BURN CARE

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BURN CARE

• INMED CONFERENCE
• JUNE 8, 2009
• Mani M Mani MD
• Maria Pena RN
• Trina Schulz OTR

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BURN CARE

• What are the standards of burn care in the United
  States?
• What are the standards of care in the country
  that you plan to work and serve?
• How do the standards that you are used to work
  over there?

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BURN CARE

• My experience in Burn Care
• in Kansas 1974 - 2007
• in Malaysia 1986 1996
• in Australia 1995 1999
• in Kyrgyzstan 1997 2000
• in India 1964 - 2009

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BURN CARE

• Burn care can be simple
• or very complex.
• One can spend a lot of time and resources to
  prolong the process of death in a severe case.
• One can do a lot of good to the majority of cases
  which fall into the minor and moderate category.

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BURN CARE

• Our pattern.
• Call 911, ambulance arrives.
• Resuscitation initiated and the patient is
  transferred to E.R and burn center.
• Protocols are put into effect.
• Most patients survive and live happily ever after
  (?) wondering how to pay the bills.

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BURN CARE

• THEIR PATTERN.
• No 911. Transfer by whatever mode available to
  the nearest hospital.
• Major burn patients do not survive.
• Minor burn cases survive but with deformities.
• Patients turns around and asks you, why did you
  save me to live like this for the rest of my
  life?.

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BURN CARE

• So what should one do?
• Leave behind your rules, protocols and
  regulations.
• Assess what they need, what they have and what
  can be done in the time and with the resources
  available to you.
• Dont be satisfied with applying a band aid and
  giving them platitudes.

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BURN CARE

• What is the average size of burn treated in burn
  centers in the USA?
• Most of the cases involve about 15 of body
  surface.
• If the average is 15, then there are a few that
  are larger and many that are smaller.

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BURN CARE.

• On an international scene, when facilities
  (equipment, supplies, staff and finances) are not
  available, it is better not to spend available
  resources on cases that are major and whose
  chances of survival is minimal.

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BURN CARE

• On an international scene it is smarter to manage
  smaller injuries that can be managed with locally
  available resources, to prevent deformities and
  make the person functional.

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BURN CARE

• Minor and Moderate burns.
• These may not life threatening injuries.
• The deformities could be prevented by using a
  simple splint during the healing period.
• Once the deformity is established, it will
  require major procedures to create a functional
  person.

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BURN CARE.WHAT CAUSES DEFORMITIES?
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BURN CARE

• Scars are an inevitable end result of wound
  healing.
• Scars can be modulated to prevent deformities and
  provide full function.
• Scars can be modulated to make appearance
  acceptable.

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DEEP BURNS, GRAFTED.
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BURN CARE

• Priorities in burn management.
• Recognize life threatening issues.
• Resuscitation.
• Pain management.
• Nutrition.
• Wound management.

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BURN CARE

• Nursing care.
• Rehabilitation
• Occupational and Physical therapy.
• Psychological care.
• Family support.
• Reentry into society.
• Late reconstruction.

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BURN CARE

• Wound Management.
• Recognize partial thickness injuries (first and
  second degree). These should heal
  within 7-10 days with adequate management.
• Prevent these from becoming full thickness
  injuries due to lack of blood supply and
  infection.

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Partial thickness
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BURN CARE

• Full thickness skin loss will not heal without
  surgical intervention or they take months or
  years to heal with all the attended complications
  of infection, scar contracture and even death.

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Full thickness skin loss
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BURN CARE

• Wound Care.
• Somehow we have come to a mind set that topical
  antimicrobials are necessary for wound healing.
• We are the only specialty that will retain dead
  tissue on the body and expect healing with the
  use of creams and ointments.

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WOUND CARE

• Wound care.
• In partial thickness injuries, the goal is to
  protect the injured tissues and allow the body to
  heal by epithelial growth.
• Provide protection.
• Provide nutrition.
• Prevent infection.
• Provide pain management.

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BURN CARE

• Wound care.
• In full thickness skin loss, excise the dead
  tissue as soon as possible and feasible and
  provide epithelial coverage.
• Prevent infection.
• Provide nutrition.
• Provide pain management.

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Late reconstruction
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BURN CARE

• International burn care efforts should involve
  educating a team to provide care on a long term.
• Band aid philosophy may make you feel good, but
  does very little for the patient.
• Use locally available facilities, equipment,
  supplies and personnel.

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INTERNATIONAL HEALTH CARE

• Go to the people,
• Live among them,
• Love them.
• Start with what they know,
• Build on what they have.
• But of the best leaders
• When their task is accomplished,
• The people will remark
• Weve done it ourselves.