, pp 397-398
Printed !n the USA
1985
?? EMERGENT CARE OF THE BURN VICTIM. By I. Feller, C. A. Jones, and K. Richards. 76 pp. Ann Arbor, National Institute for Burn Medicine, 1977, $15.00. The author’s objective in writing this manual is to “provide the principles and practices necessary to improve the skills of the EMT and ED personnel as they become integrated into the (burn) team.” This manual succeeds in providing a good basis for the care of the burn victim in the prehospital phase but adds little to the ED physician’s or nurse’s knowledge of burn victim management. However, this manual provides a more thorough discussion of the emergent care of the burn victim than most of the standard prehospital care texts, including the American Academy of Orthopedic Surgeons’ Emergency Care and Transport of the Sick and Injured, and Grant and Murray’s Emergency Care. The text is organized into three main sections, including an introduction and discussions of care at the scene and in the ED. The organization of the text and flow between chapters is good. The authors have placed “key” sentences and informative highlights in the margins and in boldface print. The quality of the writing is excellent, concise, and easily readable. The figures and tables are helpful in general, although the figure for “Recommendations for Burn Care Facility Triage” (Fig 12) is somewhat difficult to interpret. A poster and cassette tape accompany the manual and highlight important points in the text. A short glossary with simple and concise definitions is included.
??
Copyright ‘F 1985 Pergamon Press Ltd
The first two sections of the manual are quite good and informative on the demographics, anatomy, physiology, diagnosis, and treatment of burns. These sections provide good general information, but seem to be directed at the basic provider rather than at the intermediate provider or paramedic. There are multiple cautions concerning IV therapy but no discussion of the indications for field intubation. The section on shock therapy is adequate as it relates to burns, but otherwise has several deficiencies. There is no mention or discussion of MAST trousers; a highlighted statement indicates that “hypovolemic shock is best treated in the hospital.” Certainly aggressive treatment for shock is best monitored in the hospital, but if treatment with MAST trousers or IV fluids can be initiated at the scene with minimal or no delay of transport, the patient will benefit. Despite these deficiencies, the first two sections provide a good, basic knowledge of burn anatomy, physiology, and management for the prehospital care responder. The third section, directed at ED personnel, has several major deficiencies. There is no adequate discussion of electrical injuries such as associated muscle damage, fractures, and myoglobinuria. There is no discussion of eye burns other than instructions to flush the eye and call an ophthalmologist . Certainly a well-qualified emergency physician should have a much better understanding of eye burns and their management than is presented in this text. A table delineating the indications for tetanus toxoid and human tetanus immune globulin would have been useful. The dosage sched-
Rook Reviews, coordinated by Edward J. Otten, MD, University of Cincinnati College =ZXYXZ of Medicine, keeps readers informed of important publications in the emergency med-
=====
icine field. 0736-4679/85 397
$3.00
+ .OO
398
ule for aminophylline (250 mg q 6 hours) is somewhat outdated, as most physicians prefer a continuous infusion. Pediatric dosages for aminophylline and steroids are not provided. There is no mention of carbonaceous sputum as an indication for concern about lower respiratory tract injury. There is no discussion of circumferential burns of the chest and extremities and indications for escharotomy. The authors seem to recommend initial fluid therapy with lactated Ringer’s solution with 25 g of human serum albumin added per liter. Most emergency physicians and burn specialists would consider lactated Ringer’s solution to be adequate initial fluid therapy. There is no discussion of nursing issues in the acute management of burns in the ED. The deficiencies in the third section of this man-
Book Review
ual limit its usefulness for the emergency physician or nurse, but it does provide some insight for the prehospital care provider into the management of the burn victim in the ED. The authors of Emergent Care of the Burn Victim have succeeded in providing a more in-depth, concise, and easily readable discussion of burn care for the prehospita1 care provider. The utility of this text for the emergency physician, house officer, or nurse is limited to usage in teaching such prehospital care providers.
Phillip Oblinger, MD Department of Emergency Medicine University of Cincinnati Cincinnati, OH
Printed !n the USA
1985
?? EMERGENT CARE OF THE BURN VICTIM. By I. Feller, C. A. Jones, and K. Richards. 76 pp. Ann Arbor, National Institute for Burn Medicine, 1977, $15.00. The author’s objective in writing this manual is to “provide the principles and practices necessary to improve the skills of the EMT and ED personnel as they become integrated into the (burn) team.” This manual succeeds in providing a good basis for the care of the burn victim in the prehospital phase but adds little to the ED physician’s or nurse’s knowledge of burn victim management. However, this manual provides a more thorough discussion of the emergent care of the burn victim than most of the standard prehospital care texts, including the American Academy of Orthopedic Surgeons’ Emergency Care and Transport of the Sick and Injured, and Grant and Murray’s Emergency Care. The text is organized into three main sections, including an introduction and discussions of care at the scene and in the ED. The organization of the text and flow between chapters is good. The authors have placed “key” sentences and informative highlights in the margins and in boldface print. The quality of the writing is excellent, concise, and easily readable. The figures and tables are helpful in general, although the figure for “Recommendations for Burn Care Facility Triage” (Fig 12) is somewhat difficult to interpret. A poster and cassette tape accompany the manual and highlight important points in the text. A short glossary with simple and concise definitions is included.
??
Copyright ‘F 1985 Pergamon Press Ltd
The first two sections of the manual are quite good and informative on the demographics, anatomy, physiology, diagnosis, and treatment of burns. These sections provide good general information, but seem to be directed at the basic provider rather than at the intermediate provider or paramedic. There are multiple cautions concerning IV therapy but no discussion of the indications for field intubation. The section on shock therapy is adequate as it relates to burns, but otherwise has several deficiencies. There is no mention or discussion of MAST trousers; a highlighted statement indicates that “hypovolemic shock is best treated in the hospital.” Certainly aggressive treatment for shock is best monitored in the hospital, but if treatment with MAST trousers or IV fluids can be initiated at the scene with minimal or no delay of transport, the patient will benefit. Despite these deficiencies, the first two sections provide a good, basic knowledge of burn anatomy, physiology, and management for the prehospital care responder. The third section, directed at ED personnel, has several major deficiencies. There is no adequate discussion of electrical injuries such as associated muscle damage, fractures, and myoglobinuria. There is no discussion of eye burns other than instructions to flush the eye and call an ophthalmologist . Certainly a well-qualified emergency physician should have a much better understanding of eye burns and their management than is presented in this text. A table delineating the indications for tetanus toxoid and human tetanus immune globulin would have been useful. The dosage sched-
Rook Reviews, coordinated by Edward J. Otten, MD, University of Cincinnati College =ZXYXZ of Medicine, keeps readers informed of important publications in the emergency med-
=====
icine field. 0736-4679/85 397
$3.00
+ .OO
398
ule for aminophylline (250 mg q 6 hours) is somewhat outdated, as most physicians prefer a continuous infusion. Pediatric dosages for aminophylline and steroids are not provided. There is no mention of carbonaceous sputum as an indication for concern about lower respiratory tract injury. There is no discussion of circumferential burns of the chest and extremities and indications for escharotomy. The authors seem to recommend initial fluid therapy with lactated Ringer’s solution with 25 g of human serum albumin added per liter. Most emergency physicians and burn specialists would consider lactated Ringer’s solution to be adequate initial fluid therapy. There is no discussion of nursing issues in the acute management of burns in the ED. The deficiencies in the third section of this man-
Book Review
ual limit its usefulness for the emergency physician or nurse, but it does provide some insight for the prehospital care provider into the management of the burn victim in the ED. The authors of Emergent Care of the Burn Victim have succeeded in providing a more in-depth, concise, and easily readable discussion of burn care for the prehospita1 care provider. The utility of this text for the emergency physician, house officer, or nurse is limited to usage in teaching such prehospital care providers.
Phillip Oblinger, MD Department of Emergency Medicine University of Cincinnati Cincinnati, OH