Preliminary Experience with Cultured Epidermal Autograft in a Community Hospital Burn Unit.

Initial experience with cultured epidermal autograft (CEA) in a community hospital burn unit is described. Five applications of CEA to three patients (mean burn size, 59% total body surface area) were made. Final graft take of CEA ranged from 10% to 80%. Healed CEA is cosmetically superior to meshed autograft and appears to form less hypertrophic scar tissue. CEA is more sensitive to infection than meshed autograft. A review of the literature concerning topical antibiotic use with CEA is included. This experience with CEA demonstrates that large burns can be successfully managed with this modality in a community hospital burn unit setting

How Accurate is Pulse Oximetry in Patients with Burn Injuries?

Pulse oximetry is a noninvasive method of measuring arterial oxygen saturation. The value of oximetry in patients with burn injuries has been questioned because of a theoretic inaccuracy in the presence of carboxyhemoglobin. We studied pulse oximetry in 27 intubated patients with burn injuries to determine the accuracy of the method and then to determine whether oximetry could replace indwelling catheters presently used for arterial blood gas analysis. Oximeter and arterial blood gas saturation data correlated closely, with a coefficient of 0.820. The pulse oximeter predicted adequate ventilation in 78% of patients with a readout of 99% or above. The arterial PO2 was greater than or equal to 90 torr in 90% of patients with oximetric readouts greater than or equal to 98% and in 10% of patients with readouts less than 95%. Pulse oximetry is an accurate adjunct in the management of patients with burn injuries and in addition provides continuous real-time data not available with arterial blood gas sampling

The Southern Region burn disaster plan.

A regional burn disaster plan for 24 burn centers located in 11 states comprising the Southern Region of the American Burn Association was developed using online and in-person collaboration between burn center directors during a 2-year period. The capabilities and preferences of burn centers in the Southern Region were queried. A website with disaster information, including a map of regional burn centers and spreadsheet of driving distances between centers, was developed. Standard terminology for burn center capabilities during disasters was defined as open, full, diverting, offloading, or returning. A simple, scalable, and flexible disaster plan was designed. Activation and escalation of the plan revolves around the requirements of the end user, the individual burn center director. A key provision is the designation of a central communications point colocated at a burn center with several experienced burn surgeons. In a burn disaster, the burn center director can make a single phone call to the communications center, where a senior burn surgeon remote from the disaster can contact other burn centers and emergency agencies to arrange assistance. Available options include diversion of new admissions to the next closest center, transfer of patients to other regional centers, or facilitation of activation of federal plans to bring burn care providers to the affected burn center. Cooperation between regional burn center directors has produced a simple and flexible regional disaster plan at minimal cost to institute or operate

Utilization of the burn unit for nonburn patients: the wound intensive care unit .

Burn units and experienced burn nurses are valuable, expensive resources that are underutilized when the burn census is low. Burn facilities can be used to treat other conditions or injuries to provide optimum wound management or to provide overflow intensive care unit beds. We studied via a questionnaire survey the admission profiles of 120 burn units in the United States to determine frequency of utilization for nonburn injuries. One hundred sixteen burn units routinely treat nonburn injuries. Seventy-seven burn units also accept overflow patients from other critical care units. A significant amount of nonburn wound care is being provided by burn units in the United States, with potential benefit to both the patient and the burn unit. The implications of the use of burn facilities as wound intensive care units are discussed