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1、CHAPTER21BURNSMarcJeschke,FeliciaN.Williams,GerdG.Gauglitz,andDavidN.Herndonburninjuriesandfatalitiesarepreventableandmandateinter-causesventionandpreventionstrategies.Overall,nosinglegroupispathophysiologyofburninjuriesimmunetothepublichealthdebtcausedbyburns.managementLocationplaysamajorroleinther
2、iskandtreatmentofwoundcareburn.Theavailableresourcesinagivencommunitygreatlyinflu-specialconsiderations:electricalandchemicalburnsencemorbidityandmortality.Alackofadequateresourcesoutcomesaffectstheeducation,rehabilitation,andsurvivalratesofburnburnunitsvictims.Someonewithasevereburninaresource-rich
3、environ-summarymentcanreceivecarewithinminutes,whereasaburnedindi-vidualinanaustereenvironmentmaysufferforanextendedperiodwaitingforcare.Theidealtreatmentofburnsrequiresthecollaborationofsurgeons,anesthesiologists,occupationalMorethan500,000burninjuriesoccurannuallyintheUnitedtherapists,physiotherap
4、ists,nurses,nutritionists,rehabilitation1States.Althoughmostoftheseburninjuriesareminor,approxi-therapists,andsocialworkersjusttoaccommodatethebasic9mately40,000to60,000burnpatientsrequireadmissiontoaneedsofamajorburnsurvivor.Anydelayinreachingthesehospitalormajorburncenterforappropriatetreatment.Th
5、eresourcescompoundsadelayinresuscitationandthusaddsto10devastatingconsequencesofburnshavebeenrecognizedbythethemortalityrisk.Forthosewhohaveaccesstoadequateburnmedicalcommunityandsignificantamountsofresourcesandcare,survivalfromamajorburnistherule,nolongertheexcep-2researchhavesuccessfullyimprovedth
6、esedismalstatistics.tion.Thesurvivalrateforallburnsis94.6%,butforat-riskSpecializedburncenters(Box21-1)andadvancesintherapypopulations,incommunitieslackingmedical,legal,andpublic7strategies,basedonimprovedunderstandingofresuscitation,healthresources,survivalcanbealmostimpossible.enhancedwoundcoverag
7、e,moreappropriateinfectioncontrol,improvedtreatmentofinhalationinjury,andbettersupportofPATHOPHYSIOLOGYOFBURNINJURIESthehypermetabolicresponsetoinjuryhavefurtherimproved3theclinicaloutcomeofthisunique
