Treatment of burns can be divided into 3 phases. During first 36 hours fluid resuscitation and securing airways are the most important aspects of therapy. The fluid resuscitation is complex, and protocols are used to increase the consistency and success of treatment. The adequacy of the protocols should be continuously monitored and adjusted to the patients response. Current studies are exploring the use of antioxidants to minimize the oxidant stress during the burn shock phase. The aim of this thesis is to review current strategies in fluid resuscitation during the first 36 hours after burns.

EPIDEMIOLOGY ( EPIDEMIOLOGIC RESEARCH) OF BURN INJURIES IN CHILDREN Lenka Eichlová Supervisor: MUDr. Monika Tokarik Background: Burn injury belongs to main cause of morbidity and mortality in children. More than 100 000 people sustain flash burn every year, 40% of them forms children. Near minimus insider babies into two years come to scorch mostly owing second men. Cardinal cause of thermic injury off elderly is by personal endeavour. Burns differ by mechanism, range, depth and localization. An age is other crucial factor determinants prognosis of patient. And just therefore children's burns are very specific disbranch of medicine. Object: I tried to created a labour, in which I elaborate statistical data of newly hospitalized patiens on clinic of burns in FNKV behind the year 2008. Patients: The set contained 373 newly hospitalized patiens. I have divided them according to age, sex, mechanism of scorch, range, depths and localization of scorch. Further I followed longitude of hospitalization, way of applied therapy and occurence of complications. Results: Predomination of burns is in boyhood (65%). The highest occurence of burns is in the group at the age of 0-2. The most frequent reason of burn in this group is caused by scalding hot liquid and further contact with hot body. In a group of 4-15 years old,...

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / Background: Burns are a significant cause of paediatric injuries, particularly in low and middle-income countries, where more than 90% of burn-related paediatric deaths occur. Physiotherapy is an essential, sometimes painful, component of burn rehabilitation therapy. The popularity of the video game use in burns rehabilitation has grown because, in addition to facilitating range of motion (ROM) in an effort to prevent joint contracture formation, the virtual imaging characteristics of these games provides additional benefit of distraction from pain. Video games provide a more efficient, effective and enjoyable method training, and are a helpful adjunct to rehabilitation. Aim: To investigate the effect of using the Xbox Kinect™ on discharge outcomes and early activity levels of children in the Paediatric Burns Unit (PBU) at Chris Hani Baragwanath Academic Hospital (CHBAH) Methods: This non-equivalent post-test only control group design study took place over a period of time until the total number of children required was achieved for each group. The control group was the first group of children recruited to the study and received standard physiotherapy treatment and rehabilitation. The experimental group was the second group of children recruited to the study who received standard physiotherapy treatment and rehabilitation as well as the Xbox Kinect™. Comparisons were made only after the intervention and analysed. Outcome measures for each participant were ROM, Activities Scale for Kids© participation (ASK©p) and a modified Wong-Baker FACES® enjoyment rating scale. On discharge from the unit, ROM assessments and the modified Wong-Baker FACES® enjoyment rating scale were administered. On follow-up one week post discharge, ROM re-assessments were done and the ASK©p was administered. A questionnaire regarding the use of the Xbox Kinect™ was completed by health professionals working within the PBU. Results: Seventy children were recruited into the study of which the data for 66 were analysed. Thirty five children were part of the control group and 31 were part of the Xbox intervention group. No significant difference was found between groups regarding demographic characteristics, the median age was seven years old and 55% of the participants were male. There was one mortality and five children in total were lost to follow up. The majority burns were as a result of hot water attributing to more than 50% of admissions, followed by flame burns (30%) and electrical burns (12%). This study population showed an overall total burn surface area (TBSA) of nine percent which were superficial partial in depth; this is seen as a minor burn injury. Forty percent were seen to have moderate-severe injury and three children were considered to have severe major burns > 30 % TBSA. We observed a greater proportion of injury involving the lower limbs (23.10%) and upper limbs (21.10%), followed by injury involving the trunk (11.40%), buttocks and genitalia (7.50%) and the head and neck regions (6.80%). There was no difference in length of stay (LoS) or the chance of Intensive Care Unit (ICU) stay between the two groups. In the intervention group 75% of the children received 2 or more Xbox Kinect™ sessions. The Xbox Kinect™ was shown to be significant in achieving higher active range of movement (AROM) at discharge (p< 0.01) and at follow up (p< 0.01), and highlights the advantages it has in providing a more amusing and comfortable option as part of the burns rehabilitation process. By allowing the children to be more engaged in the Xbox Kinect™ experience and games, they were distracted and thus experienced less pain. In this study we found that TBSA% was a predictor of ASK©p scores (p= 0.03), thus the higher the burn percentage the lower the ASK©p scores. We also found that age (p= 0.05) and AROM (p= 0.04) were associated with ASK©p scores, thus the younger the child or a child with reduced AROM would have lower ASK©p scores. Fun and enjoyment (p<0.01) was found to be significant in this study, thus highlighting the fun and enjoyment factor the Xbox Kinect™ offers as part of therapy and as an adjunct to burns rehabilitation. Thirty one questionnaires regarding the value and use of the Xbox Kinect™ were completed by health professionals working within the PBU. Many highlighted the value of fun, enjoyment and distraction the Xbox Kinect™ offered as part of the rehabilitation, as well as assisting in achieving more AROM but also indicated that the Xbox Kinect™ sessions still needed to be supervised and guided. Conclusion: This study was the first study done in South Africa involving video game technology during physiotherapy within the paediatric burns population. The use of the Xbox Kinect™ as seen in this study has proven to be beneficial and a useful adjunct to burns rehabilitation within in the paediatric burns population. This distraction and decline in pain assists in reducing the fear associated with movement these burns children experience and assist in improvements related to activity and ultimately age-appropriate play and activities of daily living (ADLs). / MT2017

Sepsis and multi-organ failure are the most frequently reported causes of death in burn injuries. Their early identification allows therapies and resources to be targeted in a more effective and efficient way. Due to its frequent antibiotic drug resistance Acinetobacter baumannii (MRAB) is increasingly causing a problem in burns units. New strategies need to be found to combat infection and sepsis in the burn ICU. This study examines the potential of the Albumin Creatinine Ratio, a marker of systemic endothelial dysfunction in predicting outcomes, sepsis and multi-organ failure; the role of Acinetobacter in causing organ failure; and explores for the presence of the cathelicidin, LL-37 in the burn wound and examines it potential utility for treating infection and sepsis. It was found that ACR on admission and at 48 hours is predictive of patient outcomes and the development of sepsis, and may be of use predicting multi-organ failure. Multi-organ failure occurs more frequently in MRAB patients compared to those patients with drug sensitive Acinetobacter baumannii. The number of agency nursing staff and work intensity are possible contributing factors in MRAB acquisition. LL-37 has been found in both acute burn wounds as well as in the grafted healing burn wound and is active against drug resistant Acinetobacter baumannii. ACR can therefore identify those patients at risk of sepsis and may have a role in predicting multi-organ failure. MRAB acquisition in the burns intensive care unit is a significant cause for concern as patients are more likely to suffer from multi-organ failure as well as prolonging their hospital stay and resulting in poorer outcomes. LL-37 has many functions and importantly plays a role in the body’s innate immune system. In the era of increasing antibiotic resistance it may provide a novel therapeutic role in treating MRAB infection.

Thesis (Ph. D.)--Oregon State University, 1985. / Typescript (photocopy). Includes bibliographical references (leaves 65-70). Also available on the World Wide Web.

Forest fires have an enormous impact on biotic and abiotic variables that control runoff and soil properties in watersheds. Because wildfires do not have a uniform effect on the burned area, significant variability occurs between areas of different burn severity and likely elicits different hydrologic responses within watersheds. Much of the control on this hydrologic response stems from the variability of soil between burned and unburned watersheds. Establishing a linkage between soil infiltration and burn severity may therefore, offer insight into the likelihood of elevated levels of runoff and the likelihood of floods. Although previous studies have sought to establish a quantitative relationship between runoff and burn severity, this relation has not been evaluated with respect to soil moisture and infiltration and varying degrees of burn severity. The Loretta-Linda Basin presents a unique opportunity to compare areas with different burn severities (with the right fork of the drainage experiencing a much higher burn severity than the left), while eliminating most other variables that may occur with greater spatial variability such as elevation, temperature, precipitation, underlying geology, and soil type. Rainfall, soil moisture, runoff, and infiltration data collected over a two-month period were used to evaluate the relationship between burn severity, runoff, and infiltration for the Loretta-Linda basin as a whole as well as for the individual forks of the basin. The impact of varying burn severity on the two sub drainages was further investigated by creating a dynamic simulation model in TopoFlow®. Comparative analysis between the two forks did not show a dramatic difference in the runoff and infiltration relationship between the two burn severities. Variability of field conditions, the presence of parameters affecting runoff not accounted for, and the limitations of point measurements, are reflected by the data analysis and lack of a strong correlation between burn severity, infiltration, and runoff. The use of spatial hydrologic modeling allowed for the investigation of the relative importance of the infiltration parameters as well as the impact of Manning’s n on the response of the basin to rainfall. The modeling results indicate a strong correlation between high burn severity, low infiltration capacity, and elevated discharge volumes.

This thesis describes the author's investigations into the design of a burn dressing; the use and mode of action of silicone gel when applied to hypertrophic scars, and its use as a burn dressing. This research was carried out at the Bioengineering Unit, Strathclyde University in conjunction with the Burns Units at Glasgow Royal Infirmary and the Royal Hospital for Sick Children, Glasgow, and the Dow Corning Corporation. The Introduction provides a background to the history of burn dressings and hypertrophic scarrinfg The need to define the "ideal" burn dressing is emphasised, and the thesis objectives are stated. Chapters 2 and 4 provide a background to the study by describing the anatomy and physiology of skin, wound healing, burns, hypertrophic scarring and burn dressings. The limitations of presently available burn dressings is reviewed in Chapter 5. Quantitative, critical criteria, useful for defining the "ideal" burn dressing, are presented in the same chapter. Chapter 6 is a literature review on the chemistry and medical applications of silicones. The treatment of hypertrophic scars with silicone gel is discussed in Chapter 7. The mode of action of the material has been examined and a possible explanation is presented. Chapter 8 explores the possibility of using silicone gel as a burn dressing by examining its relevant properties and the application to burn wounds. The results of the investigation are discussed in Chapter 9. Silicone gel has been found to be a very effective treatment for hypertrophic scars. However, more research is required to fully discover its potential as a burn dressing, and to completely define the "ideal" burn dressing quantitatively.