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,...

According to the demografic researches, the population is getting older. The death is caused not only by cardiovascular or tumorous diseases, but it include external fault as well. The seniors are more endangered. On the one side there are more possibilities to injure themselves, on the other they have more chronic diseases, that may influenced the progress of therapy. Because the subpopulation of seniors will be getting bigger in the next years, it will be great to think of some possible methods of prevention and of their practical use. That our senior days could be spend not only in quantity, but in quality as well.

Burn injury is considered a distressing and traumatic injury often leading to psychological disturbances such as depression, anxiety, posttraumatic stress disorder, and body image dissatisfaction. At the same time, the literature also suggests that people demonstrate surprising resiliency when dealing with their burn injury. How women who have experienced burns understand their injury and what it means to them to be a resilient, is largely ignored in the burn literature. This study addressed these shortcomings by exploring narratives from thirteen women, recruited from a regional burn center, who experienced a burn injury of up to 30% of their total body surface area (TBSA). Two interviews were conducted with each participant. The first interview employed a photo elicitation technique whereby photographs taken by the participant of her life with a burn injury were used to elicit stories in the context of the interview. The second interview was conducted using a semi-structured interview schedule developed to investigate experiences and understandings of distress and resiliency. The interview transcripts were analyzed using narrative analysis in order to explore how women constructed stories about distress and resiliency following burn injury. The findings show three main struggles the women faced in negotiating resiliency which all pertained to relational tension, that is, relationships with others. The three struggles of resiliency identified in the study are 1) feeling as though the body was public, 2) deciding how to share their burn experience with others, and 3) accepting support from others while maintaining independence. The findings of this study are discussed in the context of a relational theory named self-silencing which delineates how women behave socially to maintain relationships by inhibiting self-expression. Findings are also discussed relative to current research in the areas of burn injury and resiliency. / February 2017

Summary Patients with burn injuries involving more than 20 percent of the total body surface area lose a lot of fluid and are in the risk of developing a severe hypovolemia. Fluid resuscitation is a corner stone in burn care and is important for preventingfurthercomplications. The most common resuscitation formula is the Parkland Formula. Hourly urine output is a measure used to evaluate if the fluid given is sufficient enough to maintain a sustainable tissue perfusion. Inhalation injury, abuse of alcohol and drugs are some of the factors that may increase the amountoffluid needed. The purposefor this study is to study thecompliance to fluid resuscitation guidelines at a burn unit and which factors lead to deviation from the guidelines. Patient charts for 38 patients with burn injury >20%, > 18 years of age with a length of stay >48 hours, were reviewed regarding size of burn injury, hourly amount of fluid given, hourly urine output and presence of inhalation injury.Statistic significancewas found between the mean values of the differences in percentage between actual and calculated fluid amount for the first 24 hours. The differences in percentage between actual and calculated hourly urine output did not reach statistic significance. The result shows complianceto the fluid resuscitation guidelines. A larger sample would be required in order to investigate which factors causing deviations from the guidelines.

Due to medical advances in burn care, the survival rate of individuals with serious burns has significantly increased. This has lead to a great need to focus on psychological aspects of burn injury recovery, particularly how people adapt to their changed bodies. The literature indicates that burn size and severity is not directly associated with the degree of distress and that for women, dissatisfaction with their bodies increases in the year after injury. In this study, women’s experiences of their bodies were investigated by asking them about pain, social relationships, mental health, and appearance. In-depth interviews were conducted with female burn survivors in the first year after injury and the transcripts were analyzed using a narrative-discursive analytic methodology. On the surface, the women told narratives which emphasized how well they were doing, however, further analysis revealed subordinate narratives which indicated body dissatisfaction and difficulties with adjustment. In order to suppress narratives of distress, the women engaged in “self-silencing,” of which three forms are outlined. The self-silencing functioned to help the women resist the cultural devaluing associated with “disfigurement” and more personally, to maintain close relationships. As self-silencing has been linked to depression and anxiety, encouraging women to discuss their difficulties may prove to be pertinent in psychological adjustment following burn injury.

Due to medical advances in burn care, the survival rate of individuals with serious burns has significantly increased. This has lead to a great need to focus on psychological aspects of burn injury recovery, particularly how people adapt to their changed bodies. The literature indicates that burn size and severity is not directly associated with the degree of distress and that for women, dissatisfaction with their bodies increases in the year after injury. In this study, women’s experiences of their bodies were investigated by asking them about pain, social relationships, mental health, and appearance. In-depth interviews were conducted with female burn survivors in the first year after injury and the transcripts were analyzed using a narrative-discursive analytic methodology. On the surface, the women told narratives which emphasized how well they were doing, however, further analysis revealed subordinate narratives which indicated body dissatisfaction and difficulties with adjustment. In order to suppress narratives of distress, the women engaged in “self-silencing,” of which three forms are outlined. The self-silencing functioned to help the women resist the cultural devaluing associated with “disfigurement” and more personally, to maintain close relationships. As self-silencing has been linked to depression and anxiety, encouraging women to discuss their difficulties may prove to be pertinent in psychological adjustment following burn injury.

Burn injuries are one of the most painful and potentially debilitating traumatic injuries that a person can suffer. Every reader is likely to have, at some point in their life, suffered a burn injury, no matter how minor and therefore can have some comprehension of the pain and suffering associated with significant burn injury. Traumatic injury is the leading cause of death and disability in children and young adults. Although much has been done to optimise pre-hospital care and emergent treatment of injuries in recent times, the mainstay of managing death and disability from traumatic injury must lie in preventing these injuries where at all possible. To enable effective preventative strategies to be put in place it is important to define the demographics of those injured and the mechanisms of injury for any given population. Only then can we ensure that strategies are targeted in the areas where they are most needed at the mechanisms that are occurring most commonly. This study has combined a number of data sources namely burns service, fire service, coroners' service and accident and emergency department in an attempt to define the epidemiology and aetiology of burn injury in Greater Manchester. Data from the different sources was pooled and underwent a process of data-linkage to remove duplicate records. Rates have been calculated and compared according to age group, sex group and deprivation status. Poisson regression modelling was used to calculate the rate ratios amongst the different groups. Postcode data was used to allow geographical mapping of injuries across the county to allow rates to be calculated for different areas of the city. Where rates have been calculated for small area geographies Bayesian modelling was used to predict injury rates for those areas. Maps have been produced that show the areas with the highest rates of injury. The results show that in children it is the under five age group that have the highest rates of injury, particularly the under 2's. In adults, those over 75 years of age have the highest rates of injury. For all age groups males were more likely to be injured than females. In both children and adults higher rates of injury were seen in those areas where there were increased levels of deprivation. Key mechanisms of injury for individual age groups have been highlighted. The maps of Greater Manchester and its constituent local authorities show those areas with the highest rates of injury. The definition of target demographic groups and geographical areas within Greater Manchester will be used to allow development of targeted prevention strategies in those areas.

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A thesis presented in partial fulfillment of the requirements for the degree of M.Sc. in Physiotherapy at the Stellenbosch University. / Thesis (MSc (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Background Albeit Virtual Reality (VR) has been shown to be a useful adjunct in the reduction of pain during burn care and therapy, the current VR systems are expensive and may not be economically feasible for developing countries such as South Africa, where health budgets are stringent. Objective The purpose of this study was to ascertain the effect of a lowcost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacologic analgesics, on reducing pain and anxiety in adult burn injury patients undergoing physiotherapy treatment, compared to pharmacologic analgesics alone at a South African hospital. Study design Single-blinded, within-subject study design. Methods Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Descriptive statistics, Chi-square tests as well as the Student’s paired t-test were used to analyze data. Main findings Eleven eligible adult burn injury patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two conditions (analgesics with VR and analgesics alone) in reducing pain was found. No significant difference (p=0.58) was found between the two conditions (analgesics with VR and analgesics alone) for anxiety. Interpretation There is a trend that a low-cost VR system, when added to routine pharmacologic analgesics, is an economically feasible and safe adjunct therapy and could be of considerable benefit if implemented into the current pain management regimen of burn injury patients at a South African Hospital. / AFRIKAANSE OPSOMMING: Agtergrond Ofskoon dit al bewys is dat Virtuele Realiteit (VR) ’n nuttige hulpmiddel is om pyn tydens die versorging en behandeling van brandslagoffers te verlig, is die huidige VR stelsels duur en dalk nie uitvoerbaar in ontwikkelende lande soos Suid-Afrika waar die gesondheidsbegrotings beperk is nie. Doel Om die uitwerking te bepaal van ’n laekoste VR stelsel (eMagin Z800 3DVisor) op die vermindering van pyn en angs by volwasse pasiënte met brandwonde wat fisioterapeutiese behandeling in ’n Suid-Afrikaanse hospitaal ondergaan. Studieplan ’n Enkel-blinde, binnesubjek-ontwerp. Metodes Volwasse proefpersone is opeenvolgend gewerf by die brandeenheid van die Tygerberg-hospitaal. Die laekoste VR stelsel, tesame met pynstillers, is ewekansig aan een helfte van die pasiënte in’n fisioterapeutiese behandelingsessie toegewys en die proefpersone is slegs een keer getoets. Die pyn en angs se resultaatmetings is deur ’n blinde meting gedoen deur die numeriese pynskattingskaal en die brandspesifieke pyn- en angsskaal te gebruik. Beskrywende statistieke, Chi-kwadraat-toetse en studente se gepaarde t-toets is gebruik om die data te analiseer. Bevindings Elf geskikte volwasse pasiënte met brandwonde het ingestem om aan die studie deel te neem, drie was vroulik en agt was manlik (mediaan-ouderdom 33; reeks 23-54). ’n Marginale (p=0.06) tot onbeduidende verskil (p=0.13) is gevind tussen die twee kondisies om pyn te verlig (met of sonder die toediening van VR). Wat angs betref, is geen beduidende verskille (p=0.58) tussen die twee kondisies (met of sonder die toediening van VR) gevind nie. Interpretasie Daar is ’n neiging dat ’n laekoste VR-stelsel, wanneer dit saam met die gewone farmakologiese pynstillers gebruik word, ’n veilige en ekonomiese praktiese adjunk therapie is en beduidend voordelig kan wees wanneer dit geïmplementeer word as deel van die huidige pynbeheerregimen van brandslagofferpasiënte by ’n Suid-Afrikaanse hospitaal.