arrFiles=new Array();arrFiles[0]=new Array("linkspage.htm","Total Burn Care Links Page","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 9-07-05 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM * LINKS * Burn Injury - Ameriburn.org American Burn Association Annals of Burns and Fire Disasters International Burn Care Info. BurnSurgery.org Nonprofit Educational Group for Burn Care Professionals BurnSurvivorsOnline.com Discussion Forum, News, Info., Stories Burn Survivors Throughout The World Message Board, News, Stories, Info. Emergency Medical Services for Children EMSC Main Page EMSC Fire and Burn Prevention Resources This page contains a listing of many useful Publications and Links to other relevant sites. Injury Prevention Web - Children Internet Injury Prevention Resources for Children and Youth Injury Prevention Web - Burns Internet Injury Prevention Resources for Burns NCIPC - National Center for Injury Prevention and Control Approximately 200 links to Injury-Related Websites NIGMS (NIH) Trauma & Burn Resources Fact Sheet from the National Institute of General Medical Sciences PhoenixSociety.org Resources for Burn Survivors, Families, Professionals WorldBurn.org International Society for Burn Injuries Burn Injury Rehabilitation Model Systems - University of Washington / Harborview Medical Center (University of Washington Burn Injury Rehabilitation Model System) University of Texas / Southwest Medical Center (North Texas Burn Rehabilitation Model System) Johns Hopkins University / Bayview Medical Center (Johns Hopkins University Burn Injury Rehabilitation Model System) Shriners Galveston Burn Hospital & University of Texas Medical Branch (Shriners / UTMB Pediatric Burn Injury Rehabilitation Model System) Disability Resources - ADA Technical Assistance Program For Businesses, Agencies and the Disabled The Cornucopia of Disability Information Disability-Related Documents Job Accommodation Network U.S. Dept. of Labor - Office of Disability Employment Policy LookingGlass.org Nat \'l Resource Center for Parents with Disabilities (with Open Forum) Office of Special Education Programs (OSEP) Social Security Disability Benefits Various Types of Benefits and Claims Procedures Student Financial Assistance Info. About Dept. of Education \'s SFA Grant & Loan Program Assistive Technology Center Freeware and Shareware for People with Disabilities General - National Institutes of Health (NIH) NIH Roadmap for Medical Research New NIH Research Initiatives CIRRIE Center for International Rehabilitation Research Information and Exchange National Institute on Disability and Rehabilitation Research (NIDRR) National Center for the Dissemination of Disability Research (NCDDR) National Library of Medicine - Sources for Medical Statistics (NLM) National Rehabilitation Information Center (NARIC) Prosthetics Research Lab. and Rehabilitation Engineering Research Program N.W. Univ. Shrine and Shriners Hospitals Web Site Shriners Hospital Directory & More U.S. Census Bureau Disability Data Analysis of Disability Data University of Texas Medical Branch Sealy Center on Aging Veteran \'s Affairs U.S. Dept. of Veteran \'s Affairs West Virginia Research and Training Center Disability Research and Training Top↑ LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[1]=new Array("funded_projects_otherspage.htm","Funded Projects - Others","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM FUNDED PROJECTS OTHER PROJECTS Glue Grant Inflammation and the Host Response to Injury is funded as a \"glue \" grant by the National Institute of General Medical Sciences (NIGMS), a component of the National Institutes of Health (NIH). This collaborative research program sponsored by NIGMS is a new mechanism that encourages independently-funded investigators to work together to solve a major biomedical research problem. The funds are intended to provide the \"glue \" to bring investigators together and allow them to work together interactively. The program also provides unique opportunities to attract the expertise of other scientists who have not traditionally been involved in biomedical research, such as engineers and informatics specialists. Funded programs make a commitment to NIGMS to share data and materials produced from the glue grant effort to the scientific community that extends beyond researchers participating in the program. GCRC The General Clinical Research Center (GCRC) is one of the first of approximately 80 centers in the nation currently supported by the University of Texas Medical Branch and by a grant from the National Center for Research Resources General Clinical Research Centers Program of the National Institutes of Health. Shrine Grant NIH Propranolol LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[2]=new Array("summary_training_programspage.htm","Summary of Training Programs","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 10-11-06 © COPYRIGHT 2006 ALL RIGHTS RESERVED TOTALBURNCARE.COM FELLOWSHIPS & OPPORTUNITIES for TRAINING TRAINING PROGRAM AT THE UNIVERSITY OF TEXAS MEDICAL BRANCH BURN SERVICES § Background Thermal injury remains a major medical problem in the United States and throughout most of the world. Although many advances have been made in reducing the high mortality associated with this injury, there are numerous unresolved questions concerning the nature of burn pathophysiology. If these questions could be answered, the cost of hospitalization and rehabilitation and the morbidity and mortality associated with this form of trauma would be markedly reduced. Basic researchers are currently answering many questions concerning the nature of the pathophysiology associated with thermal injury. However, to make this knowledge usable by the population of clinicians caring for burned patients in general, trained burn physicians must be available who have the ability to interpret these data and test them in a clinical settings. To accomplish this latter objective, clinical researchers must have the ability to communicate their findings in the traditional academic settings through oral presentations, poster displays, and in the preparation of manuscripts. The objective of this program is to train these individuals. The University of Texas Medical Branch has been training clinical researchers since the latter part of the 19 th century. Following the second world war, a multi-disciplinary program for the care of burn patients, research into the nature of thermal injury, and the training of clinicians and researchers in the area of thermal trauma was developed. This program was greatly enhanced 26 years ago by the philanthropy of Shriners of North America through their decision to establish the first center of teaching burn care research in the Galveston medical complex. This program has been integrated into The University of Texas Medical Branch and today, encompasses a large interdisciplinary team including 17 faculty from the Department of Surgery, 5 from Anesthesiology, 2 from Internal Medicine, 4 from Physiology, 3 from Microbiology, 3 from Pathology, 1 from Pharmacology, 3 from Human Biological Chemistry and Genetics, 1 from Otolaryngology, and 2 from Pediatrics. This team conducts a multi-million dollar research program, which investigates thermal injury and other areas of related pathophysiology. An integral part of these clinical and research activities is a training program, which has involved medical students, Pre and Postdoctoral Fellows in the basic science disciplines, residents, house staff, Fellows, nurses, and the allied health personnel. In addition, numerous medical students have been involved in summer research projects and there is an on-campus program to stimulate the interest of minority students in academic careers related to medicine. These training activities are supported from a variety of sources that include research grants from the public health service by the State of Texas. Continued funding from this grant proposal will enable us to expand the training programs for postdoctoral individuals, especially those who are looking for an academic career in investigating areas that relate to thermal injury. Goals and Rationale The goal of this program is to train physicians and scientists to accomplish research in the burn/trauma area. These individuals will have at least one year of postdoctoral training and upon completing our program, will return to finish their specialty training and become clinician investigators. We will hopefully select individuals in more advanced areas of training in order that their research experience will be fresh when they enter into their academic careers. It is hoped, however, the individuals who enter our program in the early part of their clinical training will continue their residencies. Balance and Integration The basic science rationale for this training program is the need for individuals in burn/trauma care who are capable of interpreting basic information from the laboratory and applying it to clinical problems and clinical research. It is hoped that these findings will ultimately lead to the dissemination of new knowledge and procedures for the care of thermally injured patients. Basic Didactic Core The core is made up of courses in various disciplines. These include statistics and scientific writing. There are additional short courses, which train the individual to perform computerized literature and word processing. These two courses are not mandatory because all students avail themselves of this service. There is a weekly lecture series in which the Fellow \'s present lectures on topics related to burn, sepsis, and trauma. At these presentations the faculty are in attendance to critique the candidates and help them in developing their skills as lecturers. There is also a bi-monthly scientific staff meeting for which there is mandatory attendance. At this meeting the operation of the various research programs is discussed and there is a presentation from the faculty and Fellows on their research efforts. The Fellows are encouraged to attend a morning conference, which covers most of the subject materials of the basic sciences as they pertain to critical care medicine. They meet four times a week for 45 minutes.Weekly Morbidity and Mortality Conference in Anesthesiology and Surgery, and Surgical Grand Rounds are held. All Fellows attend the weekly Fellow’s Conference with Drs. Herndon, Traber, Papaconstantinou, Townsend, Barrow, Wolfe, and Hawkins to present their week’s data and plan their next week’s program. Didactic Program for the Cardiopulmonary Track Fellows in the cardiopulmonary track have daily lab rounds in the morning and evening. During rounds Dr. Traber reviews the progress of each ongoing experiment with the Fellows and technical personnel. There is a weekly luncheon meeting with Dr. Herndon and staff in which each Fellow summarizes the progress made in their research programs and plans made for presentations at national and international meetings, the preparation of manuscripts and new projects. There is a weekly Journal Club in which a Fellow presents a literature review of a specific area and current pertinent literature applicable to their particular research projects. These Journal Clubs also function to preview the contents and abstracts of forthcoming meetings, as well as to report important papers that the Fellows may have heard in attendance at national or international meetings. As the Fellows ready themselves for presentations at national meetings, presentations are made before the group. Thus the candidate who is presenting receives constructive criticism of their performance and the attending Fellows gain experience in critiquing the work of others, as well as learning how a presentation should be made. There are courses and seminars in the basic science departments at UTMB and several of the Fellows participate in them. There is a close relationship between mentor and trainee in all the programs. Thus, the activities of the candidates are constantly monitored. In addition, their progress is evaluated at the various weekly presentations. During these time periods, areas that need improvement are identified, important changes in the data are noted and interpreted, and modifications of the various protocols and/or presentations are made. As the Fellows become more experienced, they become more independent and begin to participate in the training of new Fellows by teaching techniques, showing them literature, asking questions and stimulating conversation. Didactic Program for the Metabolism Segment The focus of research is the regulation of metabolism in human subjects. Emphasis is on the response to injury and sepsis, but a broader focus is taken in order to understand physiological control mechanisms of metabolic events. The experimental approach involves the use of stable isotopes and kinetic analysis to assess metabolism. This is generally not an area in which Postdoctoral Fellows have extensive experience. Consequently, the first few months involve training in basic aspects of stable isotope tracer methodology. Some sessions are didactic lectures on fundamental principles. These lectures are given in part of Dr. Chinkes. Also, each Fellow is assigned a topic to cover for one or two weeks, and the other faculty members active in the Metabolism Unit (Drs. Chinkes, Herndon, Zhang and Aarsland) also lead sessions. Other sessions focus more specifically on experiments in progress. Technical aspects of performing experiments, such as mixing isotope solutions, performing infusions, and determining metabolic rate, are generally learned from the other faculty members and Fellows in the program. Experience is also provided in analysis, although emphasis is not placed on this unless it is of specific interest to the Fellow. When Fellows have completed a two-year Fellowship in the program, they will be able to perform and interpret all aspects of stable isotopic tracer experiments. Drs. Aarsland, Zhang and Chinkes are involved with the Metabolism Unit projects on a daily basis, and spenda good deal of their time either performing experiments in the CRC or Shriners, or in the analytical lab. Fellows are involved in a project with at least one of these faculty members as a major collaborator. The broadening of the experience of a Research Fellow in the Metabolism Unit also stems from the numerous investigators who come for a few days to six months to work on specific projects with the group, or to learn some aspects of stable isotope analysis. The strength of the Metabolism Program is two-fold: 1) the unique capability of performing human experimentation using stable isotopes in human volunteers and patients, and 2) the breadth of the exposure to different perspectives. Experience is provided by direct and frequent interaction with a diversified faculty, including a mathematician; a biochemist; an anesthesiologist with advanced training in nutrition; an endocrinologist; and a pulmonary physician. In studies involving patients, Dr. Herndon (Surgery) interacts on a daily basis with the Fellows. Thus, we feel this is an ideal environment in which an individual wishing to establish a career that will include investigation of metabolic regulation in burn injury and sepsis can receive training. Didactic Program for Wound Healing New Program in Wound Healing Wound Healing: Pathogenesis of soft and hard tissue injury and repair The didactic program in the wound healing track consists of a series of seminars on the various components of wound healing, i.e., the ubiquitous fibroblast, collagen metabolism, soluble mediators, growth factors, the complement cascade, etc. In the early segments, normal wound healing is stressed, and later, abnormal wound healing resulting in hypertrophic scar and keloid formation is reviewed. Other members of faculty participate in specific areas such as immunology, scanning, and electron microscopy, and the interaction of the clotting cascade with wound healing. Dr. Herndon directs each research project. However, the individual project might be a specific subset of the repair mechanism and the Fellow may work directly with Dr. McCauley, or jointly with other members of the program such as Dr. Jeschke or Dr. Traber. To learn the various techniques necessary to teach wound healing, the Fellows rotate into various core facilities for briefs periods of time. Since the wound-healing segment is rapidly growing, it will be possible for Fellows to work with new faculty being recruited for specific aspects of wound pathogenesis and repair, such as a molecular biologist, electrical engineer, and a biophysicist. Electives In addition to these tracks the Fellows may elect course work from any of the graduate programs in the school of Biomedical Sciences.These Fellows are encouraged to participate in teaching medical students in their basic science laboratories. These performances are evaluated by faculty and assist the Fellows in learning new experimental techniques, as well as perfecting their abilities as teachers. Opportunities for Collaborative Research with Other Labs In the development of the Fellows experimental protocol, they are encouraged by their mentors to pursue collaborative research ventures outside of their mentor’s laboratory. If the pilot studies identify the probability of a particular mediator being involved in a response, then the Fellow is encouraged to collaborate with an investigator who has the expertise in quantitation of such mediators and who has in-depth knowledge in that particular area. This expertise can be gleaned from a review of the credentials limited to faculty at our institution. Past Fellows have collaborated with investigators at University of California at Davis, the Thomas Jefferson College of Medicine in Philadelphia, the University of Ohio College of Medicine in Rootstown, Cetus Corporation in California, DuPont Chemical Company in Delaware, and the Ludwig Boltzmann Hospital for Traumatology in Vienna, Austria. Interaction Among Trainees There are numerous opportunities for interaction among the trainees and the different programs as can be gathered from descriptions of the didactic sessions mandatory post-up at weekly conferences of all Fellows. In addition, there is a common study area for each of the programs. The study areas not only contain the Fellows from this proposed program, but others studying at the Hospital. These include individuals from all over the world. Consequently, there is an opportunity to gain some understanding of educational systems in medicine and techniques for research activities and funding from other countries. This interaction is indeed a special feature of the program, as is the close interaction of the mentor-fellow relationship and the established integrated interdisciplinary aspects of the system. In addition to the Postdoctoral Fellows working in the laboratory, there are also Predoctoral Fellows, mainly medical students working on various research projects, as well as residents who are in training. At the time that a Fellow is accepted into the program, the Fellow indicates his/her choice of a mentor. If his choice is agreeable, then the mentor usually assigns a project that is acceptable to the candidate. As the candidates gain more experience in the laboratory, they may select additional projects of their own volition. PROGRAM FACULTY Dr. \'s Zhang and Chinkes are actively involved in developing new stable isotopic tracer techniques for measuring metabolic processes, including the measurement of fractional synthesis and breakdown rates of tissue proteins (muscle and skin wound) and the measurement of DNA synthesis in skin wounds. These new methods are currently used in various research projects in this institute. Dr. Zhang \'s primary applied focus is the study of nutritional effects on wound healing using stable isotope tracer techniques. Dr. Aarsland in an expert in lipid metabolism and looks at the effects of treatment such as PPAR agonists and propranolol on ameliorating fatty liver in burn patients. Dr. \'s Aarsland, Chinkes, and Zhang are actively working with Dr. Herndon on clinical trials to study the effects of anabolic agents on muscle wasting in burn patients. Dr. Traber’s efforts in researching the cardiopulmonary aspects of thermal injury are concentrated on determining the various lesions noted with inhalation injury, sepsis, and identification of the mediators which are responsible for them. There are also studies evaluating fluids shifts that occur during sepsis and following thermal injury. Dr. Traber currently uses an ovine model for these studies. This model is especially suited for the study of integrated Physiology. The studies all center around chronically instrumented animals. They are maintained in an investigative intensive care unit. There are two major thrusts to the research project : studies of the effects of inhalation injury and chronic sepsis on pulmonary microvascular function, and the changes in systemic organ flow and function with inhalation injury and sepsis. There is a special interest in evaluating the cerebral blood flow in sepsis. A close correlation exists with the Metabolism group since they have several ongoing projects evaluating metabolism in these animals. Dr. David Herndon has performed small animal and human studies investigating mediators of post-burn hypermetabolism and ovine studies investigating the pathogenesis of increased pulmonary microvascular permeability after smoke inhalation insults. He is also involved in the study of inhalation injury in patients, with special emphasis on the tracheobronchial changes which occur. He has accomplished studies which identified inhalation injury as a major contributor to mortality and morbidity in thermally injured individuals. He, likewise, has investigated the changes in immunological functions present in thermally injured individuals, and performed studies which examined the efficacy of various therapeutic modalities. These latter include investigations into the use of artificial skin, wound covering, and in vitro skin growth. Dr. Herndon has studied wound healing in the normal and contaminated state. He has defined the bacterial balance in wounds and demonstrated how bacteria interfere with normal wound healing. He has investigated the role of the various inflammatory mediators in the pathophysiology of both thermal and non-thermal wounds. Presently, he has in vitro and in vivo studies proceeding on various growth factors, and has established both small and large animal models to investigate their effects on wound healing and their control. The participating faculty offers research experience in integrally related areas. These include expertise in immunology, tissue culture and cell biology, pharmacology and endocrinology, and recombinant genetic technology. Stronger Points of the Postdoctoral Teaching Program The excellent facilities at the Shriners Burns Hospital in Galveston and the generous support provided makes two years of training and research a truly effective and fruitful experience for the young doctors involved. Each has the opportunity for innovative thought input and originality in their projects. Doctors are closely associated with a faculty member noted for expertise in their field of research. The post-doctoral student is quickly indoctrinated in disgorging research protocols, collecting data, and presenting abstracts at national meetings. Within one year, the writing of full-length manuscripts is expected and at this time the writing of research grants is suggested. At the end of two rather busy years, many of these doctors are capable of conducting and supporting their own research programs. Scientific meetings and presentations within the Shriners Burns Hospital teaching structure supplement this intensive research training. At these gatherings, pertinent information presented in the literature is reviewed along with other basic science and clinical departments to further enrich their research efforts. The productivity and quality of research is evidence that this system works and is successful here at the Galveston Unit. Top ↑ LINKS DISCLAIMER SITE SEARCH Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[3]=new Array("specific_training_programspage.htm","Specific Training Program Descriptions","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM SPECIFIC TRAINING PROGRAMS Clinical and Clinical Research Burn Fellowship at Shriners Burn Hospital Accreditation Council for Graduate Medical Education (ACGME) Training - National Institutes of Health (NIH) Shriners Burn Hospital in Galveston Clinical and Clinical Research Burn Fellowship Program Description We are presenting a 2-year training program, which begins with one year of clinical research and continues with a second year of clinical work. Thermal injury remains a major medical problem throughout the world. Although many advances have been made, there are numerous unresolved questions concerning the nature and treatment of this injury. To gain new knowledge and to make it available to the general population of clinicians caring for burned patients, trained specialized burn physicians are needed. Besides their clinical skills these clinical researchers should also have the ability to interpret new findings, test hypotheses in a clinical setting and then relate then to fellow physicians in a scientific manner. The objective of this program is to train such individuals. It is hoped that this will ultimately lead to the dissemination of new knowledge for the care of thermally injured patients. The Shriners Burn Hospital in Galveston is a teaching center for burn care and burn care research. The program is integrated into The University of Texas Medical Branch and encompasses a large interdisciplinary team. This team conducts a multi-million dollar research program, which investigates thermal injury and other areas of related pathophysiology. The basic didactic core covers courses in various disciplines. These include statistics, ethics and scientific writing. There is a weekly interdisciplinary lecture series in which the fellows present lectures on topics related to burns, sepsis and trauma. At these presentations the faculty are in attendance to help the candidates develop their skills as lecturers. In a twice-weekly meeting the various research programs are discussed and the faculty and fellows present their current research efforts and plan their next week \'s program. Weekly Morbidity & Mortality Conferences in Anesthesiology & Surgery and Surgical Grand Rounds are held. First Year, Clinical Research The fellow will be educated in the conducting of clinical studies on the burn units. These studies are planned, designed and conducted in collaboration with the Division of Metabolism at the Shriners Burn Hospital. The patients on the burn units are involved in these clinical studies. To perform the studies the patients are followed from the time of arrival throughout their entire hospital stay and on their return visits to the outpatient clinic. Each study involves the following : - Screening of patients before the study. - Placement of lines. - Monitoring the patients during the study. - Biopsies. - Follow-up after the study. - Processing of samples. - Analysis of data. At the end of the year of clinical research the fellow should have gained knowledge in the planning of research projects and should be able to analyze and present scientific data. In this year the fellow will be trained to be able to write full-length scientific publications and to present the abstracts at national meetings. This work can be continued during the second year at the Shriners Burn Hospital. At the same time the fellow can gain insight into the care of patients on the unit and thus prepare for the clinical year. Second Year, Clinical Work The fellow supervises the Intensive Care Unit at the Shriners Burn Hospital, which has 15 beds and the 8-bed adult Burn Intensive Care Unit at The University of Texas Medical Branch. Additionally, patients involved in the day-surgery program and patients who are re-admitted for reconstructive procedures after their acute hospitalization are treated. The clinical work comprises the following : - Acute burn care of newly admitted patients. - Planning and performance of surgery on burn patients. - Intensive medical treatment of burn patients. - Participation in the twice-daily teaching rounds on the units. - Training of surgical residents and medical students who rotate to the unit. - Interaction with the clinical research team. - Interaction with other disciplines in treating the patients, e.g. Physical Therapy, Clinical Psychology. - Care for the patients seen in the outpatient clinic twice a week. In this year the fellow should learn to establish a plan of care for a thermally-injured patient and also acquire the skills needed to then fulfill this plan. The fellow should be aware of problems and possible pitfalls in the treatment and should be able to avoid these, or else be able to manage them. Parallel to the clinical work there is the possibility to continue and complete the research projects begun in the first year. The excellent facilities at the Shriners Burns Institute in Galveston, Texas and the generous support provided make the combination of a year of clinical training and a year of research a truly effective and fruitful experience for the young doctors involved. Top ↑ LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[4]=new Array("ACGME_page.htm","ACGME Page","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM ACGME Sponsoring Institution Information LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[5]=new Array("contacts_fellowships_training.htm","Contacts - Fellowships and Opportunities for Training","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM FELLOWSHIPS & OPPORTUNITIES for TRAINING CONTACTS Carole Miller Phone: (409) 770-6728 Email: cmiller@utmb.edu Julie Bailey Phone (409) 770-6727 Email: jlbailey@utmb.edu LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[6]=new Array("tbcbookpage6.htm","Total Burn Care Chapter 6 Excerpt","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM TOTAL BURN CARE 2nd edition Copyright © 2001 Elsevier Science Edited by Dr. David N. Herndon Reprinted with permission of Elsevier (excerpt from chapter 6, pages 67-70 and 75-76) Pre-hospital management, transportation and emergency care Ronald P Mlcak, Michael C Buffalo Pre-hospital care Prior to any specific treatment, a patient must be removed from the source of injury and the burning process stopped. As the patient is removed from the injuring source, care must be taken so that a rescuer does not become another victim. 2 All care givers should be aware of the possibility that they may be injured by contact with the patient or the patient \'s clothing. Universal precautions, including wearing gloves, gowns, masks and protective eye wear should be used whenever there is likely contact with blood or body fluids. Burning clothing should be removed as soon as possible to prevent further injury. 3 All rings, watches, jewelry and belts should be removed as they can retain heat and produce a tourniquet-like effect with digital vascular ischemia. 4 If water is readily available, it should be poured directly on the burned area. Early cooling can reduce the depth of the burn and reduce pain, but cooling measures must be used with caution, since a significant drop in body temperature may result in hypothermia with ventricular fibrillation or asystole. Ice or ice packs should never be used, since they may cause further injury to the skin or produce hypothermia. Initial management of chemical burnsinvolves removing saturated clothing, brushing the skin if the agent is a powder and irrigation with copious amounts of water, taking care not to spread chemical on burns to adjacent unburned areas. Irrigation with water should continue from the scene of the accident through emergency evaluation in the hospital. Efforts to neutralize chemicals are contraindicated due to the additional generation of heat which would further contribute to tissue damage. A rescuer must be careful not to come in contact with the chemical, so gloves, eye protectors, etc. should be worn. Removal of a victim from an electrical current is best accomplished by turning off the current and by using a nonconductor to separate the victim from the source. 5 On-site assessment of a burned patient Assessment of a burned patient is divided into primary and secondary surveys. In the primary survey, immediate life-threatening conditions are quickly identified and treated. The secondary survey is a more thorough head-to-toe evaluation of the patient. Initial management of a burned patient should be the same as for any other trauma patient, with attention directed at airway, breathing, circulation and cervical spine immobilization. Primary Assessment Exposure to heated gases and smoke from the combustion of a variety of materials results in damage to the respiratory tract. Direct heat to the upper airways results in edema formation, which may obstruct the airway. Initially, 100%-humidified oxygen should be given all patients when no obvious signs of respiratory distress are present. Upper airway obstruction may develop rapidly following injury, and the respiratory status must be continually monitored in order to assess the need for airway control and ventilator support. Progressive hoarseness is a sign of impending airway obstruction. Endotracheal intubation should be done early before edema obliterates the anatomy of the area.³ The patient \'s chest should be exposed in order to adequately assess ventilatory exchange. Circumferential burns may restrict breathing and chest movement. Airway patency alone does not assure adequate ventilation. After an airway is established, breathing must be assessed in order to insure adequate chest expansion. Impaired ventilation and poor oxygenation may be due to smoke inhalation or carbon monoxide intoxication. Endotracheal intubation is necessary for unconscious patients, for those in acute respiratory distress, or for patients with burns of the face or neck which may result in edema which causes obstruction of the airway. The nasal route is the recommended site of intubation. Assisted ventilation with 100%-humidified oxygen is required for all intubated patients. Blood pressure is not the most accurate method of monitoring a patient with a large burn because of the pathophysiologic changes which accompany such an injury. Blood pressure may be difficult to ascertain because of edema in the extremities. A pulse rate may be somewhat more helpful in monitoring the appropriateness of fluid resuscitation. 6 If a burn victim was in an explosion or deceleration accident, there is the possibility of a spinal cord injury. Appropriate cervical spine stabilization must be accomplished by whatever means necessary, including a cervical collar to keep the head immobilized until the condition can be evaluated. Secondary Assessment After completing a primary assessment, a thorough head-to-toe evaluation of a patient is imperative. 7 A careful determination of trauma other than obvious burn wounds should be made. As long as no immediate life-threatening injury or hazard is present, a secondary examination can be performed before moving a patient; precautions such as cervical collars, backboards, and splints should be used. 8 Secondary assessment should examine a patient \'s past medical history, medications, allergies, and the mechanisms of injury. There should never be a delay in transporting burn victims to an emergency facility due to an inability to establish intravenous (IV) access. If the local/regional emergency medical system (EMS) protocol prescribes that an IV line is started, then that protocol should be followed. The pre-hospital burn life support course recommends that if a patient is less than 60 minutes from a hospital, an IV is not essential and can be deferred until a patient is at a hospital. If an IV line is established, Ringer \'s lactate solution should be infused at 500 ml/h in an adult and 250 ml/h in a child 5 years of age or over. In children younger than 5 years of age no IV lines are recommended. 4 Pre-hospital care of wounds is basic and simple, because it requires only protection from the environment with an application of a clean dressing or sheet to cover the involved part. Covering wounds is the first step in diminishing pain. If it is approved for use by local/regional EMS, narcotics may be given for pain, but only intravenously in small doses and only enough to control pain. Intramuscular or subcutaneous routes should never be used, since fluid resuscitation could result in unpredictable patterns of uptake. 4 No topical antimicrobial agents should be applied in the field. 4,9 The patient should then be wrapped in a clean sheet and blanket to minimize heat loss and to control temperature during transport. Transport to Hospital Emergency Department Rapid, uncontrolled transport of a burn victim is not the highest priority, except in cases where other life-threatening conditions coexist. In the majority of accidents involving major burns, ground transportation of victims to a hospital is available and appropriate. Helicopter transport is of greatest use when the distance between an accident and a hospital is 30-150 miles or when a patient \'s condition warrants. 10 Whatever the mode of transport, it should be of appropriate size, and have emergency equipment available as well as trained personnel, such as a nurse, physician, paramedic, or respiratory therapist. Findings of the group at the Army Surgical Research Institute pointed out the necessity of involving many disciplines in the treatment of patients with major burn injuries and stressed the utility of a team concept.¹ The International Society of Burn Injuries and its journal, Burns , and the American Burn Association with its publication, Journal of Burn Care and Rehabilitation , have publicized to widespread audiences the notion of successful multidisciplinary work by burn teams. Functioning of a burn team Gathering together a group of experts from diverse disciplines will not constitute a team. 43 In fact, the diversity of the disciplines, in addition to individual differences of gender, ethnicity, values, professional experience and professional status render such teamwork a process fraught with opportunities for disagreements, jealousies and confusion. 44 The process of working together to accomplish the primary goal, i.e. a burn survivor who returns to a normally functional life, is further is complicated by the requirement that the patient, and family of the patient, collaborate with the professionals. It is not unusual for the patient to attempt to diminish his immediate discomfort by pitting one team member against another or \'splitting \' the team. Much as young children will try to manipulate parents by going first to one and then to the other, patients, too, will complain about one staff member to another or assert to one staff member that another staff member allows less demanding rehabilitation exercises or some special privilege. 45 Time must be devoted to a process of trust-building among the team members. It is imperative that the team communicate - openly and frequently - or the group will lose effectiveness. Assessment and emergency treatment at initial care facility The assessment of a patient with burn injuries in a hospital emergency department is essentially the same as outlined for a pre-hospital phase of care. The only real difference is the availability of more resources for diagnosis and treatment in an emergency department. As with other forms of trauma, the primary survey begins with the ABC \'s, and the establishment of an adequate airway is vital. Endotracheal intubation should be accomplished early if impending respiratory obstruction or ventilatory failure is anticipated, because it may be impossible after the onset of edema following the initiation of fluid therapy. Securing an endotracheal tube may be difficult because traditional methods often do not adhere to burned skin, and tubes are easily dislodged. One method of choice includes securing an endotracheal tube with woven tape under the ears as well as over the ears. 11 While doing assessments and making interventions for life-threatening problems in the primary survey, precautions should be taken to maintain cervical spine immobilization until injuries to the spine can be ruled out. Following a primary survey, a thorough head-to-toe evaluation of a patient should be done. This includes obtaining a history as thorough as circumstances permit. The history should include the mechanism and time of the injury and a description of the surrounding environment, such as whether injuries were incurred in an enclosed space, the presence of noxious chemicals, the possibility of smoke inhalation, and any related trauma. A complete physical examination should include a careful neurological examination, as evidence of cerebral anoxic injury can be subtle. Patients with facial burns should have their corneas examined with fluorescent staining. Routine admission laboratories should include a complete blood count, serum electrolytes, glucose, blood urea nitrogen (BUN), and creatine. Pulmonary assessment should include arterial blood gases, chest x-rays, and carboxyhemoglobin. 12 All extremities should be examined for pulses, especially with circumferential burns. Evaluation of pulses can be assisted by use of a Doppler ultrasound flowmeter. If pulses are absent, the involved limb may need urgent escharotomy for release of the constrictive, unyielding eschar. In circumferential chest burns, escharotomy may also be necessary to relieve chest wall restriction and improve ventilation. Escharotomies may be performed at the bedside under IV sedation using electrocautery. Mid-axial incisions are made through the eschar, but not into subcutaneous tissue of the eschar in order to assure adequate release. Limbs should be elevated above the heart level. Pulses should be monitored for 48 hours. 12 If pulses are still present, but appear endangered, chemical escharotomy with enzymatic ointments (Accuzyme, collagenase, Elase) can be effective. Enzymatic escharotomy in hand burns may be preferred since surgical incisions risk exposure of superficial nerves, vessels, and tendons. Enzymatic escharotomy is indicated only during the first 24-48 hours post-burn, and it should be used only in combination with a topical antimicrobial agent or sepsis can occur. With enzymatic escharotomy, there is usually a spike in temperature, which subsides after the enzyme is removed. Evaluation of Wounds After surveys are completed and resuscitation is underway, a more careful evaluation of burn wounds is performed. The wounds are gently cleaned, and loose skin - and in large wounds, blisters - are debrided. Blister fluid contains high levels of inflammatory mediators, which increase burn wound ischemia. The blister fluid is also a rich medium for subsequent bacterial growth. Deep blisters on the palms and soles may be aspirated instead of debrided in order to improve patient comfort. After burn wound assessment is complete, the wounds are covered with a topical antimicrobial agent and appropriate burn dressings or a biological dressing is applied. An estimate of burn size and depth assists in making a determination of severity, prognosis, and disposition of a patient. Burn size directly affects fluid resuscitation, nutritional support, and surgical interventions. The size of a burn wound is most frequently estimated by using the rule-of-nines method. A more accurate assessment can be made of a burn injury, especially in children, by using the Lund and Browder chart, which takes into account changes brought about by growth. 4,9 The American Burn Association identifies certain injuries as usually requiring a referral to a burn center. Patients with these burns should be treated in a specialized burn facility after initial assessment and treatment at an emergency department. Questions about specific patients should be resolved by consultation with a burn center physician. Fluid Resuscitation Establishment of IV lines for fluid resuscitation is necessary for all patients with major burns, including those with inhalation injury or other associated injuries. These lines are best started in the upper extremity peripherally. A minimum of 2 large caliber IV catheters should be established through non-burned tissue if possible, or through burns if no unburned areas are available. Ringer \'s lactate solution should be infused at 2-4 ml/kg/% total body surface area (TBSA) which is burned. 1,4,9 Children must have additional fluid for maintenance. 14 Taking into account the increased evaporative water loss in the formula for fluid resuscitation for pediatric patients, the initial resuscitation should begin with 5000 ml/m²/% TBSA burned/day + 2000 ml/m²/BSA total/day 5% dextrose in Ringer \'s lactate. This formula calls for 1/2 of the total amount to be given in the first 8 hours post-injury with the remainder given over the following 16 hours. All resuscitation formulas are designed to serve as a guide only. The response to fluid administration and physiologic tolerance of a patient is the most important determinant. Additional fluids are commonly needed with inhalation injury, electrical burns, associated trauma, and delayed resuscitation. The appropriate resuscitation regimen administers the minimal amount of fluid necessary for maintenance of vital organ perfusion; the subsequent response of the patient over time will dictate if more or less fluid is needed so that the rate of fluid administration can be adjusted accordingly. Inadequate resuscitation can cause diminished perfusion of renal and mesenteric vascular beds. Fluid overload can produce undesired pulmonary or cerebral edema. Urine Output Requirements The single best monitor of fluid replacement is urine output. Acceptable hydration is indicated by a urine output of more than 30 ml/h in an adult (0.5 ml/kg/h) and 1 ml/kg/h in a child. Diuretics are generally not indicated during an acute resuscitation period. Patients with high-voltage electrical burns and crush injuries with myoglobin and/or hemoglobin in the urine have an increased risk of renal tubular obstruction. Sodium bicarbonate should be added to IV fluids in order to alkalinize the urine, and urine output should be maintained at 1-2 ml/kg/h as long as these pigments are in the urine. 1,4 The addition of an osmotic diuretic such as mannitol may also be needed to assist in clearing the urine of these pigments. Additional Assessments and Treatments Decompression of stomach To combat the problem of gastric ileus, a nasogastric tube should be inserted in all patients with major burns in order to decompress the stomach. This is especially important for patients being transported at high altitudes. Additionally, all patients should be restricted from taking anything by mouth until after the transfer has been completed. Decompression of the stomach is usually necessary because an anxious, apprehensive patient will swallow considerable amounts of air and distend the stomach. Narcotics also diminish peristalsis of the gastrointestinal tract and result in distension. A patient must be kept warm and dry. Hypothermia is detrimental to traumatized patients and can be avoided or at least minimized by the use of sheet and blankets. Wet dressings should be avoided. The degree of pain experienced initially by the burn victim is inversely proportional to the severity of the injury. No medication for pain relief should be given intramuscularly or subcutaneously. For mild pain, aspirin 650 mg orally every 4-6 hours may be given. For severe pain, morphine 1-4 mg intravenously every 2-4 hours is the drug of choice, although meperidine (Demerol) 10-40 mg by IV push every 2-4 hours may be used. Recommendations for tetanus prophylaxis are based on the patient \'s immunization history. All patients with burns should receive 0.5 ml of tetanus toxoid. If prior immunization is absent or unclear, or if the last booster was more than 10 years ago, 250 units of tetanus immunoglobulin is also given. Transportation guidelines The primary purpose of any transport team is not to bring a patient to an intensive care unit, but to bring that level of care to the patient as soon as possible. Therefore, the critical time involved in a transport scenario is the time it takes to get the team to the patient. The time involved in transporting a patient back to a burn center becomes secondary. Communication and teamwork are the keynotes to an effective transport system. When transportation is required from a referring facility to a specialized burn center, a patient can be fairly well stabilized before being moved. Initially, the referring facility should be informed that all patient referrals require physician-to-physician discussion. Pertinent information needed will include patient demographic data; time, date, cause and extent of burn injury; weight and height; baseline vital signs; neurological status; laboratory data; respiratory status; previous medical and surgical history; and allergies. A referring hospital is informed of specific treatment protocols regarding patient management prior to transfer. To ensure patient stability the following guidelines are offered: Establish 2 IV sites, preferably in an unburned upper extremity, and secure IV tubes with sutures. Insert a Foley catheter and monitor for acceptable urine output (30 ml/h adult, 1 ml/kg/h child). Insert a nasogastric tube and ensure that the patient remains NPO. Maintain body temperature between 38° and 39°C rectally. Stop all narcotics. For burns less than 24 hours old, only use lactated Ringer \'s solution. The staff physician will advise on the infusion rate, which is calculated based on the percentage of total body surface area burned. Following physician-to-physician contact and collection of all pertinent information, the physicians will make recommendations regarding an appropriate mode of transportation. The options are based on distance to a referring unit, patient complexity, and comprehensiveness of medical care required. Options include: Full medical intensive care unit transport with a complete team, consisting of a physician, a nurse, and a respiratory therapist from the burn facility. Medical intensive care transport via a fixed-wing aircraft or helicopter with a team from a referring facility. Private plane with medical personnel to attend patient. Commercial airline. Private ground ambulance. Transport van with appropriate personnel. Stabilization One of the primary reasons for a specialized transport team is to be able to transport a patient in as stable condition as possible. Current practice has evolved to embrace the concept that events during the first few hours following burn injury may affect the eventual outcome of the patient; this is especially true with regard to fluid management and inhalation injury. Stabilization techniques performed by the transport team have been expanded to include procedures that are usually not performed by nursing or respiratory personnel. Such techniques include interpreting radiographs and laboratory results and then conferring with fellow team members, referring physicians, and the team \'s own medical staff, in order to arrive at a diagnosis and plan for stabilization. The transport team may perform such procedures as venous cannulation, endotracheal intubation, arterial blood gas interpretation, and management of mechanical ventilators. Team members may request new radiographs, in order to assess catheter or endotracheal tube placement or to assess the pulmonary system \'s condition. Team members may aid in the diagnosis of air leaks (pneumothorax) and evacuate the pleural space of the lung by needle aspiration as indicated. All of these procedures may be immediately necessary and life-saving. Cross-training of all team members to be able to perform the others \' jobs is recommended in order to safeguard patients in the event that any team member becomes incapacitated during transport. All these skills can be learned via experience in a burn intensive care unit, through formal training seminars, and via a thorough orientation program. Mature judgment, excellent clinical skills, and the ability to function under stress are characteristics needed when selecting candidates for a transport program. Summary Burn injuries present a major challenge to a health care team, but an orderly, systematic approach can simplify stabilization and management. A clear understanding of the pathophysiology of burn injuries is essential for providing quality burn care in the pre-hospital setting, at the receiving health care facility, and at the referring hospital prior to transport. After a patient has been rescued from an injury-causing agent, assessment of the burn victim begins with a primary survey. Life-threatening injuries must be treated first, followed by a secondary survey, which documents and treats other injuries or problems. Intravenous access may be established in concert with logical/regional medical control and appropriate fluid resuscitation begun. Burn wounds should be covered with clean, dry sheets; and the patient should be kept warm with blankets to prevent hypothermia. The patient should be transported to an emergency room in the most appropriate mode available. At the local hospital, it should be determined if a burn patient needs burn center care according to the American Burn Association Guidelines. In preparing for organizing a transfer of a burn victim, consideration must be given to the continued monitoring and management of the patient during transport. In transferring burn patients, the same priorities developed for pre-hospital management remain valid. During initial assessment and treatment and throughout transport, the transport team must ensure that the patient has an adequate airway, breathing, circulation, fluid resuscitation, urine output, and pain control. Ideally, transport of burn victims will occur through an organized, protocol-driven plan, which includes specialized transport mechanisms and personnel. Successful transport of burn victims, whether in the pre-hospital phase or during inter-hospital transfer, requires careful attention to treatment priorities, protocols, and details. References 1. Boswick JA, ed. The Art and Science of Burn Care . Rockville, MD: Aspen Publishers, 1987 2. Dimick AR. Triage of burn patients. In: Wachtel TL, Kahn V, Franks HA, eds. Current Topics in Burn Care . Rockville, MD: Aspen Systems, 1983: 15-18 3. Wachtel TL. Initial care of major burns. Postgrad. Med. 1989; 85(1): 178-196 4. American Burn Association. Advanced Burn Life Support Providers Manual . Chicago, IL: American Burn Association, 1994 5. American Burn Association. Radiation injury. Advanced Burn Life Support Manual . Appendix 1 Chicago, IL: American Burn Association, 1994 6. Bartholomew CW, Jacoby WD. Cutaneous manifestations of lightning injury. Arch Dermatol 1975; 26: 1466-1468 7. Committee on Trauma, American College of Surgeons. Burns. In: Advanced Trauma Life Support Course Book. Chicago: American College of Surgeons, 1984: 155-163 8. Rauscher LA, Ochs GM. Pre-hospital care of the seriously burned patient. In: Wachtel TL, Kahn V, Franks HA, eds. Current Topics in Burn Care . Rockville, MD: Aspen Systems, 1983: 1-9 9. Goldfarb JW. The burn patient, Air Medical Crew national Standards Curriculum, Phoenix, 1988, ASHBEAMS 10. Marvin JA, Heinback DM. Pain control during the intensive care phase of burn care. Crit Care Clin 1985; 1: 147-157 11. Mlcak RP, Helvick B. Protocol for securing endotracheal tubes in a pediatric burn unit. J Burn Care Rehabil 1987; 8: 233-237 12. Herndon DN, Desai MH, Abston S. et al. Residents Manual. Galveston: Shriners Burns Hospital, and the University of Texas Medical Branch, 1992: 1-17 13. Collini FJ, Kealy GP. Burns: a review and update. Contemp Surg 1989; 34: 75-77 14. Herndon DN, Rutan R, Rutan T. The management of burned children. J Burn Care Rehabil 1993; 14: 3-8 This article was excerpted from the book Total Burn Care , 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier. Single copies of this article may be downloaded or copied only for the reader \'s personal research and study. (This link takes you to the \"Total Burn Care \" page at the publishers web site.) TOTAL BURN CARE 2nd ed. ↑ Top Return to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[7]=new Array("tbcbookpage7.htm","Total Burn Care Chapter 7 Excerpt","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM TOTAL BURN CARE 2nd edition Copyright © 2001 Elsevier Science Edited by Dr. David N. Herndon Reprinted with permission of Elsevier (excerpt from chapter 7, pages 78-79) Pathophysiology of burn shock and burn edema George C Kramer, Tj ø lstolv Lund, David N Herndon Introduction and historical notes If left untreated, cutaneous thermal injury greater that one-third of the total body surface area (TBSA) invariably results in the severe and unique derangement of cardiovascular function called burn shock. Shock is defined as an abnormal physiologic state in which the flow of blood is insufficient to maintain adequate nutritive perfusion to meet cellular needs. Before the 19th century, it was demonstrated that after a burn, fluid is lost from the blood so that the blood becomes thicker; and in 1897, saline infusions for severe burns were first advocated. 1,2 However, a real understanding of burn pathophysiology was not reached until the work of Frank Underhill. 3 He demonstrated that unresuscitated burn shock correlates with greatly increased hematocrit values in burned patients, which are secondary to fluid and electrolyte loss after burn injury. The increased hematocrit values occurring shortly after severe burn were interpreted as a plasma volume deficit. Cope and Moore showed that the hypovolemia of burn injury resulted from fluid and protein translation into burned and nonburned tissues. 4 Throughout the 20th century, both animal and clinical studies have established the importance of fluid resuscitation for burn shock. Investigations have focused on the rapid and massive fluid sequestration in the burn wound and the resultant hypovolemia. We now have an extensive experimental database on the circulatory and microcirculatory alterations associated with burn shock and edema generation in both the burn wound and nonburned tissues. During the last decade, research has focused on identifying and defining the release mechanisms and effects of the many inflammatory mediators produced and released after burn injury. 5 It is now recognized that burn shock is a complex process of circulatory and microcirculatory dysfunction, not easily or fully repaired by fluid resuscitation. Severe burn injury results in significant hypovolemic shock and substantial tissue trauma, both of which cause the formation and release of many local and systemic mediators. 6-8 Burn shock results from the interplay of hypovolemia and mediator action and continues as a significant pathophysiologic state, even if hypovolemia is corrected. Increases in pulmonary and systemic vascular resistance (SVR) and myocardial depression occur despite adequate preload and volume support. 8-12 These physiologic changes can further exacerbate the whole body inflammatory response into a vicious cycle of accelerating organ dysfunction. 7,8,13 Chapter 7 of \"Total Burn Care, 2nd edition \" examines our present understanding of the pathophysiology of the early events in burn shock, focusing on the many facets of organ and systemic effects directly resulting from the hypovolemia and circulating mediators. Inflammatory shock mediators, both local and systemic, that are implicated in the pathogenesis of burn shock include histamine, serotonin, kinins, oxygen free radicals, and products of the eicosanoid acid cascade - prostaglandins, thromboxanes, and interleukins. Additionally, certain hormones and mediators of cardiovascular function are elevated several-fold after burn injury; these include epinephrine, norepinephrine, vasopressin, angiotensin II, and neuropeptide-Y. Most certainly other mediators and factors are also involved. Understanding the complex mechanism of the pathophysiologic actions of these mediators may be of great relevance when optimally effective therapies are designed. The hope is that an improved early treatment of burn shock, perhaps through individualized fluid resuscitation protocols and methods of mediator blockade, can be developed to ameliorate or eliminate the incidence of organ dysfunction. Effective burn resuscitation and treatment of burn shock remain major challenges in modern medicine. References 1. Cockshott WP. The history of the treatment of burns. Surg Gynecol Obstet 1956; 102: 116-124 2. Haynes BW. The history of burn care. In: Boswick JAJ, ed. The Art and Science of Burn Care , 1987; 3-9 3. Underhill FP, Carrington GL, Kapsinov R, Pack GT. Blood concentration changes in extensive superficial burns, and their significance for systemic treatment. Arch Intern Med 1923; 32: 31-39 4. Cope O, Moore FD. The redistribution of body water and fluid therapy of the burned patient. Ann Surg 1947; 126: 1010-1045 5. Youn YK, LaLonde C, Demling R. The role of mediators in the response to thermal injury. World J Surg 1992; 16(1): 30-36 6. Aulick LH, Wilmore DW, Mason AD, Pruin BA. Influence of the burn wound on peripheral circulation in thermally injured patients. Am J Physiol 1977; 233: H520-H526 7. Settle JAD. Fluid therapy in burns. J Roy Soc Med 1982; 1(75): 7-11 8. Demling RH. Fluid replacement in burned patients. Surg Clin North Am 1987; 67: 15-30 9. Demling RH, Will JA, Belzer FO. Effect of major thermal injury on the pulmonary microcirculation. Surgery 1978; 83(6): 746-751 10. Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg 1974; 1(4): 693-709 11. Baxter CR, Cook WA, Shires GT. Serum myocardial depressant factor of burn shock. Surg Forum 1966; 17: 103 12. Hilton JG, Marullo DS. Effects of thermal trauma on cardiac force of contraction. Burns Incl Therm Inj 1986; 12: 167-171 13. Clark WR. Death due to thermal trauma. In: Dolecek R. Brizio-Molteni L, Molteni A, Traber D, eds. Endocrinology of Thermal Trauma . Philadelphia, PA: Lea & Febiger, 1990: 6-27 This article was excerpted from the book Total Burn Care , 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier. Single copies of this article may be downloaded or copied only for the reader \'s personal research and study. (This link takes you to the \"Total Burn Care \" page at the publishers web site.) TOTAL BURN CARE 2nd ed. ↑ Top Return to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[8]=new Array("tbcbookpage8.htm","Total Burn Care Chapter 8 Excerpt","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM TOTAL BURN CARE 2nd edition Copyright © 2001 Elsevier Science Edited by Dr. David N. Herndon Reprinted with permission of Elsevier (excerpt from chapter 8, pages 88, 90) Fluid resuscitation and early management Glenn D Warden Introduction Proper fluid management is critical to the survival of the victim of a major thermal injury. In the 1940 \'s, hypovolemic shock or shock-induced renal failure was the leading cause of death after burn injury. Today, with our current knowledge of the massive fluid shifts and vascular changes that occur during burn shock, mortality related to burn-induced volume loss has decreased considerably. Although a vigorous approach to fluid therapy has ensued in the last 20 years and fewer deaths are occurring in the first 24-48 hours post-burn, the fact remains that approximately 50% of the deaths occur within the first 10 days following burn injury from a multitude of causes, one the most significant being inadequate fluid resuscitation therapy. 1 Knowledge of fluid management following burn shock resuscitation is also important and is often over-looked in burn education. Pathophysiology of Burn Injury Modern fluid resuscitation formulas originate from experimental studies in the pathophysiology of burn shock. Burn shock is both hypovolemic shock and cellular shock, and is characterized by specific hemodynamic changes including decreased cardiac output, extracellular fluid, plasma volume and oliguria. As in the treatment of other forms of shock, the primary goal is to restore and preserve tissue perfusion in order to avoid ischemia. However, in burn shock, resuscitation is complicated by obligatory burn edema, and the voluminous transvascular fluid shifts which result from a major burn are unique to thermal trauma. Although the exact pathophysiology of the postburn vascular changes and fluid shifts is unknown, one major component of burn shock is the increase in total body capillary permeability. Direct thermal injury results in marked changes in the microcirculation. Most of the changes occur locally at the burn site, when maximal edema formation occurs at about 8-12 hours post-injury in smaller burns and 12-24 hours post-injury in major thermal injuries. The rate of progression of tissue edema is dependent upon the adequacy of resuscitation. Resuscitation from Burn Shock Fluid resuscitation is aimed at supporting the patient throughout the initial 24-hour to 48-hour period of hypovolemia. The primary goal of therapy is to replace the fluid sequestered as a result of thermal injury. The critical concept in burn shock is that massive fluid shifts can occur even though total body water remains unchanged. What actually changes is the volume of each fluid compartment, intracellular and interstitial volumes increasing at the expense of plasma volume and blood volume. In light of all the studies on different fluid regimens, the question still remains: \'What is the best formula for resuscitation of the burn patient? \' It is quite clear that the edema process is accentuated by the resuscitation fluid. The magnitude of edema will be affected by the amount and type of fluid administered. 25 The National Institutes of Health consensus summary on fluid resuscitation in 1978 was not in agreement in regard to a specific formula; however, there was consensus in regard to two major issues - the guidelines used during the resuscitation process and the type of fluid used. In regard to the guidelines, the consensus was to give the least amount of fluid necessary to maintain adequate organ perfusion. The volume infused should be continually titrated so as to avoid both under-resuscitation and over-resuscitation. 26,27 As for the optimum type of fluid, there is no question that replacement of the extracellular salt lost into the burned tissue and into the cell is essential for successful resuscitation. 19,21 Summary The volume necessary to resuscitate burn patients is dependent upon injury severity, age, physiological status, and associated injury. Consequently, the volume predicted by a resuscitation formula must commonly be modified according to the individual \'s response to therapy. In optimizing fluid resuscitation in severely burned patient, the amount of fluid should be just enough to maintain vital organ function without producing iatrogenic pathological changes. The composition of the resuscitation fluid, within limitations, in the first 24 hours postburn probably makes very little difference; however, it should be individualized to the particular patient. The utilization if the beneficial properties of hypertonic, crystalloid, and colloid solutions at various times postburn will minimize the amount of edema formation. The rate of administration of resuscitation fluids should maintain urine outputs of 30-50 cc in adults and 1-2 cc/kg in children. When a child weighs 30-50 kg, the urine output should be maintained at the adult level. Fluid resuscitation based on our current knowledge of the massive fluid shifts and vascular changes that occur following burn injury has markedly decreased mortality related to burn-induced volume loss. The failure rate for adequate resuscitation is <5% even for patients with burns >85% TBSA. These improved statistics, however, are derived from experience in burn centers where there is substantial knowledge of the pathophysiology of burn injury. Inadequate volume replacement in major burns is, unfortunately, common when clinicians lack sufficient knowledge and experience in this area. Areas of burn shock research that need further attention include: 1. the definition of the postburn course of capillary permeability changes, and identification of humoral or cellular factors influencing these changes; 2. the identification and evaluation of pharmacological agents that can significantly alter capillary leakage; 3. elucidation of the relationships between resuscitation fluid composition and pulmonary function changes; and 4. the effect of resuscitation on late organ dysfunction, such as post-resuscitation wound, renal, and pulmonary complications. 87 References 1. Artz CP, Moncrief JA. The burn problem. In: Artz CP, Moncrief JA, eds. The Treatment of Burns . Philadelphia: WB Saunders, 1969: 1-22 19. Neely AN, Nathan P, Highsmith RF. Plasma proteolytic activity following burns. J Trauma 1988; 28: 362-367 21. Moyer CA, Margraf HW, Monafo WW. Burn shock and extravascular sodium deficiency: treatment with Ringer \'s solution with lactate. Arch Surg 1965; 90: 799-811 25. Hilton JG. Effects of fluid resuscitation on total fluid loss following thermal injury. Surg Gynecol Obstet 1981; 152: 441-447 26. Schwartz SL. Consensus summary on fluid resuscitation. J Trauma 1979; 19(11 Suppl): 876-877 27. Shires GT. Proceedings of the Second NIH Workshop on Burn Management. J Trauma 1979; 19(11 Suppl): 862-863 87. Pruitt BA Jr. Fluid resuscitation of extensively burned patients. J Trauma 1981; 21(Suppl): 690-692 This article was excerpted from the book Total Burn Care , 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier. Single copies of this article may be downloaded or copied only for the reader \'s personal research and study. (This link takes you to the \"Total Burn Care \" page at the publishers web site.) TOTAL BURN CARE 2nd ed. ↑ Top Return to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[9]=new Array("tbcbookpage9.htm","Total Burn Care Chapter 9 Excerpt","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM TOTAL BURN CARE 2nd edition Copyright © 2001 Elsevier Science Edited by Dr. David N. Herndon Reprinted with permission of Elsevier (excerpt from chapter 9, pages 101, 102, 106) Evaluation of the burn wound management decisions David Heimbach, Roberta Mann, Loren Engrav Introduction In addition to the extent of burn and the age of the patient, the depth of burn is a primary determinant of mortality following thermal injury. Burn depth is also the primary determinant of the patient \'s long-term appearance and function. For many years burns were treated by daily washing, removal of loose dead tissue, and some sort of topical nostrum until they healed by themselves or, eventually, granulation tissue appeared in the base of the wound. Superficial dermal burns healed within 2 weeks and deep dermal burns healed over many weeks if infection was prevented. Full-thickness burns lost their eschar in 2-6 weeks by collagenase production from bacteria and mechanically by daily debridement. When the granulation bed became free of debris and relatively uninfected, split-thickness skin grafts were applied, usually some 3-8 weeks after injury, and a 50% graft take was considered to be acceptable. Repeated graftings eventually closed the wound. The prolonged and intense inflammatory response made hypertrophic scar and contractures part of normal burn treatment. Vigorous physical therapy, nutritional support, psychosocial support, and pain management were required on a daily basis for many weeks in order to yield a satisfactory result. Modern treatment involves early surgical removal of the burn. Rather than waiting for spontaneous separation, the eschar is now surgically removed early in the burn course and the wound closed with grafting techniques and acute flaps individualized to each patient. When non-operative treatment is the routine, the accurate assessment of burn depth is of little importance save for predicting mortality. On the other hand, with aggressive surgical treatment, an accurate estimation of burn depth becomes crucial. Burns which heal within 3 weeks generally do so without hypertrophic scarring of functional impairment, although long-term pigment changes are common. Burns which take longer than 3 weeks to heal often produce unsightly hypertrophic scars and frequently lead to functional impairment, as well as providing only a thin, fragile epithelial cover for many weeks or months. State of the art care now, at least in patients with small and moderate burns, involves early excision and grafting of all burns which will not heal within 3 weeks. 1-5 The challenge is to determine which burns will heal within 3 weeks. An understanding of burn depth requires an understanding of skin thickness. The anatomy and pathophysiology of the skin is well covered in another chapter. The standard technique for determining burn depth has long been clinical observation of the wound. Unfortunately, the difference in burn depth between a burn which heals in 3 weeks and a deep dermal burn which will heal only after many weeks, or a full-thickness burn which will not heal at all, may be only a matter of only a few tenths of a millimeter. Further, a burn is a dynamic process for the first few days, and a burn which appears shallow on day 1 may appear deep by day 3. Finally, the kind of topical wound care used can dramatically change the appearance of the burn. Because of these limitations, and because of its increased importance in planning definitive burn wound care, interest has been stirred and technology has brought numerous devices and techniques to determine burn depth more precisely than clinical observation. Estimation of burn depth Clinical Observation Despite modern technology, clinical observation still remains the standard for diagnosis. Very shallow (heal in less than 2 weeks) and very deep (full-thickness charred burns) present little difficulty even to inexperienced observers. Superficial dermal burns involve only the papillary dermis and characteristically form blisters with fluid collection at the interface of the epidermis and dermis. Blistering may not occur for some hours following injury and burns thought to be first degree may subsequently be diagnosed as superficial dermal burns by day 2. Once blisters are removed, the wound is pink and wet and is quite painful as currents of air pass over it. The wound is hypersensitive to touch and the patient will rarely permit more than one diagnostic adventure with a pin to test sensation. These wounds blanch with pressure, and the blood flow to the dermis is increased over that of normal skin. Obvious charred full-thickness burns are leathery, firm, depressed when compared to adjoining normal skin, and are insensitive to light touch and pinprick. Unfortunately for the clinician, there are many burns whose depth is intermediate between these obvious ones. Deep dermal burns extend into the reticular dermis and generally will take 3 or more weeks to heal. They also blister, but the wound surface is usually a mottled pink and white color immediately following the injury. The patient complains of discomfort rather than pain. When pressure is applied to the burn, capillaries refill slowly or not at all. The wound is often less sensitive to pinprick than the surrounding normal skin. 6,7 By the second day the wound may be white and is usually fairly dry. Non-charred full-thickness burns can masquerade with many of the clinical findings of a deep dermal burn. Like deep dermal burns, they may be mottled in appearance. They rarely blanch on pressure, and may have a dry, white appearance. In some cases the burn may be translucent with clotted vessels visible in the depths. Some full-thickness burns, particularly immersion scalds, may have a red appearance, and can be confused by the uninitiated as a superficial dermal burn. They can be distinguished, however, because these red, full-thickness burns do not blanch with pressure. Evaluation by an inexperienced surgeon as to whether an apparent deep dermal burn will heal in 3 weeks is about 50% accurate 8 - tossing a coin is about as useful a technique. In experienced hands, however, early excision and grafting provides better results than non-operative car for such \'indeterminate \' burns. 2 An intense search for a more precise diagnosis of burn depth has been mounted ever since it became important to determine whether the patient would benefit from early operation. A number of techniques have been used based on the physiology of the skin and alterations produced by burning. These techniques take advantage of: the ability to detect dead cells or denatured collagen (biopsy, ultrasound, vital dyes); altered blood flow (fluorescein, laser Doppler, and thermography); the color of the wound (light reflectance); and physical changes, such as edema (magnetic resonance imaging). Conclusion Although there are many different types of burn wounds, the extent of tissue destruction is always a function of the temperature of the heat source, the duration of contact and the thickness of the involved skin. Burns which are unlikely to heal in less than 3 weeks should be treated by early excision and grafting (within 7 days of injury). Benefits of this approach include reduction in length of hospital stay, earlier return to work or school, and optimal functional and cosmetic results. Research is ongoing to determine reliable methods of defining burn depth, so that those patients who need grafting may be treated expeditiously and so that the risks of operation can be avoided in those who do not. References 1. Deitch E. A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival. Burns Incl Thermal Inj 1985; 12: 109-114 2. Engrav L, Heimbach D, Reus J, Harner T, Marcin JA. Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J Trauma 1983; 23: 1001 3. Frist W, Ackroyd F, Burke J, Bondoc C. Long-term functional results of selective treatment of hand burns. Am J Surg 1985; 149: 516-521 4. Gray D, Pine R, Harner T. Early excision versus conventional therapy in patients with 20% to 40% burns. Am J Surg 1982; 149: 76 5. Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma 1987; 27: 205-207 6. Jackson D. Second thoughts on the burn wound. J Trauma 1969; 9: 839 7. Bajaj SP, Nield DV, Rayment R, Khoo CT. A simple modification of the pinprick test for the assessment of burn depth in children. Burns Incl Thermal Inj 1988; 14: 468-472 8. Hlava P, Moserov AJ, Konigov AR. Validity of clinical assessment of the depth of a thermal injury. Acta Chir Plast 1983; 25: 202-208 This article was excerpted from the book Total Burn Care , 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier. Single copies of this article may be downloaded or copied only for the reader \'s personal research and study. (This link takes you to the \"Total Burn Care \" page at the publishers web site.) TOTAL BURN CARE 2nd ed. ↑ Top Return to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[10]=new Array("orientation_section2.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD SECTION TWO: Acute Burn Management INTRODUCTION Although burn injuries are frequent in our society, many surgeons feel uncomfortable in managing patients with major thermal trauma. Every year, 1.2 million Americans sustain a burn injury requiring medical attention. About 50,000 of these need hospitalization. Up to 10,000 people die every year from burns and burn-related injuries or infections. Only motor vehicle accidents cause more accidental deaths than burns. Mortalities are highest among the very young and very old. Two-thirds of all burn accidents occur at home and most commonly involve young adult males and children. Young adults are most commonly burned by flammable liquids, while toddlers are most often scalded by hot liquids while in the kitchen. 16% of burns in children are due to child abuse. Structural fires result in about 5% of burn-related admissions, but account for 45% of associated deaths. Inhalation injury has the biggest impact on both early and late mortality. Advances in trauma and burn management over the past 3 decades have resulted in improved survival and reduced morbidity from major burns. 25 years ago, the mortality rate of a 50% body surface area (BSA) burn in a young adult was about 50% despite treatment. Today, over 50% of these patients are surviving. Improved results are due to advancements in resuscitation, surgical techniques, infection control and nutritional/metabolic support. In the last year for which complete data is available (1998) 1/3 of the deaths were due to invasive fungal infection, 1/3 from anoxic brain injury and 1/3 from pulmonary failure. DEFINITIONS The skin is the largest organ is the body, comprising 15% of body weight and covering approximately 1.7 m² in the average adult. The function of the skin is complex: it warms, it senses, and it protects. Of its 2 layers, only the epidermis is capable of true regeneration. When the skin is seriously damaged, this external barrier is violated and the internal milieu is exposed and altered. Burn Injury A burn injury implies damage or destruction of skin and/or its contents by thermal, chemical, electrical or radiation energies or combinations thereof. Thermal injuries are by far the most common and frequently present with concomitant inhalation injuries. A thermal injury involves the heating of tissues above the critical level at which damage occurs via protein denaturation. Tissue injury is a function of the heat content of the burning agent, length of exposure and thermal conductivity of the involved tissue. The hydrophilic human skin possesses a high specific heat and a low thermal conductivity. Therefore, skin becomes overheated quite slowly, but also cools slowly. As a result, thermal damage continues after the burning agent is extinguished or removed. The Burn Syndrome Following a major burn injury a myriad of physiologic changes occur that together comprise the clinical scenario of the burn patient. These derangements include: 1. Fluid and Electrolyte Imbalance The burn wound becomes rapidly edematous due to microvascular changes induced by direct thermal injury and by release of chemical mediators of inflammation. This results in systemic intravascular losses of water, sodium, albumin and red blood cells. Unless intravascular volume is rapidly restored, shock develops. 2. Metabolic Disturbances This is evidenced by an increased resting oxygen consumption (hypermetabolism), an excessive nitrogen loss (catabolism), and a pronounced weight loss (malnutrition). 3. Bacterial Contamination of Tissues The damaged integument creates a vast area for surface infection and invasion of microorganisms. Burned patients with a major thermal injury are unable to mount an adequate immunologic defense, increasing the risks for septic shock. 4. Complications from Vital Organs All major organ systems are affected by the burn injury. Renal insufficiency can result from hypoperfusion or from nephron obstruction with myoglobulin and hemoglobin. Pulmonary dysfunction may be caused from initial respiratory tract damage of from progressive respiratory insufficiency due to pulmonary edema, adult respiratory distress syndrome or bronchopneumonia. Gastrointestinal complications include paralytic ileus and gastrointestinal ulcerations. Small bowel ischemia and stasis promote bacterial translocation as a mechanism for endogenous infection. Multi-system organ failure is a common final pathway leading to late burn mortality. Next - Emergency Treatment ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[11]=new Array("contributorspage.htm","Total Burn Care Book Contributors","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM TOTAL BURN CARE 2nd edition Copyright © 2001 Elsevier Science Edited by Dr. David N. Herndon Reprinted with permission of Elsevier Contributors to Total Burn Care A - B - C - D - E - F - G - H - J - K - L - M O - P - R - S - T - V - W - Z Naoki Aikawa, MD, DMSc, FACS Professor and Chairman Department of Emergency and Critical Care Medicine Keio University Hospital Tokyo, Japan Craig S Amin, PhD Research Associate (Surgery) Department of Surgery Loyola University Medical Center Maywood, Illinois Carlos Angel, MD Assistant Professor of Surgery Department of Surgery University of Texas Medical Branch Galveston, Texas Top Juan P Barret, MD Plastic and Reconstructive Surgery Department of Surgery University Hospital Groningen Groningen, The Netherlands Robert E Barrow, PhD Professor of Surgery, University of Texas Medical Branch Coordinator of Research, Shriners Burns Hospital Galveston, Texas Debra A Benjamin, RN, MSN Assistant Director of Clinical Research and Medical Staff Administration Shriners Burns Hospital Galveston, Texas Palmer Q Bessey, MD Professor of Surgery Weill Cornell Medical College New York Presbyterian Hospital Rochester, New York Patricia E Blakeney, PhD Clinical Professor, Department of Surgery University of Texas Medical Branch Senior Psychologist, Shriners Burns Hospital Galveston, Texas Stephen Boyce, PhD Director, Tissue Engineering Lab Shriners Burns Hospital Cincinnati, Ohio Michael C Buffalo, RN, ACPNP Associate Nursing Director of Outpatient and Perioperative Care Shriners Burns Hospital Galveston, Texas Top Jason H Calhoun, MD Professor and Chairman of Orthopedics and Rehabilitation Department of Orthopedics and Rehabilitation University of Texas Medical Branch Galveston, Texas Dai H Chung, MD Chief, Section of Pediatric Surgery Assistant Professor of Surgery University of Texas Medical Branch Galveston, Texas William G Cioffi, Jr, MD, FACS Chief, Division of Trauma and Burns Rhode Island Hospital Providence, Rhode Island Top Kumudika Iyanthi de Silva, PhD Research Associate (Surgery) Burn and Shock Trauma Institute Loyola University Medical Center Maywood, Illinois Robert H Demling, MD Professor of Surgery, Harvard Brigham and Women’s Hospital Boston, Massachusetts Matthias B Donelan, MD, FACS Assistant Professor of Surgery Assistant Clinical Professor of Surgery Newton-Wellesley Hospital Newton, Massachusetts William R Dougherty, MD, FACS Director Lehigh Valley Hospital Regional Burn Center Allentown, PA Top Patricia L Edgar, RN Certified Infection Control Professional Director, Infection Control Shriners Burns Hospital Galveston, Texas Loren H Engrav, MD Professor and Chief of Plastic Surgery University of Washington Harborview Medical Center Seattle, Washington E Burke Evans, MD Professor Orthopedics Department of Orthopedics and Rehabilitation University of Texas Medical Branch Galveston, Texas Top James A Fauerbach, PhD Assistant Professor, Johns Hopkins University School of Medicine Chief Psychologist, Baltimore Regional Burn Center Baltimore, MD John C Fitzpatrick, MD Staff Surgeon US Army Institute of Surgical Research Fort Sam Houston, Texas Top Richard L Gameli, MD, FACS The Robert J Freeark Professor of Surgery Professor and Chairman, Department of Surgery Director, Burn and Shock Trauma Institute Chief, Burn Center Loyola University Medical Center Maywood, Illinois Aziz Ghahary, PhD Associate Professor of Surgery University of Alberta Edmonton, Alberta Canada Warren Gold, MD Clinical Fellow Shriners Burns Hospital Galveston, Texas Cleon W Goodwin, MD Commander and Director US Army Institute of Surgical Research Fort Sam Houston, Texas Mary Gordon, RN, MS Burn Clinical Nurse Specialist Shriners Burns Hospital Galveston, Texas David G Greenhalgh, MD, FACS Chief of Burns, Professor of Surgery Shriners Hospitals for Children Sacramento, California Top C Edward Hartford, MD Professor, Department of Surgery University of Colorado Health Sciences Center Denver, Colorado Leslie C Hannon, Certified Orthotist-Prosthetist Manager of Orthotics Hanger Prosthetics-Orthotics Galveston, Texas Hal K Hawkins, MD, PhD Associate Professor, Pathology and Pediatrics Shriners Burns Hospital Galveston, Texas John P Heggers, PhD, BCLD, CWS(AAWM), FAAM Director of Clinical Microbiology Professor of Surgery (Plastic), Microbiology & Immunology Shriners Burns Hospital Galveston, Texas David M Heimbach, MD, FACS Director, Burn Center University of Washington Harborview Medical Center Seattle, Washington Ambrosio Hernandez, MD Chief Resident Department of Surgery University of Texas Medical Branch Galveston, Texas David N Herndon, MD, FACS Jesse H Jones Distinguished Chair in Burn Surgery, University of Texas Medical Branch Chief of Staff and Director of Research, Shriners Burns Hospital Galveston, Texas Marsha Hildreth Director, Dietary/Support Services Shriners Burns Hospital Galveston, Texas Maureen A Hollyoak, MBBS, M Med Sci, FRACS Clinical Associate Professor Royal Brisbane Hospital Herston, Brisbane Queensland, Australia Ted T Huang, MD Clinical Professor of Surgery University of Texas Medical Branch Shriners Burns Hospital Galveston, Texas John L Hunt, MD Co-Director, Burn Unit, Parkland Memorial Hospital Professor, Department of Surgery UT Southwestern Medical Center Dallas, Texas Top Marc G Jeschke, MD, MMS Surgical Resident Klinik und Poliklinik für Chirurgie Klinikum der Universität Regensburg Regensburg, Germany Stephen B Jones, PhD Professor of Physiology (Surgery) Department of Physiology and the Burn and Shock Trauma Institute Loyola University Medical Center Maywood, Illinois Top Gordon L Klein, MD, MPH Professor of Pediatrics and Preventive Medicine Department of Pediatrics University of Texas Medical Branch Shriners Burns Hospital Galveston, Texas George C Kramer, PhD Professor, Resuscitation Laboratories Department of Anesthesiology University of Texas Medical Branch Shriners Burns Hospital Galveston, Texas Top Hugo A Linares, MD Chief of Research Pathology (retired) Shriners Burns Hospital Galveston, Texas Tjøstolv Lund, MD, PhD Department of Anesthesia and Intensive Care National Burn Center Haukeland University Hospital Bergen, Norway Arnold Luterman, MD Department of Surgery University of South Alabama Mobile, Alabama Top Robert L McCauley, MD Chief, Plastic & Reconstructive Surgery Shriners Burns Hospital Galveston, Texas Roberta Mann, MD Director of Burn Center Torrance Memorial Burn Center Torrance, California Janet A Marvin, RN, MN Director of Nursing Shriners Burns Hospital Galveston, Texas Arthur D Mason, Jr, MD Consultant US Army Institute of Surgical Research Brooke Army Medical Center Fort Sam Houston, Texas Walter J Meyer, III, MD Professor in Child Psychiatry Head, Department of Psychology and Psychiatry Services Shriners Burns Hospital Galveston, Texas Stephen M Milner, MD, BDS, FRCS, FACS Associate Professor of Plastic Surgery and Director, Regional Burn Center The Plastic Surgery Institute Southern Illinois University School of Medicine and Memorial Medical Center Springfield, Illinois Joseph M Mlakar, MD Director St. Joseph’s Burn Center Fort Wayne, Indiana Ron P Mlcak, RRT, MS Director of Respiratory Care Shriners Burns Hospital Galveston, Texas William W Monafo, BA, MD Professor of Surgery Emeritus Washington University School of Medicine St. Louis, Missouri Dan Morgan, Certified Prosthetist, BS Physical Therapy Certified Prosthetist-Orthotist Manager, Hanger Prosthetics-Orthotics Galveston, Texas Stephen E Morris, MD, FACS Assistant Professor of Surgery Department of Surgery University of Utah School of Medicine Salt Lake City, Utah Elise M Morvant, MD Assistant Professor of Anesthesiology and Pediatrics University of Texas Medical Branch Galveston, Texas David W Mozingo, MD Associate Professor of Surgery Department of Surgery University of Florida Gainesville, Florida Michael J Muller, MBBS, M Med Sci, FRACS Clinical Associate Professor Royal Brisbane Hospital Herston, Brisbane Queensland, Australia Thomas Muehlberger, MD, PhD, FRCS Attending Plastic Surgeon Department of Plastic and Reconstructive Surgery Hannover Medical School Hannover, Germany Andrew M Munster, MD, FRCS, FACS (Eng & Ed) Professor of Surgery & Plastic Surgery Baltimore Regional Burn Center Johns Hopkins Bayview Medical Center Baltimore, Maryland Top Sheila Ott, OTR Occupational Therapist University of Texas Medical Branch Galveston, Texas Top David R Patterson, PhD, ABPP, ABPH Professor of Rehabilitation Medicine Harborview Medical Center Department of Rehabilitation Medicine Seattle, Washington Lynn A Peterson, CRNA Administrative Director of Anesthesia Chief CRNA Shriners Burns Hospital Galveston, Texas Donald S Prough, MD Professor and Chair Department of Anesthesiology University of Texas Medical Branch Galveston, Texas Basil A Pruitt, Jr, MD Clinical Professor of Surgery University of Texas Health Science Center Department of Surgery San Antonio, Texas Gary F Purdue, MD Professor of Surgery UT Southwestern Medical Center Parkland Memorial Hospital Dallas, Texas Top John P Remensynder, MD Associate Professor of Surgery Plastic and Reconstructive Surgery Visiting Surgeon Harvard Medical School Massachusetts General hospital Boston, Massachusetts Rhonda S Robert, PhD Psychologist, Assistant Professor Shriners Burns Hospital Galveston, Texas Daniel K Robie, MD Chief of Pediatric Surgery Assistant Professor of Surgery Tripler Army Medical Center Honolulu, Hawaii Martin C Robson, MD Professor Emeritus of Surgery Department of Surgery University of South Florida Tampa, Florida Top Jeffrey R Saffle, MD, FACS Professor of Surgery University of Utah Health Center Salt Lake City, Utah Roger E Salisbury, MD Professor of Surgery, NY Medical College Chief, Plastic and Reconstructive Surgery Director, Westchester Burn Center Valhalla, New York Arthur P Sanford, MD Assistant Professor, Department of Surgery University of Texas Medical Branch Shriners Burns Hospital Galveston, Texas Paul G Scott, PhD Professor of Biochemistry University of Alberta Edmonton, Alberta Canada Michael Serghiou, OTR Director, Rehabilitation Services Shriners Burns Hospital Galveston, Texas Ravi Shankar, PhD Associate Professor of Surgery and Cell Biology Department of Surgery Loyola University Medical Center Maywood, Illinois Robert L Sheridan, MD, FACS Director of Trauma, Massachusetts General Hospital Associate Professor of Surgery Harvard Medical School Assistant Chief of Staff Shriners Burns Hospital Boston, Massachusetts Edward R Sherwood, MD, PhD Assistant Professor University of Texas Medical Branch Consultant, Medical Staff Shriners Burns Hospital Galveston, Texas Yotaro Shinozawa, MD, PhD Professor of Emergency Medicine Department of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai, Japan Kumudika Iyanthi de Silva, PhD Research Associate (Surgery) Burn and Shock Trauma Institute Loyola University Medical Center Maywood, Illinois Kazutaka Soejima, MD Department of Plastic & Reconstructive Surgery Tokyo Women’s Medical University Tokyo, Japan Marcus Spies, MD Burn Fellow, Shriners Burns Hospital Department of Surgery University of Texas Medical Branch Galveston, Texas Top Steven J Thomas, MD Research Burn Fellow Shriners Burns Hospital Galveston, Texas Chris R Thomas, MD Professor of Psychiatry and Behavioral Sciences University of Texas Medical Branch Galveston, Texas Ronald G Tompkins, MD, ScD Massachusetts General Hospital Boston, Massachusetts Daniel L Traber, PhD Professor of Anesthesiology University of Texas Medical Branch Galveston, Texas Edward E Tredget, MD, MSC, FRCSC Professor of Surgery University of Alberta Hospital Alberta, Canada Top Cynthia Villarreal, BS Pharmacy Director of Pharmacy Shriners Burns Hospital Galveston, Texas Peter M Vogt, MD, PhD Professor of Plastic Surgery, Chief of Staff Department of Plastic and Reconstructive Surgery Hannover Medical School Hannover, Germany Top Thomas L Wachtel, MD, MMM, CPE, FACS, FCCM Clinical Professor of Surgery Medical Director, Trauma Paradise Valley, Arizona Glenn D Warden, MD Professor of Surgery, University of Cincinnati College of Medicine Chief of Staff, Shriners Burns Hospital Cincinnati, Ohio Petra M Warner, MD Assistant Professor University of Cincinnati College of Medicine and Shriners Burns Hospital Cincinnati, Ohio W Geoff Williams, MD Assistant Professor Division of Plastic and Reconstructive Surgery Shriners Burns Hospital Galveston, Texas Steven E Wolf, MD Assistant Professor, Department of Surgery Shriners Burns Hospital Galveston, Texas Lee C Woodson, MD, PhD Associate Professor, University of Texas Medical Branch Chief, Anesthesiology, Shriners Burns Hospital Galveston, Texas Top Bruce E Zawacki, MD, MA Emeritus Associate Professor of Surgery and of Religion/Social Ethics University of Southern California School of Medicine and of Religion/Social Ethics Los Angeles, California This listing was published in the book Total Burn Care , 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier. (This link takes you to the \"Total Burn Care \" page at the publishers web site.) TOTAL BURN CARE 2nd ed. ↑ Top Return to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[12]=new Array("orientation_emergency_treatment.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD EMERGENCY TREATMENT Initial Burn Management Treatment of the burn injury begins at the scene of the accident. The first priority is to stop the burning. The patient must be separated from the burning source. For thermal burns, immediate application of cold compress can reduce the amount of damaged tissue. This application must be guarded in large burns and in children, as prolonged cooling can precipitate a dangerous hypothermia. For electrical burns, the offending source should be removed from the victim with a nonconducting object made of wood or rubber. In chemical injuries, the agent should be diluted with copious irrigation, not immersion. A person with burning clothing should stop, drop, and roll. As with other forms of trauma, initial establishment of an adequate airway is vital. Endotracheal intubation is not an essential part of management of all inhalation injuries, but may be prudent prior to patient transport or referral as airway edema will gradually increase over the first 18-24 hours post-injury. If the patient displays evidence of airway edema and impending obstruction with hoarseness, wheezing, or stridor, then intubate the patient. In all fire victims, administer 100% oxygen by mask or tube to reduce the likelihood of problems from pulmonary dysfunction or carbon monoxide poisoning. If present, control external hemorrhage and stabilize fractures from concomitant trauma. Burn wounds should be covered by a clean, dry sheet. Although, a 20-40% injury can initially appear fairly benign, burn shock can develop rapidly if fluid resuscitation is delayed. Burns of less then15 % BSA in the conscious and cooperative patient can often be resuscitated orally. The patient with more than 15% BSA burn on cursory assessment requires IV access. Cut downs or central lines initially is less desirable. Begin infusion of Ringer \'s lactate solution of about 1000 ml/hr in adults, 400-500 ml/m²BSA/hr in children, until more accurate assessments of burn size and fluid requirements can be made. An indwelling Foley catheter should be placed to monitor urinary output. A nasogastric tube is inserted for gastric decompression. Patient evaluation should include an AMPLE history: allergies, medications, pre-existing diseases, last meal, and events of the injury; including time, location and insults. A history of loss of consciousness should be sought. In adults and adolescents, burn injuries are frequently associated with alcohol or drug use, smoking, or psychiatric problems. A complete physical exam should include a careful neurological exam, as evidence of cerebral anoxic injury can be subtle. As in all trauma patients, occult injuries must be ruled out. Patients with facial burns should have their corneas examined with fluorescein staining. Routine admission labs should include CBC, serum electrolytes, glucose, BUN, creatinine, albumin, and calcium. Pulmonary assessment should include arterial blood gases, chest x-ray, and arterial carboxyhemoglobin. Despite a toxic level of a carbon monoxide (i.e. greater than 15%), pO ² and saturation values may be normal. An EKG is especially important in patients > 40 years of age or in case of electrical injuries. All extremities should be examined for pulses, especially with circumferential burns. Evaluation of pulses can be assisted by use of a Doppler ultrasound flowmeter. If pulses are absent, and fluid resuscitation is adequate, the involved limb should undergo urgent escharotomy for release of the constrictive, unyielding eschar. In severe chest burns, escharotomy may also be indicated to relieve chest wall restriction and improve ventilation. Escharotomies are generally performed at the bedside under IV sedation using electrocautery. Midaxial incisions are completed through the bleeding tissue, extending the full length of the eschar to assure adequate release, limbs should be elevated above heart level. Pulses should be monitored for 48 hours. If pulses are still present but appear endangered, chemical escharotomy with sultilains ointment (e.g. Travase of Santyl) may be called for. We prefer enzymatic escharotomies in hand burns since incisions risk superficial nerves, vessels and tendons. Enzymatic debridement is indicated only within 24 hours of burn injury, or it otherwise increases risk of infection and sepsis. Deep circumferential burns are coated with sultilains ointment, then wrapped with saline-soaked gauze to keep the wounds moist. Wounds and pulses are re-evaluated in one hour. Once capillary refill has been restored, the wounds are treated with a topical antimicrobial agent. Occasionally, escharotomy alone will fail to relieve intra-compartmental pressures, and a formal fasciotomy under general anesthesia is indicated. Distal numbness and tingling are the earliest signs of ischemia, and loss of pulses is a late finding. ~ If you consider a patient \'s central venous pressure is normally 8-12 cm H 2 O and arterial pressure is typically 80-120 mmHg, you will see that venous compromise occurs much before the loss of arterial pulsations in an affected extremity. ~ Intra-compartment pressures can be measured with a wick catheter or inserting a spinal needle connected to a pressure catheter, such as for an arterial line, into all compartments of the affected extremity. Compartment pressures of >20 cmH 2 O are significantly elevated and require immediate attention. Fasciotomies are always indicated in high voltage electrical injuries and in severe crush injuries. This should also include Carpal Tunnel and Guyton (Ulnar) canal releases. An \'intrinsic-minus \' hand deformity is evidence of need for deep muscle compartment decompressions. Keep in mind that as a patient is resuscitated, new swelling and reperfusion injury can cause delayed onset of compartment syndromes. This highlights the need for continued vigilance. All patients with significant burns should receive 0.5 ml of tetanus toxoid. If prior immunization is absent or unclear, or their last booster was more than 10 years ago, 250 units of tetanus immunoglobulin is also given. The Administration of Burn Assessment When cardiopulmonary assessment is complete and resuscitation underway, a more careful evaluation of the burn wounds is performed. If the patient is adequately hydrated, appropriate doses of sedatives and narcotics may be safely administered. Excessive narcotic doses in light of inadequate resuscitation, however, can precipitate burn shock. The wounds are gently cleaned and loose skin and blisters debrided. Blister fluid contains high levels of inflammatory mediators which increase burn wound ischemia. The blister fluid is also a rich media for subsequent bacterial growth. Deep blisters on the palms and soles are generally aspirated instead of debrided to improve patient comfort. After burn wound assessment is complete, the wounds are covered with a topical antimicrobial agent or a biologic dressing, and an appropriate burn dressing applied. Outer elastic compressive dressings (e.g. Ace wraps) are applied carefully, and all involved extremities are elevated. An estimation of burn size and depth assists in determinations of severity, prognosis and disposition of the patient. Burn size directs the efforts of fluid resuscitation, nutritional support and surgical interventions. Estimation of burn depth is a clinical judgment based on experience. DEGREE DEPTH HISTORY ETIOLOGY SENSATION APPEARANCE HEALING 1st degree superficial momentary exposure sunburn sharp, uniform pain blanches red, pink, edematous, soft, flaking, peeling + 7 days 2nd degree partial thickness exposure of limited duration to lower temperature (40-55°C) scalds, flash burn without contact, weak chemical dull or hyperactive pain, sensitive to air/temp changes mottled red, blanches red/pink, BLISTERS, edema, serous exudate, moist 14-21 days 3rd degree full thickness long duration of exposure to high temperature immersion, flame, electrical, chemical painless to touch and pinprick, may hurt at deep pressure no blanching, pale white, tan charred, hard, dry, leathery, hair absent granulates, requires grafting 4th degree underlying structures prolonged duration of exposure to extreme heat electrical, flame, chemical usually painless charred, \'skeletonized \' amputation fasciectomy Attempts at estimation of burn depth with ultrasound, temperature mapping and vital stains such as fluoroscein have not proven clinically useful. 1st degree burns are superficial and involve just the epidermis. Typified by a sunburn, 1st degree burns are inconsequential in subsequent burn management. Partial-thickness injuries are 2nd degree burns that involve variable amounts of dermis. The hallmark of a partial-thickness burn is a weeping, blistering, painful wound that will potentially heal within 2 to 6 weeks. 3rd degree burns are full-thickness injuries, which require skin replacement following loss of the devitalized dermis (eschar). Classically, full-thickness burns are identified as dry or leathery wounds that are initially insensate to light touch or pinprick. However, 3rd degree burns can still hurt. In infants, 3rd degree burns may also appear cherry red. Determinations of burn depth can be somewhat misleading initially, as the tissue destruction is progressive over the first 48 hours. Burn size is based on the percentage of 2nd and 3rd degree burns as compared to total body surface area. Burn injuries are quantifiable, and pathophysiologic derangement is related to the size of the injury. The surface area of a patient \'s palm is approximately 1% of their total body surface area and provides a quick estimate of burn size in smaller injuries. Typically, burn size estimations are derived from the \"Rule of Nines \". The body \'s surface is divided into areas of roughly 9% each, which includes the head and neck, the chest, the abdomen, the upper back, the lower back and buttocks, each thigh, each lower leg, and each upper extremity. Although useful in adults, the \"Rule of Nines \" overestimates burn size in children. The head and neck account for a larger proportion of the total body surface area (BSA) in children, more than 21% BSA in toddlers and babies. For greatest accuracy and reproducibility, burn size should be determined by plotting the burn wound on Lund and Browder burn diagrams. A major burn injury is defined as greater than 25% BSA involvement (15% in children), or more than 10% BSA full-thickness involvement. Major burns require aggressive resuscitation, hospitalization, and appropriate burn care. Additional criteria for major burns include: deep burns of the hands, feet, eyes, ears, face, or perineum; inhalation injuries; and electrical burns. Moderate thermal burns of 15-25% BSA, or 3-10% BSA full-thickness, often require hospitalization for optimal patient care. Other criteria for admission include concomitant trauma, significant pre-existing disease, and suspicion of child abuse. Minor burns can generally be treated as outpatients. Classification of Burn Injuries Major Burns Moderate Burns Minor Burns Burn surface involvement of 25% body surface area. Full-thickness burns 10% body surface area. Deep burns of the head, hands, feet, and perineum. Inhalation injury. Chemical or high-voltage electrical burn. Burn area of 15-25% body surface area. Superficial partial-thickness burns of the head, hands, feet or perineum. Suspected child abuse. Concomitant trauma. Significant pre-existing disease. 15% body surface area. Nothing involving the head, feet hands or perineum. Next - Burn Shock ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[13]=new Array("orientation_electrical_injury.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD ELECTRICAL INJURIES Electrical injuries account for only 3-5% of all burn admissions. Low-voltage burns most commonly involve the oral commissure in infants and toddlers due to suckling on the female end of live extension cords or biting electrical cords. These low-voltage injuries cause little tissue destruction and are best managed conservatively with intraoral splinting. A significant late complication may be hemorrhage from the labial artery. On the other hand, high-voltage electrical injuries are classified as major burns due to associated massive tissue damage. On average, high-voltage cutaneous involvement is only 10-15% BSA, but this visible injury is only a small portion of the overall tissue destruction. The human body serves as a volume conductor to electricity. Current flow is therefore concentrated in the extremities by their narrowing. Since bone has the highest resistance to electrical current, conduction through bone produces the greatest amount of heat. For this reason, damage to muscle by electricity is greatest at tendonous attachments and periosteal regions. Massive muscle destruction causes myoglobinemia. Precipitation of myoglobin in the renal tubules can produce acute tubal necrosis and acute renal failure. In addition, high-voltage electrical burns are commonly associated with dislocations, fractures, vertebral injuries, myocardial damage, neurologic sequelae, and intra-abdominal injuries due in part to concomitant trauma. The most common cause of early mortality is cardiopulmonary arrest due to induced fibrillation. Treatment of the high-voltage electrical victim should include prompt initiation of aggressive fluid resuscitation, serial assessment of distal vascular integrity, and urgent surgical intervention for fasciotomies and muscle compartment explorations. If the urine is rose-pigmented from haemochromogens, the urine output should be maintained at 100-125 ml/hr (1-2 ml/kg/hr) in adults, or twice the normal hourly rate in infants and young children, until gross pigment is cleared. The urine can be alkalized by IV administration of sodium bicarbonate to help prevent myoglobin precipitation. In severe injuries, IV mannitol (12.5 gm in an adult) is given in addition to aggressive fluid replacement to help promote an osmotic diuresis. Early use of other diuretics is contraindicated. Development of compartment syndromes should be anticipated. Deeper muscle groups sustain the greatest injury. Intraoperative exploration, decompression, and debridement is an essential part of early treatment. Serial technetium-99m stannous pyrophosphate muscle scans can be useful in assisting determination of progressive muscle damage. Initial assessment of high-voltage patients would also include a careful neurologic examination, cardiac evaluation, and a skeletal survey. Vertebral fractures are frequent due to falls or forceful muscular contractions. All patients should have an electrocardiogram and serum CPK-MB determinations. In the patients without history of unconsciousness or cardiac arrest who have normal EKG \'s and myocardial isoenzymes, routine cardiac monitoring is not needed. Two-thirds of patients will have early neurological changes on initial exam, although long-term neurologic complications are rare. Late formation of cataracts following major electrical injuries has been documented. Next - Chemical Burns ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[14]=new Array("orientation_chemical_burns.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD CHEMICAL BURNS Chemical burn injuries are uncommon. These are not hyperthermic, but are due to tissue reactions to noxious substances, including oxidizing agents, reducing agents, corrosives, protoplasmic poisons, desiccants, and vesicants. In general, chemical injuries are deeper than they initially look. The key to treatment of most chemical burns is early and continued copious irrigation of the insulted skin surface. Wounds can be most easily irrigated with water, while a balanced saline solution is preferable for irrigation of mucosal surfaces or eyes. Dilution and not neutralization is paramount. Misdirected attempts at neutralization of acid or alkali burns can produce exothermic damage as well. Deep alkali burns should be irrigated for 24 hours. Initial copious hydrotherapy is indicated for all chemical burns except those caused by dry-line, phenol, concentrated sulfuric acid, sodium metal, and muriatic acid; which either are not miscible with water or react with water exothermically. Besides irrigation, \'antidotes \' are often helpful for burns from hydrofluoric aced, phenol, and white phosphorous. Hydrofluoric acid (HFA) causes liquefaction necrosis of the subcutaneous tissue and can penetrate to bone. Systemic complications of HFA toxicity include hypocalcemia and pulmonary edema. HFA wounds are covered with a 10% calcium gluconate solution mixed to a slurry with a water soluble ointment, or infiltrated if excruciatingly painful. Phenol is an acidic alcohol which produces local coagulation and systemic toxicity in large doses, including fatal arrhythmias. Acute phenol burns are treated topically with polyethylene glycol solution irrigation. White phosphorus is contained in grenades and anti-personnel mines. Once particles are imbedded in skin, white phosphorus causes burn by both chemical and thermal reactions, as particles are spontaneously ignited with prolonged exposure to air. Patients should be submersed in water until imbedded particles can be surgically debrided. The skin is washed with a solution of 5% sodium bicarbonate, 3% copper sulfate, and 1% hydroxycellulose to blacken the particles and aid earlier identification. Prolonged exposure to copper sulfate solution can induce coagulopathies. Next - Future Developments & Conclusions ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[15]=new Array("orientation_developments_conclusions.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD FUTURE DEVELOPMENTS Both basic science and clinical research efforts the past 30 years have changed the methods of fluid resuscitation, wound closure and nutritional support of the burned patient and significantly decreased the mortality and morbidity experienced by patients with severe thermal injuries. On-going research will significantly alter our ability to appropriately intervene into the various aspects of the \'burn syndrome \'. The early vascular changes invoked by the burn injury may be modulated with the use of various thromboxane synthetase inhibitors, decreasing the incidence of tissue ischemia and progressive dermal necrosis. Inhalation injury, which continues to account for a significant number of burn-related deaths, may be treated with high-frequency \'jet \' ventilation, synthetic surfactants, oxygen radical scavengers and mucolytic agents. These agents may also decrease the severity of ARDS in the burn population, which has replaced the \'shock lung syndrome \' so frequently seen 20 years ago. Hypertonic saline resuscitation may hold promise for the treatment of burn injuries in the pre-morbidly compromised patient who is exquisitely sensitive to volume overload. Bacterial translocation, which is currently thought to be a major component of the infection/sepsis cycles of the burn patient, may be attenuated or ablated with early aggressive enteral nutrition, selective mesenteric vasodilators or prostaglandin inhibitors. Other infectious complications may be combated with monoclonal antibodies, future generations of antibiotics, pseudomonal \'vaccination \' or selective endotoxin binding agents. Replacement of the destroyed cutaneous tissue may be performed completely in the laboratory, using new tissue culturing techniques of autologous or non-antigenic homologous cells. Artificial collagen matrices may also become available, providing a scaffolding for the in-growth of autologous fibroblasts and capillaries. Various endogenous human growth factors have recently been identified, isolated and spliced into bacterial hosts, making sufficient quantities available so that their application to wounds becomes feasible. The use of various pharmacologic agents to modulate the post-burn hypermetabolic response, such as beta blocking agents and human growth hormone, may decrease the amount of post-burn morbidity and promote the maintenance or rapid restoration of nutrient substrate hemostasis. CONCLUSIONS Successful management of the acute burn patient requires prompt aggressive fluid resuscitation, metabolic/nutritional support, control of bacterial infection, anticipation and prevention of complications, timely closure of the burn wound, and early initiation of rehabilitation therapy. Burn shock must be adequately treated. Post-burn malnutrition must be prevented. In the post-burn stress response, all major organ systems are affected. Closure of the wound is essential for correction of the pathophysiologic post-burn derangements. In essence, management of the burn patient is a race against time, as rapidity of wound closure is inversely related to mortality. This race must be tempered, however, with thoughtful considerations of ultimate function, cosmesis, and quality of life. Next - Documentation for Special Studies ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[16]=new Array("orientation_document_special_studies.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD DOCUMENTATION FOR SPECIAL STUDIES All x-rays and all special studies, radiographic or otherwise, will be documented as follows: 1.) Order written. 2.) Dated and timed entry in progress notes naming the study and giving indication for study and name of surgeon requesting study, if other than person writing note. 3.) Dated and timed entry in progress notes listing findings of study, pertinence of findings and any change in management based on findings. All procedures requiring radiographic monitoring - as central line placement - will be documented in the same way, except that one timely note may suffice for indication and outcome. Next - Psychological and Psychiatric Services to Children and Families ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[17]=new Array("ABLS_course_outline.htm","Advanced Burn Life Support","Advanced Burn Life Support (ABLS) During the 1 day ABLS Course the following topics are discussed: Course Introduction Initial Assessment and Management Airway Management and Smoke Inhalation Injury Shock and Fluid Resuscitation Wound Management Electric Injuries Chemical Injuries Pediatric Burns Transfer and Transport Case Studies Patient Simulations Course Coordination Michael Buffalo, RN, ACPNP - National Faculty - Address - Shriners Galveston Burn Hospital 815 Market St. Galveston, TX 77550 Email - mcbuffal@utmb.edu Phone - 409-770-6953","null","null","");arrFiles[18]=new Array("orientation_closure_wound.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD CLOSURE OF THE WOUND The ultimate solution of burn management is closure of the burn wound through surgical intervention. The alternative burn-care philosophies differ in the timing of the surgical procedure. The conservative approach awaits spontaneous separation of the burn eschar over 3-5 weeks. Topical antimicrobial wound therapy is used for prevention of infection. The resultant granulation bed is then skin grafted. This method advocates maximal preservation of viable tissue. However, conservative treatment increases the risk period for infection, fluid and electrolyte disturbances, and malnutrition. The eschar is separated by the action of bacterial proteolytic enzymes, and the granulation bed is generally heavily colonized. Prolongation of the inflammatory phase of wound healing can result in increased hypertrophic scarring. This method is currently disfavored except for facial burns and small burns (<20% BSA). The alternative approach involves excisional therapy of the burn wound prior to spontaneous eschar separation. A clinical comparison of conservative versus early excision demonstrated significant reductions in infectious complications and length of hospital stay in the latter group. Excisional therapy may also reduce protein catabolism, immunosuppression, and evaporative water losses. In some cases, early excision can improve cosmesis by reducing hypertrophic scarring. Timing of excisional therapy is debatable. Some surgeons prefer excision 4 to 14 days post-burn when the acute resuscitation period is well over. This may involve serial excision of various portions of the burn over days to weeks. Other surgeons prefer early excision of the burn wound within 5 days of the injury prior to bacterial colonization of the wound. In experimental models, complete excision of the wound within 24 hours of injury prevented hypermetabolism and immune suppression in the post-burn period. Clinically, in children with greater than 60% BSA burns, excisional therapy resulted in improved survival. We recommend early excisional therapy of major burn wounds as soon as hemodynamic stability, physiological tolerance, and reliable determination of burn depth are ascertained. In other words, the patient should undergo excisional therapy of full-thickness wounds when surgical risks do not increase risk of mortality nor compromise anticipated functional and cosmetic results. Early accurate determination of burn depth can be difficult. In scald burns, delay of excision for one week reduces blood loss and areas of skin grafting. However, clinical determination of depth in most flame wounds in more readily apparent. For most flame burns, excisional therapy can be completed within 48 hours of admission unless delayed by serious inhalation injury, concomitant injuries, frailty from extremes of age, or pre-existing medical conditions. Partial-thickness flame burns that will spontaneously heal within 14-21 days are not excised. If treated conservatively, deep partial-thickness burns produce poorer scars, more complications, and prolonged hospitalization. If healing takes longer than 21 days, 78% will result in hypertrophic scar formation. Therefore, deep partial-thickness wounds are often treated similar to full-thickness injuries. Surgical Techniques First described by Janzekovic 20 years ago, tangential excision involves sequential removal of eschar in layers (0.010-0.025 in.) with a dermatome or guarded knife (Goulian, Humby, or Weck) until viable dermis or subcutaneous fat is reached. An acceptable wound bed is identified by active punctate bleeding. By using this technique, a maximum of viable tissue is preserved and optimal functional and cosmetic results are achieved. Fascial excision removes all layers of eschar and underlying tissue to the level of fascia. Excision to this plane minimizes bleeding and provides a reliable, clean, vascular bed. Fascial excision is recommended if the subcutaneous fat is burned, and in selected large burns with >60% BSA full-thickness who have high risks for infection, blood loss, or skin graft slough. Fascial excision results in considerable cosmetic deformity. For example, fascial truncal excision sacrifices the breast buds in pre-pubertal females. Therefore, fascial excision is not used except in the worst burns. The extent of excision is determined by the stability of the patient, the speed of the surgical team, the adequacy of anesthesia, the rate of blood loss, and the availability of skin graft or its substitute. Central venous access, and arterial line, an nasogastric tube, and a Foley catheter are needed for patient monitoring during the procedure. Ketamine is the preferred anesthetic agent in children. If ketamine is used, endotracheal intubation is not always needed. Anticipated blood losses are 0.75 ml/cm² of area of excision during 2-16 days post-burn, or 0.40 ml/cm² if excision is performed during the first 24 hours. Blood losses are minimized by use of tourniquets, pressure, topical thrombin, and topical or subcutaneous epinephrine. Overdoses of epinephrine producing hypertension or paroxysmal tachycardia do occur with injudicious topical use, especially in children. In burns <40% BSA, excision can be completed in a single procedure. Skin Substitutes The early excision of the burn wound mandates early wound closure. Preferably, closure is with permanent skin autograft, but closure can also be achieved with skin allograft, other biological dressings, or skin substitutes. Without immediate closure, dessication or infection can increase tissue loss and negate the benefits of early excision. In burns <40% TBSA, wide availability of donor sites permits wound closure with autograft. Sheet grafts are always preferred for their improved cosmetic results. In burns >40% BSA, donor sites are more limited. Many unburned areas, e.g. the face, are unacceptable for graft harvest. By meshing the grafts, better expansion ratios can be obtained for greater surface coverage at the price of reducing cosmesis. Sheet grafts are always used for the face, neck, and hands when available. Mesh expansion ratios larger than 4:1 result in sub-optimal healing and thin, easily damaged skin coverage, so are generally not used. As described by Alexander, we cover our 4:1 meshed skin autografts with 2:1 meshed skin allograft to protect the wound beds during healing. As the autograft heals and spreads underneath, the allograft is shed. In massive burns (>70%), donor sites are severely restricted, prompting searches for an acceptable skin substitute. Unlike biologic dressings, skin substitutes become incorporated permanently, in part or as a whole, into the wound closure. An artificial skin developed by Burke, et al (Integra © ) is composed of an outer silastic \'epidermis \' (0.1 mm thick) and an inner biodegradable bovine collagen glycosaminoglycan (GAG) based dermal analog. The inner surface provides for good wound adherence while the outer layer prevents exogenous bacterial contamination and excessive evaporative losses. After 26-30 days, fibroblasts and collagen at the GCG-wound interface organize into a neodermis. The outer silastic layer is then gently peeled off and replaced with a 0.004 in. thick epidermal graft. Other dermal replacements include cultured allogenic fibroblasts and/or keratinocytes, decellularized human collagens, and other synthetics similar to Integra © . Clinical trials of these substances are on-going. Using tissue culture techniques, human epithelial cells can be grown in vitro . Over a period of 2 to 4 weeks, larger confluent multi-layered sheets of cultured keratinocytes are obtainable from a small patch of donor skin (see the policy and procedure manual for exact method of obtaining biopsies), its surface area coverage expanded 100 times or more. Cultured epithelial autograft (CEA) has been successfully used to provide permanent wound closure in massively burned patients. Unfortunately, wounds covered with just epidermis display poor skin function and continued wound contraction. Resultant scars are not optimal. The search for a suitable dermal epidermal skin replacement continues. Combined use of CEA with either allograft cadaver dermis, cultured dermal fibroblasts, or a synthetic dermal analog may provide the ultimate solution for massive skin replacement. Next - Regional Considerations ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[19]=new Array("orientation_psychological_psychiatric_services.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD PSYCHOLOGICAL AND PSYCHIATRIC SERVICES TO CHILDREN AND FAMILIES Every child who is admitted to Shriners Hospital can be expected to experience psychological distress and to demonstrate symptoms of that distress. The psychological, as well as the physical condition must be addressed from the time of admission of the patient in order to promote recovery. The acutely burned child \'s distress is both physical and psychological. Common reactions of children in this situation are fear, anxiety, acute stress disorder and, of course, expressions of pain. Issues of body image, social relations and self-concept will arise as the child progresses toward discharge from the acute care setting. It is not uncommon for the acutely burned child to have experienced great losses in addition to their injury; for example, children may have lost a parent, a sibling, their home or a beloved pet in the catastrophe that caused their own injuries. They must be told of such losses and assisted in grieving even while continuing to struggle with the discomfort of recovery and rehabilitation. The family of the burned child is also greatly impacted by the injury to the child. They are traumatized and grieving and feeling extreme guilt, usually irrational. They, too, can be expected to exhibit symptoms of trauma. They, too, are our \'patients \', for we need them to be healthy assets to the recovery of the child. Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services. There is no need to write a consult for these services for they are provided routinely for every patient. However, there is a need for the psychology-psychiatry team to hear of any observations made by other staff on an on-going basis. Clinical Services Staff: Clinical Psychologist 2 part-time Child Psychiatrists 2 Psychologists 1 Psychology Post-Doctoral Fellow We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family. Intake Assessment: Upon arrival, the family is assessed for risk factors or problems that must be addressed during and following hospitalization. All families have strengths and weaknesses, and their difficulties are exacerbated by trauma. At this time, risk for abuse is also assessed. If the child is 2 years of age or younger OR if any risk factors are present, e.g. injury does not match parent \'s story, Department of Protective and Regulatory Services (DPRS) have been contacted prior to arrival at Shriners; inconsistencies in repeated versions of the story, appearance of burn (e.g., dip lines, bottom of feet not burned while all surrounding skin is), we will contact DPRS. Resident \'s Role: If you observe indicators of abuse, tell us. You, and we, must report suspicious injuries and protect the child. You must order a long bone series x-ray and be sure that signs of abuse are documented in your notes and by photographs. If we contact DPRS, we ask you to complete the Physician \'s Report of Suspicious Injury form. If we report a suspicious injury, we must not discharge the child until DPRS gives the \'okay \'. Psychotherapy (both individual and family): Each family is assigned a primary mental health professional. The family can choose the extent of service they receive. At minimum, the mental health professional will routinely assess for current or anticipated adjustment difficulties and intervene accordingly. If appropriate, the professional will offer more extensive psychotherapy. Issues commonly brought to counseling by the child include: symptoms of acute stress, management of acute pain (through hypnosis or relaxation), anxiety or depression, grief due to death of another or loss of objects or partial loss of self, body image, and self-esteem. Families are commonly dealing with fear, guilt, anxiety, and post-trauma stress. Resident \'s Role: For both the patient and the patient \'s family, you are likely to see signs of emotional distress and behaviors that have the potential to escalate into a crisis situation. Symptoms of depression and anxiety (notably Acute Stress Disorder) are most common. Common signs of distress include, but are not limited to: tears, withdrawal, sleep disturbance, agitation, refusing treatment plan, yelling, grinding teeth, verbalization of hopelessness, denial of disfigurement, expressed fears, short temper, anger, hypervigilance (in general and in seeking information about child \'s care), nightmares, flashbacks. You should hunt for emotional distress in the same manner you would hunt for any anomaly in physical function. Note your observation to the patient or parent. Express your interest/concern through queries. If distress is present and you wonder if further intervention may help, call the assigned mental health professional or call x6718 and state the name of the child for whom you are concerned. School Services: Our full-time school teacher will enroll a school-aged child in the school program as soon as possible. The hospital school is accredited by Galveston ISD and our patients receive credit for the time they are enrolled in this school. School is important in the hospital because it is the normal activity for most children, and our goal is to return them to normalcy as soon as possible. If you have concerns about a patient \'s involvement in the school program, call Psychological Services at x6718 and ask to speak to the teacher. Bereavement Counseling: If a child \'s condition is taking a life threatening direction or if a child is dying, call the psychologist or psychiatrist involved with that child at x6718 or ask the unit clerk to page that clinician. The psychologist or psychiatrist will assist in discussions with the family and in attending to family concerns while you attend to the child. Clinical Research Longitudinal Assessment: A multi-disciplinary research project that assesses post-burn adaptation for a minimum of 3 years. Areas assessed include: 1) physical adaptation - bone age, bone density, muscle strength, pulmonary functioning, magnitude of disfigurement, sexual maturation, growth (height and weight); 2) emotional adjustment - family environment, child \'s behavior as measured by parent, child and teacher, parenting stress, post-trauma symptoms, child \'s developmental competency level, level of emotional distress for parent and child. {Part of the National Institute on Disability and Rehabilitation Research (NIDRR) Burn Model Systems project} Resident \'s Role: Parents will likely ask you about the NIDRR studies, so be aware of the study, know that research protocols are available to you on the unit, and call for any questions or assistance in responding to parent or child queries/concerns: x6715 -or- x6718. Pain, itch, anxiety and post-trauma symptoms - Assessment: In addition to the pain medication protocol, the staff in the Department of Family Services work at assessing the patient \'s discomfort, as well as guiding all staff to assess the patient \'s pain in the most effective manner. Symptom management can be addressed at any time, but is specifically addressed in the Discharge Planning Meeting, Tuesday, 7:30a.m. and in Rehab. Rounds, Thursday 7:00a.m. Resident \'s Role: As you spend a great amount of time with the patients and their families and are involved with the most painful of interventions, you can be most effective in assessing and treating the patient \'s pain. With the infant and children up to the age of 3, the patient \'s pain is assessed by the Observer Pain Scale with the primary caregiver being the reporter. Ask the parent to assess pain in each of these 4 environments: 1) when your child is lying or sitting and his/her wounds are fully dressed, how much pain do you imagine he/she is in?; 2) during the bath, how much pain do you believe your child is in?; 3) during dressing changes in the hospital room,........; 4) during the rehab. exercises, ......... Elicit from the parent what behaviors of the child contribute to his/her assessment, e.g. flailing of limbs, rigid extension of limbs, lack of cooing, developmentally regressed behavior, type of cry or whimper, lack of interest in toys, changes in indicators of symptomatic function (blood pressure, pulse, temperature), repetitive or stereotypic behavior. For the children 4-8 years of age or greater, the Faces of Pain Scale is utilized, and the patient is the reporter. Assess pain for the same 4 environments. Also, when addressing pain, a good habit is to inquire about quality and amount of sleep, especially nightmares, and level of itching. Sleep Disturbance and other symptoms of acute post-trauma anxiety: We have studied the efficacy of imipramine in low doses to treat these symptoms and have now begun a study comparing imipramine to prozac. Both studies are blinded. If a child is experiencing nightmares, flashbacks, intrusive memories, please refer that child for the \'sleep study \' by calling x6715, x6718 or x6722. We will assess and communicate our findings/recommendations to you. And finally, we are always on call and serve a liaison service to you. If you have any hint of a concern or any question, please dial x6722 or ask the unit clerk to page us. Next - Nursing Service Resident Orientation ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[20]=new Array("orientation_nursing_service.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD NURSING SERVICE RESIDENT ORIENTATION Unit Operations: For each shift - the inpatient units have a Resource Nurse assigned. The Resource Nurse coordinates the units \' activities. The Resource Nurse is an experienced nurse that is available to you to assist in problem solving. The Resource Nurse also coordinates all referral calls from other hospitals. They will seek you to speak with referring hospitals as needed. The Resource Nurse will attend rounds and help share information discussed in rounds. Lead Nurses are senior nurses on each unit. They supervise nurses with less experience to assist in their care. Lead Nurses serve as an identified resource for a set number of nurses. The individual nurse in the room is responsible for the care of the patient assigned to them, however the Lead Nurse serves as a support to the assigned nurses. A Tub Room Team will be providing care to the patients as they go to the Tub Room. A lead nurse is available for questions. Patient care technicians are integral members of the nursing team. They are usually found at the bedside helping with wound care, weights and staple removal. Customer Communication Clerks are responsible for the communication at the Nursing Station. They will be entering orders and paging you for the staff as needed. Please feel free to ask them for assistance with questions regarding x-ray \'s, lab, blood and ordering consults. Please let the clerk know if you page someone and are expecting a call back so they can locate you. General Information: Orders We do not have on-line order entry. Admission orders should be written as quickly as possible so the team can begin care of the patients. Consents must be obtained before providing care to patients . Please write orders ASAP on all post-op patients. Remember that all pre-op orders are discontinued and those you wish to restart must be re-written. Discharge orders must also be written early to facilitate the coordination of care that must take place. Care Coordinators will assist if you have questions regarding after care. Verbal orders are not able to be accepted by Residents per hospital policy except from the Plastic Surgery Resident. This will require you to come to the unit to write orders for needed changes, even in the middle of the night if you are on call. Calculation of BSA/TBSA on Emtek Emtek will calculate the BSA & TBSA automatically. 1. Log on to Emtek. 2. At the bottom right-hand corner of the screen, click on \'admit \' (F10) 3. \'Admit Patient \' screen will appear. 4. Click on the far right-side of the screen underneath the arrows to expand the screen. 5. Type in the height and weight - the BSA will automatically calculate - then type in the % burn and amount of 3rd degree burns , the TBSA will automatically calculate. 6. Hit cancel at the bottom of the screen and log out. Daily Rounds: The entire Burn Team (Attendings, Fellows, Residents, Medical Students, Resource Nurse, Care Coordinators, Dietitians, Rehab. Therapists, Respiratory Therapists, etc.) attend rounds. Rounds begin at 0700 on M,T,W,T,F on 2 East. On Tuesday the rounds will stop at 0730 and the team will go to Discharge Planning Rounds in the Board Room on the 7th floor. Picture presentations by the medical staff, followed by input from the entire team occurs. These rounds are taped and transcribed for Medical Records. On Thursday the team will go to the 3rd floor for Recon. Teaching Rounds. These are walking rounds where the patient is presented and the case discussed. The resident tapes the presentation for transcription in the medical records. Wednesday rounds will vary due to the Surgery Grand Rounds. Weekend rounds usually occur at 9a.m., but may change depending upon the Attending On-Call \'s schedule. Afternoon rounds usually occur between 2-4p.m. and are usually announced on the overhead or paged on staff beepers. Referrals: Shriners Hospitals for Children accepts children that have been acutely burned by a physician \'s referral up to their 18th birthday from the United States and Mexico. Children from other countries needing our services require special approval from the Chief of Staff and Tampa. The Referral form guides our interaction with the referring physician and hospital. The Resource Nurse will assist you in communication and planning of the transport. Remember, you are considered a representative of Shriners when you are talking with the referring hospital, your approach is key to future relationships. The Attending On-Call should be kept informed of the referral \'s progress. They will approve the patient \'s admission and method of transport. It is important that you remind the referring hospital about necessary steps on stabilization (fluids, temperature, pain management, etc.) Many times we will transport the child. Our flight team consists of 1 Resource Nurse and 1 Respiratory Therapist. A second nurse may be used if the child \'s condition warrants. Also, the Baylor Resident or a Shriners Attending may be included if the Attending physician believes it is necessary. Detailed hospital policies are located on the unit for further reference. Patient Condition Reports: The physician is responsible for indicating the patient \'s condition. Hospital Policy #HP1A1.012 indicates that the following condition descriptions will be used: GOOD - vital signs are stable and within normal limits; patient is conscious and comfortable; indicators are excellent FAIR - vital signs are stable and within normal limits; patient is conscious, but may not be comfortable; indicators are unfavorable SERIOUS - vital signs are unstable and not within normal limits; patient may be unconscious; indicators are unfavorable CRITICAL - condition is unstable and not within normal limits; patient may be unconscious; indicators are unfavorable The condition is usually written to allow the staff to have consistent information for release to the media, etc. Next - Out Patient Clinic ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[21]=new Array("ABLS_point_contact.htm","Advanced Burn Life Support","Advanced Burn Life Support (ABLS) Point of Contact Course Coordination Michael Buffalo, RN, ACPNP - National Faculty - Address - Shriners Galveston Burn Hospital 815 Market St. Galveston, TX 77550 Email - mcbuffal@utmb.edu Phone - 409-770-6953","null","null","");arrFiles[22]=new Array("orientation_nursing_outpatient.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD NURSING SERVICE RESIDENT ORIENTATION cont \'d Out Patient Clinic: A weekly Burn Clinic is held on Tuesday \'s on the 4th floor. In the morning 2 clinics run simultaneously, acute care on one side and recon (plastic) on the other. Burn children return for clinic follow-up after discharge. The recon clinic usually includes initial evaluations for newly accepted patient or follow-up for children being seen on the Recon. (Plastic) service. Cleft Palate Clinic is held on the 1st and 3rd Wednesdays of every month. The UTMB Cleft Palate Team comes to Shriners for this clinic. Acute Rehab. Clinic is held on Thursday mornings for the children that are still at Shriners as outpatients. This includes the children here for the 3 month NIDRR Comprehensive Rehab. Program. During these rounds a chosen PA, PNP or Fellow coordinates the taped summary for the medical record. Housing & Food for Parents & Outpatients: The local Shrine Temples provide the funding for the parents requiring housing and food when their child is here as a patient. Housing is coordinated by the Outpatient office. We utilize in-hospital(4) and outside(5) apartments, Ronald McDonald House and local hotels. The decision for the exact housing location is made based upon the parent and child \'s needs and funding available. The Associate Director for Outpatient and Perioperative Services is responsible for overall housing coordination. Day Surgery Program: Patients requiring day surgery come to the clinic area and are seen the day before for their History & Physical and Anesthesia work-up. Pre-op teaching is done by Child Life to help prepare the child and parent for the procedure. The Day Surgery nurse also works with the family to help coordinate the process. The morning of surgery the parent will be told where to bring the child. Once fully recovered the child will return to the Day Surgery area until ready to leave the hospital. Parents are reminded they can call the in-patient unit at any point with questions or concerns. To post AM admissions and Day Surgery cases call the Day Surgery nurse. The Resource Nurse should be notified on weekends or holidays if Monday Day Surgery is needed. Scheduling OR Cases: The OR Director or Charge Nurse carries the posting pager #643-9617. This pager is to be used to schedule cases for the next day or to modify cases that have already been scheduled. When scheduling a case the following information is needed : 1) Name & room number for the child 2) Faculty covering the procedure 3) Procedure 4) Estimated operating time 5) Amount of blood & skin that has been ordered 6) Position - whether prone, supine, lateral - different positioning devices may be required A resident or fellow needs to be in the operating room at the time the child is induced. General OR Information: Surgery starts at 07:30 on Monday, Tuesday, Thursday & Friday. On Wednesday an 09:00 start time usually occurs due to the medical & anesthesia staff meetings at UTMB. Surgical scrubs are available for you to use during the time you are in the OR at Shriners. These must be changed if you leave the building before the next surgical procedure. The operating rooms are kept very warm during the surgical procedures for the acute patients. If you should become extra warm or feel faint during a procedure, please step out of the room or sit down on a stool in the room. Gatorade, cold drinks, cheese and crackers are available for you outside the OR. Remember this is not meant to be your breakfast or lunch, but as a supplement during the OR time. Recovery for patients will occur in the PACU for all patients on the 3rd floor, Day Surgery or 2 East, unless the patient is a 1:1 assignment. Recovery usually takes about 1 hour or until they meet discharge criteria. Parent Beepers During OR Procedures: Just prior to the patient going to surgery, the OR nurse will give the parent a numeric pager. The parent will be instructed to come to the 2nd floor waiting area when the pager beeps. If at anytime during or following the OR procedure a physician would like to speak to the parent, the Circulating Nurse will page the parent. The pager will be collected once the pager is no longer needed. Next - Pain Management Protocol ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[23]=new Array("ABLS_exportable_reqs.htm","Advanced Burn Life Support","Advanced Burn Life Support (ABLS) Exportable Program Requirements Course Length: 1 Day Maximum Students: 25 Minimum Students: 16 In order to host a ABLS Course at your unit you must meet the following requirements: 1. One Instructor Prep Room- Must seat 10 personnel, have 3 electrical outlets, and have tables and chairs. It should be in close proximity to the classroom. 2. One 25 Person Classroom- Must have writing surfaces for all students, must be temperature controlled, must have a podium. Lights should dim in front half of the classroom. Must have electrical outlet in center front or center rear of the classroom for audiovisual equipment. 3. Skill Station Rooms (4)- Must be within 1 minute walk to classroom and in same hallway, preferably adjacent to one another. Each must have a minimum floor space of 20 \' x 20 \'. Must be well-lit and temperature controlled. All skill station rooms must be cleared of personal items, furniture, equipment, etc. Each room must have 2 tables in it. 4. One Class A Phone- Preferably in the instructor prep room but in same building is acceptable. 5. Copier- In same building as classroom. 6. LCD Projector- Must be able to connect Laptop computer. Course Coordination Michael Buffalo, RN, ACPNP - National Faculty - Address - Shriners Galveston Burn Hospital 815 Market St. Galveston, TX 77550 Email - mcbuffal@utmb.edu Phone - 409-770-6953","null","null","");arrFiles[24]=new Array("orientation_pain_mgmt.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD PAIN MANAGEMENT PROTOCOL Pain Control Recommendations (Revised 01/04/01) Tenet #1 - If the patient says he/she has pain - he/she has pain. Tenet #2 - Analgesics are most effective when given on a regular basis (not as needed or required). Tenet #3 - Intra-muscular injections are not usually appropriate because the child fears the injection as much as the pain (when IM injections are given, EMLA cream should be used). Tenet #4 - Bowel management begins with the narcotic pain management. Tenet #5 - Pain management protocol should be initiated beginning with the following suggested doses. These are starting doses to be modified as the situation dictates in consultation with faculty. Exceptions: This protocol includes the following exceptions in which each dose of pain medication should be individualized for each situation. The following patients will be handled by the senior resident in consultation with faculty -- First 24-48 hours post-burn wherein blood flow is reduced to all organs if patient is in shock. Respiratory difficulty - any cause, if not intubated. Septic shock patient. Malnutrition, unless approved by faculty. Background Pain: 1) Begin with Acetaminophen: Acetaminophen dose = 15 mg/kg/dose PO q4h Draw acetaminophen blood levels starting one day after scheduled acetaminophen is begun. Draw level one hour after dose is given, then weekly thereafter on Mondays. Therapeutic Level = 10-30 ug/ml Toxic Level = >50 ug/ml 2) If the pain is not controlled, give morphine in addition to acetaminophen: IV Morphine dose = 0.03 mg/kg/dose IV q4h PO Morphine dose = 0.1 to 0.3 mg/kg/dose PO q4h 3) If morphine is given in children less than 3 years of age, these rules must be followed: a. Do not give if asleep. b. Do not give for sleep - give only for pain. c. Do not give during initial resuscitation (i.e., first 24 hours post-injury). d. Do not give if patient is in shock or is septic. e. Give only if the patient is being monitored for ECG, respiration, pulse and oxygen saturation. f. Do not give if the respiratory rate is less than 20 or the oxygen saturation is less than 95%. g. If the patient is still in pain, call faculty. Do not increase the morphine dose without faculty approval. 4) Levorphanol (Levo-Dromoran): Use only in patients that are over 16 years of age and > 50 kg in weight. Call psychiatrist-on-call prior to ordering this medication. Levorphanol dose = 2 mg PO q6-24h prn pain. 5) Taper narcotics over 3 days. 6) Ibuprofen (when anti-inflammatory action is also indicated) Ibuprofen dose = 10 mg/kg PO q4h. Do not prescribe for others without approval from the psychiatrist-on-call. Bowel Regimen: 1) Start with the following anytime narcotics are administered - Prune Juice < 5 years 2 oz. > 5 years 4 oz. > 10 years 6 oz. Docusate Sodium < 3 years 25 mg/day (Colace © ) 3-6 years 50 mg/day 6-12 years 100 mg/day 2) Then, add one of the following if the patient becomes constipated: a. Mineral Oil -- 1-3 oz./day b. Mini-enema (Colace © - glycerine) if no bowel movement by noon c. SBH enema if no bowel movement by 15:00 hours Benzodiazepines for Baseline Anxiety: 1) Before using anxiolytics: Address pain management Address Acute Stress Disorder (ASD) problems 2) Lorazepam IV or PO Lorazepam dose: 0.03 mg/kg/dose q4h Lorazepam taper for patients on Lorazepam for > 15 days: Reduce dose by 50% every 2nd day and then reduce frequency. May be tapered post-discharge, if necessary. 3) Diazepam Useful for rehabilitation therapy because it relaxes skeletal muscle. Longer half-life than Lorazepam or Midazolam. No taper necessary. IV or PO Diazepam dose: 0.1 mg/kg/dose q8-12h Procedural Pain Relief and Anxiety Management: 1) For all age groups. 2) To be added in addition to background pain management. 3) The Child Life Therapy Department may be consulted before the procedure for teaching and development of coping skills. 4) Procedural pain medication should be scheduled 30 minutes to 1 hour pre-procedure rather than prn. 5) An anxiolytic with amnesic properties should be given in conjunction with the pain medication (Lorazepam or Midazolam are more potent amnesics than diazepam). 6) Procedural Pain Medication for Dressing Changes : Increase these doses if pain is not well-controlled and over-sedation is not seen. a. Acetaminophen 15 mg/kg/dose may be used if patient does not require opiate therapy. b. Morphine dose for procedural pain is typically twice the dose for background pain -- PO Morphine dose: 0.3 - 0.6 mg/kg/dose (if >15kg) IV Morphine dose: 0.05 - 0.1 mg/kg/dose (if >15kg) c. Fentanyl Oralet dose: 10 mcg/kg/dose rounded to nearest hundred. (Fentanyl Oralets available in 100mcg, 200mcg, 300mcg and 400mcg.) 7) Procedural Anxiolytics for Dressing Changes : a. IV or PO Lorazepam dose: 0.05 mg/kg/dose. 8) Pain Medication for Pre-Rehab Therapy : On request of the therapist 30 minutes before exercise -- a. Morphine PO Morphine dose: 0.1 - 0.3 mg/kg/dose IV Morphine dose: 0.03 mg/kg/dose b. Hydrocodone/Acetaminophen Combinations Hydrocodone dose: 0.2 mg/kg/dose → Lortab Elixir: Each 5ml contains 2.5mg Hydrocodone and 167mg Acetaminophen Lortab Elixir dose: 0.4 ml/kg/dose → Vicodin Tablet: Each tablet contains 5mg Hydrocodone and 500mg Acetaminophen Vicodin dose: 1 tablet/25 kg 9) Pain Management for Acute Patients During Post-Operative Period: a. Patient Controlled Analgesia (PCA) : Recommended for children >5 years old undergoing reconstructive surgery and considered for acute patients. Quality of analgesia should be assessed frequently by the nursing staff. Inadequate pain control should be reported to the primary physician as soon as discovered. PCA is discontinued when pain can be controlled adequately by oral medication. → Morphine PCA - PCA dose: 0.01 - 0.015 mg/kg Lockout: 6 - 10 minutes 4 hour limit: 0.24 - 0.3 mg/kg → Meperidine PCA - PCA dose: 0.15 - 0.2 mg/kg Lockout: 6 - 10 minutes 4 hour limit: 2.5 mg/kg b. Morphine Continuous Infusion via PCA pump : Infusion dose: 0.015 mg/kg/hour and/or Self/administered bolus: 0.05 mg/kg c. Nurse or Physician administered bolus : Morphine IV 0.02 - 0.03 mg/kg/dose q2h (hold if level of responsiveness < 3) 10) Pain Management for Reconstruction Patients During Post-Operative Period: a. Hydrocodone/Acetaminophen Combinations : Do not give concomitantly with Tylenol © -- → Hydrocodone dose: 0.2 mg/kg/dose PO q4h prn pain → Lortab Elixir: Each 5ml contains 2.5mg Hydrocodone and 167mg Acetaminophen Lortab Elixir dose: 0.4 ml/kg/dose → Vicodin Tablet: Each tablet contains 5mg Hydrocodone and 500mg Acetaminophen Vicodin dose: 1 tablet/25 kg b. Morphine : If pain is not controlled with hydrocodone/acetaminophen combination or patient is not on morphine PCA -- IV Morphine dose: 0.05 mg/kg/dose IV q4h prn pain PO Morphine dose: 0.3 mg/kg/dose PO q4h prn pain 11) Opiate and Benzodiazepine Reversal Agents : Flumazenil and Naloxone (Narcan TM ) at bedside - Physician is called whenever flumazenil or naloxone are administered. Doses as follows -- → Flumazenil for Reversal of Benzodiazepines: < 40 kg: 0.01 mg/kg (max. 0.2 mg) then after 45 seconds, 0.005 - 0.01 mg/kg (max. 0.2 mg) then every 60 seconds to 1 mg max. dose. > 40 kg: 0.2 mg over 15 seconds. May repeat 0.2 mg dose over 45 seconds, then every 60 seconds to 1 mg max. dose. → Naloxone (Narcan TM ) for Reversal of Opiates: (Dilute 0.4 mg/ml ampule in 10 ml of NS = 0.04 mg/ml) < 20 kg: Give 1 ml = 0.04 mg. May repeat every 1 minute x 3 doses > 20 kg: Give 2 ml = 0.08 mg. May repeat every 1 minute x 3 doses DEEP SEDATION and ANALGESIA for MAJOR INVASIVE PROCEDURES Ketamine : Titrate to effect according to pain stimulus and respiratory function. Repeated doses of ketamine may increase tolerance to effect. a. Children IV Ketamine dose: 1 -2 mg/kg/dose . May repeat dose every 20 minutes if child vocalizes pain. IM Ketamine dose: 3 - 7 mg/kg/dose . Give only when there is no peripheral IV access. PO Ketamine dose: 6 - 10 mg/kg/dose . b. Adults For patients that are > 16 years of age and > 50 kg in weight, order benzodiazepines in conjunction with ketamine to counteract higher incidence of hallucinations and nightmares in adults receiving ketamine. IV Ketamine dose: 1 - 2 mg/kg/dose, titrate to effect IM Ketamine dose: 3 - 8 mg/kg Next - Post-Operative Management of Nausea in Reconstruction Patients ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[25]=new Array("shrine_acknowledgment_SPANISH.pdf","Microsoft Word - Acknowledgment SPANISH.doc","Shriners Hospitals for Children ­ Galveston Certificación Fundados en 1922, los Hospitales Shriners para Niños nunca le han cobrado a un paciente por concepto de servicios médicos prestados en el Hospital. Gracias a la generosa ayuda de la comunidad, el hospital ha estado prosperando, ofreciendo excelente cuidado médico a niños de todos los rincones de Texas, los estados vecinos y otros países, e impactando a los niños del mundo entero a través de educación y de investigación innovadora. Hoy día, las leyes del estado protegen tanto a los pacientes como a los proveedores de cuidado de la salud, así como al Hospital y sus médicos. De acuerdo con las leyes de Texas, en cualquier acción civil ejecutada en contra de los Hospitales Shriners para Niños, sus empleados, oficiales, directores o voluntarios, la responsabilidad de los Hospitales Shriners para Niños es limitada a daños de dinero en una cantidad máxima de quinientos mil dólares ($500,000) por cualquier acto de omisión que resulte en muerte, daño, o lesión a mí/mi niño(a), pupilo. Entiendo y reconozco de mi parte y la de mi niño(a), pupilo que: 1) Los Hospitales Shriners para Niños están dando atención médica y tratamiento que no es administrado por o en espera de ninguna compensación; y 2) las limitaciones en la recuperación de daños provenientes del Hospital son un intercambio de los servicios del cuidado de la salud. padre, madre o tutor del paciente, responsable de la supervisión de su cuidado abuelos paternos o maternos del paciente hermano o hermana mayor del paciente adulto con el control, cuidado y supervisión del paciente y quien tiene autorización escrita de parte de los padres del paciente para dar consentimiento para sus cirugías y tratamiento persona con responsabilidad legal del cuidado del paciente paciente, 18 años de edad o mayor, paciente, menor emancipado (sin el control de adultos o sus padres)_________________________________ Firma _________________________________ Nombre (en letra de molde) __________________________ FechaNombre del paciente:_________________________ Fecha de Nacimiento:_________________________","null","null","");arrFiles[26]=new Array("orientation_postop_nausea.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD POST-OPERATIVE MANAGEMENT OF NAUSEA IN RECONSTRUCTION PATIENTS PACU Nausea Management ONLY -- 1) Ondansetron (Zofran) dose: 0.15 mg/kg/dose up to 4 mg/dose if needed 2) Droperidol dose: 0.005 - 0.05 mg/kg/dose IV q4-6h if needed Reconstruction Unit Nausea Management -- 1) Trimethobenzamide (Tigan) dose: 5 mg/kg/dose PO or PR q6-8h if needed 2) Promethazine (Phenergan) dose: 0.25mg - 1mg/kg/dose IV, PO, PR q6h if needed Next - Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[27]=new Array("orientation_ASD_PTSD.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD ACUTE STRESS DISORDER (ASD) and POST-TRAUMATIC STRESS DISORDER (PTSD) Pharmacological management of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) symptoms can be the most helpful intervention in acutely burned children. Symptoms commonly described by children and parents include nightmares, flashbacks (re-experiencing the trauma while awake), difficulty falling asleep, difficulty staying asleep, hyper-vigilance, startle response, and dissociative feelings. 1) Please contact the Psychologist-on-call. ASD/PTSD assessment will be conducted prior to beginning therapy and will access possible consent to participate in study, \"Evaluating Effectiveness of Imipramine and Fluoxetine in Treating Pediatric Burn Patients with Symptoms of Acute Stress Disorder \". Post-consent write orders - \"Study drugs are as follows: Fluoxetine Study dose PO qam at 08:00 hours Imipramine Study dose PO qhs at 20:30 hours \" 2) Dosage and Monitoring of Imipramine, a Tricyclic Anti-depressant (TCA) a. Imipramine dose: 1 mg/kg/dose - administer at bedtime (20:30 hours) Imipramine is available only as a 10mg, 25mg, and 50mg tablet and as a 100mg and 150mg capsule. Not available in a liquid form. b. Advance dose based on levels or PR interval (<0.2). c. Draw levels starting one week after imipramine is begun and draw level exactly 8 hours at 05:00 hours the next morning after bedtime dose is given at 21:00 hours the night before. Combined imipramine and its demethylated metabolite, desimipramine, levels: Therapeutic = 150-300 ng/ml total Toxic = >500 ng/ml total 3) Dosage of Fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine dose : Administer in the morning (08:00 hours) 5mg for patients < 40kg 10mg for patients > 40kg and < 60kg 20mg for patients > 60kg Next - Management of Itch Due to Inflammatory Response in Burn Scar Area ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[28]=new Array("search.html","Search Engine Builder Standard -- Search this site","Total Burn Care 2006","null","null","");arrFiles[29]=new Array("orientation_chemical_injury.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD CHEMICAL BURNS Chemical burn injuries are uncommon. These are not hyperthermic, but are due to tissue reactions to noxious substances, including oxidizing agents, reducing agents, corrosives, protoplasmic poisons, desiccants, and vesicants. In general, chemical injuries are deeper than they initially look. The key to treatment of most chemical burns is early and continued copious irrigation of the insulted skin surface. Wounds can be most easily irrigated with water, while a balanced saline solution is preferable for irrigation of mucosal surfaces or eyes. Dilution and not neutralization is paramount. Misdirected attempts at neutralization of acid or alkali burns can produce exothermic damage as well. Deep alkali burns should be irrigated for 24 hours. Initial copious hydrotherapy is indicated for all chemical burns except those caused by dry-line, phenol, concentrated sulfuric acid, sodium metal, and muriatic acid; which either are not miscible with water or react with water exothermically. Besides irrigation, \'antidotes \' are often helpful for burns from hydrofluoric aced, phenol, and white phosphorous. Hydrofluoric acid (HFA) causes liquefaction necrosis of the subcutaneous tissue and can penetrate to bone. Systemic complications of HFA toxicity include hypocalcemia and pulmonary edema. HFA wounds are covered with a 10% calcium gluconate solution mixed to a slurry with a water soluble ointment, or infiltrated if excruciatingly painful. Phenol is an acidic alcohol which produces local coagulation and systemic toxicity in large doses, including fatal arrhythmias. Acute phenol burns are treated topically with polyethylene glycol solution irrigation. White phosphorus is contained in grenades and anti-personnel mines. Once particles are imbedded in skin, white phosphorus causes burn by both chemical and thermal reactions, as particles are spontaneously ignited with prolonged exposure to air. Patients should be submersed in water until imbedded particles can be surgically debrided. The skin is washed with a solution of 5% sodium bicarbonate, 3% copper sulfate, and 1% hydroxycellulose to blacken the particles and aid earlier identification. Prolonged exposure to copper sulfate solution can induce coagulopathies. Next - Future Developments & Conclusions ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[30]=new Array("shrine_acknowledgment.pdf","Microsoft Word - Acknowledgment.doc","Shriners Hospitals for Children ­ Galveston Acknowledgment Founded in 1922, Shiners Hospitals for Children has never charged a patient for services rendered at the Hospital. Thanks to the generous support of the community, the Hospital has been thriving, providing excellent care to children from all over Texas, surrounding States and other Countries, and impacting children worldwide through teaching and innovative research. Today, state law protects both patients and health care providers, like the Hospital and its physicians. In accordance with Texas law, in any civil action brought against Shriners Hospitals for Children, its employees, officers, directors, or volunteers, the liability of Shriners Hospitals for Children is limited to money damages in a maximum amount of five hundred thousand dollars ($500,000) for any act or omission resulting in death, damage, or injury to me/my child/my ward. I understand and acknowledge on behalf of me/my child/my ward that: 1) Shriners Hospitals for Children is providing medical care and treatment that is not administered for or in expectation of compensation; and 2) the limitations on the recovery of damages from the Hospital are in exchange for receiving the health care services. I hereby certify that I am authorized to sign on behalf of the child herein named because I am the: patient \'s parent, managing conservator, or guardian patient \'s grandparent patient \'s adult brother or sister adult with actual care, control, and possession of the patient who has written authorization to consent from the patient \'s parent, managing conservator, or guardian person with legal responsibility for the care of the patient patient, 18 years or older patient, emancipated minor_________________________________ Signature _________________________________ Print Name __________________________ DatePatient Name:_______________________________ Date of Birth:________________________________","null","null","");arrFiles[31]=new Array("orientation_conclusions.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD FUTURE DEVELOPMENTS Both basic science and clinical research efforts the past 30 years have changed the methods of fluid resuscitation, wound closure and nutritional support of the burned patient and significantly decreased the mortality and morbidity experienced by patients with severe thermal injuries. On-going research will significantly alter our ability to appropriately intervene into the various aspects of the \'burn syndrome \'. The early vascular changes invoked by the burn injury may be modulated with the use of various thromboxane synthetase inhibitors, decreasing the incidence of tissue ischemia and progressive dermal necrosis. Inhalation injury, which continues to account for a significant number of burn-related deaths, may be treated with high-frequency \'jet \' ventilation, synthetic surfactants, oxygen radical scavengers and mucolytic agents. These agents may also decrease the severity of ARDS in the burn population, which has replaced the \'shock lung syndrome \' so frequently seen 20 years ago. Hypertonic saline resuscitation may hold promise for the treatment of burn injuries in the pre-morbidly compromised patient who is exquisitely sensitive to volume overload. Bacterial translocation, which is currently thought to be a major component of the infection/sepsis cycles of the burn patient, may be attenuated or ablated with early aggressive enteral nutrition, selective mesenteric vasodilators or prostaglandin inhibitors. Other infectious complications may be combated with monoclonal antibodies, future generations of antibiotics, pseudomonal \'vaccination \' or selective endotoxin binding agents. Replacement of the destroyed cutaneous tissue may be performed completely in the laboratory, using new tissue culturing techniques of autologous or non-antigenic homologous cells. Artificial collagen matrices may also become available, providing a scaffolding for the in-growth of autologous fibroblasts and capillaries. Various endogenous human growth factors have recently been identified, isolated and spliced into bacterial hosts, making sufficient quantities available so that their application to wounds becomes feasible. The use of various pharmacologic agents to modulate the post-burn hypermetabolic response, such as beta blocking agents and human growth hormone, may decrease the amount of post-burn morbidity and promote the maintenance or rapid restoration of nutrient substrate hemostasis. CONCLUSIONS Successful management of the acute burn patient requires prompt aggressive fluid resuscitation, metabolic/nutritional support, control of bacterial infection, anticipation and prevention of complications, timely closure of the burn wound, and early initiation of rehabilitation therapy. Burn shock must be adequately treated. Post-burn malnutrition must be prevented. In the post-burn stress response, all major organ systems are affected. Closure of the wound is essential for correction of the pathophysiologic post-burn derangements. In essence, management of the burn patient is a race against time, as rapidity of wound closure is inversely related to mortality. This race must be tempered, however, with thoughtful considerations of ultimate function, cosmesis, and quality of life. Next - Documentation for Special Studies ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[32]=new Array("orientation_mgmt_itch.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD MANAGEMENT OF ITCH DUE TO INFLAMMATORY RESPONSE IN BURN SCAR AREA 1) Use moisturizing body shampoo and lotions to alleviate itching due to dry, scaly skin. 2) Topicals : a. Preparation H: Astringent properties relieve itch. b. Benadryl Cream: Sometimes helpful in relieving itch. c. Hydrocortisone 1% Cream: Low potency corticosteroid. Used only in very resistant cases because of corticosteroid necrotizing local effect. - Need Attending Staff approval - 3) Diphenhydramine (Benadryl) : a. Sedating properties useful in calming patient, thus relieving itch. b. Antihistamine properties useful in management of itch due to morphine histamine release. c. May cause hyperactive paradoxical effect. d. Dose: 1.25 mg/kg/dose PO q6h. 4) Hydroxyzine (Atarax) : a. Literature states hydroxyzine most effective antihistamine for chronic urticaria. b. Dose: 0.5 mg/kg/dose PO q6h. 5) Cyproheptadine (Periactin) : a. Phenothiazine side effects useful in producing sedation and itch management at bedtime. b. Dose: 0.1 mg/kg/dose PO q6h . 6) Loratidine (Claritin) : a. Non-sedating antihistamine. b. Dose: Children > 6 years of age = 10mg . Next - Rehabilitation Services \'Child Life \' ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[33]=new Array("orientation_special_studies.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD DOCUMENTATION FOR SPECIAL STUDIES All x-rays and all special studies, radiographic or otherwise, will be documented as follows: 1.) Order written. 2.) Dated and timed entry in progress notes naming the study and giving indication for study and name of surgeon requesting study, if other than person writing note. 3.) Dated and timed entry in progress notes listing findings of study, pertinence of findings and any change in management based on findings. All procedures requiring radiographic monitoring - as central line placement - will be documented in the same way, except that one timely note may suffice for indication and outcome. Next - Psychological and Psychiatric Services to Children and Families ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[34]=new Array("orientation_dictation.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD DICTATION SYSTEM Shriners Hospital For Children 815 Market St. Galveston, TX 77550-2725 To Dictate : (follow the voice prompts) 1. Enter your 4-digit physician ID number. 2. Enter the 2-digit work type (or press appropriate station keypad). 3. Enter the 5-digit medical record number. 4. Enter the 2-digit department number (or appropriate station keypad). DEPARTMENTS 10 - General Surgery 14 - Plastics 11 - Ortho 15 - Otolaryngology 12 - OutPatient/Nursing Svc 16 - Maxillofacial 13 - Rehab 17 - Other WORK TYPES 01 - History & Physical 05 - Rehab 02 - Operative Reports 06 - Letters 03 - Discharge Summary 07 - Consultations 04 - Clinic 08 - Other To dictate another report, press \"5 \" and repeat from step 3. Please press \"9 \" to disconnect at the end of your dictation session. If you wish to change from Dictate to Report Review, after you have pressed \"5 \" to end your current dictation, press \"# \" then \"1 \". Listen to the voice prompts for Review choices. To change from Report Review to Dictate, press \"# \" then \"2 \". To Insert Text: 1. Press \"4 \" to pause at the point where you wish to insert text. 2. Press \"# \" then \"6 \" to switch to the insertion mode. Dictate the new text. 3. Press \"3 \" to rewind and verify the change. Lanier Keypad Functions 1 Listen (Review) 2 Record/ Dictate 3 Rewind 4 Pause 5 End 6 Go to End (Insert) 7 Fast Forward 8 Go to Beginning 9 Disconnect * Clear 0 # (Shift) FORMAT FOR DICTATION Discharge Summary : When dictating the discharge summary, please indicate your name and title, the staff physician \'s name, the date of admission, date of discharge and the patient unit history number. * Chief Complaint * History of Present Illness * Physical Examination * Diagnostic Laboratory and X-Ray Findings * Hospital Course * Operations (include date, pin insertions, and donor site) * Final Diagnosis * Condition on Discharge (this should be compared to the admission status) * Disposition (include special instructions for wound care) a) Medications c) Physical Activity b) Diet d) Follow-up and Plan Operative Reports : When dictating operative reports, please indicate your name and title, the staff physician \'s name and any assistants present during the operation, the date the procedure was performed and the patient unit history number. * Pre-Operative Diagnosis * Operation (name of procedure performed) * Post-Operative Diagnosis * Indications * Operative Findings * Procedure (detailed explanation) * Estimated Blood Loss * Sponge and Needle Count * Condition of Patient on Transfer * Cm 2 skin excised Next - Safety in the Workplace and Accident Prevention ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[35]=new Array("orientation_psychological_services.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD PSYCHOLOGICAL AND PSYCHIATRIC SERVICES TO CHILDREN AND FAMILIES Every child who is admitted to Shriners Hospital can be expected to experience psychological distress and to demonstrate symptoms of that distress. The psychological, as well as the physical condition must be addressed from the time of admission of the patient in order to promote recovery. The acutely burned child \'s distress is both physical and psychological. Common reactions of children in this situation are fear, anxiety, acute stress disorder and, of course, expressions of pain. Issues of body image, social relations and self-concept will arise as the child progresses toward discharge from the acute care setting. It is not uncommon for the acutely burned child to have experienced great losses in addition to their injury; for example, children may have lost a parent, a sibling, their home or a beloved pet in the catastrophe that caused their own injuries. They must be told of such losses and assisted in grieving even while continuing to struggle with the discomfort of recovery and rehabilitation. The family of the burned child is also greatly impacted by the injury to the child. They are traumatized and grieving and feeling extreme guilt, usually irrational. They, too, can be expected to exhibit symptoms of trauma. They, too, are our \'patients \', for we need them to be healthy assets to the recovery of the child. Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services. There is no need to write a consult for these services for they are provided routinely for every patient. However, there is a need for the psychology-psychiatry team to hear of any observations made by other staff on an on-going basis. Clinical Services Staff: Clinical Psychologist 2 part-time Child Psychiatrists 2 Psychologists 1 Psychology Post-Doctoral Fellow We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family. Intake Assessment: Upon arrival, the family is assessed for risk factors or problems that must be addressed during and following hospitalization. All families have strengths and weaknesses, and their difficulties are exacerbated by trauma. At this time, risk for abuse is also assessed. If the child is 2 years of age or younger OR if any risk factors are present, e.g. injury does not match parent \'s story, Department of Protective and Regulatory Services (DPRS) have been contacted prior to arrival at Shriners; inconsistencies in repeated versions of the story, appearance of burn (e.g., dip lines, bottom of feet not burned while all surrounding skin is), we will contact DPRS. Resident \'s Role: If you observe indicators of abuse, tell us. You, and we, must report suspicious injuries and protect the child. You must order a long bone series x-ray and be sure that signs of abuse are documented in your notes and by photographs. If we contact DPRS, we ask you to complete the Physician \'s Report of Suspicious Injury form. If we report a suspicious injury, we must not discharge the child until DPRS gives the \'okay \'. Psychotherapy (both individual and family): Each family is assigned a primary mental health professional. The family can choose the extent of service they receive. At minimum, the mental health professional will routinely assess for current or anticipated adjustment difficulties and intervene accordingly. If appropriate, the professional will offer more extensive psychotherapy. Issues commonly brought to counseling by the child include: symptoms of acute stress, management of acute pain (through hypnosis or relaxation), anxiety or depression, grief due to death of another or loss of objects or partial loss of self, body image, and self-esteem. Families are commonly dealing with fear, guilt, anxiety, and post-trauma stress. Resident \'s Role: For both the patient and the patient \'s family, you are likely to see signs of emotional distress and behaviors that have the potential to escalate into a crisis situation. Symptoms of depression and anxiety (notably Acute Stress Disorder) are most common. Common signs of distress include, but are not limited to: tears, withdrawal, sleep disturbance, agitation, refusing treatment plan, yelling, grinding teeth, verbalization of hopelessness, denial of disfigurement, expressed fears, short temper, anger, hypervigilance (in general and in seeking information about child \'s care), nightmares, flashbacks. You should hunt for emotional distress in the same manner you would hunt for any anomaly in physical function. Note your observation to the patient or parent. Express your interest/concern through queries. If distress is present and you wonder if further intervention may help, call the assigned mental health professional or call x6718 and state the name of the child for whom you are concerned. School Services: Our full-time school teacher will enroll a school-aged child in the school program as soon as possible. The hospital school is accredited by Galveston ISD and our patients receive credit for the time they are enrolled in this school. School is important in the hospital because it is the normal activity for most children, and our goal is to return them to normalcy as soon as possible. If you have concerns about a patient \'s involvement in the school program, call Psychological Services at x6718 and ask to speak to the teacher. Bereavement Counseling: If a child \'s condition is taking a life threatening direction or if a child is dying, call the psychologist or psychiatrist involved with that child at x6718 or ask the unit clerk to page that clinician. The psychologist or psychiatrist will assist in discussions with the family and in attending to family concerns while you attend to the child. Clinical Research Longitudinal Assessment: A multi-disciplinary research project that assesses post-burn adaptation for a minimum of 3 years. Areas assessed include: 1) physical adaptation - bone age, bone density, muscle strength, pulmonary functioning, magnitude of disfigurement, sexual maturation, growth (height and weight); 2) emotional adjustment - family environment, child \'s behavior as measured by parent, child and teacher, parenting stress, post-trauma symptoms, child \'s developmental competency level, level of emotional distress for parent and child. {Part of the National Institute on Disability and Rehabilitation Research (NIDRR) Burn Model Systems project} Resident \'s Role: Parents will likely ask you about the NIDRR studies, so be aware of the study, know that research protocols are available to you on the unit, and call for any questions or assistance in responding to parent or child queries/concerns: x6715 -or- x6718. Pain, itch, anxiety and post-trauma symptoms - Assessment: In addition to the pain medication protocol, the staff in the Department of Family Services work at assessing the patient \'s discomfort, as well as guiding all staff to assess the patient \'s pain in the most effective manner. Symptom management can be addressed at any time, but is specifically addressed in the Discharge Planning Meeting, Tuesday, 7:30a.m. and in Rehab. Rounds, Thursday 7:00a.m. Resident \'s Role: As you spend a great amount of time with the patients and their families and are involved with the most painful of interventions, you can be most effective in assessing and treating the patient \'s pain. With the infant and children up to the age of 3, the patient \'s pain is assessed by the Observer Pain Scale with the primary caregiver being the reporter. Ask the parent to assess pain in each of these 4 environments: 1) when your child is lying or sitting and his/her wounds are fully dressed, how much pain do you imagine he/she is in?; 2) during the bath, how much pain do you believe your child is in?; 3) during dressing changes in the hospital room,........; 4) during the rehab. exercises, ......... Elicit from the parent what behaviors of the child contribute to his/her assessment, e.g. flailing of limbs, rigid extension of limbs, lack of cooing, developmentally regressed behavior, type of cry or whimper, lack of interest in toys, changes in indicators of symptomatic function (blood pressure, pulse, temperature), repetitive or stereotypic behavior. For the children 4-8 years of age or greater, the Faces of Pain Scale is utilized, and the patient is the reporter. Assess pain for the same 4 environments. Also, when addressing pain, a good habit is to inquire about quality and amount of sleep, especially nightmares, and level of itching. Sleep Disturbance and other symptoms of acute post-trauma anxiety: We have studied the efficacy of imipramine in low doses to treat these symptoms and have now begun a study comparing imipramine to prozac. Both studies are blinded. If a child is experiencing nightmares, flashbacks, intrusive memories, please refer that child for the \'sleep study \' by calling x6715, x6718 or x6722. We will assess and communicate our findings/recommendations to you. And finally, we are always on call and serve a liaison service to you. If you have any hint of a concern or any question, please dial x6722 or ask the unit clerk to page us. Next - Nursing Service Resident Orientation ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[36]=new Array("72hour_burn_assessment.pdf","72hour_burn_assessment.tif","","null","null","");arrFiles[37]=new Array("orientation_rehab_services_child_life.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION New staff will be introduced to Rehabilitation Services \' Divisions of Child Life, Graphic Arts, Medical Sculpture, Occupational Therapy, and Physical Therapy. Child Life Objectives : A. Present philosophy of Child Life Department. B. Family-centered care. C. Continuing emotional/developmental growth of hospitalized children. D. Increase coping skills through play and music. E. Provide emotional support. F. Normalize the hospital experience. Responsibilities of Child Life Staff : A. Playroom. B. Pre-op teaching. C. Make-up program guidelines. D. School re-entry guidelines for videos and/or re-entry visits. E. Bedside interventions. F. Emotional support provided by Child Life Specialist and Music Therapist. Communications : A. Multidisciplinary discharge planning meetings. B. Chart notes. C. School/Staff referrals. Next - Rehabilitation Services \'Graphic Arts \' ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[38]=new Array("bbu_referral1.pdf","bbu_referral1.tif","","null","null","");arrFiles[39]=new Array("orientation_rehab_services_graphic_arts.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION cont \'d The Graphic Arts Dept. provides all photographic and illustration services for the hospital. Normal working hours are 7:30a.m. - 4:00p.m., Monday through Friday. The dept. is comprised of a customer service area, photography studio, finishing room, 2 darkrooms, and graphic arts areas. Graphic Arts Department Customer Service Area : A. Customer work request filled out by Graphic Arts personnel. B. Service performed per posted turn-around schedule. Medical Photography : - Patient photography (Acute & Reconstructive) - (See Patient Rights, Section PR.013) A. Admissions (Use Polaroid if not during normal working hours. Call immediately if suspected abuse or patient going immediately to OR) B. Dressing changes as per medical/paramedical staff. C. Operating room as per medical/paramedical staff. D. Clinical as requested by medical/paramedical staff. E. Discharge of patient. F. Clinic as per medical/paramedical staff via photography request form. G. Outreach clinic as per photography request form located with patient \'s clinic forms. H. Autopsy. Other In-House Services : A. Slide Duplicates - legal and teaching. B. Film Processing - color slide E-6 process, black & white film developing. C. Passports - for official use only. D. Public Relations - as directed by Administration/Public Relations. E. Color, Black & White Slides from Books, X-rays, etc. - In-house teaching, medical/scientific meetings. F. Displays/Exhibits - Public relations, medical/scientific. G. Photographic Printing includes publications, public relations, or as needed by hospital. Medical Illustrations : A. Poster Exhibits - Medical/scientific staff, public relations, and teaching. B. Produce & Design Forms - Medical and administrative. C. Framing & Matting - Photographs, certificates. D. Produce & Design Certificates - Medical/scientific staff, administrative. E. Charts, Graphs, Color Slides - Computer generated in PowerPoint. Next - Rehabilitation Services \'Medical Sculpture \' ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[40]=new Array("bbu_referral2.pdf","bbu_referral2.tif","","null","null","");arrFiles[41]=new Array("orientation_rehab_services_medical_sculpture.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION cont \'d Medical Sculpture Provides the following services for inpatients and outpatients: These services are provided at bedside, in the operating suites or recovery room and in the department. Department Services : A. Silicone rubber face masks. B. U-vex face masks. C. Silicone rubber conformers of various types. D. Mouth splints. E. Ear and nose conformers. F. Hair pieces. G. Ear and nose prosthesis. H. Supply conformers for scheduled outreach clinics. Orders : A. All orders evaluated and accepted according to specified criteria of need and by physicians \' orders (green stripe) only. Educational : A. Open and ongoing communication and problem-solving with all members of the health care teams. Encouraged and followed-through as needed. B. Available for tours of facility by outside groups, i.e. Shriners and Medical Staff. C. Available for informational in-services as needed, or upon request. Next - Rehabilitation Services \'Occupational/Physical Therapy \' ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[42]=new Array("RACE_firepage.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD R.A.C.E. METHOD FOR FIRE RESPONSE The R.A.C.E. method for responding to a fire emergency : R - Rescue Move patients and assist visitors or impaired employees away from immediate danger of fire or smoke IF YOU CAN DO THIS WITHOUT PUTTING YOURSELF IN IMMEDIATE DANGER and IF THERE ARE OTHER STAFF AVAILABLE TO COMMUNICATE THE EMERGENCY AND TURN IN THE ALARM. A - Alert others Activate manual pull station alarm as soon as possible. Call #6688 and state the location, type of fire and size. Notify co-workers - and make sure everybody in the area, and in other departments in your area, know as well. C - Confine Close all doors and windows. Pack sheets and towels under doors to contain smoke. If there is oxygen in the area : Oxygen to a patient can be shut off by a nurse at the bedside after other staff have the patient and are ventilating them. Oxygen to a zone (a whole unit) can ONLY be shut off by Maintenance and Engineering after nursing staff authorize it (patients on oxygen are cared for). Oxygen to the building is only shut off after the Fire Marshal orders it and after nursing staff authorize it (patients on oxygen are cared for). E - Extinguish Select the appropriate fire extinguisher. Use the P-A-S-S technique to extinguisher the fire. (see below for P-A-S-S technique) E - Evacuate Move people (patients, parents, visitors, staff) to next lateral fire compartment on the 1st, and 4th through 8th floors. On 2E and 3E and 2W and 3W, move 2 compartments laterally. Stay in the evacuation area until ordered to move by the Fire Marshal. Staff on floors above the fire use fire stairwells to evacuate. Staff on the 3rd floor use stairwells to evacuate patients to the 2nd floor if ordered to do so. Patients are evacuated from the building by the 2nd floor crosswalk. Close doors behind you. If you are not at the scene of the fire, make sure you can hear overhead instructions and the \'all clear \'. Have someone posted in the hallway to relay this information. LISTEN for the \"Dr. Red, All Clear \" announcement or further instructions. REMEMBER √ Memorize the telephone number to call to report a fire in the building - #6688. (770-6688) √ Learn how many fire compartments there are, and their locations, in your work area. √ Know the R.A.C.E. response to fires. √ Learn the differences between response to fire at the scene of the fire, and response to a fire on a different floor or in a different compartment. Back to Fire Safety LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[43]=new Array("orientation_PTSD.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD ACUTE STRESS DISORDER (ASD) and POST-TRAUMATIC STRESS DISORDER (PTSD) Pharmacological management of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) symptoms can be the most helpful intervention in acutely burned children. Symptoms commonly described by children and parents include nightmares, flashbacks (re-experiencing the trauma while awake), difficulty falling asleep, difficulty staying asleep, hyper-vigilance, startle response, and dissociative feelings. 1) Please contact the Psychologist-on-call. ASD/PTSD assessment will be conducted prior to beginning therapy and will access possible consent to participate in study, \"Evaluating Effectiveness of Imipramine and Fluoxetine in Treating Pediatric Burn Patients with Symptoms of Acute Stress Disorder \". Post-consent write orders - \"Study drugs are as follows: Fluoxetine Study dose PO qam at 08:00 hours Imipramine Study dose PO qhs at 20:30 hours \" 2) Dosage and Monitoring of Imipramine, a Tricyclic Anti-depressant (TCA) a. Imipramine dose: 1 mg/kg/dose - administer at bedtime (20:30 hours) Imipramine is available only as a 10mg, 25mg, and 50mg tablet and as a 100mg and 150mg capsule. Not available in a liquid form. b. Advance dose based on levels or PR interval (<0.2). c. Draw levels starting one week after imipramine is begun and draw level exactly 8 hours at 05:00 hours the next morning after bedtime dose is given at 21:00 hours the night before. Combined imipramine and its demethylated metabolite, desimipramine, levels: Therapeutic = 150-300 ng/ml total Toxic = >500 ng/ml total 3) Dosage of Fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI) Fluoxetine dose : Administer in the morning (08:00 hours) 5mg for patients < 40kg 10mg for patients > 40kg and < 60kg 20mg for patients > 60kg Next - Management of Itch Due to Inflammatory Response in Burn Scar Area ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[44]=new Array("shrine_application1.pdf","shrine_application1.tif","","null","null","");arrFiles[45]=new Array("orientation_rehab_services_occup_phys_therapy.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION cont \'d Occupational/Physical Therapy The rehab philosophy is to assist the patient to reach the highest level of function possible. This requires efforts of the entire interdisciplinary team. Our therapists are cross-trained and there is not a difference in patient care between the 2 disciplines. Therapists are known as \"Burn Therapists \" and physicians \' orders should be written for \"Rehab \" or \"OT/PT \". Evaluations/Assessments : A. Initial - Evaluation requires physician signature for performance (orange stripe form). B. Ongoing - Physicians \' orders reflect rehabilitative care throughout hospitalization. C. Discharge - Referral for outpatient therapy requires physician signature. D. Return to Clinic - Outpatient Summary requires physician signature. Parent/Patient Education : A. Bandage wrapping and splint application classes are Monday and Wednesday at 13:30 (staff invited to classes) B. Educational slide programs are Friday at 13:30. The program stresses the importance of pressure, splints, activity, exercises, and positioning. Patients are included in this formal training at age 9 and above. The primary therapist assigned to the patient provides one-on-one training on exercises. Communication : A. Tuesday - Interdisciplinary D/C Planning Meeting. B. Thursday - Grand Rounds. C. Monday, Wednesday, Friday - Unit rounds on a daily basis at bedside with team, 7:00a.m. D. Saturday, Sunday & Holidays - Unit rounds at 9:30a.m. (or as the attending physician schedules). E. Weekend Treatment - Therapists provide priority treatments only. Only 2 therapists are present on weekends and holidays. Rehabilitation Referrals : A. Referral process and paperwork. Outpatient/Outreach Clinics : A. All above procedures are tracked and continued in terms of the patient and family meeting their rehabilitation goals. Outpatient summaries are updated and provided to patient family and referral source. Our department participates in outreach clinics to provide follow-up treatments to patients in their community or surrounding areas. During these clinics we proved priority therapy needs, i.e. splinting and pressure therapy, and we make recommendations for the next level of rehab care. School Re-entries : A. The department assists with school re-entries so the children \'s return to school may be a smooth transition. TEAM WORK IS VITAL FOR GOOD PATIENT CARE Next - Basic Treatment Procedures ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[46]=new Array("orientation_rehab_services.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION New staff will be introduced to Rehabilitation Services \' Divisions of Child Life, Graphic Arts, Medical Sculpture, Occupational Therapy, and Physical Therapy. Child Life Objectives : A. Present philosophy of Child Life Department. B. Family-centered care. C. Continuing emotional/developmental growth of hospitalized children. D. Increase coping skills through play and music. E. Provide emotional support. F. Normalize the hospital experience. Responsibilities of Child Life Staff : A. Playroom. B. Pre-op teaching. C. Make-up program guidelines. D. School re-entry guidelines for videos and/or re-entry visits. E. Bedside interventions. F. Emotional support provided by Child Life Specialist and Music Therapist. Communications : A. Multidisciplinary discharge planning meetings. B. Chart notes. C. School/Staff referrals. Next - Graphic Arts Department ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[47]=new Array("orientation_rehab_services_basic_treatment.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION cont \'d Basic Treatment Procedures Splinting - Pressure - Positioning - ROM/Strengthening - Ambulation Activities of Daily Living (ADL \'s) Splinting Static Splint : Have no movable parts and maintain joint in one position. Preventative : Prevents deformities. Usually we allow patient to be free of splint wear during ADL \'s and dressing changes. Protective : Post-operative to prevent disruption of newly applied skin grafts. Supportive : Immobilize, protect, and position damaged tendons and joints. Corrective : To gradually/serially correct a contracture by assisting to maintain joint following active and passive exercises. Dynamic Splinting : Applies specific force in a place of motion through elastic traction while allowing the patient some motion of the joint. These splints should be considered for those joints that demonstrate the most resistance to passive stretch and positioning. Splints that are commercially available work best when this problem occurs over large joints. ADL \'s : We provide adaptive equipment as needed, and train patients in achieving maximum independence in performing activities of daily living. Focus on splinting should be on those motions that are most difficult to regain: Neck extension/rotation MCP flexion Shoulder flexion/abduction IP extension of the hand Elbow/Knee extension Ankle dorsiflexion MPT flexion Positioning Positioning is one of the fundamental practices necessary for successful burn patient rehabilitation. Positioning in bed and in sitting is important. Pressure Pressure is used as treatment of scar management and can vary by use of: Ace Bandages - Tubigrip - Interim Garments (pre-fabricated) - Custom Garments - Coban (elastic woven wrap that can be used for the hand and fingers as a temporary glove). When a healed burn surface is able to tolerate a minimal shearing force, a tubular bandage or garments can be used. Tubular bandages may be used as an interim compression device or used as a definitive appliance. Inserts: Due to body makeup, inserts are sometimes necessary to achieve adequate pressure in certain body areas. These devices help to apply even pressure over the scar. The effectiveness of pressure garments is under evaluation at Shriners Burns Hospital-Galveston. We are conducting a study where patients with small burns are randomized to receive, or not receive, pressure garments after informed consent is obtained. Patients with large burns (> 10% grafted area) will receive pressure only to one extremity vs. no pressure to the contra-lateral extremity. All patients will remain in ace wraps to burned/grafted areas 1 month post-discharge. Next - How to Use the Dictation System ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[48]=new Array("PASS_firepage.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD P-A-S-S TECHNIQUE FOR FIRE EXTINGUISHER USE The P-A-S-S technique for fire extinguisher use : P - Pull the pin. It is there to prevent accidental discharge. A - Aim low at the base of the fire. This is the where the fuel source is. S - Squeeze the lever above the handle. Release to stop the flow. (Some extinguishers have a button instead of a lever) S - Sweep from side to side. Move toward the fire, aiming low at its base. Sweep until all flames are extinguished. Watch for re-igniting. Repeat as necessary. Have site inspected by fire department. Place any fire extinguisher that has been used on its side on the floor. It will be collected and recharged after the fire scene is secure. REMEMBER √ Learn Pull-Aim-Squeeze-Sweep (PASS) to help you remember how to use fire extinguishers and what to do with them after use. √ Fire extinguishers are located in fire cabinets next to fire stairwell doors. They are multi-purpose (ABC) extinguishers. Back to Fire Safety LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[49]=new Array("tbcflashbanner.htm","Untitled Document","null","null","null","");arrFiles[50]=new Array("disclaimerpage.htm","Total Burn Care Disclaimer","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM * DISCLAIMER * Medical knowledge and treatment is always changing. New information necessitates change in the treatment, equipment, procedures and use of drugs in patients. We have been diligent in seeing to it that the information contained on this web site is accurate and up-to-date. Visitors are strongly advised to confirm that the information they take from this site complies with the latest standards of practice. This is especially true of drug usage, as information and legislation are ever-changing. LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[51]=new Array("shrine_application2.pdf","shrine_application2.tif","","null","null","");arrFiles[52]=new Array("orientation_accident_prevention.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD SAFETY IN THE WORKPLACE AND ACCIDENT PREVENTION 1. Adopt a safety-minded attitude. Safety is everybody \'s job, but working safe is your individual responsibility. Make Prevention a part of your work habits. 2. Focus on the task at hand. When \'noise \' in your environment distracts you, everyone is at risk for accidents. Identify the \'noise \' in your work situation and take actions to limit the source of the distraction. 3. Time pressures can interfere with safe practices. Take the time to do the job right. Do not be tempted to take short-cuts with safe practices. Do not work in an unsafe manner because of pressure to get the job done. 4. Alertness to hazards can prevent most accidents. Make a habit of noticing and eliminating potential hazards. For example: - Wet, slippery surfaces - Tangled cords and tubing - Misused alarms - Misused wheel locks - Equipment in need of repair 5. Everyone in the hospital shares responsibility for a safe environment. Patients, family members and their visitors need instruction related to their roles in keeping the hospital \'s environment safe. Raise the awareness level of safety hazards. (Your co-workers \' pro-safety attitudes can reduce your personal risk of accidents and injury on the job). You are encouraged to tell your supervisor immediately if you are concerned about safe working practices. Report unsafe conditions, accidents and incidents immediately. 6. Commitment to do the \'right thing \' creates a positive environment for safety. Set an example for others in your use of safe work practices. Next - Fire Safety ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[53]=new Array("orientation_fire_safety.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD FIRE SAFETY 1. The code-name for a fire situation at Shriners Galveston Hospital is \" Dr. Red \". 2. The telephone number to call to report a fire is #6688. 3. A \"fire compartment \" is created by 2-hour fire-rated walls with fire doors. The walls are continuous (without gaps or open spaces) between floors. There are 3 fire compartments on the 2nd through 7th floors of the hospital. These are named East , Central , or West preceded by the floor number (e.g., 2 East, 3 West, 4 Central) There are 2 fire compartments on the 1st and 8th floors. These are named East or West. The 2nd and 3rd floors have a \"Zone \" within the central compartment - this is the open atrium between the 2nd and 3rd floors. 4. Shriners Galveston Hospital uses the R.A.C.E. method of fire response. (Click here for the R.A.C.E. method) 5. Learn how to respond if there is a fire in your building, but not on your floor. 6. Learn fire alarm locations and how to operate them. 7. Learn where fire compartments stop and start. 8. Learn fire extinguisher locations and the classes of fire extinguishers in use in your area. 9. Learn the location of fire exits, fire compartments and review the evacuation plan. While on duty, be sure to : - Keep corridors clear. - Take fire drills seriously. - Strictly enforce \'no-smoking \' policy. (Smoking causes 50% of all fires) - Report any smell of smoke by calling #6666. - Operate fire extinguishers using the P-A-S-S technique. (Click here for the P-A-S-S technique) While on duty, DON \'T : - Allow trash to build up. - Allow corridor or fire exits to be blocked. - Use, or allow patients and visitors to use, any unapproved extension cords or appliances. Next - Safe Medical Devices ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[54]=new Array("admission_deposit.pdf","admission_deposit.tif","","null","null","");arrFiles[55]=new Array("orientation_medical_devices.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD SAFE MEDICAL DEVICES Medical device - any implement used to assess, treat or rehabilitate a patient, with the exception of drugs. The federal \"Safe Medical Devices Act \" requires that medical devices that injure patients or employees, be reported and investigated. Medical Devices Reportable Incident (MDR) - any event in which a medical device causes serious illness, serious injury or death. When an MDR occurs : 1. The patient or injured party comes first. Notify the in-house physician in all cases. 2. Attend to the physical and emotional needs of the injured person. 3. Remove and impound the medical device. - Label the device. - Save all materials and packaging related to the device. - Leave the device intact. Do not disassemble, clean or otherwise modify it. - Protect yourself and others by using universal precautions and biohazard labeling. 4. Report the incident to your supervisor AND notify the Risk Manager. (#6675) (pager: 645-5670) 5. The Risk Manager will give instructions for handling of impounded equipment for evaluation and repair. 6. You may be instructed by your supervisor to complete the Shriners Galveston Hospital occurrence report form. Do not complete this form until instructed to do so by your manager. 7. A physician must examine the patient or injured party. They will evaluate the severity of the injury, document their findings, and state what treatment was initiated. There are no exceptions, no matter how small a patient injury seems to be. REMEMBER √ If medical equipment malfunctions or is involved in a patient injury, first take care of the patient and immediately notify the in-house physician. √ Impound the equipment and any disposable parts that connect, and wrappings. √ Notify Risk Management (#6675 or pager 645-5670) where the equipment is and what has happened STAT. √ Await instructions from your supervisor on completing occurrence reports. Next - Radiation Safety ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[56]=new Array("orientation_radiation_safety.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD RADIATION SAFETY Everyone is exposed daily to various kinds of radiation: heat, light, ultraviolet, microwave, ionizing and so on. For the purpose of this guide, only ionizing radiation (such as x-rays, gamma rays, neutrons and other high-speed atomic particles) is considered. Actually, everything is radioactive and all human activities involve exposure to radiation. People are exposed to different amounts of natural \'background \' ionizing radiation depending on where they live. The average person is exposed to a total dose of about 125 millirems per year from natural background radiation. Biologic effects of ionizing radiation : Genetic - radiation induced gene mutations, chromosome breakage and anomalies Somatic - incidence of leukemia, thyroid tumors, skin lesions and cataracts Growth - adverse effects of fetus and young children Life Span - shortened life-span or premature aging To prevent injury : Keep your radiation exposure as low as reasonably achievable by: - Reducing the time and potential for exposure. - Maintaining distance from radiation sources. - Using shielding. Observe radiation safety practices : 1. Identify radiation warning signs. 2. Observe rules of time, distance and shielding. In Labs : Do not smoke, eat, drink, or apply cosmetics around radioactive materials in labs. Do not pipette solutions by mouth in labs where radioactive materials are used. Use disposable gloves while handling radioactive material when feasible. Wash hands after working around radioactive material. In Clinical Areas : Wear protective shielding material when indicated. Wear a monitoring device based on use of radiation equipment or radioactive materials if your job requires it. Do not hold patients for radiological procedures. 3. When in doubt, ask the hospital \'s Safety Officer by calling #6675. Next - Electrical Safety ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[57]=new Array("orientation_electrical_safety.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD ELECTRICAL SAFETY Prevent electrical shock : ◦ Never use adapters (or anything) if the grounding pin of a plug has been removed. (This turns a normal plug into a dangerous plug) ◦ Extension cords are prohibited for connection of equipment as the permanent power source in the building. The hospital engineering department should be consulted for assistance if a power supply is not available where it is needed. ◦ Always unplug electrical devices by pulling the plug, not the cord. ◦ If you receive even a small amount of shock from a device, take the device out of operation - Immediately : → Follow the hospital policy on obtaining repairs for clinical equipment. → Report it to maintenance/engineering department or your supervisor immediately. ◦ Report any hazardous conditions or unauthorized devices immediately. ◦ Report devices with any visible damage. Remove from the work or patient-care area and tag for repair by Research Technology Support (formerly BMEE). ◦ Do not bring in privately-owned electrical equipment. Treat the victim of electrical shock : 1. Turn off the power immediately. Unplug the device at the outlet. Trip the circuit breaker if safe and accessible. Separate the victim from the power source only if it is safe to do so. The victim \'s body can conduct electricity, as can other conductive materials. Be careful what you touch! 2. Check the victim for pulse and respiration. Start ventilations if respirations are absent. Start CPR if pulse and respirations are absent. Call for help as needed. 3. Complete the hospital occurrence report ( and Safe Medical Device Act procedures if applicable). Next - Medical Emergencies Including Cardiac Arrest ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[58]=new Array("orientation_emergencies_cardiac_arrest.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD MEDICAL EMERGENCIES INCLUDING CARDIAC ARREST Patient on a nursing unit : ◦ First person on scene initiates CPR. ◦ Second individual notifies 2E to page \"Code Blue \" Team response. ◦ CPR sheet completed. Patient off nursing unit : ◦ First individual on scene qualified to initiate CPR does so, if this is needed. ◦ Second individual on scene dials \"0 \" (after hours this rings on 2E) and advises of the nature of the emergency. ◦ Operator (or after hours the Unit Clerk on 2E) pages \"Code Blue \" Team response. ◦ Occurrence report completed after event. Employee, Visitor, Parent or Other person away from nursing units : ◦ First person on scene qualified to initiate CPR does so, if this is needed. ◦ Second person on scene dials \"0 \" (after hours this rings on 2E) and advises of the nature of the emergency. ◦ Operator (or after hours the Unit Clerk on 2E) pages \"Code Blue \" Team response. ◦ Physician at scene requests ambulance to be called. ◦ Patient is transported to UTMB Emergency Department for further care. ◦ Occurrence report completed after event. REMEMBER √ The code for a medical emergency at Shriners Galveston Hospital is: Code Blue √ The telephone number to report/get assistance for medical emergencies including cardiac arrest is \"0 \". After hours, this rings on 2 East. √ For medical emergencies that involve parents, employees, or visitors: Shriners staff respond to the scene - stabilize individual - and call EMS to transport to the UTMB Emergency Department. Next - Prevention of Sharps Injuries ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[59]=new Array("orientation_sharps_injuries.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD PREVENTION OF SHARPS INJURIES Staff needs to consider the following in protecting themselves from sharps injuries and infections. At the beginning of your employment and in orientation : ◦ Actively participate in all orientation/competency opportunities. ◦ Learn the hospital policies on blood-borne pathogens and how to follow them. ◦ Learn how to use the needle-less system/sharps safety equipment used by the hospital. At the beginning of each shift : ◦ Locate the personal protective equipment (PPE), supplies for phlebotomies and vascular access, and disposal system for sharps. ◦ Be certain that the gloves fit you. ◦ Review types of vascular access and safety devices. ◦ Identify disposal containers. During procedures : ◦ Follow the hospital \'s written procedures. ◦ Use appropriate PPE. When setting up your workspace, place PPE in easy reach so that use is not overlooked in urgent situations. ◦ Assess your patient \'s ability to cooperate with you during any invasive procedure and protect yourself accordingly. Follow the hospital \'s policy on the use of restraints and local anesthetics. ◦ Moving a patient increases the risk of injury. Be certain to assess all IV access sites and equipment for stability prior to moving the patient, and stabilize all equipment and lines to prevent dislodging of sharps and disconnection of tubing. ◦ Respect sharps and their associated risks. Follow the hospitals policies on re-sheathing and disposal. ◦ Do not place fingers inside a sharps disposal container. ◦ Don \'t overfill disposal containers. Once a container is 3/4 full, start a new container. Call Environmental Services to pick up the full container. REMEMBER √ Sharps are disposed of at the site of use is a sharps container. √ Do not recap syringes. √ Learn how to use the equipment the Shriners Galveston Hospital uses to help prevent needlestick. If you do get a needlestick: Clean and disinfect the injury first, then report the injury to your supervisor. You will be asked to complete an occurrence report. Next - Prevention of Needlesticks ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[60]=new Array("orientation_prevent_needlesticks.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD PREVENTION OF NEEDLESTICKS Some of the more significant risks for hospital staff are injuries and infections from handling sharps. The following guidelines are provided to enhance staff awareness of: 1. Activities that increase risks of injuries. 2. Factors contributing to those injuries. 3. Measures available to protect oneself while working. Activities that create risks for occupationally acquired injuries and/or blood-borne pathogens : The following activities are known to increase the risk of an injury and/or infection from sharps - ◦ Inserting intra-vascular catheters. ◦ Restraining patients. ◦ Moving patients with staples in wounds prior to visually inspecting for loose staples. ◦ Removing needle during threading of catheter. ◦ Disassembly of devices. ◦ Transporting sharps any distance to disposal containers; overfilled containers. ◦ Disposal of sharps. ◦ Accessing IV line with needles. ◦ Removing needle devices when disconnecting IV. ◦ Preparing needle and holder. ◦ Withdrawing blood sample. ◦ Recapping needles. ◦ Removing needle from holder. ◦ Opening lancet cover. ◦ Positioning/using lancet. ◦ Passing of instruments in the operating room. ◦ Use of non-safety catheters. ◦ Separate packaging of safety devices. ◦ Not wearing gloves in procedures involving sharps. ◦ Increasing the number of times devices must be assembled/disassembled. ◦ Skill level of employee or failure to adhere to policy and procedure regarding safe use of sharps. ◦ Choosing an inappropriate device for procedure. REMEMBER √ Know situations that put you at risk for sharps injuries and implement the strategies to keep yourself safe. √ Learn how to use the equipment the hospital uses to help prevent needlesticks. √ Be sure to report any sharps injury or risk of sharps injury to your supervisor as soon as possible. Next - Latex Allergies ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[61]=new Array("orientation_latex_allergies.htm","Resident Orientation Manual - Inhalation Injury","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burn Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally AbstonMD,Patricia Blakeney PhD,Manubhai DesaiMD, Patricia EdgarRN, CIC,John P HeggersPhD, David N Herndon MD, Marsha HildrethRD, Janet A MarvinRN, MSN, Ray J Nichols Jr. MD LATEX ALLERGIES The extensive gloving required by current universal precaution standards and the predominant use of latex and latex-bearing powder in gloves has caused a dramatic increase in the incidence of irritant contact dermatitis and allergic reactions in healthcare professionals. According to the National Institute for Occupational Safety and Health (NIOSH), the incidence of latex allergies is on the rise with 12% of healthcare workers affected. Once a healthcare worker has begun to develop sensitivity, the signs and symptoms of latex sensitivity continue to increase until the professional takes steps to prevent repeated exposure. Latex use hit a previously unknown high in 1987 when the Centers for Disease Control (CDC) recommended universal precautions for healthcare workers and facilities. These precautions let to a dramatically increased need for gloves. To cope with the growing demands for gloves and the decreasing supply of pure latex, glove manufacturers had to make changes that lessened the purity of the latex found in gloves. The use of latex with a higher percentage of impurities has put more healthcare professionals at risk for the development of latex allergies. The latex used in rubber gloves comes from the rubber tree Hevea Brasiliensis . This latex is also used in medical devices from catheters to syringes, and everyday products such as balloons, rubber bands and telephone cords. It is important to be aware of all objects containing latex because once sensitivity is developed, it can become more severe with further exposure. Although direct skin exposure is the largest cause of sensitivity, airborne latex proteins can lead to inhalation-based sensitivities as well. Individuals with asthma or inhalant allergies, (e.g., ragweed) are at a higher risk to develop a latex allergy. Shriners Galveston Hospital has adopted a latex-safe environment policy. This means the glove standard for jobs requiring barrier protection is reduced protein, powder free. In the event a caregiver is latex-sensitive and requires barrier protection, the hospital provides non-latex supplies for caregivers and for patients who are latex sensitive. Symptoms: Symptoms of a latex allergy are similar to other allergic responses - - Itching - Watery or burning eyes - Sneezing - Coughing These are only a few of the potential warning signs. See your doctor if you have any concerns that you have, or are developing, a latex allergy. Protection: There are simple ways you can protect yourself from latex exposure and allergy - Use non-latex gloves for any activities that will not involve direct contact with infectious material. If you must use latex gloves, the hospital provides reduced protein, powder-free latex gloves. Use these unless you are allergic to latex. Do not use oil-based hand creams or lotions with latex gloves. These lotions can deteriorate the gloves. Wash and dry hands thoroughly after removing the latex gloves. Dispose of latex gloves as biohazardous waste. Clean the areas contaminated with latex dust, and keep them clean. Avoidance of latex is the only means to assure prevention of a latex allergy; and it is the only protection from allergic symptoms in a person who has already developed a latex allergy. REMEMBER √ Immediately report signs and symptoms of a latex allergy or sensitivity to your supervisor and to the employee health nurse. √ Do not use latex gloves unless your job involves exposure to blood or body fluids. End of Manual ↑ Top Back to Table of Contents LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[62]=new Array("shrine_application1_spanish.pdf","shrine_application1_spanish.tif","","null","null","");arrFiles[63]=new Array("shrine_application2_spanish.pdf","shrine_application2_spanish.tif","","null","null","");arrFiles[64]=new Array("burn_diagram.pdf","burn_diagram.tif","","null","null","");arrFiles[65]=new Array("Summary_activities.pdf","Microsoft Word - Summary- 7.04.doc","SUMMARY OF PATIENT CARE PROGRAMS AND ACTIVITIESPatient Census:Total admissions through June 2004 were 925, which is 82 more than 2003. Acute admissions were 219, which is 43 less than 2003. While Reconstructive patient admissions were 56 as compared to 88 for 2003. The average acute length of stay in 2004 is 8 days, which is 1 day more than 2003. The average length of stay for reconstructive patients was 2 days for 2004, which is the same as 2003. Outreach Clinics: During the first 6 months of 2004, 8 outreach clinics in 8 cities have been held. The following is a summary of Outreach Clinics for 2000 thru June 2004:Outreach Clinic El Paso El Paso Guadalajara Guadalajara Guadalajara Kansas City Kansas City Kansas City Kansas City Mexico City Mexico City Mexico City Mexico City Mobile Mobile Mobile Monterrey Monterrey Monterrey New Orleans New Orleans New Orleans New Orleans Pharr Pharr Pharr Shreveport Toluca, Mexico Toluca, Mexico Wichita Falls/Pharr TOTAL Date January July June October December February March August September April May October November March August September January February August March May October November June November December September May October June 2000 72 54 124 95 --40 --40 --59 --63 --29 --28 86 --46 --43 ----37 --39 --------855 2001 33 63 35 --43 24 --33 --81 81 67 --46 --58 38 --42 --26 ----33 --55 --------855 2002 54 --106 46 67 52 ----36 --109 434 --------56 --106 --60 ----50 --52 --775 537 --2488 2003 94 77 106 --101 --52 --36 --55 124 ----76 ----42 51 54 ----51 58 42 ----124 140 --1283 2004 76 --96 ------41 ------126 ------------51 --43 ------51 ------96 ----580Revised 1/14/04","null","null","");arrFiles[66]=new Array("orientation_basic_treatment_procedures.htm","NO TITLE","TOTAL BURN CARE HOME FORUM LINKS BURNCARE This is the location for your welcome statement, and to let your visitors know about your website. This is the location for your welcome statement, and to let your visitors know about your website. Res ident Orientation Manual (Feb. 2000) Produced by Galveston Shriners Burns Hospital and The University of Texas Medical Branch Blocker Burn Unit. Contributors : Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD, Patricia Edgar RN, CIC, John P Heggers PhD, David N Herndon, MD, Marsha Hildreth RD, Janet A Marvin RN, MSN, Ray J Nichols Jr. MD REHABILITATION SERVICES RESIDENT ORIENTATION cont \'d Basic Treatment Procedures Splinting - Pressure - Positioning - ROM/Strengthening - Ambulation Activities of Daily Living (ADL \'s) Splinting Static Splint : Have no movable parts and maintain joint in one position. Preventative : Prevents deformities. Usually we allow patient to be free of splint wear during ADL \'s and dressing changes. Protective : Post-operative to prevent disruption of newly applied skin grafts. Supportive : Immobilize, protect, and position damaged tendons and joints. Corrective : To gradually/serially correct a contracture by assisting to maintain joint following active and passive exercises. Dynamic Splinting : Applies specific force in a place of motion through elastic traction while allowing the patient some motion of the joint. These splints should be considered for those joints that demonstrate the most resistance to passive stretch and positioning. Splints that are commercially available work best when this problem occurs over large joints. ADL \'s : We provide adaptive equipment as needed, and train patients in achieving maximum independence in performing activities of daily living. Focus on splinting should be on those motions that are most difficult to regain: Neck extension/rotation MCP flexion Shoulder flexion/abduction IP extension of the hand Elbow/Knee extension Ankle dorsiflexion MPT flexion Positioning Positioning is one of the fundamental practices necessary for successful burn patient rehabilitation. Positioning in bed and in sitting is important. Pressure Pressure is used as treatment of scar management and can vary by use of: Ace Bandages - Tubigrip - Interim Garments (pre-fabricated) - Custom Garments - Coban (elastic woven wrap that can be used for the hand and fingers as a temporary glove). When a healed burn surface is able to tolerate a minimal shearing force, a tubular bandage or garments can be used. Tubular bandages may be used as an interim compression device or used as a definitive appliance. Inserts: Due to body makeup, inserts are sometimes necessary to achieve adequate pressure in certain body areas. These devices help to apply even pressure over the scar. The effectiveness of pressure garments is under evaluation at Shriners Burns Hospital-Galveston. We are conducting a study where patients with small burns are randomized to receive, or not receive, pressure garments after informed consent is obtained. Patients with large burns (> 10% grafted area) will receive pressure only to one extremity vs. no pressure to the contra-lateral extremity. All patients will remain in ace wraps to burned/grafted areas 1 month post-discharge. Next - How to Use the Dictation System ↑ Top © COPYRIGHT 2003 ALL RIGHTS RESERVED totalburncare.com Provided By Kwik Internet Technologies - KwikIT.com","null","null","");arrFiles[67]=new Array("Buffalo_resume.htm","MICHAEL C","MICHAEL C. BUFFALO, RN, MSN, CCRN, ACPNP April 1, 2006 Home Address: Phone: 409-737-2859 9339 Jamaica Beach Business: 409-770-6953 Galveston, Texas 77554-9657 Cell: 409-682-5444 E-mail: mbuffal@utmb.edu work mbuffalo@shrinenet.org work mbuffalo@houston.rr.com home SUMMARY OF I am nationally recognized as a clinical expert in burn EXPERIENCE: care specializing in pediatrics. I have extensive experience in ICU’s/trauma, adults and pediatrics. PROFESSIONAL EXPERIENCE: 2/03-Present Shriners Hospital for Children, Galveston, Texas Acute Care Pediatric Nurse Practitioner on Acute/ICU manages daily care, admissions, and outpatients and infusion studies. Twenty four responsibilities, on call and member flight team 3/01-2/03 Associate Nursing Director of Outpatient and Perioperative Care responsible for OR, PACU, Clinic and Outreach clinics. Reports to Nurse Executive. 2/99-Present University of Texas Medical Branch, Galveston, Texas ACPNP assigned at Shriners Hospital for Children, Galveston, TX, specializing in research and pediatric burn care. Commander of Burn Specialty Team # 3 of National Disaster Medical System/FEMA/Department of Homeland Security 10/97-2/99 University of Texas Medical Branch, Galveston, Texas Interim Nurse Manager, Nurse Clinician III in 8 bed Adult Burn ICU unit, cross trained in all ICU’s 2/94-9/97 Shriners Hospital for Children, Galveston, Texas Nursing Director of 15 bed Acute/ICU Member of Transportation/Flight Team 2/93-2/94 Hamot Medical Center, Erie, Pennsylvania Staff nurse, Surgical Pulmonary Intensive Care Unit 2/91-1/93 Nursing Manager, Regional Burn Unit 7/87-2/92 Staff nurse, Surgical Pulmonary Intensive Care Unit and Burn Unit, at a Level 1 Trauma Center. 9/82-7/87 Fairview Manor, Fairview, Pennsylvania LPN Charge nurse in a long term care facility 9/68-8/73 United States Army Active duty as computer guidance repairman for Nike Hercules and Pershing Missile Systems. Decorated with Honors, Vietnam Era Veteran, and Honorable Discharge. 9/80-6/03 United States Army Reserves Assigned to: 339 th CSH (HUS), Erie, Pennsylvania Current rank, Major, retired formerly combat medic EDUCATION: 8/95-4/99 University of Texas, Galveston, Texas Masters in Nursing, Acute Care Pediatric Nurse Practitioner 1/93-11/93 Gannon University, Erie, PA Courses in Nurse Anesthesia 9/88-12/92 Bachelor Science in Nursing 8/85-6/87 St. Vincent School of Nursing, Erie, PA Diploma in Nursing 8/82-8/83 Erie School District, Erie, PA Diploma as Practical Nurse PROFESSIONAL Licensed Advanced Practice Nurse, with prescriptive CERTIFICATIONS, privileges, as an Acute Care Pediatric Nurse Practitioner, in Texas, Alabama and Louisiana MEMBERSHIPS AND LICENSURE: Registered Professional Nurse in: Texas 602468 RN/ACPNP exp 1/07 Pennsylvania RN288278L exp 4/08 Alabama 1-096399 RN/NP exp 12/08 Louisiana RN103497 exp1/07 AP03934 exp 01/07 Missouri 2001022858 exp 4/07 Oklahoma 85499 exp 01/08 Critical Care Registered Nurse, (CCRN) American Heart Association Member, (AHA) Basic Life Support Provider, Instructor/ Instructor Trainer Automated External Defibrillator Provider/Instructor Advance Cardiac Life Support Provider/Instructor Pediatric Advance Life Support Provider/Instructor Green Cross/AHA FACTS Instructor (First Aid) Trauma Nurse Qualified TNCC provider/instructor Pediatric Emergency Nurse Certification National Member American Association of Critical Care Nurses (AACN) Past President times two of Galveston Island Chapter of AACN Past President Presque Isle Chapter of AACN American Burn Association, (ABA), national member Advance Burn Life Support Provider/Instructor/ National Faculty National Fire Protection Association, (NFPA) International Society For Burn Injuries, (ISBI) Reserve Officers Association, United States Army Association of Military Surgeons of the U.S. National Association of Pediatric Nurse Associates and Practitioners Galveston Coalition of Advanced Practice Nurses The University of Texas Medical Branch School of Nursing at Galveston Alumni Association Gannon University Alumni Association Sigma Theta Tau International, Alpha Delta Chapter Member American Telemedicine Association","null","null","");arrFiles[68]=new Array("2006_bar_graph.htm","2006 Funding Bar Graph","null","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[69]=new Array("clinical_advances_page.htm","Total Burn Care Home Page","Home Links Discussion Forum Hospitals & Departments Staff Members & Contacts Disclaimer Clinical Advances & Activities / Research Overview & Activities / Funded Projects Educational Burn Care Information / Publications / Fellowships & Training Burn Patient Care & Referral Clinical Advances & Activities ADVANCES SUMMARY STATISTICS CLINICAL ACTIVITIES © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[70]=new Array("index.htm","Total Burn Care Home Page","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 1-13-05 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM W e would like to welcome you to the Total Burn Care website. A major burn injury is a devastating injury, both physically and psychologically, to its victims and their families. Publications from the 1960 \'s list that survival was only 50% for a child with a 35-44% burn. Currently, because of the continued striving to improve clinical care and the research that has occurred in the area of burn injury, a child with a 98% burn can have a 50% chance of survival. Doctors specializing in burn care were one of the first specialty areas to develop a multidisciplinary approach to care. Total Burn Care addresses the varied physiological, psychological and emotional care of acutely injured burn patients evolving through recovery, rehabilitation, and reintegration back into society and daily life activities. Our hope for the future is that through multidisciplinary collaboration, scientists and clinicians will pursue solutions to the perplexing problems that burn survivors must encounter. The purpose of this website is to provide information on obtaining clinical care for burn victims, provide educational information on clinical care, describe research advances and activities, and provide an opportunity for further communication and contacts. David N. Herndon, MD LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[71]=new Array("2001-2006_articles_books.htm","Articles and Book Chapters","Article and Book Citations 2001 - 2006 2006 - 2005 - 2004 - 2003 - 2002 - 2001 2006 Atar S, Ye Y, Rasanio S, Huang MH, Lin Y, Freeberg SY, Nishi SP, Uretsky BR, Perez-Polo JR, Birnbaum Y. Statin-induced cardioprotection is mediated by incrasing inducible nitric oxide synthase and consequent S-nitrosylation of cycloxygenase-2. A Jour Physio, 290:1960-1968, 2006. Barrow RE, Wolfe RR, Dasu MR, Barrow LN, Herndon DN. The Use of Beta-Adrenergic Blockade in Preventing Trauma-Induced Hepatomegaly. Ann Surg, 243:115-120, 2006. Borsheim E, H Kobayashi, D Traber, RR Wolfe. Compartmental distribution of amino acids during hemodialysis induced hyposminoacidemia. Am J Physiol Endocrinol Metabl 290:E643-E645, 2006. Cardoso LD, Freitas RN, Mafra Cl, Neves CVB, Figueira FCB, Labruna MB, Gennari SM, Walker DH, Galvao MAM. Characterization of Rickettsia spp. Circulating in a peri-urban silent focus for Brazilian spotted fever in Caratinga, Minas Gerais, Brazil. Cad Saude Publica, 22:495-501, 2006. Carmichael KD, Longo A, Lick S, Swischuk L. Posterior sternoclavicular epiphyseal fracture-dislocation with delayed diagnosis. Skeletal Radiology, 35:608-612, 2006. Caruso DM, Foster KN, Blome-Eberwein SA, Twomey JA, Herndon DN, Luterman A, Silver stien P, Antimarino JR, Bauer GJ. Randomized clinical study of hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns. J Burn Care Res, 27(3):298-309, 2006. Cox RA, Burke AS, Traber DL, Herndon DN, Hawkins HK. Production of pro-inflammatory polypeptides by airway mucous glands and its potential significance. Pulm Pharmacol Ther, 5/13/06. De Sousa R, Barata C, Vitorino L, Santos-Silva M, Carrapato C, Torgal J, Walker DH, Bacellar F. Rickettsia sibirica isolation from a patient and detection in ticks, Portugal. Emerg Infec Dis, 12:1103-1108, 2006. Elliott TA, Cree MG, Sanford AP, Tipton KD, Wolfe RR. Milk ingestion stimulates net muscle protein synthesis following resistance exercise. Med Sci Sports Exerc, 38(4):667-674, 2006. Englander EW and Ma H. Differential modulation of base excision repair activities during brain ontogeny: Implications for repair of transcribed DNA. Mechanisms of Aging and Development, 127:64, 2006. Enkhbaatar PE, Murakami K, Traber LD, Cox R, Parkinson JF, Westphal M, Esechie A, Morita N, Maybauer MO, Maybauer DM, Burke AS, Schmalstieg FC, Hawkins HK, Herndon DN. The inhibition of inducible nitric oxide synthase in ovine sepsis model. Shock, 25(5):522-527, 2006. Enoh VT, Fairchild CD, Lin CY, Varma TK, Sherwood ER. Differential effect of imipenem treatment on wild-type and NK cell-deficient CD8 knockout mice during acute intra-abdominal injury. Am J Physiol Regul Integr Comp Physiol 290:685-693, 2006. Enoh VT, Lin CY, Varma TK, Sherwood ER. Differential effect of imipenem treatment on injury caused by cecal ligation and puncture in wild-type and NK cell deficient ß 2 -microgloblin knockout mice. Am J Physiol Gastrointest Liver Physiol 290:G277-G284, 2006. Fagan SP, Nugent N, Herndon DN. Skin substitutes as treatment for burn injuries. Dialysis, Transplantation and Burns, 17(1):15-22, 2006. Finnerty CC, Herndon DN, Przkora R, Pereira CT, Oliveira HM, Queiroz DM, Rocha AM, Jeschke MG. Cytokine expression profile over time in severely burned pediatric patients. Shock, 26(1):13-19, 2006. Fram RY, Watson VE, Herndon DN. Modulatin of the hypermetabolic response after thermal injury. Dialysis Transplantation and Burns, 17(1):1-8, 2006. Fujita K, Kobayashi M, Brutkiewicz RR, Hanafusa T, Herndon DN, Suzuki F. Role for IL-4 nonproducing NKT cells in CC-chemokine ligand 2-induced Th2 cell generation. Immunology and Cell Biology, 84:44-50, 2006. Gore DC, Wolfe RR. Hemodynamic and metabolic effects of selective Beta-1 adrenergic blockage during sepsis. Surgery, 139:686-694, 2006. Gore DC, Chinkes DL, Wolf SE, Sanford AP, Herndon DN, Wolfe RR. Quantification of protein metabolism in vivo for skin, wound, and muscle in severe burn patients. JPEN, 30:331-338, 2006. Hoskins SL, Elgjo GI, Lu J, Ying H, Grady JJ, Herndon DN, Kramer GC. Closed-loop resuscitation of burn shock. J Burn Care Res, 27(3):377-385, 2006. Ismail N, Stevenson HL, Walker DH. The role of TNF-a and IL-10 in the pathogenesis of severe murine monocytotropic ehrlichiosis: increased resistance of TNF receptor p55- and p75- deficient mice to fatal ehrlichial infection. Infect Immun, 74:1846-1856, 2006. Jeschke MG, Herndon DN. Blood transfusion in burns: Benefit or risk? Crit Care med, 34(6):1822-1823, 2006. Klein MB, Silver G, Gamelli RL, Gibran NS, Herndon DN, Hunt JL, Tompkins RG, The inflammation and the host response to injury investigators. Inflammation and the host response to injury: An overview of the multicenter study of the genomic and proteomic response to burn injury. J Burn Care Res 27(4):448-451, 2006. Kobayashi M, Tsuda Y, Yoshida T, Takeuchi D, Utsunomiya T, Takahashi H, Suzuki F. Bacterial Sepsis and Chemokines. Current Drug Targets, 7:119-134, 2006. Mavromatis K, Doyle CK, Lykidis A, Ivanova N, Francino MP, Chain P, Shin M, Malfatti S, Larimer F, Copeland A, Detter JC, Land M, Richardson PM, Yu XJ, Walker DH, McBride JW, Kyrpides NC. The genome of the obligatelyintracellular bacterium Ehrlichia canis reveals themes of complex membrane structure and immune evasion strategies. J Bacteriol, 188:4015-4023, 2006. Maybauer MO, Maybauer DM, Herndon DN, Traber DL. The role of superoxide dismutase in systemic inflammation. Shock 25(2):206-207, 2006. Maybauer MO, Maybauer DM, Fraser JF, Traber LD, Westphal M, Enkhbaatar P, Cox RA, Huda R, Hawkins HK, Morita N, Murakami K, Mizutani A, Herndon DN, Traber DL. Recombinant human activated protein C improves pulmonary function in ovine acute lung injury resulting from smoke inhalation and sepsis. Crit Care Med, 6/27/06. Maybauer DM, Traber DL, Rademacher P, Herndon DN, Maybauer MO. Treatment strategies for acute smoke inhalation injury. Anaesthetist 9:1-8, 2006. McEntire SJ, Herndon DN, Sanford AP, Suman OE. Thermoregulation during exercise in severely burned children. Pediatr Rehabil 9(1):57-64, 2006. Mlcak RP, Jeschke MG, Barrow RE, Herndon DN. The influence of age and gender on resting energy expenditure in severely burned children. Ann Surg 244(1):121-130, 2006. Morita N, Traber MG, Enkhbaatar P, Westphal M, Murakami K, Leonard SW, Cox RA, Hawkins HK, Herndon DN, Traber LD, Traber DL. Aerosolized alpha-tocopherol ameliorates acute lung injury following combined burn and smoke inhalation injury in sheep. Shock, 25:277-282, 2006. Nowak K, Lange-Dohna C, Zeitschel U, Gunther A, Luscher B, Robitzki A, Perez-Polo JR, Rossner S. The transcript factor Yin Yang 1 is an activator of BACE1 expression. J Neurochemistry, 96:1696-1707, 2006. Nugent N, Fagan SP, Huang T, Herndon DN. Trends in burn reconstruction-Our experience with early reconstruction. Dialysis, Transplantation and Burns, 17(1):9-14, 2006. Paddon-Jones D, M Sheffield-Moore, X-J Zhang, CS Katsanos, RR Wolfe. Differential stimulation of muscle protein synthesis in elderly humans following isocaloric ingestion of amino acids or whey protein. Exp Gerontol 41:215-219, 2006. Palmieri TL, Enkhbaatar P, Bayliss R, Traber LD, Cox RA, Hawkins HK, Herndon DN, Greenhalgh DG, Traber DL. Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation. Crit Care Med, 34(6):1719-1724, 2006. Pereira CT, Barrow RE, Hawkins HK, Kimbrough CW, Jeschke MG, Lee JO, Sanford AP, Herndon DN. Age-dependent differences in survival after severe burns: A unicentric review of 1,674 patients and 179 autopsies over 15 years. J Am Coll Surg, 202(3):536-548, 2006. Pikosky MA, PC Gaine, WF Martin, KC Grabarz, AA Ferrando, RR Wolfe, NR Rodriguez. Aerobic exercise training increases skeletal muscle protein turnover at rest. J Nutr 136:379-383, 2006. Przkora R, Herndon DN, Suman OE, Jeschke MG, Meyer WJ, Chinkes DL, Mlcak RP, Huang T, Barrow RE. Beneficial effects of extended growth hormone treatment after hospital discharge in pediatric burn patients. Ann Surg, 243:796-803, 2006. Przkora R, Jeschke MG, Herndon DN. Use of oxandrolone in burn patients. J Burn Care Res, 27(2):140-141, 2006. Przkora R, Barrow RE, Jeschke MG, Suman OE, Celis M, Sanford AP, Chinkes DL, Mlcak RP, Herndon DN. Body composition changes with time in pediatric burn patients. J Trauma, 60(5):968-971, 2006. Rasmussen BB, Fujita S, Wolfe RR, Mittendorfer B, Roy M, Rowe VL, Volpi E. Insulin resistance of protein metabolism in aging. FASEB, 20(6):768-769, 2006. Snyder N IV, Craven C, Phillips LG. Delayed type IV muscle flap in a feline model. Ann Plast Surg, 56(3):316-319, 2006. Suman OE, Mlcak RP, Chinkes DL, Herndon DN. Resting energy expenditure in severely burned children: Analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method. Burns 32(3):335-345, 2006. Sun D, MG Cree, RR Wolfe. Quantification of the Concentration and 13 C tracer enrichment of long-chain fatty acyl-coenzyme A in muscle by liquid chromatography/mass spectrometry. Analytical Biochem 349:87-95, 2006. Sun D, MG Cree, RR Wolfe. Measurement of stable isotopic enrichment and concentration of long-chain fatty acyl-carnitines in tissue by ion-pairing HPLC/MS. J Lipid Res 47:431-439, 2006. Swischuk LE. Football injury to the back. Ped Emerg Care, 22:59-61, 2006.Swischuk LE. Obvious Head Injury: Analyzing the mechanism. Ped Emerg Care, 22:195-196, 2006. Swischuk LE. Known asthmatic: Right-side wheezing. Ped Emerg Care, 22:266-267, 2006. Takahaski H, Tsuda Y, Kobayashi M, Herndon DN, Suzuki F. CCL2 as a trigger of manifestations of compensatory anti-inflammatory response syndrome in mice with severe systemic inflammatory response syndrome. J Leukoc Biol , 79:789-796, 2006. Traber DL, Hawkins, HK, Enkhbaatar P, Cox RA, Schmalstieg FC, Zwischenberger JB, et al. The role of bronchial circulation in the acute lung injury resulting from burn and smoke inhalation. Pulm Pharmacol Ther, 2006. Wei W, Qi X, Reed J, Ceci J, Wang HQ, Wang G, Englander EW, Greeley GH Jr. Effect of chronic hyperghrelinemia on ingestive action of ghrelin. Am J Physiol Regul Integr Comp Physiol, 290(3):R803-808, 2006. Westphal M, Cox RA, Traber LD, Morita N, Enkhbaatar P, Schmalstieg FC, et. al. Combined burn and smoke inhalaiton injury impairs ovine hypoxic pulmonary vasoconstriction. Crit Care Med, 34:1428-1436, 2006. Yoshida T, Tsuda Y, Takeuchi D, Kobayashi M, Pollard RB, Suzuki F. Glycyrrhizin inhibits neutrophil-associated generation of alternatively activated macrophages. Cytokine, 33:317-322, 2006. Yue Y, Croitoru MM, Bidani A, Zwischenberger JB, Clark Jr, JW: Nonlinear multiscale wavelet diffusion for speckle suppression and edge enhancement in ultrasound images. IEEE Transactions on Medical Imaging, 25(3):297-311, 2006. Zavala-Velazquez J, Laviada-Molina H, Zavala-Castro J, Perez-Osorio C, Becerra-Carmona G, Ruiz-Sosa JA, Bouyer DH, Walker DH. Rickettsia felis , the agent of an emerging infectious disease: report of a new case in Mexico. Arch Med Res, 37:419-422, 2006. Zavala-Castro JE, Zavala-Velazquez JE, Walker DH, Arcilla EER, Laviada-Molina H, Olano JP, Ruiz-Sosa JA, Small MA, Azul-Rosado KR. Fatal human infection with Rickettsia rickettsii in Yucatan, Mexico. Emerg Infect Dis, 12:672-674, 2006. Zhang XJ, Heggers JP, Chinkes DL, Wolf SE, Hawkins HK, Wolfe RR. Topical Sulfamylon cream inhibits DNA and protein synthesis in the skin donor site wound. Surgery, 139:633-639, 2006. Zhang JZ, Hao JF, Walker DH, Yu SJ. A mutation inactivating the methyltransferase gene in avirulent Madrid E strain Rickettsia prowazekii reverted to wild type in the virulent revertant strain Evir. Vaccine, 24:2317-2323, 2006. Top 2005 Barrow RE, Hawkins HK, Aarsland A, Cox RE, Rosenblatt R, Barrow LN, Jeschke MG, Herndon DN. Identification of Factors Contributing to Hepatomegaly in Severely Burned Children. Shock, Vol 24 (6): 523-528, 2005. Barrow RE, Przkora R, Hawkins HK, Barrow LN, Jeschke MG, Herndon DN. Mortality related to gender, age, sepsis, and ethnicity in severely burned children. Shock, 23(6):485-487, 2005. Bjertnaes LJ, McGuire R, Jodoin J, Salzman AL, Traber LD, Passerini DJ, Smith DJ, Szabo C, Traber DL. Nebulized nitric oxide/nucleophile adduct reduces pulmonary vascular resistance in mechanically ventilated septicemic sheep. Crit Care Med, 33(3):616-622, 2005. Blakeney P, Thomas C, Holzer C, Rose M, Berniger F, Meyer W. Efficacy of a short-term, intensive social skills training program for burned adolescents. J Burn Care and Rehab., 26(6):546-555, 2005. Bolster D, Pikosky M, Gaine P, Martin W, Wolfe RR, Tipton KD, Maclean D, Maresh C, Rodriguez N. Dietary protein intake impacts skeletal muscle protein fractional synthetic rates following endurance exercise. Am J Physiol Endocrinol Metab, 289(4):E678-683, 2005. Calvano SE, Xiao W, Richards DR, Felciano RM, Baker HV, Cho RJ, Chen RO, Brownstein BH, Cobb JP, Tschoeke SK, Miller-Graziano C, Moldawer LL, Minfrinos MN, Davis FW, Tompkins RG, Lowry SF, Bankey PE, Billiar TR, Camp DG, Caselia G, Chaudry IH, Choudhry MA, Cooper C, De A, Elson C, Freeman B, Gameli RL, Campbell-Finnerty C, Gibran NS, Hayden DL, Harbrecht BG, Herndon DN, Horton JW, Hubbard WJ, Hunt JL, Johnson J, Klein MB, Lederer JA, Logvinenko T, Maier RV, Mannick JA, Mason PH, McKinley BA, Minei JP, Moore EE, Moore FA, Nathens AB, O’Keefe GE, Rahme LG, Remick DG, Schoenfield DA, Schwacha MG, Shapiro MB, Silver GM, Smith RD, Storey JD, Toner M, Warren HS, West MA. A network-based analysis of systemic inflammation in humans. Nature 437:1032-1037, 2005. Calvano SE, Xiao W, Richards DR, Felciano RM, Baker HV, Cho RJ, Chen RO, Brownstein BH, Cobb JP, Tschoeke SK, Miller-Graziano C, Moldawer LL, Minfrinos MN, Davis FW, Tompkins RG, Lowry SF, Bankey PE, Billiar TR, Camp DG, Caselia G, Chaudry IH, Choudhry MA, Cooper C, De A, Elson C, Freeman B, Gameli RL, Campbell-Finnerty C, Gibran NS, Hayden DL, Harbrecht BG, Herndon DN, Horton JW, Hubbard WJ, Hunt JL, Johnson J, Klein MB, Lederer JA, Logvinenko T, Maier RV, Mannick JA, Mason PH, McKinley BA, Minei JP, Moore EE, Moore FA, Nathens AB, O’Keefe GE, Rahme LG, Remick DG, Schoenfield DA, Schwacha MG, Shapiro MB, Silver GM, Smith RD, Storey JD, Toner M, Warren HS, West MA. Corrigendum: A network-based analysis of systemic inflammation in humans. Nature 438 (7068):696, 2005. Chen DD, Xu XH, Wang ZS, Chen JDZ. Alternation of gastric myoelectrical activity with audio stimulation in healthy humans. Scan J Gastroenterology, 40:814-821, 2005. Chen JDZ, Xu X, Abo M, Lin XM, McCallum RW, Ross B. Potential of multi-channel gastric electrical stimulation for gastroparesis: a canine study on its efficiency and efficacy. Neuroaastroenterology and Motility. 17:878-882, 2005. Chinkes DL. Methods for measuring tissue protein breakdown in vivo. Curr Opin Clin Nutr Metab Care, 8:534-537, 2005. Cobb JP, Mindrinos MN, Miller-Graziano C, Calvano SE, Baker HV, Xiao W, Laudanki K, Brownstein RW, Elson CM, Hayden DL, Herndon DN, Lowry SF, Maier RV, Schoenfeld DA, Moldawer LL, Davis RW, Tompkins R. Inflammation and host response to injury large-scale collaborative research program. Application of genome-wide expression analysis to human health and disease. Proc Natl Acad Sci USA, 102(13):4801-4806, 2005. Coppack SW, Chinkes DL, Miles JM, Patterson BW, Klein S. A multicompartmental model of in vivo adipose tissue glycerol kinetics and capillary permeability in lean and obese humans. Diabetes, 54:1934-1941, 2005. Cox RA, Enkhabaatar P, Burke AS, Katahira J, Shimoda K, Chandra A, Traber LD, Herndon DN, Hawkins HK, Traber DL. Effects of dual endothelin-1 receptor antagonist on airway obstruction and acute lung injury in sheep following smoke inhalation and burn injury. Clin Sci (London), 108(3):265-272, 2005. Dasu MRK, Barrow RE, Herndon DN. Gene profiling in muscle of severely burned children: Age-and Sex-Dependent Changes. J Surg Res, 123:144-152, 2005. Dasu MRK, Barrow RE, Herndon DN. Gene expression changes with time in skeletal muscle of severely burned children. Ann Surg, 241:647-653, 2005. Dubick MA, Williams CA, Elgjo GI, Kramer GC. High dose Vitamin C infusion reduces fluid requirements in the resuscitation of burn injured in sheep. Shock, 24(2):139-144, 2005. Englander EW. Gene expression changes reveal patterns of aging in the rat digestive system. Aging Research Reviews, 4:564, 2005. Enkhbaatar P, Kikuchi Y, Traber LD, Westphal M, Morita N, Maybauer MO, Maybauer DM, Herndon DN, Traber DL. Effect of inhaled nitric oxide on pulmonary vascular hyperpermeability in sheep following smoke inhalation. Burns, 31(8):1013-1019, 2005. Enoh V, Lin C, Varma T, Sherwood E. Differential effect of imipenem treatment on injury caused by cecal ligation and puncture in wild type and natural killer cell-deficient B2 microglobulin knockout mice. Am J Physiol Gastroint Liver Phys. EPub, September 2005. Enoh V, Fairchild C, Lin C, Varma T, Sherwood E. Differential response of wild type and natural killer cell-deficient CD8 knockout mice to acute intra-abdominal injury. Am J Physiol Reg Integ Comp Physiol, EPUB, November, 2005. Fauerbach JA, Lezotte D, Hills RA, Cromes GF, Kowalske K, de Lateur BJ, Goodwin CW, Blakeney P, Herndon DN, Wiechman SA, Engrav LH, Patterson DR. Burden of burn: A norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial function. J. Burn Care Rehabil., 26(1):21-32, 2005. Fujita K, Sanford AP, Kobayashi M, Hanafusa T, Herndon DN, Suzuki F. Role of natural killer T (NKT) cells lacking interleukin (IL)-4 producing abilities on the CC-chemokine ligand 2-associated herpes simplex virus type 1 infection in human severe combined immunodeficiency (SCID) mouse chimeras. Burns, 31(2):145-152, 2005. Fujita K, Kobayashi M, Brutkiewicz RR, Hanafusa T, Herndon DN, Suzuki F. Role for IL-4 nonproducing NKT cells in CC-chemokine ligand 2-induced Th2 cell generation. Immunol Cell Biol, 1-7, 2005. Gore DC, Wolf SE, Sanford AP, Herndon DN, Wolfe RR. Influence of metformin on glucose intolerance and muscle catabolism following severe burn injury. Ann Surg, 241(2):334-342, 2005. Gore DC, Herndon DN, Wolfe RR. Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury. J Trauma, 59(2):316-323, 2005. Gould LJ, Leon M, Sonstein J, Wilson S. Optimization and validation of an ischemic wound model. Wound Repair and Regeneration, 13:576-582, 2005. Heggers J, Goodheart RE, Washington J, McCoy L, Carino E, Dang T, Edgar P, Maness C, Chinkes DL. Therapeutic efficacy of three silver dressings in an infected animal model. JBCR, 26(1):53-56, 2005. Hernandez JA, Walser EM, Swischuk LE. Aortosternal venous compression in patients with aberrant right subclavian arteries. Am J Roentgenol, 184:1434-1436, 2005. Hernandez JA, Swischuk LE. Acute fever and left flank pain. Pediatric Emergency Care, 21:629-630, 2005. Horch RE, Jeschke MG, Spilker G, Herndon DN, Kopp J. Treatment of second degree facial burns with allografts-preliminary results. Burns, 31(5):597-602, 2005. Hoskins SL, Williams CA, Kramer GC, Ying H, Elgjo GI, Lu J, et al. Closed loop resuscitation of burn shock in sheep. Jour Burn Care Rehabil, 2005. Hou XH, Yin JY, Pasricha PJ, Chen JDZ. In-vivo gastric and intestinal slow waves in W/W v mouse. Dig Dis Sic, 50:1335-1341, 2005. Jeschke MG, Barrow RE, Przkora R, Finnerty CC, Mlcak R, Herndon DN. Endogenous anabolic hormones and hypermetabolism: effect of trauma and gender differences. Ann Surg, 241(5):759-768, 2005. Jeschke MG, Schubert T, Krickhahn M, Polykandriotis E, Klein D, Perez-Polo JR, Przkora R, Herndon DN. Interaction of exogenous liposomal insulin-like growth factor-1 cDNA gene transfer with growth factors on collagen expression in acute wounds. Wound Rep Reg, 13(3):269-277, 2005. Jeschke MG, Sandmann G, Schubert T, Klein D. Effect of oxidized regenerated cellulose/collagen matrix on dermal and epidermal healing and growth factors in an acute wound. Wound Rep Reg, 13(3):324-331, 2005. Jeschke MG, Sandmann G, Finnerty CC, Herndon DN, Pereira CT, Schubert T, Klein D. The structure and composition of liposomes can affect skin regeneration, morphology and growth factor expression in acute wounds. Gene Ther, 1-7, 2005. Jeschke MG, Herndon DN, Finnerty CC, Bolder U, Thompson JC, Mueller U, Wolf SE, Przkora R. The effect of growth hormone on gut mucosal homeostatisis and cellular mediators after severe trauma. J Surg Res, 127(2):183-189, 2005. Jeschke MG, Bolder U, Finnerty CC, Przkora R, Muller U, Maihofer R, Thompson JC, Wolf SE, Herndon DN. The effect of hepatocyte growth factor on gut mucosal apoptosis and proliferation, and cellular mediators after severe trauma. Surgery, 138(3):482-489, 2005. Kamolz LP, Andell H, Schramm W, Meissl G, Herndon DN, Frey M. Lactate: Early predictor of morbidity and mortality in patients with severe burns. Burns, 31(8):986-990, 2005. Katakura T, Yoshida T, Kobayashi M, Herndon DN, Suzuki F. Immunological control of methicillin-resistant Staphylococcus aureus (MRSA) infection in an immunodeficient murine model of thermal injuries. Clin Exp Immunol, 142(3):419-425, 2005. Katsansos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of small bolus of essential amino acids. Am J Clin Nutr, 82:1065-1073, 2005. Katsanos CS, Chinkes DL, Sheffield-Moore M, Aarsland A, Kobayashi H, Wolfe RR. Method for the determination of the arteriovenous muscle protein balance during non-steady state blood and muscle amino acid concentrations. Am J Physiol Endocrinol Metab, 289(9):E1064-E1070. Klein GL, Cooper CW. Hormones and other agents influencing bone, and novel pharmacologic treatments for metabolic bone disease. Curr Opin Pharmacol, 5(6):610-611, 2005. Klein GL, Fitzpatrick LA, Langman CB, Beck TJ, Carpenter TO, Gilsanz V, Holm IA, Leonard MB, Specker BL. The State of Pediatric Bone: Summary of the ASBMR Pediatric Bone Initiative. J Bone Miner Res, 20(12):2075-2081, 2005. Klein GL. Aluminum: New recognition of an old problem. Curr Opin Pharmacol, 5(6):637-640, 2005. Klein GL, Wimalawansa SJ, Kulkarni G, Sherrard DJ, Sanford AP, Herndon DN. The efficacy of acute administration of pamidronate on the conversation of bone mass, following severe burn injury in children: a double-blind, randomized, controlled study. Osteoporos. Int. 16(6):631-635, 2005. Lee HM, Greeley GH, Herndon DN, Singh M, Luxon BA, Englander EW. A rat model of smoke inhalation injury: signature of combustion-smoke inhalation on gene expression in the brain. Toxicology and Applied Pharmacology, 208:255-65, 2005. Lee JO, Benjamin D, Herndon DN. Nutrition support strategies for severely burned patients. Nutr Clin Pract, 20(3):325-330, 2005. Lei Y, Xing J, Chen JDZ. Effects and mechanisms of implantable gastric stimulation on proximal gastric distention in conscious dogs. Obesity Surgery, 15:528-533, 2005. Lei Y, Zhu HB, Xing JH, Chen JDZ. Rectal distention modulates canine gastric tone and accommodation. Dig Dis Sic, 50:2134-2140, 2005. Liang HL, Lin QH, Chen JDZ. Application of the empirical mode decomposition to the analysis of esophageal manometric data in gastroesophageal reflux disease. IEEE Trans Biomedical Eng, 10:1692-1701, 2005. Liu S, Hou XH, Chen JDZ. Therapeutic potential of duodenal electrical stimulation for obesity: effects on satiety and gastric emptying. Am J Gastroenterology, 4:792-796, 2005. Liu S, Wang LJ, Chen JDZ. Cross-talk along gastrointestinel tract during electrical stimulation: effects and mechanisms of gastric/colon stimulation on rectal tone in dogs. Am J Physiuology –GI and Liver Physiology, 288:G1195-1198, 2005. Lu CL, Chen CY, Luo JC, Chang FY, Kang LC, Lee SD, Wu HC, Chen JDZ. The factor responsible for the abnormal postprandial stomach myoelectricity in patients with chronic pancreatitis. World J Gastroenterology, 11:372-376, 2005. Lyuksutova O, Murphey ED, Toliver-Kinsky T, Lin C, Cui W, Williams DL, Sherwood E. Glucan phosphate treatment attenuates burn-induced inflammation and improves resistance to Pseudomonas Aeruginosa burn wound sepsis. Shock, 23:224-232, 2005. Martini WZ, Chinkes DL, Pusateri AE, Holcomb JB, Yu YM, Zhang XJ, Wolfe RR. Acute changes in fibrinogen metabolism and coagulation after hemorrhage in pigs. Am J Physiol Endocrinol Metab, 289(5):E930-E934, 2005. Maybauer MO, Kikuchi Y, Westphas M, Maybauer DM, Nishida K, Traber LD, Westphal-Varghese BB, Morita N, Enkhbaatar P, Herndon DN, Traber DL. Effects of manganese superoxide dismutase nebulization on pulmonary function in an ovine model of acute lung injury. Shock, 23(2):138-143, 2005. Maybauer MO, Maybauer DM, Traber LD, Westphal M, Enkhbaatar P, Morita N, Jodoin JM, Heggers JP, Herndon DN, Traber DL. Gentamicin improves hemodynamic in ovine septic shock after smoke inhalation injury. Shock, 24(3):226-231, 2005. McCauley RL. Tissue expansion and reconstruction of the scalp. Seminars in Plastic Surgery, 19(2):143-152, 2005. Mlcak RP, Suman OE, Murphy KD, Herndon DN. Effects of growth hormone on anthropometric measurements and cardiac function in children with thermal injury. Burns, 31(1):60-66, 2005. Nesic-Taylor O, Cittelly D, Ye Z, Xu GY, Unabia G, Lee JC, Svrakic NM, Liu XH, Youle RJ, Wood TG, McAdoo D, Westlund KN, Hulsebosch CE, Perez-Polo JR. Exogenous Bcl-xL fusion protein spares neurons after spinal cord injury. J Neurosc Res, 79(5):628-637, 2005. Norbury WB, Jeschke MG, Herndon DN. Tissue engineered fetal skin constructs for pediatric burns. Crit Care 9(6):533-534, 2005. Oliveira GV, Chinkes DL, Mitchell C, Oliveira G, Hawkins HK, Herndon DN. Objective assessment of burn scar vascularity, erythema, pliability, thickness and planimetry. Dermatol Surg, 31:48-58, 2005. Ouyang H, Chen JDZ. Assessment of gastric volume changes with sonometry compared with barostat. Neurogastroenterology and Motility, 17:447-452, 2005. Ouyang H, Chen JDZ. Tachygastria induced by gastric electrical stimulation is mediated via ß-Adrenergic pathway and inhibits antral motility in dogs. Neurogastroenterology and Motility, 17:846-853, 2005. Paddon-Jones D, Sheffield-Moore M, Urban RJ, Aarsland A, Wolfe RR, Ferrando AA. The catabolic effects of prolonged inactivity and acute hypercortisolemia are offset by dietary supplementation. J Clin Endocrinol Metab, 90(3):1453-1459, 2005. Penn J, Thomas C. Practice parameter for the assessment and treatment of youth in juvenile detention and correctional facilities. J Am Academy of Child and Adoles Psy, 44(10):1085-1098, 2005. Pereira CT, Murphy KD, Herndon DN. Altering metabolism. J Burn Care & Rehab, 26(3):194-199, 2005. Pereira CT, Jeschke MG, Herndon DN. Use of Oxandrolone in ventilator dependent surgical patients. Ann Surg, 241(6):1030-1031, 2005. Pereira CT, Fram R, Herndon DN. Serum creatinine kinase levels for diagnosing muscle damage in electrical burns. Burns, 31:670-671, 2005. Pereira CT, Murphy KD, Jeschke MG, Herndon DN. Post burn muscle wasting and the effects of treatment. Intl J Biochem Cell Biol, 37:1948-1961, 2005. Przkora R, Jeschke MG, Barrow RE, Suman OE, Meyer WJ, Finnerty CC, Sanford AP, Lee J, Chinkes DL, Mlcak RP, Herndon DN. Metabolic and hormonal changes of severely burned children receiving long-term Oxandrolone treatment. Ann Surg, 242:384-391, 2005. Qin C, Sun Y, Chen JDZ, Foreman R. Gastric electrical stimulation modulates neuronal activity in nucleus tractus solitarii in rats. Autonomic Neuroscience: Basic and Clinical, 119:1-8, 2005. Rose M, Hozer C, Tuden C, Rosenberg M, Herndon DN, Blakeney P. Reported stress of parents of burned children differs on the Spanish and English versions fo the parenting stress inventory. J Burn Care Rehabil., 26(5):446-452, 2005. Rosenberg M, Robertson C, Murphy KD, Rosenberg L, Mlcak R, Robert RS, Herndon DN, Meyer WJ. Neuropsychological outcome of pediatric burn patients who sustained hypoxic episodes. Burns, 31(7):883-889, 2005. Sakurai H, Nozaki M, Soejima K, Traber LD, Traber DL. Atrial natriuretic peptide release associated with smoke inhalation and physiological responses to thermal injury in sheep. Burns, 31:737-743, 2005. Schinkel S, Schinkel C, Pollard V, Garofallo R, Heberle H, Reisner P, Papaconstantinou J, Herndon DN. Effects of endotoxin on serum chemokines in man. Eur J Med Res, 10(2):76-80, 2005. Song GQ, Hou XH, Yang B, Liu JS, Qian W, Chen JDZ. Two-channel gastric electrical stimulation accelerates delayed gastric emptying induced by vasopressin. Dig Dis Sci, 4:662-668, 2005. Stubbe HD, Traber DL, Booke M, Traber LD, Westphal M, Van Aken H, Hinder F. Role of atrial natriuretic peptide in pulmonary permeability and vasoregulation in ovine sepsis. Crit Care Med, 32(12):2491-2495, 2005. Sun Y, Chen JDZ. Gastric electrical stimulation reduces gastric tone energy dependently. Scan J Gastroenterology, 40:154-159, 2005. Susaki E, Wang G, Cao G, Wang HQ, En glander EW, Greeley GH. Apelin cells in the rat stomach. Regul Pept., 129:37, 2005. Svensen CH, Clifton B, Brauer KI, Olsson J, Uchida T, Traber LD, Traber DL, Prough DS. Sepsis produced by pseudomonas bacteremia does not alter plasma volume expansion after 0.9% saline infusion in sheep. Anesthesia Analgesia, 101:835-842, 2005. Swischuk LE. Emergency pediatric imaging: changes over the years (Part 1). Emerg Radio, 11:193-198, 2005. Swischuk LE. Acute abdomen: Previous urinary tract infections. Pediatric Emergency Care, 21:541-542, 2005. Swischuk LE. Playing with friends: Fell on my arm. Pediatric Emergency Care, 21:687-688, 2005. Takahaski H, Kobayashi M, Tsuda Y, Herndon DN, Suzuki F. Contribution of the sympathetic nervous system on the burn-associated impairment of CCL3 production. Cytokine, 29(5):208-214, 2005. Tao W, Enoh V, Lin C, Johnston W, Li P, Sherwood E. Cardiovascular dysfunction caused by cecal ligation and puncture is attenuated in CD8 knockout mice treated anti-asialogm. Am J Physiol Reg Integr Comp Phys, 289:R478-485, 2005. Tcheung W, Robert R, Rosenberg L, Rosenberg M, Villareal C, Thomas C, Meyer W. Early treatment of acute stress disorder in children suffering from major burn injury. Ped Crit Care Med, 6(6):676-681, 2005. Thakkar K, Kien CL, Rosenblatt JL, Herndon DN. Diarrhea in severely burned children. JPEN, 29(1):8-11, 2005. Thomas C, Miller G, Hartshorn J, Speck N, Walker G. Telepsychiatry program for rural victims of domestic violence. Telemedicine Journal and e-Health, 11(5):602-608, 2005. Tokumaru O and Chen JDZ. Effects of acupressure on gastric myoelectrical activity in healthy humans. Scan J Gastroenterology, 40:319-325, 2005. Toliver-Kinsky TE, Cui W, Murphey ED, Lin C, Sherwood ER. Enhancement of dendritic cell production by fms-like Tyrosine Kinase-3 Ligand increases the resistance of mice to a burn wound infection. J of Immun, 174(1):404-410, 2005. Traber DL, Maybauer MO, Maybauer DM, Westphal M, Traber LD. Inhalational and acute lung injury. Shock, 24:82-87, 2005. Vaid SU, Shah A, Michell MW, Rafie AD, Deyo DJ, Prough DS, Kramer CG. Normotensive and hypotensive closed-loop resuscitation using 3.0% NaC1 to treat multiple hemorrhages in sheep. Crit Care Med, 2005. Varma T, Durham M, Murphey ED, Cui W, Huang Z, Lin C, Toliver-Kinsky T, Sherwood E. Endotoxin priming improves clearance of Pseudomonas Aeruginosa in wild type and IL-10 knockout mice. Infect Immun, 73:7340-7347, 2005. Voruganti VS, Klein GL, Lu HX, Thomas S, Freeland-Graves JH, Herndon DN. Impaired zince and copper status in children with burn injuries: Need to reassess nutritional requirements. Burns, 31(6):711-716, 2005. Wollaston DE, Xu XH, Tokumaru O, Chen JDZ, McNearney TA. Systemic sclerosis patients have unique and persistent alterations in gastric myoelectrical activity (GMA) with acupuncture to Neiguan point PC6. J of Rheumatology, 32:494-501, 2005. Wang ZS, He ZY, Chen JDZ. Robust time delay estimation of gastric myoelectrical signals using least absolute deviation neural network. IEEE Trans Biomedical Engineering, 52(3):454-62, 2005. Wei W, Wang G, Qi X, Englander EW, Greeley GH, Jr. Characterization and regulation of the rat and human ghrelin promoters. Endocrinology, 146:1611-1625, 2005. Xing JH and Chen JDZ. Reproducibility of gastric tone, compliance and gastric accommodation assessed with barostat in dogs. Neurogastroenterology and Motility, 17:83-88, 2005. Xu XH, Zhu HB, Chen JDZ. Pyloric electrical stimulation for obesity: reduced food intake and possible mechanisms. Gastroenterology, 128(1):43-50, 2005. Xu XH, Brining D, Chen JDZ. Effects of vasopressin and long pulse gastric electrical stimulation on gastric emptying, gastric and intestinal myoelectrical activity and symptoms in dogs. Neurogastroenterology and Motility, 17:236-244, 2005. Xu XH, Brining D, Rafiq A, Hayes J, Chen JDZ. Effects of enhanced viscosity on gastric and intestinal motility in the canine. J of Gastroenterology and Hepatology, 20:387-394, 2005. Yao SK, Ke MY, Wang ZF, Xu DB, Zhang YL, Chen JDZ. Visceral Sensitivity to Gastric Stimulation and its Correlation with Alterations in Gastric Emptying and Accommodation in Humans. Obesity Surgery, 15:247-253, 2005. Yin JY, Chen JDZ. Retrograde gastric electrical stimulation reduces food intake and weight in obese rats. Obesity Res, 13:1580-1587, 2005. Zhu HB, Chen JDZ. Implantable gastric stimulation inhibits asataric motility via sympathetic pathway in dogs. Obesity Surgery, 15:95-100, 2005. Zuchner, Those, Schliebs R, Perez-Polo JR. Down-regulation of muscarinic acetylcholine receptor M2 adversely affects the expression of Alzheimer’s disease relevant genes and proteins. J Neurochemistry, 95:20-32, 2005. Top 2004 Barrow RE, Spies M, Barrow LN, Herndon DN. Influence of demographics and inhalation injury on burn mortality in children. Burns, 30(1):72-77, 2004. Boersheim E, Cree MG, Tipton KD, Elliott TA, Aarsland A, Wolfe RR. Effect of carbohydrate intake on net muscle protein balance during recovery from resistance exercise. J Applied Physiol, 96:674-678, 2004. Chung DH, Herndon DN. Multiple converging mechanisms for postburn intestinal barrier dysfunction. Crit Care Med, 32(8):1803-1804, 2004. Cox RA, Enkhabaatar P, Burke AS, Katahira J, Shimoda K, Chandra A, Traber LD, Herndon DN, Hawkins HL, Traber DL. Effects of dual endothelin-1 receptor antagonist on airway obstruction and acute lung injury in sheep following smoke inhalation and burn injury. Clin Sci (Lond), 2004. Cree MG, Newcomer BR, Katsanos CS, Sheffield-Moore M, Chinkes DL, Aarsland A, Urban R, Wolfe RR. Intramuscular and liver triglycerides are increased in the elderly. J Clin Endocrinol Metab, 89:3864-3871, 2004. Dasu MRK, Hawkins HK, Barrow RE, Xue H, Herndon DN. Gene expression profiles from hypertrophic scar fibroblasts before and after IL-6 stimulation. J Pathol, 202:476-485, 2004. Dasu MRK, Herndon DN, Spies M, Perez-Polo JR. Genomic analysis of insulin-like growth factor-1 gene transfer in thermally injured rate. Wound Rep Reg, 12:217-224, 2004. Dasu MRK, Cobb JP, Laramie JS, Chung P, Spies M, Barrow RE. Gene expression profiles of livers from thermally injured rats. Gene, 327:51-60, 2004. Dasu MRK, Barrow RE, Hawkins HK, McCauley RL. Gene expression profiles of giant hairy nevi. J Clin Path, 57:849-855, 2004. Dhanraj P, Asuku M, Oh S, McCauley RL. Management of postburn recalcitrant knee ulcers in burn patients. J Burn Care Rehabil, 129-133, 2004. Durhan WJ, Li Y-P, Gerken E, Farid M, Wolfe RR, Redi MB. Fatiguing exercise reduces DNA-binding activity of NF-kB in skeletal muscle muclei. J Appl Physiol, 97(5):1740-1745, 2004. Durhan WJ, Miller SL, Yeckel CW, Chinkes DL, Tipton KD, Rasmussen BB, Wolfe RR. Leg glucose and protein metabolism during an acute bout of resistance exercise in humans. J Appl Physiol, 97:1379-1386, 2004. Englander EW, Gomez GA, Greeley GH Jr. Alterations in stomach ghrelin production and in ghrelin-induced growth hormone secretion in the aged rat. Mech Ageing Day, 125:871-875, 2004. Enkhbaatar P, Murakami K, Cox R, Westphal M, Morita N, Brantley K, Burke A, Hawkins H, Schmalstieg F, Traber L, Herndon DN, Traber D. Aerosolized tissue plasminogen inhibitor improves pulmonary function in sheep with burn and smoke inhalation. Shock, 22(1):70-75, 2004. Fabia RH, Perez-Polo JR, Kent TA. Extracellular superoxide concentration increases following cerebral hypoxia but does not affect cerebral blood flow. Int J Devl Neuro, 22:225-230, 2004. Fafie AD, Rath PA, Michell MW, Kirschner RA, Deyo DJ, Prough DS, Kramer GC. Hypotensive resuscitation of multiple hemorrhages using crystalloid and colloids. Shock, 22:262-269, 2004. Gomez G, Englander EW, Greeley GH Jr. Nutrient inhibition of ghrelin secretion in the fasted rat. Regul Pept, 177:33-36, 2004. Gomez G, Englander EW, Wang G, Greeley GH Jr. Increased expression of hypoxia-inducible factor-1a, p48, and the notch-signaling cascade during acute pancreatitis in mice. Pancreas, 28:58-64, 2004. Gordon MD, Gottschlich MM, Helving EI, Marvin JA, Richard RL. Review of evidenced-based practice for the prevention of pressure sores in burn patients. J Burn Care Rehab., 23:388-401, 2004. Heggers JP, Goodheart RE, Washington J, McCoy L, Carino E, Dang T, Edgar P, Maness C, Chinkes DL. Therapeutic efficacy of three silver dressings in an infected animal model. J Burn Care Rehabil, 26:53-55, 2004. Herndon DN, Tompkins RG. Support of the metabolic response to trauma. The Lancet, 363(9424), 1895-1902, 2004. Jeschke MG, Barrow RE, Przkora R, Finnerty CC, Mlcak R, Herndon DN. Endogenous anabolic hormones and hypermetabolism: effect of trauma and gender differences. Crit Care Med, 32(12 Suppl): A2, 2004. Jeschke MG, Barrow RE, Herndon DN. Extended hypermetabolic response of the liver in severely burned pediatric patients. Arch Surg, 139(6):641-647, 2004. Jeschke MG, Herndon DN. Effect of growth factors as therapeutic drugs in hepatic metabolism during the system inflammatory response syndrome. Curr Drug Metab., 5(5):399-413, 2004. Katakura T, Mlyazaki M, Kobayashi M, Herndon DN, Suzuki F. CCL17 and IL-10 as effectors that enable alternatively activated macrophages to inhibit the generation of classically activated macrophages. J Immunol, 172:1407-1413, 2004. Katakura T, Kobayashi M, Herndon DN, Suzuki F. Effect of IL-12 and soluble IL-4 receptor on the herpes virus infection in human SCID chimera whose TH2 cells predominate. Immuno and Cell Biol., 82:421-426, 2004. Kien CL, Chang JC, Cooper JR, Frankel WL. Effects of prefeeding a prebiotic on diarrhea and colonic cell proliferation in piglets fed lactulose. J Perenter Enteral Nutr., 28(1):22-26, 2004. Klein D, Schubert T, Horch RE, Jauch KW, Jeschke MG. Insulin treatment improves hepatic morphology and function through modulation of hepatic signals after severe trauma. Ann of Surg, 240(2):340-349, 2004. Klein GL, Chen TC, Holick MF, Langman DB, Price H, Celis MM, Herndon DN. Synthesis of Vitamin D in skin after burns. Lancet, 363:291-291, 2004. Klein GL. Glucocorticoid induced bone loss in children. Clinical Reviews of Bone and Mineral Metabolism, 2(1):37-52, 2004. Klein GL, Bi LX, Sherrard DJ, Beavan SR, Ireland D, Compston JE, Williams WG, Herndon DN. Evidence supporting a role of glucocorticoids in short-term bone loss in burned children. Osteoporos Int., 15(6):468-474, 2004. Klein GL, Chen TC, Holick MF, Langman CB, Herndon DN. Vitamin D deficiency in burned children: causes and consequences. Asia Pac J Clin Nutr, 12 (Suppl) S152. Lee HM, Hu Z, Greeley GH Jr., Wang C, Englander EW. Developmental changes in expression and subcellular localization of the DNA repair lycosylase. J Neurochem, 88:394-400, 2004. Martini WJ, Chinkes DL, Wolfe RR. Quantification of DNA synthesis from different pathways in cultured human fibroblasts and myocytes. Metabolism, 53:128-133, 2004. Martine WJ, Chinkes DL, Wolfe RR. The intracellular free amino acid pool represents tracer precursor enrichment for calculation of protein synthesis in cultured fibroblasts and myocytes. J Nutr, 134:1546-1550, 2004. Meyer WJ III, Blakeney P, Russell W, Thomas C, Robert R, Berniger F, Holzer C. Psychological problems reported by young adults who were burned as children. J Burn Care Rehabil, 25:98-106, 2004. Miller S, Chinkes DL, Maclean D, Gore D, Wolfe RR. In vivo muscle amino acid transport involves two distinct processes. Am J Physiol, 287:138-141, 2004. Motykie Gary D., Obeng Michael K., Heggers John P. Aloe Vera in wound healing. Aloes, Chapter 10:239-250, 2004. Morio B, Holmback U, Gore D, Wolfe RR. Increased VLDL-TAG turnover during and after acute moderate intensity exercise. Med Sci Sports Exerc, 39(5):801-806, 2004. Murphey ED, Lin CY, McGuire RW, Toliver-Kinsky T, Herndon DN, Sherwood ER. Diminished bacterial clearance is associated with decreased IL-12 and interferon-y production but a sustained pro-inflammatory response in a murine model of post-septic immunosuppression. Shock, 21(5):415-425, 2004. Murphy KD, Thomas S, Mlcak RP, Chinkes DL, Klein GL, Herndon DN. Effects of long-term oxandrolone administration in severely burned children. Surgery, 136:219-224, 2004. Obeng Michael K, Motykie Gary D, Dastgir Amer, McCauley Robert L, Heggers John P. Aloe Vera in Thermal and Frostbite Injuries. Aloes, Chapter 11:251-264, 2004. Oliveira GV, Chinkes D, Mitchell C, Oliveira G, Hawkins HK, Herndon DN. Objective postburn scar evaluation with tools to assess vascularity, erythema, pliability, thickness and planimetry. Dermatol Surg, 2004. Oliveira GV, Sanford AP, Murphy KD, Oliveira HM, Wilkins JP, Wu X, Hawkins HK, Kitten G, Chinkes DL, Barrow RE, Herndon DN. Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children Wound Repart Regen., 12:404-411, 2004 Oliveira GV, Shimoda K, Enhkbaatar P, Jodoin J, Burke AS, Chinkes DL, Hawkins HK, Herndon DN. Skin nitric oxide and its metabolites are increased in non-burned skin after thermal injuries. Shock, 22:278-282, 2004. Paddon-Jones D, Sheffield-Moore M, Urban RJ, Aarsland A, Wolfe RR, Ferrando AA. The catabolic effects of prolonged inactivity and acute hypercortisolemia are offset by dietary supplementation. J Clin Endocrinol Metab, 2004. Paddon-Jones D, Sheffield-Moore M, Zhang XJ, Volpi E, Wolf SE, Aarsland A, Ferrando AA, Wolfe RR. Amino acid ingestion improves muscle protein synthesis in the young and elderly. Am J Physio., 286:E321-328, 2004. Paddon-Jones D, Borsheim E, Wolfe RR. Potential ergogenic effects of arginine and creatine supplementation. J Nutr, 134:2888S-2894S, 2004. Pereira C, Murphy K, Herndon DN. Outcome measures in burn care: Is mortality dead? Burns, 30(7):761-771, 2004. Ratcliff SL, Meyer WJ, Cuervo LJ, Villarreal C, Thomas CR, Herndon DN. The use of haloperidol and associated complications in the agitated, acutely ill pediatric burn patient. J Burn Care Rehabil, 25(6):472-478, 2004. Robert R, Brack A, Blakeney P, Villarreal C, Rosenberg L, Thomas C, Meyer W. A double-blind study of the analgesic efficacy of oral transmucosal fentanyl citrate and oral morphine in pediatric patients undergoing burn dressing change and tubbing. J Burn Care Rehabil., 24(6):351-355, 2004. Serghiou M, Holmes CL, McCauley RL. A Survey of Current Rehabilitation Trends for Burn Injuries to Head and Neck. J Burn Care Rehabil, 25(^):514-518, 2005. Sha J, Kozlova EV, Fadl AA, Houston CW, Peterson JW, Chopra AK. Molecular characterization of a glucose-inhibited division gene (gidA) that regulates cytotoxic enterotoxin of Aeromonas hydrophila. Infect Immun, 78:1084-1095, 2004. Shah A, Connolly CA, Kirschner RA, Herndon DN, Kramer GC. Evaluation of hyperdynamic resuscitation in 80% TBSA burn-injured sheep. Shock, 21(2):86-92, 2004. Sheffield-Moore M, Yacket CW, Volpi E, Solf SE, Morio B, Chinkes DL, Paddon-Jones D, Wolfe RR. Post-exercise protein metabolism in older and younger men following moderate-intensity aerobic exercise. Am J Physiol, 287:E513-E522, 2004. Sidossis LS, Magkos F, Mittendorfer B, Wolfe RR. Stable isotope tracer dilution for quantifying very low-density lipoprotein-triacyglycerol kinetics in man. Clin Nutri, 23:457-466, 2004. Spies M, Herndon DN. Metabolic Response to Trauma. Basic Science for Surgeons: A review. 387-404, 2004. Suman OE, Mlcak RP, Herndon DN. Effects of exogenous growth hormone on resting pulmonary function in children with thermal injury. J Burn Care Rehabil., 25(3):287-293, 2004. Tadros T, Traber DL, Herndon DN. Opposite effects of prostacyclin on hepatic blood flow and oxygen consumption after burn and sepsis. Ann Surg, 239(1):67-74, 2004. Takahashi H., Tsuda Y., Kobayashi M, Herndon DN, Suzuki F. Increased norepinephrine production associated with burn injuries results in CCL2 production and type 2 T-cell generation. Burns, 30 (4):317-321, 2004. Takahashi H, Tsuda Y, Takeuchi D, Kobayashi M, Herndon DN, Suzuki F. Influence of systemic inflammatory response syndrome on host resistance against bacterial infections. Crit Care Med., 32(9):1879-1885, 2004. Tao W, Sherwood E. Beta 2 microglobulin knockout mice treated with anti-asiaioGM1 exhibit improved hemodynamics and cardiac contractile function during acute intraabdominal sepsis. Am J Physiol Regul Integr Comp Physiol, 286:R569-575, 2004. Tao W, Deyo D, Traber D, Johnston W, Sherwood E. Hemodynamic and cardiac contractile function during sepsis caused by cecal ligation and puncture in mice. Shock, 21:31-37, 2004. Tatsuski Katakura, Masaru Mlyazaki, Makiko Kobayashi, David N. Herndon, Fujio Suzuki. CCL17 and IL-10 as effectors that enable alternatively activated macrophages to inhibit the generation of classically activated macrophages. J of Immun, 172:1407-1413, 2004. Thomas C, Ayoub M, Rosenberg L, Robert R, Meyer W. Attention deficit hyperactivity disorder and pediatric burn injury: A preliminary retrospective study. Thomas S, Wolf SE, Murphy KD, Chinkes DL, Herndon DN. The long-term effect of oxandrolone on hepatic acute phase proteins in severely burned children. J Trauma, 56(1):37-44, 2004. Thomas S, Wolf SE, Chinkes DL, Herndon DN. Recovery from the hepatic acute phase response in the severely burned and the effects of long-term growth hormone treatment. Burns, 30:675-679, 2004. Thyfault JP, Raymond M, Hickner RC, Howell AW, Wolfe RR, Gohm GL. Impaired plasma fatty acid oxidation in extremely obese women. Am J Physiol, 287:E1076-E1081, 2004. Tipton KD, Elliott TA, Cree MG, Wolf SE, Sanford AP, Wolfe RR. Ingestion of casein and whey proteins result in muscle anabolism after resistance exercise. Med Sci Sports Exerc, 2073-2081, 2004. Tsuda Y, Takahashi H, Kobayashi M, Hanafusa T, Herndon DN. CCL2, a product of mice early after systemic inflammatory response syndrome (SIRS), induces alternatively activated macrophages capable of impairing antibacterial resistance of SIRS mice. Jour of Leukocyte Biol., 76:368-373, 2004. Tsuda Y, Takahashi H, Kobayashi M, Hanafusa T, Herndon DN, Suzuki F. Three different neutrophil subsets exhibited in mice with different susceptibilities to infection by methicillin-resistant staphylococcus aureus. Immunity, 21(2):215-226, 2004. Wang G, Leiter AB, Englander EW, Greeley GH Jr. Insulin-like growth factor-1 increases rat peptide YY promoter activity through Sp-1 binding sites. Endocrinology, 145:659-666, 2004. Wang G, Anini Y, Wei W, O’Carroll AM, Mochizuki T, Wang HQ, Hellmich MR, Englander EW, Greeley GH Jr. Apelin, a new enteric peptide: Localization in the gastrointestinal tract, ontogeny, and stimulation of gastric cell proliferation and of cholecystokinin secretion. Endocrinology, 145:1342-1348, 2004. Wolfe RR, Jordan D, Wolfe ML. The Walkabout: A new solution for falls in the elderly and disabled. Arch Phys Med Rehab, 85:2067-2069, 2004. Wolfe RR and Chinkes DL. Isotope tracers in metabolic research: Principles and Practice Kinetic Analysis. Wiley, New York, NY (274 pages), 2004. Zhang XM, Chinkes DL, Wolfe RR. Leucine supplementation has an anabolic effect on proteins in rabbit skin wound and muscle. J Nutr, 134:3313-3318, 2004. Zhang XJ, Chinkes DL, Wu Zhanpin, Martini WZ, Wolfe RR. Fractional synthesis rates of DNA and protein in rabbit skin are not correlated. J Nutri, 134:2401-2406, 2004. Zuchner T, Perez-Polo JR, Schlisbs R. Beta-Sacretase BACE1 is differentially controlled through muscarinic acetylcholine receptor signaling. J Nueuros Res, 77:250-257, 2004. Top 2003 Barret JP, Herndon DN. Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours. Arch Surg;138:127-132, 2003. Barret JP, Herndon DN. Effects of burn wound excision on bacterial colonization and invasion. Plast Reconstr Surg; 111(2):744-752, 2003. Barrow RE, Dasu M, Ferrando AA, Spies M, Thomas SJ, J. Regino Perez-Polo. Gene expression patterns in skeletal muscle of thermally injured children treated with oxandrolone. Annals of Surgery; 237(3), 2003. Barrow RE, Spies M, Barrow LN, Herndon DN. Influence of demographics and inhalation injury on burn mortality in children. J Burn, 1712:1-6, 2003. Celis MM, Suman OE, Huang TT, Yen P, Herndon DN. Effect of a supervised exercise and physiotherapy program on surgical interventions in children with thermal injury. J Burn Care Rehabi; 24:57-61, 2003. Chaisson NF, Kirschner RA, Deyo DJ, Lopez JA, Prough DS, Kramer GC. Near-infrared spectroscopoy-guided closed-loop resuscitation of hemorrhage. J Trauma 54(5):S183-S192, 2003. Chandra A, Katahira J, Schmalstieg FS, Murakami K, Enkhbaatar P, Cox RA, Hawkins HK, Traber LD, Herndon DN, Traber DL. P-sectin blockade fails to improve acute lung injury in sheep. Clinical Science; 104:313-321, 2003. Connolly CM, Barrow RE, Chinkes DL, Martinez JA, Herndon DN. Recombinant human growth hormone increases thyroid hormone-binding sites in recovering severely burned children. Shock;19:399-403, 2003. Connolly CM, Kramer GC, Hahn RG, Chaisson NF, Svensen C, Kirschner RA, Hastings DA, Chinkes D, Prough DS. Isoflurane but not mechanical ventilation promotes third-space fluid losses during crystalloid volume leading. Anesthesiology, 98(3):670-681, 2003. Cox RA, Burke AS, Soejima K, Murakami K, Katahira J, Traber LD, Herndon DN, Schmalstieg FC, Traber DL, Hawkins HK. Airway obstruction in sheep with burn and smoke inhalation injuries. Am J Respir Cell Molec Biol, 29(3):295-302, 2003. Dasu RKM, Spies M, Barrow RE, Herndon DN. Matrix Metalloproteinases and their tissue inhibitors in severely burned children. Wound repair and regenerations; 11:1-4, 2003. Dasu MRK, Barrow RE, Spies M, Herndon DN. Matrix metalloproteinase expression in cytokine stimulated human dermal fibroblasts. Burns, 29:527-531, 2003. Dasu MRK, Herndon DN, Nesic O, Perez-Polo JR. IGF-1 gene transfer effects on inflammatory elements present after thermal injury. Am J Physol Regul Integr Comp Physiol, 285:R741-R746, 2003. Enkhbaatar P, Murakami K, Shimoda K, Mizutani A, Traber L, Phillips GB, Parkinson JP, Cox R, Hawkins H, Herndon DN, Traber D. The inducible nitric oxide synthase inhibitor BBS-2 prevents acute lung injury in sheep after burn and smoke inhalation injury. Am J Respir Crit Care Med; 167:1021-1028, 2003. Enkhbaatar P, Murakami K, Shimoda K, Mizutani A, Traber DL, Phillips G, Parkinson J, Salsbury J, Biondo N, Schmalstieg F, Burke A, Cox R, Hawkins H, Herndon DN, Traber D. An inducible nitric oxide synthase dimerization inhibitor prevents cardiovascular and renal morbidity in sheep with combined burn and smoke inhalation injury. Am J Physiol Heart Circ Physiol, 2003. Ferrando AA, Sheffield-Moore M, Paddon-Jones D, Wolfe RR, Urban RJ. Differential anabolic effects of testosterone and amino acid feeding in older men. J Clin Endocrino Metag 88:358-362, 2003. Galindo CL, Sha J, Ribardo DA, Fadl AA, Pillai L, Chopra AK. Identification of aeromonas hydrophila cytotoxic enterotoxin-induced genes in macrophages using microarrays. J Biol Chem, 278:40198-40212, 2003. Gore DC, Wolf SE, Herndon DN, Wolfe RR. Metformin blunts stress-induced hyperglycemia after thermal injury. J Trauma; 54(3):555-561, 2003. Gore DC, Chinkes DL, Sanford AP, Hart DW, Wolf SE, Herndon DN. Influence of fever on the hypermetabolic response in burn injured children. Arach Surg; 138:169-174, 2003. Hart DW, Wolf SE, Chinkes DL, Beauford RB, Mlcak RP, Heggers JP, Wolfe RR, Herndon DN. Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after burn. J Trauma; 54:755-764,2003. Hart DW, Gore DC, Rinehart AJ, Asimakis GK, Chinkes DL. Sepsis-induced failure of hepatic energy metabolism. J Surg Res, 115:139-147,2003. Hawkins HK. Effect of Poly (ADP-RIBOSE) synthetase inhibition on burn and smoke inhalation injury in sheep. Am J Physiol Lung Cell Mol Physiol, 2003. Heggers JP, Villarreal C, McCoy L, Goodheart MLT, Maness C, Carino E, Washington J. Antimicrobial susceptibility of mafenide acetatae 5% with Nystatin 10,000 U/ml solution: Synergy or Antagonism. Journal of Burns and Surgical Wound Care, 2003. Heggers JP. Assessing and controlling wound infection. Clin Plastic Surg; 30:25-35, 2003. Herndon DN. Nutritional and pharmacological support of the emetabolic response to injury. Minerva Anestesiological, 69(4):264-274, 2003. Herndon DN, Dasu MRK, Wolfe RR, Barrow RE. Gene expression profiles and protein balance in skeletal muscle of burned children after β-adrenergic blockade. Am J Physiol Endocrinol Metab. 285:E783-E789, 2003. Katakura T, Kobayashi M, Fujita K, Herndon DN, Pollard RB, Suzuki F. A combination therapy using IL-12 and Soluble IL-4 receptor on herpes simplex virus Type 1 infection in a human-SCID chimera model of thermal injury. Clinical Immunology; 105(3): 363-370, 2003. Kobayashi H, Kobayashi M, Takahashi H, Herndon DN, Pollard RB, Suzuki F. Soluble IL-4 receptor improves the skin-graft associated cytomegalovirus infection in thermally injured mice. Burns; 29:315-321, 2003. Kobayashi J, Borsheim E, Anthony T, Traber DL, Badalamenti J, Kimball S, Jefferson L, Wolfe RR. Reduced amino acid availability inhibits muscle protein synthesis and decreases activity of initiation factor elF2B. Am J Physiol Endocrinol Metab; 284:E488-E498, 2003. Kobayashi M, Takahashi H, Herndon DN, Pollard RB, Suzuki F. Therapeutic effects of IL-12 combined with benzoylmesaconine, a non-toxic aconitine-hydrolysate, against herpes simplex virus type 1 infection in mice following thermal injury. Burns; 29:37-42, 2003. Kramer GC. Hypertonic resuscitation: Physiologic mechanisms and recommendations for trauma care. J Trauma; 54(5):S89-S99, 2003. Kramer GC. Counterintuitive red blood cell substitute-Polyethylene Glycol-Modified Human Hemoglobin. Crit Care Med., 31(6):1882-1884, 2003. Mileski WJ, Burkhart D, Hung JL, Kagan RJ, Saffle JR, Herndon DN, Heimbach DM, Luterman A, Yurt RW, Goodwin CW, Hansborough J. Clinical effects of inhibiting leukocyte adhesion with monoclonal antibody to intracellular adhesion molecule-1 (Enlimomab) in the treatment of partial-thickness burn injury. J. Trauma, 54(5):950-958, 2003. Miller SL, Tipton KD, Chinkes DL, Wolf SE, Wolfe RR. Independent and combined effects of amino acids and glucose on muscle protein following resistance exercise. Med Sci Sports Exerc; 35:449-455, 2003. Muller MJ, Hollyoak MA, Moaveni Z, Brown TLH, Herndon DN, Heggers JP. Retardation of wound healing by silver sulfadiazine is reversed by Aloe Vera and Nystatin. Burns, 29(8):834-836, 2003. Murakami K, McGuire R, Cox RA, Jodoin JM, Schmalstieg FC, Traber LD, Hawkins HK, Herndon DN, Traber DL. Recombinant antithrombin attenuates pulmonary inflammation following smoke inhalation and pneumonia in sheep. Crit Care Med; 3(2), 2003. Murphy KD, Lee JO, Herndon DN. Current pharmacotherapy for the treatment of severe burns. Expert Opin. Pharmacother; 4(3), 2003. Paddon-Jones D, Sheffield-Moore M, Creson D, Sanford AP, Wolf SE, Wolfe RR, Ferrando AA. Hypercortisolemia alters muscle protein anabolism following ingestion of essential amino acids. Am J Physiol Endocrinol Metabl, 284:E946-953, 2003. Ramzy PI, Jeschke MG, Wolf SE, Swischuk L, Heggers JP, Herndon DN. Correlation of bronchoalveolar lavage with radiographic evidence of pneumonia in thermally injured children. J Burn Care and Rehabil, 24:382-385, 2003. Robert R, Brack A, Blakeney P, Villarreal C, Rosenberg L, Thomas C, Meyer WA. A double-blind study of the analgesic efficacy of oral transmucosal fentanyl citrate and oral morphine in pediatric patients undergoing burn dressing change and tubbing. Journal of Burn Care & Rehabilitation, 2003. Serghiou MA, McLaughlin A, Herndon DN. Alternative splinting methods for the prevention and correction of burn scar torticollis. J Burn Care Rehabil, 24(5):336-340, 2003. Shah A, Kramer GC, Grady JJ, Herndon DN. Meta-analysis of fluid requirements for burn injury. J Burn Care Rehabil, 24(2):S118, 2003. Spies M, Herndon DN, Rosenblatt JL, Sanford AP, Wolf SE. Prediction of mortality from catastrophic burns in children. Lance; 361(9362):989-994, 2003. Spies M, Herndon DN, Sparkes BG, Allgower M. Skin toxicity induced by wet heat. Burns; 29:215-220, 2003. Spies M, McCauley RL, Mudge BP, Herndon DN. Management of acute calvarial burns in children. J Trauma; 54(4):765-769, 2003. Suman OE, Thomas SJ, Wilkins JP, Mlcak RP, Herndon DN. Effect of exogenous growth hormone and exercise on lean mass and muscle function in children with burns. J Appl Physiol,94:2273-2281, 2003. Svrakic NM, Nesic O, Dasu MRK, Herndon DN, Perez-Polo JR. Statistical approach to DNA chip analysis. Recent Prog. Horm. Res.; 58:75-93, 2003. Tadros T, Traber DL, Heggers JP, Herndon DN. Effects of Interleukin1A Administration on Intestinal Ischemia/Reperfusion Injury, Mucosal Permeability and Bacterial Translocation in Burn and Sepsis. Ann Surg, 237(1):101-109, 2003. Thomas CR. Phantom limb pain in pediatric burn survivors. Burns; 29:139-142, 2003. Thomas C, Ayoub M, Rosenberg L, Robert R, Meyer W. Attention deficit hyperactivity disorder and pediatric burn injury: A preliminary retrospective study. Burns, 2003. Thomas SJ, Kramer GC, Herndon DN. Burns: Military options and tactical solutions. J Trauma, 54 (S5):S207-S218, 2003. Toliver-Kinsky TE, Cheng YL, Herndon DN, Sherwood ER. Stimulation of hematopoieses by the Fms-like tyrosine kinase 3 ligand restores bacterial induction of Th1 cytokines in thermally injured mice. Immun. Infec, 71(6):3058-3067, 2003. Volpi E, Kobayashi H, Sheffield-Moore M, Mittendorfer B, Wolfe RR. Essential amino acids stimulate muscle protein anabolism in healthy older adults regardless of the presence of non-essential amino acids. Am J Clin Nutr, 78:250-258, 2003. Vu H, McCoy LF, Carino E, Washington J, Dang T, Villarreal C, Rosenblatt J, Maness C, Goodheart R, Heggers JP. Burn wound infection susceptibilities to topical agents: The Nathan’s Agar Well Diffusion Technique. P&T, Vol.27(8), 390-396, 2003. Wade CE, Grady JJ, Kramer GC. Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma. J Trauma, 54(5):S144-S148, 2003. Waiser EM, Savage C, Ozkahn O, Zwischenberger JB. Percutaneous unknotting and retrieval of swan-ganz catheter. Ann Thorac Surg;75(3):1027, 2003. Wilkins JP, Suman OE, Benjamin DA, Herndon DN. Comparison of self-reported and monitored compliance of daily injection of human growth hormone in burned children. Burns; 29(7):697-701, 2003. Wolf SE, Thomas SJ, Dasu MRK, Ferrando AA, Chinkes DL, Wolfe RR, Herndon DN. Improved net protein balance, lean mass, and gene expression changes with oxandrolone treatment in the severely burned. Ann Surg, 237(6):801-811, 2003. Woodside KJ, VanSonnenberg E, Chon KS, Loran DB, Tocino IM, Zwischenberger JB. Pneumo-thorax in patients with acute respiratory distress syndrome: Pathophysiology, detection and treatment. J Intensive Care Med; 18(1):9-20, 2003. Wu XW, Herndon DN, Wolf SE. Growth hormone down-regulation of IL-1 B and IL-6 induced acute phase protein gene expression is associated with increased gene expression of suppressor of cytokine signal-3 (SOCS-3). Shock;19(4):314-320, 2003. Zhang XJ, Chinkes DL, Wolfe RR. Measurement of protein metabolism in epidermis and dermis. Am J Physiol; 284:E1191-1201, 2003. Top 2002 Angel C, Shu T, French D, Orihuela E, Lukefahr J, Herndon DN. Genital and perineal burns in children: 10 years of experience at a major burn center. J Pediatr Surg 2002; 37(1):99-103. Babraj J, Cuthbertson DJ, Rickhuss P, Meier-Augenstein W, Smith K, Bohe J, Wolfe RR, Gibson JNA, Adams C, Rennie MJ. In: Metabolite Channeling and Metabolic Complexity: Sequential extracts of human bone show differing collagen synthetic rates. Biochem Soc Trans (30) 61-65, 2002. Barret JP, Herndon DN, McCauley RL. Use of previously burned skin as random cutaneous local flaps in pediatric burn reconstruction. Burns; 28:500-502, 2002. Barrow RE, and Herndon DN, In: Critical Care Medicine: Perioperative Management, Chapter 61, In: Acute Care of Burns, Prough D, Ed. Lippincott Williams & Wilkins, Philadelphia, pp 801-817, 2002. Biolo G, Flemming RYD, Maggi SP, Nguyen TT, Herndon DN, Wolfe RR. Inverse regulation of protein turnover and amino acid transport in skeletal muscle of hypercatabolic patients. J Clin Endocrinol Metab 87:3378-3384, 2002. Boersheim E, Tipton KD, Wolf SE, Wolfe RR. Essential amino acids and muscle protein recovery from resistance exercise. Am J Physiol; 46(4):E648-657,2002. Campbell WW, Trappe TA, Jozsi AC, Kruskall LJ, Wolfe RR, Evans WJ. Dietary protein adequacy and lower body vs whole body resistive training in older humans. J Physiol 542:631-642, 2002. Chappell VC, Mileski WM, Wolf SE, Gore DC. Impact of discontinuing a hospital-based air ambulance service on trauma patients outcomes. Journal of Trauma, 52:486-491,2002. Chu D., JX Qiu, M. Grafe, R. Fabian, T.A. Kent, D. Rassin, O. Nesic, K. Werrbach-Perez & R. Perez-Polo. Delayed cell death signaling in traumatized central nervous system: Hypoxia. Neurochemical Res., 27:97-106, 2002. Cole KK, Perez-Polo JR. Ploy (ADP-ribose) polymerase inhibition prevents both apoptotic-like delayed neuronal death and necrosis after HS)2 injury. Journal of Neuro; 82:19-29, 2002. Dhanraj PK, Owiesy F, Phillips LG, McCauley RL. Burn scar contracture of the feet: efficacy of bilateral simultaneous surgial correction. Burns, 2002. Ferrando AA, Sheffield-Moore M, Yeckel CW, Gilkison C, Jiang J, Marcell T, Achacosa A, Lieberman SA, Tipton K, Wolfe RR, Urban RJ. Testosterone administration to older men improves muscle function: molecular and physiological mechanisms. Am J Physiol 282:E601-E607, 2002. Ferrando AA, Paddon-Jones D, Wolfe RR. Alterations in protein metabolism during space flight and inactivity. Nurtition 18:387-341, 2002. Furukawa K, Kobayashi M, Herndon DN, Pollard RB, Suzuki F. Appearance of monocyte chemoattractant protein 1 (MCP-1) early after thermal injury. Role in the subsequent development of burn-associated type 2 T-cell responses. Ann Surg 2002; 236(1):112-119. Furukawa K, Kobayashi M, Sasaki H, Herndon DN, Pollard RB, Suzuki F. Cryptococcal encephalitis in thermally injured mice is accelerated by type 2 T-cell responses. Crit Care Med; 30(7): 1419-1424, 2002. Galvano F., A. Campisi, A. Russo, G. Galvano, M. Palumbo, M. Renis, M.L. Barcellona, J.R. Perez-Polo, A. Vanella. DNA Damage in astrocytes exposed to fumonisin B 1 . Neurochemical Res. 27:345-351, 2002. Goodpaster BH, Wolfe RR, Kelley DE. Effects of obesity on substrate utilization during exercise. Obes Res, 10(7):575-584, 2002. Gore DC, Wolf SE, Herndon DN, Wolfe RR. Relative influence of glucose and insulin on peripheral amino acid metabolism in severely burned patients. JPEN 2002; 26(5):271-277. Gore DC, Chinkes DL, Hart DW, Wolf SE, Herndon DN, Sanford AP. Hyperglycemia exacerbates muscle protein catabolism in burn-injured patients. Crit Care Med; 30:2438-2442, 2002. Gore DC, Wolfe RR. Glutamine supplementation fails to affect muscle protein kinetics in critically ill patients. J Parenteral Enteral Nutr; 26:342-349, 2002. Gregory Scott R., Piccolo Nelson, Piccolo Maria T., Piccolo Monica S., Heggers John P. Comparison of Propolis Skin Cream to Silver Sulfadiazine: A Naturopathic Alternative to Antibiotics in Treatment of Minor Burns. Journ Altern and Compl Med Volume 8 (1); 77-83, 2002. Hart DW, Wolf SE, Herndon DN, Chinkes DL, Lal SO, Obeng MK, Beauford RB, Mlcak RP. Energy expenditure and caloric balance after burn: Increased feeding leads to fat rather than lean mass accretion. Ann Surg; 235(1):152-161, 2002. Hart DW, Wolf SE, Chinkes DL, Las SO, Ramzy PI, Herndon DN. B-blockade and growth hormone after burn. Annals of Surgery, 236:450-457,2002. Heggers JP, Goodheart R, McCoy L, Washington J, Carino E, Rosenblatt J, Villarreal C. Is Linezolid an Alternative to Vancomycin in the Treatment of Burns? Journal of Burns, Volume 1, 2002. Heggers JP, Cottingham J, Gusman J, Reagor L, McCoy L, Carino E, Cox R, Zhao J. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and In Vitro Toxicity. Jour Altern and Complemen Med, Volume 8(3): 333-340, 2002. Herndon DN, Barrow RE, Guha SC, Bhama JK. In: Classic Papers in Intensive Care. Chapter 16, Burns. Moore, Ed. Bladon Medical Publishing Limited, Oxfordshire, PP 1-23, 2002. Jeschke MG, Barrow RE, Suzuki F, Herndon DN. IGF-1/IGFBP-3 equilibrates ratios of pro-to anti-inflammatory cytokines which are predictors for organ function and mortality in severely burned pediatric patients. Mol Med; (In Press) 2002. Jeschke MG, Richter G, Hofstadter F, Herndon DN, Perez-Polo JR, Jauch KW. Non-viral liposomal Keratinocyte growth factor (KGF) cDNA gene transfer improves dermal and epidermal regeneration through stimulation of epithelial and mesenchymal factors. Gene Ther 2002; 9:1065-1074. Klein GL, Langman CB, Herndon DN. Vitamin D depletion following burn injury in children: A possible factor in post-burn osteopenia. J Trauma 2002; 52(2):346-350. Klein GL, Soriano H, Shulman RJ, Levy M, Jones G, Langman CB. Hepatic osteodystrophy in chronic cholestasis: Evidence for a multifactorial etiology. Pediatric Transplantation; 6:136-140, 2002. Kobayashi M, Takahashi H, Sanford AP, Herndon DN, Pollard RB, Suzuki F. An increase in the susceptibility of burned patients to infectious complications due to impaired production of macrophage inflammatory protein, 1a1. J Immunol, 169:4460-4466, 2002. Kobayashi M, Takahashi H, Herndon DN, Pollard RB, Suzuki F. Effect of a combination therapy between IL-12 and soluble IL-4 receptor (sIL-4R) on candida albicans and herpes simplex virus type 1 infections in thermally injured mice. Can J. Microbiol. 48:886-894, 2002. Loran DB, Woodside KJ, Cerfolio RJ, Zwischenberger, JB. Predictors of alveolar air leaks. Chest Surg Clin N Am; 12(3):477-488, 2002. Maykel JA, Pezirandeh S, Bistrian BR, Wolf SE, Wolfe RR, Herndon DN. Beta-blockade and severe burns. N Engl J Med 2002; 346:707-708. Morio B, Irtun O, Herndon DN, Wolfe RR. Propranolol decreases hepatic triacylglycerol storage in burn patients receiving a high-carbohydrate diet. Ann Surg 2002; 236(2):218-225. Murakami K, McGuire R, Cox RA, Jodoin JM, Bjertnaes LJ, Katahira J, Traber LD, Schmalstieg FC, Hawkins HK, Herndon DN, Traber DL. Heparin Nebulization Attenuates Acute Lung Injury in Sepsis following Smoke Inhalation in Sheep. Shock; 18(3): 236-241, 2002. Murakami K, Bjertnaes LJ, Schmalstieg FC, McGuire R, Cox RA, Hawkins HK, Herndon DN, Traber LD, Traber DL. A Novel Animal Model of Sepsis after Acute Lung Injury in Sheep. Crit Care Med, Vol 30, No. 9, 2083-2090, 2002. Nesic O, Svarkic NM, Xu GY, McAdoo D, Westlund KN, Hulsebosch CE, Zeiming YE, Galante A, Soteropoulos P, Tolias P, Young W, Hart RP, Perez-Polo JR. DNA Microarray Analysis of the Contused Spinal Cord: Effect of NMDA Receptor Inhibition. Journal of Neuroscience Res. 68:406-423, 2002. Palmieri TL, Greenhalgh DG, Saffle JR, Spence RJ, Peck MD, Jeng JC, Mozingo DW, Yowler CJ, Sheridan RL, Ahrenholz DH, Caruso DM, Foster KN, Kagan RJ, Voight DW, Purdue GF, Hunt JL, Wolf SE, Molitor F. A multicenter review of toxic epidermal necroslysis treated in US burn centers at the end of the twentieth century. Journal of Burn Care and Rehabilitation, 23:87-96. Parmer KS, Zwischenberger JB, Reeves AL, Waxman I. Clinical Impact of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Axis Lymph Nodes. (M1a disease) in Esophageal Cancer. Annals of Thorac Surg; 73:916-921, 2002. Phillips SM, Parise G, Roy BD, Tipton KD, Wolfe RR, Tarnopolsky MA. Resistance training-induced adaptations in skeletal muscle protein turnover in the fed state. Can J Physiol Pharmacol; 10:1045-1053, 2002. Rasmussen BB, Holmback UC, Volpi E, Morio-Lindore B, Paddon-Jones D, Wolfe RR. Malonyl coenzyme A and the regulation of functional carnitine palmitoyltransferase-1 activity and fat oxidation in human skeletal muscle. J Clin Invest 110:1687-1693, 2002. Rasmussen BB, RR Wolfe, E Volpi. Oral and intravenously administered amino acids produce similar affects on muscle protein synthesis in the elderly. J Nutr Health Agin 6:358-362, 2002. Reagor L, Gusman J, McCoy L, Carino E, Heggers JP. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: l. An In Vitro Agar Assay. Jour Altern and Complemen Med, Volume 8(3): 325-332, 2002. Richard III JW, Spencer BA, McCoy LF, Carino E., Washington J, Edgar P, Rosenblatt J, Goodheart R., Heggers JP. ActicoatTM Versus Silverlon®: The Truth. Journal of Burns; Volume 1, 2002. Spencer BA, Richard III JW, McCoy LF, Carino E, Washington J, Edgar P, Rosenblatt J, Goodheart R, Heggers JP. Antimicrobial Activity of Meropenem on Multi-Resistant Gram-Negative Organisms. Journal of Burns; Volume 1, 2002. Spies M, Wolf SE, Barrow RE, Jeschke MG, Herndon DN. Modulation of types I and II acute phase reactants with insulin-like growth factor-1/binding protein-3 complex in severely burned children. Crit Care Med 2002; 30(1):83-88. Spies M, Chappell VL, Dasu MRK, Herndon DN, Thompson JC, Wolf SE. The role of TNF-alpha in burn induced apoptosis in the small bowel. Am J Physiol-Gastrointest Liver Physiol 2002; 283 L 3):G703-G708. Spies M, Dasu M, Svrakic N, Nesic O, Barrow RE, Perez-Polo R, Herndon DN. Gene Expression Analysis in Burn Wounds of Rats. Am J Physiol Regul Integr Comp Physiol, 283:R1-11, 2002. Suman OE, Mlcak RP, Herndon DN. Effect of exercise training on pulmonary function in children with thermal injury. J. Burn Care Rehabil 2002; 23(4):288-293. Tadros T, Traber DL, Heggers JP, Herndon DN. Effects of Interleukin-1 alpha administration in intestinal ischemia and reperfusion injury, mucosal permeability, and bacterial translocation in burn and sepsis. Thomas S, Barrow RE, Herndon DN. History of the Treatment of Burns. In: Total Burn Care 2 nd ed., Herndon DN, Ed., W.B. Saunders, New York, PP 1-10, 2002. Thomas SJ, Morimoto K, Herndon DN, Ferrando AA, Wolfe RR, Klein GL, Wolf SE. The effect of prolonged euglycemic hyperinsulinemia on lean body mass after severe burn. Surgery, 132:341-347, 2002. Tipton KD, Borsheim E, Wolf SE, Sanford AP, Wolfe RR. Acute response of net muscle protein balance reflects 24h balance after exercise and amino acid ingestion. Am J Physiol 284:E76-E79, 2002. Toliver-Kinsky T, Varma TK, Lin CY, Herndon DN, Sherwood ER. Interferon-y production is suppressed in thermally injured mice: Decreased production of regulatory cytokines and corresponding receptors. Shock; 28(4):322-330, 2002. Vu H, McCoy LF, Carino E, Washington J, Dang T, Villarreal C, Rosenblatt J, Maness C, Goodheart R, Heggers JP. Burn Wound Infection Susceptibilities to Topical Agents: The Nathan’s Agar Well Diffusion Technique. Jour Phar and Ther; 27(8):390-396, 2002. Wolfe RR, Martini WZ, Irtun O, Hawkins HK, Barrow RE. Dietary Fat Composition Alters Pulmonary Function in Pigs. J Nutrition; 18:647-653, 2002. Wu XW, Herndon DN, Spies M, Sanford AP, Wolf SE. Effects of delayed wound excision and grafting in severely burned children. Arch Surg 2002; 137:1049-1054. Wu XW, Spies M, Chappell VL, Herndon DN, Thompson JC, Wolf SE. Effect of bombesin on gut mucosal impairment after severe burn. Shock; 18(6):518-522, 2002. Zhang Xiao-Jun, Chinkes David L., Irtun Oivind, Wolfe Robert R. Anabolic action of insulin on skin wound protein is augmented by exogenous amino acids. Am J Physiol Endocrinal Metab 282:E1308-E1315, 2002. Zhang XJ, Chinkes DL, Wolfe RR. Measurement of muscle protein fractional synthesis and breakdown rates from a pulse tracer injection. Am J Physiol;283:E753-E764, 2002. Zwischenberger JB, Savage C, Witt SA, Alpard SK, Harper DD, Deyo DJ. Arterio-Venous CO 2 Removal (AVCO 2 R). Perioperative Management: Rapid Recovery and Enhanced Survival. J Investigative Surgery; 15:15-21, 2002. Zwischenberger JB, Savage C, Alpard SK, Anderson C, Marroquin S, Goodacare B. Madiastinal Lymph Node Transthoracic Needle Aspiration and Core Biopsy-Should it precede mediastinoscopy. Chest; 121(4):1165-1170, 2002. Top 2001 Barnett, J.R., McCauley, R.L., Schultzer, S., Sheridan, K., Heggers, J.P. Cadaver Donor Discards Secondary to Serology. Journal of Burn Care & Rehabilitation, 22:124-127,2001. Barret JP, Herndon DN. Initial care and resuscitation. IN: Color Atlas of Burn Care, (eds) JP Barret, DN Herndon, W.B. Saunders, London, England, pp. 33-46, 2001. Barret JP, Dardano AN, Herndon DN. Complications. IN: Color Atlas of Burn Care, (eds) JP Barret, DN Herndon, W.B. Saunders, London, England, pp. 123-135, 2001. Barret, J.P., Jeschke, M.G., Herndon, D.N. Selective decontamination of the digestive tract in severely burned pediatric patients. Burns 27(5):439-445,2001. Barret, J.P., Jeschke, M.G., Herndon, D.N. Fatty Infiltration of the Liver in Severely Burned Pediatric Patients: Autopsy Findings and Clinical Implications. Journal of Trauma, 51:736-739,2001. Barrow, R.E., Meyer, N.A., Jeschke, M.G. Effect of varying burns size and ambient temperature on the hypermetabolic rate in thermally injured rats. J Surg Res 99,253-257, 2001. Benjamin D, Herndon DN. Special considerations of age: The pediatric burned patients. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 427-438, 2001. Blakeney PE, McCauley RL, Herndon DN. Prolonged hypermetabolic response over time, the use if anabolic agents and exercise, and longitudinal evaluation of the burned child. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 611-619, 2001. Bohe, J., Low, A.F., Wolfe, R.R., Rennie, M.J. Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids. Journal Physiology 532(2):575-579, May 2001. Button, B., Baker, R.D., Vertrees, R.A., Allen, S.E., Brodwick, M.S., Kramer, G.C. Quantitative assessment of a circulating depolarizing factor in shock. Schock 15(3):239-244, 2001. Chrysopoulo, M.T., Rubin, S., Herndon, D.N., Barrow, R.E. Chest Radiographic Appearances in severely Burned Adults ‘A Comparison of Early Radiographic and Extravascular Lung Thermal Volume Changes.’ Journal Burn Care and Rehab. 22:104-110, 2001. Chung DH, Robie DK, Hernandez A, Angel C, Herndon DN. Surgical management of complications of burn injury. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, 2001, pp. 442-454. Cucuzzo, N.A., Ferrando, A., Herndon, D.N. The Effects of Exercise Programming vs Traditional Outpatient Therapy in the Rehabilitation of Severely Burned Children. Journal of Burn Care & Rehabilitation 29(7):1318-1324, 2001. Dziewulski P, Barret JP, Herndon DN. Prevention and treatment of deformity in burned patients. In: Color Atlas of Burn Care, (eds) JP Barret, DN Herndon, W.B. Saunders, London, England, 2001, pp. 137-153. Ferrando, A.A., Sheffield-Moore, M., Wolf, S.E., Herndon, D.N., Wolfe, R.R. Testosterone administration in severe burns ameliorates muscle catabolism. Crit Care Med (29)10:1936-1942,2001. Glasgow JN, Qiu, J.X., Rassin, D., Grafe, M., Wood, T., Perez-Polo, R.J. Transcriptional Regulation of the Bcl-x gene by NF- k B is an element of hypoxic responses in the rat brain. Neurochemical Research, 26:647-659,2001. Gore, D.C., Chinkes, D., Heggers, J., Herndon, D.N., Wolf, S.E., Desai, M. Association of hyperglycemia with increased mortality following severe burn injury. J of Trauma 51(3):540-544, 2001. Gottschlich, M.M., Klein, G.D. Nutrition Forum. Journal of Burn Care and Rehabilitation, 22:2, 186-187, 2001. Harper, D.D., Alpard, S.K., Deyo, D.J., Lick S.D., Traber, D.L., Zwischenberger, J.B. Anatomic Study of the Pulmonary Artery as a Conduit for an Artificial Lung. ASAIO J: 47 (1): 34-36, 2001. Hart, D.W., Herndon, D.N., Klein, G.L., Lee, S.B., Celis, M., Mohan, S., Chinkes, D.L., Wolf, S.E. Attenuation of muscle catabolism and osteopenia with growth hormone therapy after severe burn. Annals of Surgery, 233: 827-834, 2001. Hart, D.W., Herndon, D.N., Klein, G., Lee, S.B., Celis, M., Mohan S., Chinkes, D.L., Wolf, S.E. Attenuation of Posttraumatic Muscle Catabolism and Osteopenia by Long-Term Growth Hormone Therapy. Annals of Surgery, 233;6, 827-834, 2001. Hart, D.W., Wolf, S.E., Ramzy, P.I., Beauford, R.B., Ferrando, A.A., Wolfe, R.R., Herndon, D.N. Anabolic effects of oxandrolone following severe burn. Annals of Surgery, 233:556-564, 2001. Hart, D.W., Wolf, S.E., Beauford, R.B., Chinkes, D.L., Herndon, D.N. Determinants of blood loss during primary burn excision. Surgery, 130: 396-401, 2001. Hart, D.W., Wolf, S.E., Xhang, X.J., Chinkes, D.L., Buffalo, M.D., Matin, S.K., DebRoy, M.A., Wolfe, .R., Herndon, D.N. Efficacy of a high-carbohydrate diet in catabolic illness. Crit Care Med 29: 1318-1324, 2001. Heggers, J.P., Hawkins, H., Edgar, P., Villarreal, C., Herndon, D.N. Treatment of Infections in Burns. In: Burn Care. Herndon, D.N. (ed). 2 nd Edition. W.B. Saunders Co. LTD.(Bailliere Tindall LTD). London, England pp 120-169, 2001. Herndon DN. Total Burn Care (2 nd Edition), W.B. Saunders, London, England, 2001. Herndon DN, Barret JP. Organization of burn care. In: Color Atlas of Burn Care , (eds) JP Barret, DN Herndon, W.B. Saunders, London, England, pp. 27-32, 2001. Herndon DN, Blakeney PE. Teamwork for Total Burn Care: Achievements, Directions and Hopes. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 11-15, 2001. Herndon, D.N., Hart, D.W., Wolf, S.E., Chinkes, D.L., Wolfe, R.R. Reversal of Catabolism by Beta-Blockade After Severe Burns. N Engl J Med, 345(17):1223-1272, 2001. Herndon, D.N., Spies, M. Modern Burn Care. Sem Ped Surg 10(1): 28-31,2001. Irtun, O., Martini, W.Z., Ozkan, O., Wolfe, R.R. Caval backflow-a potential problem during blood sampling from the hepatic vein. Metabolism 50(2):189-193, Feb 2001. Jayroe, J.B., Alpard, S.D., Deyo, D.J., Savage, C., Murphy, J., Zwischenberger, J.B. Hemodynamic Stability During Arteriovenous Carbon Dioxide Removal (AVCO 2 R) for ARDS: A Prospective Randomized Outcomes Study in Adult Sheep. ASAIO Journal, 47(3): 322-214, 2001. Jeschke, M.G., Herndon, D.N., Baer, W., Barrow, R.E., Jauch, K.W. Possibilities of Non-viral Gene Transfer to Improve Cutaneous Wound Healing. Current Gene Therapy, 1;267-278, 2001. Jeschke, M.G., Low, .J.F., Spies, M., Vita, R., Hawkins, H.K., Herndon, D.N., Barrow, R.E. Cell proliferation, apoptosis, NF-kappaB expression, enzyme, protein, and weight changes in livers of burned rats. American Journal of Physiology Gastrointestinal and Liver Physiology 280:G1314-20, 2001. Klein GL, Herndon DN. Effects of burn injury of the bone and mineral metabolism. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 300-305, 2001. Kramer GC, Lund TjØstolv, Herndon DN. Pathophysiology of burn shock and burn edema. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 78-87, 2001. Low, J.F., Spies, M., Desai, M., Herndon, D.N. Toxic Epidermal Necrolysis in Pediatric Patients. 5 th World Congress on Trauma, Shock, Inflammation and Sepsis 639-641,2001. Martini, W.Z., Itrun, O., Chinkes, D.L., Barrow, R.E., Wolfe, R.R. Surfactant metabolism in conscious pigs after burn injury. Crit Care Med 29 (7), 1417-1422, Jul 2001. McCauley, R.L., Smith, D.M., Heggers, J.P., Robson, M.C. Frostbite Injuries and Other Cold-Induced Injuries for Auerbach: Management of Wilderness and Environmental Emergencies. Wilderness Medicine 4 th (edition), 2001. McCauley, R., Smith, D.J. Jr., Robson, M.C., Heggers, J.P. “Frostbite” In: Management Of Wilderness and Environmental Emergencies Auerbach, P.S., Geehr, E.C. (ed) 4th Ed., C.V. Mosby Co., St. Louis, MO, pp 178-196, 2001. Meyer, III, W.J., Bockting, W.O., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, H., Gooren, L., Hage, J.J., Kirk, S., Kuiper, B., Laub, D., Lawrence, A., Menard, Y., Patton, J., Shaefer, L., Webb, A., Christine, C. The Standards of Care for Gender Identity Disorders, 6 th Edition, International Journal of Transgenderism, 5:1-22, February, 2001. Milner SM, Herndon DN. Radiation injuries, vesicant burns and mass casualties. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 481-491, 2001. Mittendorfer, B., Volpi, E., Wolfe, R.R. Whole-body and skeletal muscle glutamine metabolism in healthy subjects. American Journal Physiology (Endocrionology Metabolism) 280:E323-333, Feb 2001. Mlcak RP, Herndon DN. Respiratory Care. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 242-256, 2001. Muller M, Herndon DN. Operative Wound Management. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 170-182, 2001. Murphey, E.D., Traber, D.L. Protective effect of tumor necrosis factor-against subsequent endotoxemia in mice is mediated, in part, by interleukin-10. Crit Care Med 29 (9): 1761-1766, 2001. Murphy J, Savage C, Alpard SK, Deyo D, Jayroe JB, Zwischenberger JB. Low-dose versus high-dose heparinization during arteriovenous carbon dioxide removal. Perfusion; 16(6):460-468, 2001. Nakajima, H., Kobayashi, M., Pollard, R.B., Suzuki, F. Monocyte chemoattractant protein-1 enchances the severity of HSV-induced encephalomyelitis through the stimulation of Th2 responses. J. Leukoc. Biol., 70, 374-380, 2001. Nesic, O., Guo-Ying, X., McAdoo, D., Westlund-High, K., Hulsebosch, C., Perez-Polo, R. IL-1 Receptor Antagonist Prevents Apoptosis and Caspase-3 Activation after Spinal Cord Injury. Journal of Neurotrauma, Vol. 18, 2001. Obeng, M.K., McCauley, R.L., Barrett, J.R., Heggars, J.P., Sheridan, K., Shutzler, S.S. Cadaveric Allograft Discards as a Result of Positive Skin Cultures. Burns (27):267-271, 2001. Peterson P., Mlcak, R.P., Barret J., Nichols, R.J. Inhalation Injury and Respiratory Care. W.B. Saunders, 2001. Robert R, Blakeney PE, Herndon DN. Abuse, neglect and fire setting: when burn injury involves reporting to a safety officer. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 774-782, 2001 . Rose, M., Sanford, A., Thomas, C., Opp, M.R. Factors Altering the Sleep of Burned Children. Sleep 24(1),45-51, 2001. Sanford, A., Herndon, D.N. Current therapy of burns. In: Surgical Treatment-Evidence-Based and Problem-Oriented. Holzheimer, R.G., Mannick, J.A., (eds.), W. Zuckschwerdt Verlag, New York, pp. 684-688, 2001. Sanford A, Herndon DN. Chemical Burns. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 475-480, 2001. Savage, C., Zwischenberger, J.B., Deyon, D.J., Heming, T.A., Alpard, S.K., Bidani, A. A New Technique For Performing Bronchoalveolar Lavage in Sheep. J Bronchology 8: 17-20, 2001. Schenarts, P.J., Schmalstieg, F.C., Hawkins, H., Bone, H.G., Traber, L.D., Traber, D.L. Effects of an L-Selection Antibody on the Pulmonary and Systemic Manifestations of Severe Smoke Inhalation Injuries in Sheep. Journal of Burn Care & Rehabilitation:21(3) 229-240.2001. Schmalstieg, F.C., Chow, J., Savage, C., Rudloff, H.E., Palkowetz, K.H., Zwischenberger, J.D. Interleukin-8, Aquaporin-1, and Inducible Nitric Oxide Synthase In Smoke and Burn Injured Sheep Treated with Percutaneous Carbon Dioxide Removal. ASAIO J 47(4):365-371, 2001. Soejima, K., Schmalsteig, F.C., Traber, L. D., and Traber, D. L. Pathophysiological analysis of combined inhalation Injury. Ameridan Journal of Physiology. Lung Cell Mol. Physiology 280:L1233-1241, 2001. Soejima, K., Traber, L.D., Schmalstieg, F.C., Hawkins, H., Jodoin, J.M., Szabo, C., Szabo, E., Varig, L., Salzman, A., Traber, D.L. Role of Nitric Oxide in Vascular Permeability after Combined Burns and Smoke Inhalation Injury. American of Journal Respiratory Critical Care Medicine 163:745-752, 2001. Spies M, Hollyoak M, Muller MJ, Goodwin CW, Herndon DN. Exfoliative and necrotizing diseases of the skin. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 492-502, 2001. Spies M, Muller M, Herndon DN. Modualtion of the hypermetabolic response after burn injury. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 363-381, 2001. Spies, M., Barret, J.P., Herndon, D.N. The use of cultured epidermal auto-grafts and serial auto-grafting in massive pediatric burns. State of the art – Cultured epidermal auto-grafts, Eds. Horch, Munster, Achauer: Heidelberg: J.A.Barth, 203-210, 2001. Spies M, Sanford AP, Low JFA, Wolf SE, Herndon DN. Treatment of extensive toxic epidermal necrolysis in children. Pediatrics, 108(5):1162-1168, 2001. Suman, O.E., Spies, R.J.,, Celis, M.M., Mlcak, R.P., Herndon, D.N. Effects of a 12-wk resistance exercise program on skeletalmuscle strength in children with burn injuries. J. Applied Physiology, 91: 1168-1175, 2001. Suman OE, Phd, Beck KC, PhD, Scanlon PD, MD. Exercise Induced Asthma. AJMS, pp 349-356 Thomas S, Barrow RE, Herndon DN. Introduction: History of the treatment of burns. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 1-10, 2001. Tipton, K.D., Rasmussen, B.B., Miller, S.L., Wolf, S.E., Owens-Stovall, S., Petrini, B., Wolfe, R.R. Timing of amino-acid carbohydrate ingestion alters anabolic response of muscle to resistance exercise. American Journal of Physiology, 281: E197-206, 2001. Tipton, K.D. Muscle Protein Metabolism in the Elderly: Influence of Nutrition and Exercise. Can. J. Applied Physiology, 26:588-606, 2001. Tipton, K.D. Muscle Hypertrophy and Resistance Training: Efficacy of Nutritional Supplementation. SCAN’S Pulse. 20 (2): 1-4, 2001. Tipton, K.D., Wolfe, R.R. Exercise, Protein Metabolism and Muscle Growth. Int J. Sports Nutrition and Exerc. Met. 11: 112-135, 2001. Tølløfsrud, S., Elgjo, G.I., Prough, D.S., Williams, C.A., Traber, D.L., Kramer, G.C.. The dynamics of vascular volume and fluid shifts of infused lactated Ringer \'s and hypertonic saline dextran (HSD) in normovolemic sheep. Anesthesia & Analgesia, 93:823-31, Oct. 2001. Traber DL, Herndon DN, Soejima K. The Pathophysiology of inhalation injury. IN: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 221-231, 2001. Tuden, C., MS, MT-BC, Guest Editor: Psychosocial Forum, Journal of Burn Care & Rehabilitation, 22(1), 82, 2001. Utsunomiya, T., Kobayashi, M., Herndon, D.N., Pollard, R.B., Suzuki, F. A mechanism of IL-12 unresponsiveness associated with thermal injury. Journal of Surgical Research, 96:211-217, 2001. Utsunomiya, T., Kobayashi, M., Ito, M., Herndon, D.N., Pollard, R.B., Suzuki, F. Glycyrrhizin restores the impaired IL-12 production in thermally injured mice. Cytokine, 14:49-55, 2001. Varedi, M, Chinery R, Greely GH, Herndon DN, Englander EW. Thermal injury effects on intestinal crypt cell proliferation and death are cell-position dependent. American Journal of Physiology 280:G157-163, 2001. Varedi M, Lee HM, Greeley GH, Herndon DN, Englander EW. Gene expression intestinal epithelial cells, IEC-6, is altered by burn injury-induced circulating factors. Shock 16:259-263, 2001. Varedi M, Jeschke MG, Englander EW, Herndon DN, Barrow RE. Serum TGF- b in Thermally Injured Rats. Shock 16:380-382, 2001. Varma, T., Kinsky, T., Lin, C., Koutrouvelis, A., Nichols, J., Sherwood, E. Cellular mechanisms causing suppressed interferon-y production in endotoxin tolerant mice. Infection and Immunity, 69:5249-5263, 2001. Ventura, K.C., Hawkins, H., Smith, M.B., Walker, D.H. Fatal neonatal echovirus 6 infection: autopsy case report and review of the literature. Modern Pathology 14:85-90, 2001. Volpi, E., Sheffield-Moore, M., Rasmussen, B.B., Wolfe, R.R. Basal muscle amino acid kinetics and protein synthesis in healthy young and elderly men: New insights into the development of sarcopenia. Journal American Medical Association 286:1206-1212, Sept 2001. Wolf SE, Herndon DN. Burns. IN: Sabiston’s Textbook of Surgery (16 th Edition), (eds) CM Townsend Jr, RD Beauchamp, BM Evers, KL Mattox, W.B. Saunders, Philadelphia, PA, pp. 345-363, 2001. Wolf SE, Sanford AP, Herndon DN. Nutritional support of the severely burned patient. IN: Update in Intensive Care Medicine, (eds) C Pritchard and KA Kudsk, Springer-Verlag (Berlin), 2001. Wolf SE, Prough DS, Herndon DN. Critical care in the severely burned: Organ support and management of complications. In: Total Burn Care (2 nd Edition), (ed) DN Herndon, W.B. Saunders, London, pp. 399-420, 2001. Ye, Y., Wang, D., Du, P., Falzon, M., Seitz, P.K., Cooper, C.W. Overexpression of parathyroid hormone-related protein enhances apoptosis in the rat intestinal cell line, IEC-6. Endocrinology 142:1906-1914, 2001. Ye, Y., Falzon, M., Seitz, P.K., Cooper, C.W. Overexpression of parathyroid hormone-related protein promotes cell growth in the rat intestinal cell line IEC-6. Regulatory Peptides 99:169-174, 2001. Ye, Y., Seitz, P.K., Cooper, C.W. Parathyroid hormone-related protein overexpression in the human colon cancer cell line HT-29 enhances adhesion of the cells to collagen type I. Regulatory Peptides 101:19-23, 2001. Zwischenberger, J.B., Anderson, C.M., Cook, K.E., Lick, S.D., Mockros, L.F., Bartlett, R.H. Development of an Implantable Artificial Lung: Challenges and Progress. ASAIO Journal 47(40: 316-320, 2001. Zwischenberger, J.B., Alpard, S.K., Tao, W., Deyo, D.J., Bidani, A. Percutaneous Arteriovenous Carbon Dioxide Removal Improves Survival in Acute Respiratory Distress Syndrome: A Prospective Randomized Outcomes Study in Adult Sheep. Journal of Thoracic and Cardiovascular Surgery 121:542-551, 2001. Top","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[72]=new Array("summary_of_patient_care_programs.htm","Patient Care Summary","Shriners Hospitals for Children - Galveston Burn Hospital Summary of Patient Care Programs and Activities Outreach Clinics From January to June 2006 there were 9 outreach clinics held in 8 cities. The following is a summary of Outreach Clinics for 2000 through June 2006. Outreach Clinic Date 2000 2001 2002 2003 2004 2005 2006 El Paso January 72 33 54 94 80 59 54 El Paso July 54 63 --- 77 67 --- 65 Guadalajara January --- --- --- --- --- 98 Guadalajara June 124 35 106 106 96 103 Guadalajara October 95 --- 46 --- --- --- Guadalajara December --- 43 67 101 --- 135 Kansas City February 40 24 52 --- --- --- Kansas City March --- --- --- 52 38 36 35 Kansas City August 40 33 --- --- --- --- Kansas City September --- --- 36 36 34 41 44 Mexico City April 59 81 --- --- --- --- Mexico City May --- 81 109 55 126 130 121 Mexico City October 63 67 434 124 125 --- Mobile March 29 46 --- --- --- --- Mobile August --- --- --- 76 --- --- Mobile September 28 58 --- --- --- --- Mobile November --- --- --- --- 38 28 Monterrey January 86 38 56 --- 151 --- --- Monterrey February --- --- --- 42 92 51 81 Monterrey August 46 42 106 51 --- 94 New Orleans March --- --- --- 54 43 25 26 New Orleans May 43 26 60 --- --- --- New Orleans September --- --- --- --- --- --- 19 New Orleans November --- --- --- 51 39 --- Pharr June 37 33 50 58 51 41 52 Pharr November --- --- --- 42 --- --- Pharr December 39 55 52 --- 52 58 Toluca, Mex. May --- --- 775 124 96 142 192 Toluca, Mex. October --- --- 537 140 104 182 Zapopan June --- --- --- --- --- --- 107 TOTAL 855 855 2488 1283 1232 1223 733","null","null","");arrFiles[73]=new Array("table_of_all_fellows.htm","Faculty Member","Faculty Member Past and Current Students Training Period Prior Academic Degree Title of Research Project Current Position of Past Fellows or Source of Support of Current Fellows Deg Yr Institution **David N. Herndon, MD +Robert E Barrow PhD * Edgar Pierre (postdoc) 1994-1996 MD 1991 University of Miami Growth Hormone and IGF-1 Studies Assistant Professor of Clinical, Department of Anesthesiology, Ryder Trauma Center, University of Miami · *Sina Matin · (postdoc) 1995-1997 MD 1993 Medical College of Virginia The Effects of Nutrition on Muscle Protein Kinetics in Severely Burned Patients Private Practice, Irving, TX Hiroto Ikeda (postdoc) 1996 MD 1993 University of Tokyo Apoptosis in the gut study Assistant Professor, Dept. of Surgery, Teikyo School of Medicine, Japan Kazuya Takagi (postdoc) 1996 MD 1993 Chiba University School of Medicine, Japan Growth hormone effects on immunologic and burns study Associate Professor, Dept. of Surgery, University of Tokyo, Japan Steven Wolf (postdoc) 1995-1996 MD 1990 University of Texas Medical Branch-Galveston Effects of glucocorticoids on protein synthesis study Professor-Dept. of Surgery-UTHSC; Director of Burns-Brooke Army Medical Center – San Antonio, Texas · *Meelie DebRoy · (postdoc) 1996-1998 MD 1992 Calcutta Medical College Propranolol inhibition of lipolysis study Assistant Professor, Dept. of Surgery UMDNJ, New Jersey Marc Jeschke (postdoc) 1996-1999 MD 1994 University of Tuebingen Protein synthesis and liposomal gene therapy in the burned rat model Assistant Professor, Dept. of Surgery-UTMB; Coordinator of Research-Shriners Burns Hospital for Children-Galveston, Texas · *Peter Ramzy · (postdoc) 1997-1999 MD 1995 University of Texas Medical Branch-Galveston Ameliorating the hypermetabolic response to thermal injury Resident, General Surgery, Suny-University at Buffalo, Buffalo, New York · *Randi Vita · (postdoc) 1998-1999 MD 1998 University of Texas Medical Branch-Galveston The effects of burns on cytokines expression and modulation of this response Research Scientist and Study Director, Dept. of Surgery, Aethlon Medical, San Diego, California Juan P. Barret (postdoc) 1997-1999 MD 1988 Univ. of Barcelona, Spain Topical nystatin and infection control Professor and Director of the Burn Unit, St. Andrew’s Center for Plastic Surgery and Burns, Broomfield Hospital, Essex, United Kingdom Minas Chrysopoulo (postdoc) 1997-1998 MBBS 1996 University College of London Medical School, UK Renal failure and the effects of TNF-a Assistant Professor, Dept. of Surgery, University of Wisconsin, Madison Victor Perez (postdoc) 1998-1999 MD 1993 University Autonomous of Nuevo Leon, Monterey, Mexico Population bacterial infection studies Assistant Professor of Plastic Surgery Kansas University Medical Center-Kansas City, KS Art Sanford (postdoc) 1998-1999 MD 1991 Creighton University Medical School, Omaha, Nebraska Chemical burn injuries Assistant Professor, Dept. of Surgery, UTMB and Assistant Chief of Staff, Shriners Burns Hospital-Galveston Aili Low (postdoc) 1999-2000 MD 1991 Univ. of Bonn, Dept of Surgery, Germany Long term effect of recombinant human growth hormone Attending Surgeon, Dept. Plastic and Reconstructive Surgery, PhD Candidate Uppsala University Hospital, Sweden Somesh C. Guha (postdoc) 2000 MD 1993 Calcutta National Medical College, Calcutta, West Bengal Morphometric analysis of smoke inhalation injury in an ovine model: after using monoclonal antibodies Assistant Professor, Family Medicine and Surgery, West Virginia University School of Medicine; Attending physician, CAMA Health Systems, Inc., Charleston, WV · *Robinlyn Sayers · (postdoc) 1999-2001 MD 1998 Baylor College of Medicine-Houston Cellular and molecular analysis of cultured human keratinocytes Co-coordinator of Grants and Program Development, Large Animal Intensive Care Facilty-UTMB · *David Hart · (postdoc) 1998-2000 MD 1996 University of Texas Medical Branch, Galveston Sepsis, oxygen metabolism Fellow, Dept. of Cardiothoracic Surgery, Indiana University, Indianapolis, IN Marcus Spies (postdoc) 1999-2002 MD 1992 University RegensburgDept of Surgery, Germany Medical technologies and product development for burns Assistant Professor, Dept. of Plastic, Hand and Reconstructive Surgery, Assistant Chief of Staff, University of Hanover, Germany Gregory Williams (postdoc) 2000-2001 MBBS FRCS 1990 1995 Kings College, London UK The use of different wound coverings to modulate the hypermetabolic response Consultant Burns and Plastic Surgeon, PhD Candidate, Chelsea and Westminster Hospital, London · *Joseph Sturdevant · (postdoc) 2000-2001 MD 1998 Texas Tech, Lubbock, TX Use of exogenous albumin administration, resuscitation and support of patients with burns and traumatic injuries Resident in Internal Medicine, Texas Tech University, Amarillo, TX · *Kaiulani Morimoto · (postdoc) 2000-2001 MD 1996 John A. Burns School of Medicine, Honolulu, Hawaii Long term insulin use and hanges in PTH and ionized calcium in burned patients Surgery Fellowship, Baylor College of Medicine, Houston, Texas Xiao-Wu Wu (postdoc) 2000-2004 MD 1991 University of Texas Medical Branch Regulation of intestinal epithelium homeostasis by TNF-Alpha Research Associate-Dept. of Surgery, UTASC, and Carrier-Scientist, Institute Surgical Research, Brook Army Medical Center, San Antonio, Texas Mohan Dasu (postdoc) 2001-2004 PhD 1998 Jiwaji University, Gwalior, India Matrix metalloproteinase expression in burns Assistant Professor, Dept. of Biochemistry & Molecular Pharmacology, West Virginia University, Morgantown Suchmor Thomas (postdoc) 2001-2003 MBBS 1998 T.D. Medical College, AlappuzhaKerala, India Hepatomegaly in burn patients General Practice, Conroe, Texas · *Pedro Loredo · (postdoc) 2001-2002 MD 2001 University of Texas Medical Branch-Galveston Effects of oxandrolone and propranolol on muscle after burn injury on children General Surgeon, St. Johns Hospital, Detroit, MI Kevin Murphy (postdoc) 2003- 2004 MD 1997 Royal College of Surgeons, Ireland Effects of long-term oxandrolone administration as an anabolic agent in severely burned children Specialist Registrar in Plastic Surgery-Ulster Hospital-Belfast, UK Giselle Oliveira (postdoc) 2003- 2004 MD 1995 Federal University of Minas Gerais, Brazil In vitro and in vivo evaluation of oxandrolone effects on scar formation: a randomized prospective clinical trial MD, 253-301-Luxembergo, BH, MG-CEP 30380-540 Brazil Hermes Oliveira (postdoc) 2003-2004 MD 1987 Federal University of Minas Gerais, Brazil Burn-induced gastric emptying delay in rats and the effect of selective COX-2 inhibitors MD, 253-301-Luxembergo, BH, MG-CEP 30380-540 Brazil · *Hui Xue (Paul) · (postdoc) 2003-2004 MD 1985 Shanghai Medical University The role of cytokines in the pathogenesis of burn hypertrophic scars and keloids Research Fellow, Dept. of Surgery, UTMB-Galveston Jonathan Tenorio (postdoc) 2003-2004 MD 1999 Central University of Venezuela School of Medicine Fungal infections in severe burns Research Fellow, Dept. of Anesthesiology, UTMB-Galveston · *Orlando Beckum · (postdoc) 2003-2005 MD 2000 University of Texas Medical Branch Ketoconozole steroids and protein synthesis in burns N/A Clifford Pereira (postdoc) 2003- 2005 MD 1995 MS University Medical College, India Use of non-viral multiple gene therapy to augment acute coetaneous wound healing Surgical Resident, UCLA, Los Angeles, CA Evan Pickus (postdoc) 2003-2005 MD 1997 Howard University College of Medicine, Washington, DC N/A Warren Gold (postdoc) 2004-2005 MD 1993 Creighton Medical School, Omaha, NE Determinants of skeletal muscle catabolism after severe burn Emergency Room Physician, California Amalia Cochran (postdoc) 2004- 2005 MD 1998 Texas A&M University College of Medicine Body composition changes in burned children Burn and Trauma Surgeon, University of Utah, Salt Lake City, Utah William Norbury 2005- MBBS 1999 St. Bartholomew and The Royal London Hospital Medical College Modulation of the hypermetabolic response: Long-term after burn using anabolic agents Current Fellow-Dept. of Surgery, UTMB-Galveston Ludwick Branski 2005- MD 2001 University of Bohn, Bohn, Germany The use of amnion as a coverage material for second degree burns Current Fellow-Dept. of Surgery, UTMB-Galveston Nora Nugent 2005- 2006 MD 2000 University College, Dublin New Technologies to Improve Wound Healing Dept. of Plastic and Reconstruction Surgery, Cork University Hospital, Wilton, Cork, Ireland Shawn Fagan 2005- 2003 MD 1994 Baylor College of Medicine, Houston, TX Pancreatis after Burn Assistant Professor, University of Massachusetts and Staff Surgeon, Shriners Hospitals for Children, Boston, MA *Jaquan Song 2006- MD 1993 Sun Yat-Sen, University of Medical Science, China The Effect of Insulin on the Inflammatory Response Postburn Current Fellow – Dept. of Surgery, UTMB-Galveston **Edward Sherwood,MD,PhD +Tracy Toliver-Kinsky, PhD Tushar Varma (postdoc) 2000 - 2002 PhD 1997 University of Texas Medical Branch Signal transduction in burn-induced immunomodulation Instructor, Dept of Anesthesiology, UTMB-Galveston · *Tracy Toliver-Kinsky · (postdoc) 2000-2003 PhD 1998 University of Texas Medical Branch Natural killer cell regulation of IFN-Gamma following thermal injury Assistant Professor, Dept. of Anesthesiology, UTMB-Galveston · *Erle D. Murphey · (postdoc) 2003-2004 PhD 2000 University of Texas Medical Branch-Galveston Dendritic cell dysfunction in a murine model of post-septic immuno-suppression Instructor, Dept. of Anesthesiology, UTMB-Galveston · *Zhiyu Huang · (postdoc) 2003-2004 MD 1991 Shanghai Second Medical University The role of TGF- b in the burn/sepsis Assistant Professor, Shanghai Virginia Watson 2005- 2006 MD 2003 University of Texas Medical Branch-Galveston Effect of Propranolol and/or Insulin on the Immune System after Burn General Resident, University of San Diego ** D. L. Traber, PhD +Joseph B. Zwischenberger, MD, PhD Weike Tao (postdoc) 1993-1996 MD 1992 Hubie Medical University, Wuhna, China Use of AVCOR in acute inhalation injury Assistant Professor – Dept. of Anesthesiology The University of Texas Southwestern Medical Center Departmental support, K08 pending Brad Brazeal (postdoc) 1996-1997 MD 1993 University of Texas Medical Branch Modified hemoglobin improved renal function in sepsis in sheep Associate Professor, Dept. of Anesthesia, UTMB-Galveston Darien Bradford (postdoc) 1993-1995 MD 1989 University of Texas Medical Branch Fluid flux in smoke inhalation injury. Private Practice, Cardiovascular Surgery, Richardson, TX Paul Schenarts (postdoc) 1994-1996 MD 1992 University of Maine Effects of an L-selectin antibody on the pulmonary and systemic manifestations of severe smoke inhalation injuries in sheep Assistant Professor, Dept. of Surgery, University of North Carolina Temporarily on active duty in Iraq Lori Cindrick (postdoc) 1995-1996 MD 1993 University of Texas Medical Branch Bronchoscopic lavage with perfluorocarbon decreases post procedure hypoxemia Assistant Professor, Dept. of Surgery, UTMB-Galveston Hans Georg Bone (postdoc) 1995-1996 MD 1993 University of Munster Germany Effect of Super Oxide Desmutase in Inhalation Injury Assistant Professor, Dept. of Anesthesia, Munster Germany Stephanie Fischer (postdoc) 1995-1998 MD 1988 Heidelberg University, Heidelberg, Germany Hypoxic Vasoconstriction in Inhalation injury Assistant Professor, Dept. of Anesthesiology, UTMB-Galveston Merci Jourdain (postdoc) 1996-1997 MD 1993 University of Lille France Renal function during burns and inhalation injury Associate Professor. Intensive Care Medicine, Lille, France Scott Alpard (postdoc) 1997-present MD 1997 University of Texas Medical Branch Prolonged hemodynamic stability during arteriovenous carbon dioxide removal for severe respiratory failure Post Doctoral Fellow, Dept. of Cardiothoracic Surgery, UTMB, Galveston Dong Fong (postdoc) 2001-2003 MD 1990 Hubie Medical University, Wuhan, China Arteriovenous CO2 removal and mitogen activated protein kinases Assistant Professor, Dept. of Surgery, UTMB-Galveston Kazutaka Soejima (postdoc) 1998-2000 MD 1990 Tsukuba University, Ibaraka, Japan Role of nitric oxide in burn and smoke inhalation combined injury Assistant Professor of Surgery, Dept. of Plastic and Reconstructive Surgery, Tokyo Women’s Medical College, Tokyo, Japan Kirk Bauer (postdoc) 1998 MD 1997 Medical University, Luebeck Germany Clearance of infused fluid from plasma is independent of large infusion volumes of 0.9% saline in sheep Assistant Professor, Dept of Anesthesia, UTSW Dallas TX Saduk Kiliturgay (postdoc) 1998-1999 MD 1991 Uludas University, Bursa Turkey Severe hemorrhage shock Associate Professor, Dept. of Surgery, Uludas University Faculty of Medicine, Ankara, Turkey Lance Bauer (postdoc) 1999 MD 1998 Medical University of Luebeck Germany Intrarenal blood flow distribution and fluid balance during ANP receptor atagonism in hyperdynamic sepsis Assistant Professor, Dept. of Anesthesiology, UTMB Galveston Kazunori Murakami (postdoc) 1999-2002 MD PhD 19851996 Kumamoto University School of Medicine, Kumamoto, Japan Recombinant antithrombin attenuates sepsis following smoke inhalation in sheep Dept. of Cardiology, Kumamoto University School of Kumamoto, Japan Jiro Katahiro (postdoc) 2000-2001 MD 1989 Kagoshima University, KagoshimaJapan Heparin nebulization attenuates acute lung injury in sepsis following smoke inhalation in sheep Assistant Professor, Dept. of Surgery, Plastic and Reconstructive Surgery Division, Kagoshima University, Kagoshima, Japan Abhijit Chandra (postdoc) 2001-2002 MD 1994 King George’s Medical College Lucknow, India Aerosolized tissue plasminogen activator (T-PA) as a new treatment strategy for septic lung Assistant Professor, Dept. of Surgery, Plastic and Reconstructive Surgery Division, King George’s Medical University Lucknow, India Katsumi Shimoda (postdoc) 2001-2003 MD 1989 Yamagata University, Yamagata, Japan Liver vitamin E depletion resulting from burn and smoke inhalation in sheep Senior Staff, Plastic and Reconstructive Surgery, Yamagata University; Yamagata, Japan Perenlei Enkebaatar (postdoc) 2001-2003 MD, PhD 2001 MD-St. Petersburg Military Medical Academy, Russia PhD-Kumamoto University School of Medicine, Kumamoto, Japan Sepsis and Burn and Smoke Inhalation Injury and Acute Lung Injury Research Instructor, Dept. of Anesthesiology, UTMB-Galveston Akio Mizutani (postdoc) 2002-2003 MD 1990 Oita Medical University, Oita, Japan Role of calcitonin gene-related peptide in ischemia/reperfusion-induced acute renal injury in rats Assistant Professor, Dept. of Anesthesiology and Intensive Care Medicine, Oita Medical University Hospital, Oita, Japan Naoki Morita (postdoc) 2003-present MD 1994 Ryukyu University, Okinawa, Japan Burn and Smoke Inhalation Injury; Acute Lung Injury Post Doctoral Fellow Dept of Anesthesiology, UTMB Galveston Martin Westphal (postdoc) 2003-present MD 1999 Johann Wolfgang Goethe University of Frankfort, Germany Hyppoxic vasoconstriction during inhalation injury and burns Assistant, Dept. of Anesthesiology University of Muenster, Muenster, Germany Ruksana, Huda (postdoc) 2004-present PhD 1992 University of Burdwan, West Bengal, India Reperfusion injury following burn and smoke inhalation injury Current Fellow, Dept. of Anesthesiology, UTMB-Galveston, TX Dirk M. Maybauer (postdoc) 2004-2005 MD, PhD 1992 2004 MD, PhD-The Justus-Liebig, University of Giessen, Germany Sepsis and Sepsis-Induced Acute Lung Injury University Clinic Ulm, Dept. of Anesthesiology and Intensive Care Medicine, Germany Marc O. Maybauer (postdoc) 2004-2005 MD, PhD 2002 2004 MD, PhD-The Justus-Liebig, University of Giessen, Germany Sepsis and Sepsis-Induced Acute Lung Injury University Clinic Ulm, Orthopedics Resident, Germany **Robert R. Wolfe, PhD **Arny Ferrando, PhD +David N. Herndon, MD * Melinda Moore (postdoc) 1997-1999 PhD 1997 Ball State University Albumin and Metabolism Studies in burned children Assistant Professor, Dept Aging, UTMB-Galveston Elisabet Borsheim ( postdoc) 1999-2002 PhD 1998 Norwegian University Oslo, Norway Energy expenditure and the role of the sympathoadrenal system Assistant Professor, Dept. of Metabolism, UTMB, Galveston, TX Oivind Irtun ( postdoc) 1999-2001 MD, PhD 1982 University of Tromsoe Norway Fatty infiltration of the liver post-trauma Professor and Assistant Chief of Staff, University Hospital of North, Tromsoe, Norway Hisamine Kobayashi ( postdoc) 1999-2001 DVM 1989 University of Tokyo, Japan Research on protein and amino acid metabolism Researcher, Ajinomoto Company, Inc. Kawasaki, Japan Beatrice Morio ( postdoc) 2000-2001 PhD 1997 University Clermont-Auvergne, France The effect of propranolol on fat and protein catabolism UMPE-Laboratoire de Nutrition Huamine, France Tabatha Elliott ( postdoc) 2000- PhD 2000 University of Conn, Storrs, CT Muscle protein metabolism Post Doc Fellow, UTMB, Galveston, TX Douglas Paddon-Jones ( postdoc) 2000-2002 PhD 1999 University of Queensland Australia Mechanisms of muscle synthesis and breakdown in humans and identification of interventions to counteract catabolism and promote anabolism Assistant Professor, Dept. of Metabolism, UTMB, Galveston, TX · *Steven Thomas · (postdoc) 2000-2002 MD 1999 East Carolina University School of Medicine, Greenville, NC Effect of intensive insulin therapy during acute hospitalization and long-term effects of recombinant growth hormone administration on linear growth, bone formation and lean body mass Resident, Dept. of Plastic Surgery Resident, Lehigh Valley Hospital, Allentown, PA Christos Katsanos ( postdoc) 2002- PhD 2001 Florida State University The effect of cortisol on muscle protein synthesis during bed rest Post Doc Fellow, UTMB, Galveston, TX Melanie Cree (predoc) 2002- BA 1999 Bryn Mawr College, Bryn Mawr, PA Examining relationship between aging, burns and insulin resistance MD, PhD Student, UTMB, Galveston, TX Carwyn Sharp (predoc) 2002- MS 2001 Ball State University Molecular biology of metabolism PhD Student, UTMB, Galveston, TX * Ricki Fram ( postdoc) 2004- 2006 (NIH 2004-2005) MD 2002 University of Texas Medical Branch, Galveston, TX Assessment of Mechanisms of improved wound healing and protein metabolism of insulin in severely burned patients Resident Physician, Anesthesiology Dept., Northwestern University, Chicago, IL +Marc G. Jeschke, MD, PhD **David N. Herndon, MD · * Celeste Finnerty · (postdoc) 2002- (NIH 2004- ) PhD 2001 UTMB Correlation of genotypic changes to phenotypic catabolic responses following major burns in children Instructor and Current Fellow – UTMB, Galveston, TX +Oscar E. Suman, PhD **David N. Herndon, MD · Rene Przkora 2004- 2006 MD 1992 Medical School, University of Bonn, Bonn, Germany Anabolic effects agents and exercise one body composition and exercise performance Resident, Dept. of Surgery, University of Florida, Gainesville, FL +Robert E. Barrow **David N. Herndon, MD · *Roque Ramirez · (postdoc) 1996-1998 MD 1993 Ross University Ibuprofen modulation of inhalation injury Private Practice, El Paso, TX; President of Pan-American Surgical Association *Jyoti Chawla Rai (postdoc) 1997-1998 MD 1995 Tulane University School of Medicine, New Orleans, LA Effects of Insulin-Like growth factor-I/Insulin-Like growth binding protein 3 on cardiac function in pediatric burns Private Practice, Chillicothe, OH · *Sophia Lal · (postdoc) 1999-2000 DO 1999 University of North Texas Health Science, Ft. Worth, Texas Recombinant human growth hormone to treat osteopenia and growth delay after major burns in children Private Practice in Osteopathic Medicine, Atlanta, Georgia * NIH Training Grant Fellow","null","null","");arrFiles[74]=new Array("blue_book_2006.htm","Blue Book Funding 2006","INVESTIGATOR FUNDING SOURCE PERIOD OF SUPPORT CURRENT YEAR AWARD TITLE Blakeney, Pat NIDRR H133G050079 10/01/05-09/30/06 x Outpatient Social Skills Training to Amplify Positive Gains for Distressed Adolescent Burn Survivors Chen, Jiande Janssen Research Foundation 01/01/06-12/31/06 x Efficacy of Rabeprazole in the Control of Reflux Symptoms in Asian Patients with Uninvestigated Gastro-Esophageal Reflux Disease (GERD) Chen, Jiande Medtronic, Inc. 01/01/06-12/31/06 x Neuronal Responses to IGS with Different Stimulation Parameters and Locations in the Ventromedial Hypothalamus (VMH) in Rats Chen, Jiande Medtronic, Inc. 01/01/06-12/31/06 x Gastric Distension in Response to Gastric Stimulation in Canines Chung, Dai NIH R01 DK614470 12/01/05-12/31/06 x Role of Gastrin-Releasing Peptide in Neuroblastoma Englander, Ella John Sealy Memorial Endowment Fund 09/15/05-09/15/06 x Modulation of Oxidative Stress in the Aging Brain Englander, Ella March of Dimes 06/01/06-05/31/07 x Effects of Neuroglobin on the Hypoxic Newborn Rat Brain Englander, Ella NIH-NINDS: R01 NS39449 12/01/05-11/30/06 x Hypoxia-Induced DNA Damage and Repair in the Rat Brain Enkhbaatar, Perenlei American Heart Association 07/01/06-06/30/07 x Role of Nitric Oxide in Sepsis Induced by Smoke Inhalation and Pneumonia Gould, Lisa NIH 08/01/06-07/31/07 x Improved Wound Healing through Modulation of Redox Control Herndon, David Clayton Foundation 01/01/06-12/31/06 x Development of Medical Technologies to Improve Cellular Regeneration in Burns, Trauma, and Wound Healing Herndon, David Clayton Foundation 01/01/06-12/31/06 x Characteristics and Applicability of Amnion as a Wound Coverage Material and as a Biomatrix Herndon, David Carl C. Anderson, Sr. and Marie Jo Anderson Charitable Foundation 01/01/06-12/31/06 x Study #1 Gene Therapy; Study #2 Skin Replacement Herndon, David NIH/NIGMS P50 GM60338 07/01/06-06/30/07 x Assessment of Anabolic Agents/Exercise in Burn Children (All Projects) Herndon, David NIDRR H133A70019 10/01/05-09/30/06 x Pediatric Burn Injury Rehabilitation Model System Herndon, David NIH R01 GM56687-05 07/01/06-06/30/07 x Modulation of the Postburn Hypermetabolic Response Herndon, David NIH 1-U54-GM-62119 04/01/06-03/31/07 x Inflammation and the Host Response to Injury Herndon, David NIH 2 T32 GM008256 07/01/06-06/30/07 x Postdoctoral Training in Trauma and Burns Jeschke, Marc American Surgical Association Foundation 07/01/06-06/30/07 x Insulin Administration Improves Hepatic Structure and Function via the P13K/Akt/Wnt/B-cantenin Kramer, George Dept. of Navy/Office of Naval Research N00014-03-1-0363 10/01/05-09/30/06 x Closed-Loop Resuscitation of Hemorrhagic Shock: Novel Solutions Infused to Hypotensive and Normotensive Endpoints Kramer, George Dept. of Navy/Office of Naval Research N00014-06-1-0300 02/01/06-01/31/07 x Resuscitation Systems for Treatment of Hemorrhagic Shock Incorporating Sensors, Pumps, Displays, And Control Algorithms Meyer, Walter J. The Mayday Fund 05/01/06-04/30/07 x Development of Systems for Evidence-Based Management of Pain, Anxiety, and Itch in Children with Burn Injury Meyer, Walter J. International Association of Fire Fighters Burn Foundation 2006-2007 x Measuring the Efficacy of Coping Techniques in Decreasing Pre-Operative Anxiety Perez-Polo, Regino NIA-N R03 AG023855-01 05/01/06-04/30/07 x Brain Cell Death Mechanisms after Perinatal Ischemia Sherwood, Edward NIH R01 GM66885 07/01/06-06/30/07 x B2 Microglobulin Knockout Mice are Resistant to Acute Intra-Abdominal Sepsis Suman, Oscar NIH K01 HL70451 04/01/03-03/31/07 x Mentored Faculty Development Award Suman, Oscar NIH R01 HD049471 08/01/06-06/30/07 x Exercise and Quality of Life in Severely Burned Children Toliver-Kinsky, Tracy NIH-R01 GM072810-01A1 07/01/06-06/30/07 x Enhancement of Dendritic Cells after Burn Injury Traber, Daniel L. NIH P012 GM066312 07/01/05-06/30/06 x MP-Pathophysiology of Lung Injury as the Result of Smoke Inhalation (All Projects) Zwischenberger, Joseph NIH 08/01/06-07/31/07 x Project IV-Role of Ventilator Damage Inflammation in Burn and Inhalation Injury Zwischenberger, Joseph NIH R44 HL064528 10/01/05-09/30/06 x Enhanced Long-Term Care of Severe Respiratory Failure Zwischenberger, Joseph NIH STTR R42 HL065030 09/29/05-08/31/06 x Subcontract: Modified Tetracycline Effect on Sepsis-Induced Mortality Zwischenberger, Joseph NIH R44 HL068375 04/01/06-12/31/06 x Novel Dense Hollow Fiber for Blood Gas Exchange","null","null","");arrFiles[75]=new Array("2006_pie_chart.htm","New Page 1","null","null","null","");arrFiles[76]=new Array("TMP6l2dfwk4m.htm","NO TITLE","Page 1 Hotmail Yahoo Mail Hotmail Page 2 Kwikit.com Yahoo Mail Hotmail","null","null","");arrFiles[77]=new Array("shrine_refer.htm","Shriners Referral","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM GALVESTON SHRINERS BURN HOSPITAL Referrals and Transfers Referrals to Galveston’s Shriners Hospitals for Children Shriners Hospitals are operated by the Shrine of North America. All medical care provided at Shriners Hospital is provided free of charge. Children to the age of 18 years, who have received a burn injury and live in North America, may be eligible for treatment. Phone:409-770-6773 Referral Sheet Fax: 409-770-6539 Burn Diagram (Preliminary) Burn Diagram (72 Hour) Application Form - English / Spanish Acknowledgment Form - English / Spanish Get Adobe Reader Emergency Admissions For emergency burn admissions, the referring physician should telephone a physician at the Shriners Hospital in Galveston and indicate the patient needs emergency care. Information will be requested concerning the patient’s demographic information, medical history and physical assessment including a description of the burn injury. A Referral Sheet and a Burn Diagram will be filled out. Non-emergency Admissions Non-emergency admission to the Galveston Hospital is dependent on the medical needs of the patient and on the availability of beds. Application forms for non-emergency admissions to a Shriners Hospital can be obtained from any Shrine Temple or Shrine Club; or by calling the Shriners Hospitals for Children toll-free referral line at 1-800-237-5055 . (In Canada, call 1-800-361-7256 .) Foreign Patient Requirements The child \'s parent/guardian will need to accompany the patient to the hospital. This is imperative for treatments/surgical consents as well as for emotional and psychological support for the patient during their stay. The parent/guardian will be trained in the care of the patient and will be responsible for care while the patient is an outpatient. Although all medical treatment if provided free of charge, the hospital cannot be responsible for any transportation, food or lodging for the parent/guardian or for any expenses incurred while a child is an outpatient in the United States. A medical history of the child must be provided (i.e. past/present diseases or conditions, previous surgeries, hospitalizations, etc.). Round trip transportation between the home country and the United States, for the child and guardian must be guaranteed prior to acceptance. Confirmation of this would be copies of airline tickets or similar documents. Please provide a letter from a local physician stating that medical treatment is available for this child upon return to his/her country. Approximate costs while at Shriners Hospital Costs for parent lodging and meals may range from approximately $140.00 to $245.00 per week depending on the place of lodging. LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[78]=new Array("UTMB_refer.htm","UTMB Referral","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM UNIVERSITY of TEXAS MEDICAL BRANCH BLOCKER BURN UNIT Burn patients of all ages may be admitted to the University of Texas Medical Branch. For transfer and admission information please call: 409-747-2500 or 800-962-3648 A Patient Referral Form will be filled out at this time. Click here for an Admission Deposit form. Get Adobe Reader LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[79]=new Array("shrine_referral_form.pdf","Microsoft Word - shrine_referral_form.doc","Shriners Hospitals for Children Galveston Burn Hospital 815 Market Street Galveston, Texas 77550 Referral Calls: 409-770-6773 Date: Time: Resource: Contact: ______________ ______________ _______________ ______________ ______________ _______________ ______________ ______________ _______________ ______________ ______________ _______________ Fax #: 409-770-6539Patient Name: _______________________________________________________ Home Address: _______________________________________________________ City, State, Zip: _______________________________________________________ County or Parish: _____________________________Telephone:Sex: ______________ Age: ______________ Race: _______________________________________ Birthdate/Birthplace: __________________________________Father \'s Name: _______________________________ Mother \'s Name: _________________________________ Accompanying Guardian:___________________________________________ Relationship: _______________ Guardian \'s birthdate/birthplace? ________________________________________________________________ Citizenship of Patient: ________________ Visas?: Yes No N/A Date of Burn: ___/___/___ Time: _________ Ask for a faxed copy of birth certificate or for one to be sent Referral Hospital/Physician Information_____________________________ Referring Physician \'s Name _____________________________ Referring Physician Address _____________________________ Referring Hospital Name Circumstances of Injury:__________________________ Telephone Contact # \'s ______________________ City__________________ Telephone/Fax #_______________________________ State ___________ Country_____________________________ Patient Location (ER, Room # or Unit)Cause of burn ______________________________________________ %Burn_______ Smoke Inhalation: ___ Yes ___ No How accident happened: ________________________________________________________________________________ _____________________________________________________________________________________________________ Was child \'s clothing involved? ____________ (ASK STAFF TO FORWARD SAMPLE WITH PATIENT). Were others involved (if yes indicate relationship): ____________________________________________________________ If injury suspicious, has Child Protective Services been notified? ___ Yes ___ No [Notify Care Coordinator & Psych if Yes] If so, please indicate name of Case Worker and phone number: _________________________________________________ ____________________________________________________________________________________________________ Significant past medical history : _______________________________________ When was initial IV/fluid resuscitation started? _______________________________________________________________ Associated injuries: __________________________________________________ Accept blood products? ____ Yes ____No Ask for a faxed copy of H & P and Immunization Record Clinical Data (Please note most recent parameters or test results):B.P. ______ Pulse: ______ Resp.: ______ Temp: _______ Oxygen: ______L/min Breath Sounds: _____ CXR: Y/N________ Artificial Airway: _________ Type/Size Placement: ______________ SaO2 _____ Carboxyhemoglobin: ________ Date/Time: __________ Has the patient had a cardiac/resp. arrest ____ yes ____ no Date/Time pH pCO2 pO2 HCO3 B.E. HgB HCT Ventilator Settings Mode:__________ FiO2: __________ Tidal Volume: _______Rate: _______ PEEP: _________ PIP: ___________Date/Time WBC PT/PTT NA+ K+ Cl- BUN Creat Gluc T.P.(See updates on last page)Patient Name: _______________________________________ Date: ____________________Please complete Burn Diagram:Please note circumferential burns of extremities or chest wall: _______________________________ _________________________________________ Note Escharotomies/Fasciotomies Performed:____________________________________ ______________________________________________ Peripheral pulses absent in any extremity (please circle): RUE LUE RLE LLE Neurological Status: (please circle)Alert Oriented x3 Moving all extremities Yes Yes Yes No No NoGlascow Coma Scale: ___________ If neurologically depressed, have any neurological Tests been done?% Burn % 3rd BSA m2 BSABm2CT scan Blood Flow Yes Yes No No MRI Yes NoPatient \'s Height: ___________ Weight: _______________ (Accurate height and weight is necessary to calculate BSA m²)Calculations for Fluid: BSA _____m2 BSAB: ______m2 Fluid Calculations First 24 hours 2000ml x _____BSAm2 = ____ml 5000ml x _____BSABm2 = ____ml Total for first 24 hours = ________ml First 8 hours = _____________ml/hr Next 16 hours = ____________ml/hrIV Lines/Site ______________ ______________Fluids/Rate Sutured?__________________ ___________ __________________ ___________Foley Catheter: _________ Urine Output: ___________________NGT: _______ Gastric pH: ______Total FluidsIn ____ Out _____x ______ hoursP.O. Intake: ________________________________ Other: _____________________________________ ___________________________________________ ___________________________________________Please call Burn Unit staff to assist with calculations and recommended resuscitation fluids. Medications (please list with doses): Antibiotics:_________________________________________________________________________________ Sedation/Pain: _____________________________________________________________________________ Immunizations: _______________________________ Tetanus Toxoid: Yes No Allergies: __________________________________________________________________________________ MD to MD referral done (Date and Time): _____________________ Preparation for Transports: Please: · Send copies of medical records and/or x-rays. · Try to keep patients temperature between 380C and 390C rectally. · Have two (2) large bore IV lines sutured in place if burns are greater than 20%. · Administer only lactated ringers unless instructed to do otherwise by the receiving physician. · Limit sedation and narcotics (only give IV medications in small, titrated doses). · Place Foley Catheter if burn is greater than 20%. · Place Salem Sump NG tube if burn greater than 20%. Resource Nurse: ___________________________________________ Date: __________________Acute Patients Supplement to Referral Form Name: _________________________________________________ Date/Time: ___________________ Initial Referral Date: __________ SBH Physician _________________ Resource Nurse: _________________ Referring Physician: _______________________________________ Phone Number: ____________________ Referring Hospital and Phone Number:___________________________________________________________ SBH Attending Physician: ____________________ Date/Time of Attending Acceptance: __________________ Burn Date:____________ %Burn:____________ Name of Temple/Sponsor: _________________________ Approval/Guarantor:______________________________ Will Referring Hospital be responsible for Transportation Costs? [ ]Yes [ ]No Will Referring Hospital charge Patient for Transportation Costs? [ ]Yes [ ]No Mode of Transportation: [ ] Jet [ ] TurboProp [ ] Helicopter [ ] Commercial Airline [ ] Ground Ambulance [ ] Shriner Van [ ] UTMB [ ] Private Auto [ ] Walk-in [ ] Other______________________ _____________________________________________________________________________________________ _ Transport Company:Company:__________________ Contact: ___________________ Quote: ____________________ ____________________Company: _________________ Contact: ___________________ Company: _________________ Contact: ___________________Quote: ____________________ Quote:Company selected:________________________ Reason:____________________________________________ ___________________________________________________________________________________________ Mileage: _________ ETA/FBO: _____________________________ FAA Certification: ___________________ Flight/Tail Number: ________________ Takeoff time _____________ Flight Times ­ To Destination: __________________ Return to Galveston:_________________ Airport to Referring Hospital transfer contact: ______________________________________________________ ___________________________________________________________________________________________ Other Transportation Information: _________________________________________________________________________________________ _________________________________________________________________________________________ SBH Staff Accompanying Team from Local Airport: _________________________________________________ETA to SBH: ______________________________ (See transport sheet for other info) SBH Flight Team: RN: _______________________________________ RT: _______________________________________ RN/MD: ____________________________________ Letters sent to VerMaas: _______________________ Armstrong: _________________________________ Acceptance letter faxed to: _____________________ ___________________________________________ Copies of original referral form made ____ Final Disposition: _____________________________ ___________________________________________Date and Time of Admission___________________Notification: (Name/time/date) Transport RN: _______________________________ Transport RT: _______________________________ Transport MD: _______________________________ Security: ____________________________________ Van Driver: __________________________________ Nurse Admin. On Call: _________________________ Photography: ________________________________ Research: ___________________________________ Administrator: ________________________________ Care Coordinator: _____________________________ Psychology Services: __________________________ OR Pager: ___________________________________ Outpt./Housing: _______________________________ Inspector Alcazar 409-766-3581 _________________NOTES: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________UPDATES: Date/Time: _____________________________ SHC Staff: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Date/Time: _____________________________ SHC Staff: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Date/Time: _____________________________ SHC Staff: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Date/Time: _____________________________ SHC Staff: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Date/Time: _____________________________ SHC Staff: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ NOTES: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________","null","null","");arrFiles[80]=new Array("emergency_carepage.htm","Emergency Care","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM EMERGENCY CARE Home Care for Minor Burns Hospital Emergency Care Burn Unit Referral Criteria Links to More Resources Home Care for Minor Burns A burn victim should be treated by a hospital physician if: Children and elderly Any electrical or lightning injury Any chemical burn Any burns of the hands, face, feet, joints, genitalia or perineum Any burn larger in size than the outline of 1-2 hands of the victim Any deep burns (may be white, brown, or dark red in color) Any burn in a patient that has other pre-existing medical conditions Any burn that becomes red around the edges after a couple days Any burn patient that also inhaled smoke or chemicals at the time of burn Minor burns can be treated with: Cool water immediately after the burn. Topical antimicrobial such as Polysporin, polymyxin, bacitracin, neomycin. Top Hospital Emergency Care Assessment Airway: Support or provide airway and provide cervical spine protection. Breathing: Assess breathing and ventilation. Provide assistance as necessary. Monitor chest movement with deep burns of the trunk. Administer oxygen at a high flow. Circulation: Assess vital signs. Assess circulatory status of burned extremities by monitoring distal pulses. Start IV access. Disability: Assess orientation and neurological status, associated injuries, hypoxia. Exposure: Keep patient warm. Medical History and Head to Toe Physical Exam with x-rays and laboratory assessment Assess Burn Assess type of burn and circumstances of injury. Percent of burn injury (% Total Body Surface Area Burn) The Burn Diagram ( Get Adobe Reader ) can be used to calculate burn size. Children are different than adults. The outline of the patient’s hand and fingers is equal to 1% of the body surface area and can be used to calculate burn size. (An area the size of 2 of the patient’s hands would be a 2% burn.) Body Surface Area nomogram : A patient’s height and weight are used to measure Total Body Surface Area in centimeters squared. Burn Depth 1 st Degree Burn 2 nd Degree Burn 3 rd Degree Burn 4 th Degree Burn Degree Depth History Etiology Sensation Appearance Healing 1 st Degree Superficial Epidermis only Momentary Exposure Sunburn Sharp, uniform pain Blanches red, pink. Edematous, soft, flaking, peeling ± 7 days 2 nd Degree Partial Thickness Epidermal and part of Dermal layer Exposure of Limited Duration to Lower Temperature (40-55 ° C) Scalds, flash burn without contact, weak chemical Dull or hyperactive pain, sensitive to air/temperature changes Mottled, red blanches red/pink, blisters, edema, serous exudate, moist 14-21 days 3 rd Degree Full Thickness Entire epidermis, dermis and subcutaneous tissue Long duration of exposure to high temperature Immersion, Flame, Electrical, Chemical Painless to touch and pinprick, May hurt at deep pressure No blanching, pale white, tan charred, hard, dry, leathery, Hair absent Granulates, Requires Grafting 4 th Degree Underlying structures of muscle or bone Prolonged duration of exposure to extreme heat Electrical, Flame, Chemical Usually painless Charred, Skeletonized Requires Fasciectomy, Possible amputation Fluid Resuscitation The most important aspect of early clinical management of the burn victim is fluid resuscitation beginning within the first couple hours of burn injury. Adult resuscitation: Ringers Lactate 2-4 ml / kg / %TBSA burned. Give ½ of total volume over the first 8 hours from time of burn injury. Give second ½ of total volume over the following 16 hours. Example Titrate to maintain blood pressure and urine output of at least 30 cc/hr. Pediatric resuscitation: Ringers Lactate 5000 ml / TBSA burn (m 2 ) + 2000 ml / TBSA (m 2 ). Give ½ of total volume over the first 8 hours from time of burn injury. Give second ½ of total volume over the following 16 hours. Example Titrate to maintain blood pressure and urine output of at least 1 cc/kg/hr. Wound Care for Emergency care and transport No ice or cold water soaks, no wet dressings or sheets. Cover with clean dry cloth. Keep patient warm. For delayed transfer - Wash wounds and débride loose tissue. Topical Antimicrobial (Silver Sulfadiazine) and gauze wrap. Monitor need for escharotomies. Top Burn Unit Referral Criteria Burn injuries that should be referred to a burn unit include the following: Partial thickness burns greater than 10% total body surface area (TBSA). Burns that involve the face, hands, feet, genitalia, perineum, or major joints. Third-degree burns in any age group. Electrical burns, including lightning injury. Chemical burns. Inhalation injury. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols. Burned children that are in hospitals without qualified personnel or equipment for the care of children. Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention. Top Links Emergency Medical Services for Children EMSC Main Page EMSC Fire and Burn Prevention Resources This page contains a listing of many useful Publications and Links to other relevant sites. Top ↑ LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[81]=new Array("shrinepage.htm","Shriners Hospital","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM SHRINERS HOSPITALS FOR CHILDREN GALVESTON BURN HOSPITAL T he first Shriners Burns Hospital for Children opened its doors in 1966 in Galveston, Texas. Dr. Truman Blocker and Mr. Harvey Beffa worked with the Shrine philanthropy to establish hospitals to treat burned children and support burn related research. Shriners Hospitals for Children also had many hospitals that cared for children with orthopedic disabilities. With their four burn hospitals, Shriners cares for children with burn injuries from the time of acute injury through rehabilitation and individual reconstructive needs throughout their childhood. Shriners Hospitals for Children at Galveston is a 30 bed hospital. It has an ICU with 15 acute beds, a reconstruction and plastic surgery unit with 15 reconstructive beds, three operating rooms, a multi-bed recovery room, clinics and a large outpatient population. The Galveston Shriners Hospital has treated patients from around the country and around the world. Shriners Hospital for Children at Galveston received their first certification from the Joint Commission for the Accreditation of Hospital Organizations in 19?? and received their most recent certification in 2004. Shriners Hospital in Galveston became Verified as a Burn Center from the American College of Surgery first in 19?? and most recently in 2001. We have recently received certification from the ACGME as a Burn and Critical Care Fellowship provider in 2003. Shriners Hospitals for Children at Galveston is well suited as a model system of comprehensive burn care and rehabilitation. For more than 27 years, through the philanthropy of the Shriners of North America and in affiliation with the University of Texas Medical Branch, the faculty and staff of this institute have successfully endeavored to develop methods and techniques to improve the outcomes of burned children. Rehabilitation after severe burn injury remains problematic both in terms of maximizing function and providing psychosocial adaptation. This situation becomes even more complex in the setting of pediatric injury where consideration must be given to the growth and development of the patients, cognitive development and differing motivations at each period, and the longer life span over which rehabilitation interventions are likely to affect outcome. Mechanisms are currently in place for the interdisciplinary comprehensive rehabilitation and follow up of the over 250 acutely burned children referred to our institute each year. Patients are cared for in our system from the time of injury until age 18; consequently our comprehensive treatment plans are directed toward long-term outcomes. Existing programs include longitudinal outcome assessments, outreach clinics to rural areas and investigations into techniques to improve functional outcomes. This institute is well suited to evaluate the benefits, costs and outcomes of rehabilitation therapies for burned children because of our collected experience, patient load and expertise in evaluating data as evidenced by our preliminary data and by our publications. We are particularly adapted to assess the costs of these varying techniques because all our care is free through philanthropy of the Shriners of North America, and thus only true costs are incurred. Probably because the staff and faculty are responsible for the burn care and burn sequelae over such a long span of each patient \'s life, there has historically been a great concern for the long-term success of the patients . The interdisciplinary team who follow the children through their physical growth and psychological development are continuously striving to meet the challenges of complex burn-related problems for the growing child and developing adolescent, as well as for the families of children so injured. PATIENT CARE DEPARTMENTS Child Life Clinical Staff Dietary Graphic Arts Laboratories Medical Sculpture Medical Staff Nursing Occupational/Physical Therapy Pharmacy Psychology and Psychiatry Public Relations Rehabilitation Services Respiratory Therapy Volunteers Wellness Center * TEAM WORK IS VITAL FOR GOOD PATIENT CARE * Child Life Objectives : A. Present philosophy of Child Life Department. B. Family-centered care. C. Continuing emotional/developmental growth of hospitalized children. D. Increase coping skills through play and music. E. Provide emotional support. F. Normalize the hospital experience. Responsibilities of Child Life Staff : A. Playroom. B. Pre-op teaching. C. Make-up program guidelines. D. School re-entry guidelines for videos and/or re-entry visits. E. Bedside interventions. F. Emotional support provided by Child Life Specialist and Music Therapist. Communications : A. Multidisciplinary discharge planning meetings. B. Chart notes. C. School/Staff referrals. Back to Dept. Listing Graphic Arts Department Customer Service Area : A. Customer work request filled out by Graphic Arts personnel. B. Service performed per posted turn-around schedule. Medical Photography : - Patient photography (Acute & Reconstructive) - (See Patient Rights, Section PR.013) A. Admissions B. Dressing changes as per medical/paramedical staff. C. Operating room as per medical/paramedical staff. D. Clinical as requested by medical/paramedical staff. E. Discharge of patient. F. Clinic as per medical/paramedical staff via photography request form. G. Outreach clinic as per photography request form located with patient \'s clinic forms. H. Autopsy. Other In-House Services : A. Slide Duplicates - legal and teaching. B. Film Processing - color slide E-6 process, black & white film developing. C. Passports - for official use only. D. Public Relations - as directed by Administration/Public Relations. E. Color, Black & White Slides from Books, X-rays, etc. - In-house teaching, medical/scientific meetings. F. Displays/Exhibits - Public relations, medical/scientific. G. Photographic Printing includes publications, public relations, or as needed by hospital. Medical Illustrations : A. Poster Exhibits - Medical/scientific staff, public relations, and teaching. B. Produce & Design Forms - Medical and administrative. C. Framing & Matting - Photographs, certificates. D. Produce & Design Certificates - Medical/scientific staff, administrative. E. Charts, Graphs, Color Slides - Computer generated in PowerPoint. Back to Dept. Listing Medical Sculpture Department Services : A. Silicone rubber face masks. B. U-vex face masks. C. Silicone rubber conformers of various types. D. Mouth splints. E. Ear and nose conformers. F. Hair pieces. G. Ear and nose prosthesis. H. Supply conformers for scheduled outreach clinics. Educational : A. Open and ongoing communication and problem-solving with all members of the health care teams. Encouraged and followed-through as needed. B. Available for tours of facility by outside groups, i.e. Shriners and Medical Staff. C. Available for informational in-services as needed, or upon request. Back to Dept. Listing Occupational/Physical Therapy The rehab philosophy is to assist the patient to reach the highest level of function possible. This requires efforts of the entire interdisciplinary team. Our therapists are cross-trained and there is not a difference in patient care between the 2 disciplines. Evaluations/Assessments : A. Initial - Evaluation requires physician signature for performance. B. Ongoing - Physicians \' orders reflect rehabilitative care throughout hospitalization. C. Discharge - Referral for outpatient therapy requires physician signature. D. Return to Clinic - Outpatient Summary requires physician signature. Parent/Patient Education : A. Bandage wrapping and splint application classes are Monday and Wednesday at 13:30 (staff invited to classes) B. Educational slide programs are Friday at 13:30. The program stresses the importance of pressure, splints, activity, exercises, and positioning. Patients are included in this formal training at age 9 and above. The primary therapist assigned to the patient provides one-on-one training on exercises. Communication : A. Tuesday - Interdisciplinary D/C Planning Meeting. B. Thursday - Grand Rounds. C. Monday, Wednesday, Friday - Unit rounds on a daily basis at bedside with team, 7:00a.m. D. Saturday, Sunday & Holidays - Unit rounds at 9:30a.m. (or as the attending physician schedules). E. Weekend Treatment - Therapists provide priority treatments only. Only 2 therapists are present on weekends and holidays. Rehabilitation Referrals : A. Referral process and paperwork. Outpatient/Outreach Clinics : A. All above procedures are tracked and continued in terms of the patient and family meeting their rehabilitation goals. Outpatient summaries are updated and provided to patient family and referral source. Our department participates in outreach clinics to provide follow-up treatments to patients in their community or surrounding areas. During these clinics we proved priority therapy needs, i.e. splinting and pressure therapy, and we make recommendations for the next level of rehab care. School Re-entries : A. The department assists with school re-entries so the children \'s return to school may be a smooth transition. Back to Dept. Listing Psychology and Psychiatry Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services. Clinical Services Staff: Clinical Psychologist 2 part-time Child Psychiatrists 2 Psychologists 1 Psychology Post-Doctoral Fellow We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family. Back to Dept. Listing Rehabilitation Services Much consideration must be given to a program of rehabilitation for the burn patient, and every patient needs an individually tailored plan of care. There are 4 principles for the rehabilitation of the burn patient: The program should start early, preferably the day of injury. A program of care should avoid prolonged periods of immobility, and any body part that is able to move freely should be moved frequently. Range of motion exercises should be started the day of injury. There should be a planned program of daily activity and rehabilitative care. The plan should be reviewed daily as rehabilitative needs change. Back to Dept. Listing Top ↑ LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[82]=new Array("blocker_burn_unitpage.htm","Blocker Burn Unit - UTMB Galveston","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 8-04-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM UNIVERSITY of TEXAS MEDICAL BRANCH BLOCKER BURN UNIT The University of Texas Medical Branch was established in 1891. It is the oldest of the four health sciences centers in the University of Texas System. Located on a barrier island bordering the Gulf Coast, the 85-acre main campus includes a complex of six hospitals, four academic schools, numerous research centers and institutes, and one of the largest medical libraries in the Southwest. The Blocker Burn Unit is named after former UTMB President Dr. Truman Blocker, who served in this capacity from 1964-1974. Dr Blocker, a plastic surgeon and burns specialist, established this unit during his tenure and expanded the service to treat burn victims from the entire Gulf Coast Area. The plastic surgeon who so skillfully repaired cleft lips and palates on the tiniest babies also was known for his pioneering work in the treatment of burn patients and mass casualties—including victims of the worst industrial accident in American history, the infamous 1947 Texas City Disaster, and Japanese patients disfigured by American atomic bombs at the end of World War II. Dr. Virginia Blocker was a collaborator in much of her husband’s research. After the 1947 Texas City explosion, they followed some 800 patients for nine years, publishing a number of articles about their findings. During World War II and immediately afterwards, Blocker was a military surgeon in the U.S. Army, becoming chief of surgery at the 2,000-bed Wakeman General Hospital in Camp Atterbury, Indiana, where combatants with head and neck injuries were treated. When he returned to UTMB as assistant professor at the end of the war, Blocker established the Special Surgical Unit (housed in a former military barracks) to help treat the large number of World War II military casualties, and the Division of Plastic and Reconstructive Surgery, of which he was named chief. In 1996, the Blocker Burn Unit became the first burn center in the United States to become certified not only by the American College of Surgeons, but also by the American Burn Association. Staffed by a range of professionals, including general and plastic surgeons, nurses, respiratory therapists, physical therapists, case managers, technicalhealthcare assistants, unit clerks, dieticians, and pastoral care, the Blocker Burn Unit provides comprehensive care to patients with debilitating burn injuries. The Blocker Burn Unit is a six bed unit with a tub room and day room for family members. In the event of mass trauma, burn beds may be found in Surgical ICU, Pediatric ICU (for children who have been burned), regular surgical units, and other ICUs and medical/surgical units around the hospital. Top ↑ LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[83]=new Array("referrals_transferspage2.htm","Total Burn Care Home Page","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM NIH TRAINING GRANT ABSTRACT POSTDOCTORAL TRAINING IN TRAUMA AND BURNS Abstract Thermal injury remains a major medical problem in the United States and throughout most of the world. The nature of burn pathophysiology however is not well defined. Basic researchers are active in this field, but trained clinicians are needed to make the knowledge generated useful in patient care. The principal objective of this proposal is to train physicians and scientists to perform research and interpret data; to apply resulting new methodology in a clinical environment; to communicate findings to the medical community. The program is divided into four major research areas: cardiopulmonary physiology; endocrinology and metabolism; wound healing; and molecular biology. Trainee’s work and study with a multidisciplinary group of faculty members, most of who have been working together for over 12 years. The major features of the program are didactic training and hands-on research. Didactic training includes a basic core curriculum in which all trainees participate in research projects of other trainees and investigators, and cooperation in research is emphasized. All projects proceed under the close tutelage of a mentor, and with collaboration of other program faculty members. This proposal calls for 3 trainees for each year proposed at a post-graduate, year-five level. This level could fluctuate based upon the qualifications of the candidates. Candidates require either an M.D. or a Ph.D. and at least two years of postdoctoral training. Research and training take place at the Shriners Burns Hospital (SBH) and the University of Texas Medical Branch (UTMB). SBH is located on the UTMB campus in Galveston, Texas. SBH facilities include 40 laboratories specifically designed for research in wound healing, tissue culture, metabolism, microbiology, electron microscopy, small animal experiments, analytical chemistry, and stable and radioactive isotope analysis. Clinical labs are available at both SBH and UTMB. Other UTMB facilities pertinent to the program include the Protein Chemistry Lab, the Ovine Intensive Care Unit and the Clinical Research Center. NIH Training Grant – 5 T32 GM 08256-07 LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[84]=new Array("emergency_carepage2.htm","Total Burn Care Home Page","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 7-23-04 © COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM EMERGENCY CARE Home Care for Minor Burns A burn victim should be treated by a hospital physician if: Children and elderly Any electrical or lightning injury Any chemical burn Any burns of the hands, face, feet, joints, genitalia or perineum Any burn larger in size than the outline of 1-2 hands of the victim Any deep burns (may be white, brown, or dark red in color) Any burn in a patient that has other pre-existing medical conditions Any burn that becomes red around the edges after a couple days Any burn patient that also inhaled smoke or chemicals at the time of burn Minor burns can be treated with: Cool water immediately after the burn. Topical antimicrobial such as Polysporin, polymyxin, bacitracin, neomycin. Hospital Emergency Care Assessment Airway: Support or provide airway and provide cervical spine protection. Breathing: Assess breathing and ventilation. Provide assistance as necessary. Monitor chest movement with deep burns of the trunk. Administer oxygen at a high flow. Circulation: Assess vital signs. Assess circulatory status of burned extremities by monitoring distal pulses. Start IV access. Disability: Assess orientation and neurological status, associated injuries, hypoxia. Exposure: Keep patient warm. Medical History and Head to Toe Physical Exam with x-rays and laboratory assessment Assess Burn Assess type of burn and circumstances of injury. Percent of burn injury (% Total Body Surface Area Burn) The Burn Diagram can be used to calculate burn size. Children are different than adults. The outline of the patient’s hand and fingers is equal to 1% of the body surface area and can be used to calculate burn size. (An area the size of 2 of the patient’s hands would be a 2% burn.) Body Surface Area nomogram : A patient’s height and weight are used to measure Total Body Surface Area in centimeters squared. Burn Depth 1 st Degree Burn 2 nd Degree Burn 3 rd Degree Burn 4 th Degree Burn Degree Depth History Etiology Sensation Appearance Healing 1 st Degree Superficial Epidermis only Momentary Exposure Sunburn Sharp, uniform pain Blanches red, pink. Edematous, soft, flaking, peeling ± 7 days 2 nd Degree Partial Thickness Epidermal and part of Dermal layer Exposure of Limited Duration to Lower Temperature (40-55 ° C) Scalds, flash burn without contact, weak chemical Dull or hyperactive pain, sensitive to air/temperature changes Mottled, red blanches red/pink, blisters, edema, serous exudate, moist 14-21 days 3 rd Degree Full Thickness Entire epidermis, dermis and subcutaneous tissue Long duration of exposure to high temperature Immersion, Flame, Electrical, Chemical Painless to touch and pinprick, May hurt at deep pressure No blanching, pale white, tan charred, hard, dry, leathery, Hair absent Granulates, Requires Grafting 4 th Degree Underlying structures of muscle or bone Prolonged duration of exposure to extreme heat Electrical, Flame, Chemical Usually painless Charred, Skeletonized Requires Fasciectomy, Possible amputation Fluid Resuscitation The most important aspect of early clinical management of the burn victim is fluid resuscitation beginning within the first couple hours of burn injury. Adult resuscitation: Ringers Lactate 2-4 ml / kg / %TBSA burned. Give ½ of total volume over the first 8 hours from time of burn injury. Give second ½ of total volume over the following 16 hours. Example Titrate to maintain blood pressure and urine output of at least 30 cc/hr. Pediatric resuscitation: Ringers Lactate 5000 ml / TBSA burn (m 2 ) + 2000 ml / TBSA (m 2 ). Give ½ of total volume over the first 8 hours from time of burn injury. Give second ½ of total volume over the following 16 hours. Example Titrate to maintain blood pressure and urine output of at least 1 cc/kg/hr. Wound Care for Emergency care and transport No ice or cold water soaks, no wet dressings or sheets. Cover with clean dry cloth. Keep patient warm. For delayed transfer - Wash wounds and débride loose tissue. Topical Antimicrobial (Silver Sulfadiazine) and gauze wrap. Monitor need for escharotomies. Electrical Burns Chemical Burns Burn Unit Referral Criteria Burn injuries that should be referred to a burn unit include the following: Partial thickness burns greater than 10% total body surface area (TBSA). Burns that involve the face, hands, feet, genitalia, perineum, or major joints. Third-degree burns in any age group. Electrical burns, including lightning injury. Chemical burns. Inhalation injury. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols. Burned children that are in hospitals without qualified personnel or equipment for the care of children. Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention. LINKS DISCLAIMER SITE SEARCH DISCUSSION FORUM Contact Webmaster Provided By Kwik Internet Technologies - KwikIT.com","Total Burn Care, Shriners Burns Hospital, Galveston, TX, burn care, burn, burns, burn surgery, burn information, burn doctors, burn patients","Total Burn Care information and discussion forum","");arrFiles[85]=new Array("advances_summary_page.htm","Advances in Burn Care","HOME BURN PATIENT CARE & REFERRAL Referrals & Transfers Emergency Care HOSPITALS & DEPARTMENTS Shriners Hospitals for Children - Galveston Burn Hospital Shriners of North America & Shriners Hospitals for Children University of Texas Medical Branch - Blocker Burn Unit University of Texas Medical Branch - Home Page CLINICAL ADVANCES, STATISTICS & ACTIVITIES Advances Summary Statistics Clinical Activities EDUCATIONAL BURN CARE INFORMATION House Staff Manual Safety & Prevention ABLS Local Educational Meetings Other Educational Resources RESEARCH OVERVIEW & ACTIVITIES Diagram Overview Research Summary Funding - Research Grant Support Scientific Staff Research Educational Meetings PUBLICATIONS Burn Bibliography Books Articles - New Findings FUNDED PROJECTS NIDRR Website NIH Training Grant NIH P50 Others STAFF MEMBERS & CONTACTS Medical Staff Clinical Staff Scientific Staff FELLOWSHIPS & OPPORTUNITIES FOR TRAINING Summary of Training Programs Specific Training Program Descriptions Contacts Page last updated 10-11-06 © COPYRIGHT 2006 ALL RIGHTS RESERVED TOTALBURNCARE.COM * Advances in Burn Care * D.N. Herndon, M.D., Chief of Staff Shriners Burn Hospital - Galveston, Texas Recent changes and new therapies have been incorporated into burn care throughout the world through the efforts of clinical and basic research. This article will summarize some of the important advances in treating burned children that were made possible through the support of the Shriners Hospitals for Children. It is often difficult to determine what specific discoveries change health delivery in burns. The areas of advancement in burn care have been resuscitation, early excision and grafting, hypermetabolic responses to burn injury, and infection control. The mortality and length of hospital stay of burned children have been greatly reduced over the last 25 years. In the 1960 \'s, the likelihood of survival was only 50% for pediatric burns covering 35-44% of the TBSA (total body surface area), and few patients with burn sizes above 45% TBSA survived. The average length of stay for the acutely burned child was 103 days. Today, the LA 50 (lethal burn size for 50% of the patients) for children exceeds 95% TBSA, and the average length of hospital stay for most serious burn injuries can be expected to be only 0.5 days per percent of TBSA that is burned. This is truly a remarkable achievement and is striking testimony to the concentrated effort in personnel and resources that have been directed toward this problem. The Shriners Hospitals for Children have contributed in a major way to this remarkable achievement by their very sound and sustained investment of substantial resources toward this endeavor. Specific aspects of burn care that have dramatically improved in burn hospitals include: treatment of the wound with prompt eschar excision and immediate wound closure, understanding and meeting the changes in metabolic and nutritional requirements, and the evolution of effective skin banks, infection control, and alternative wound-closure materials and strategies. Table of Contents Prompt Eschar Excision and Immediate Wound Closure Metabolism and Nutrition Pressure Garments and Scarring Air-Fluidized Bed Fluid Resuscitation Anesthetic Agents Bacterial Translocation Mediators of Burn Injury Inhalation Injury Early Enteral Feeding Rehabilitation and Psychosocial Adjustment References Prompt Eschar Excision and Immediate Wound Closure Although as early as 1947 researchers (1) had recognized that prompt eschar removal and immediate wound closure could improve outcome in burn injuries, application of this approach to large burns had not been practical before the 1970’s because of an associated high rate of infection and bleeding complications. Many burn units adopted the excision technique (2), which was a single tangential slice that was intended to remove the superficial layer of second-degree injuries. The application of this tangential excision method to superficial injuries by most surgeons had been frustrated by the excessive blood losses that accompanied its use in large burns and those burns with full-thickness depths. The development of effective topical antimicrobials and systemic antibiotics in the 1960’s, combined with hypotensive anesthetic techniques and other blood-conservation measures, allowed prospective, but nonrandomized, clinical trials to be conducted. In these studies (3), improvements in survival and length of hospital stay were seen and as a result of these encouraging outcomes this surgical approach was promoted. The exact contribution to the outcome of prompt eschar excision and immediate wound closure in large burns has largely remained unknown because prospective randomized clinical trials have not been conducted. A few prospective studies have been performed (4,5), which demonstrated that prompt excision improves hospital stay (6) and survival (7). Several centers have reported improvements in long-term function and cosmesis, leading to a decreased need for reconstructive procedures. Further developments have allowed safer operations and minimized blood losses (8). These advancements have allowed this method to be effectively used in burns of all sizes and make this approach the standard method of treating these injuries (9,10). In order for prompt excision and immediate wound closure to be practical in massive burn injuries, alternative materials and approaches to wound closure became necessary in burns that covered more than 50% of the TBSA. A system of cryopreservation and long-term storage of human skin for periods extending up to several months was developed (11). Although controversy surrounds the degree of viability of the cells within this preserved skin, the method has allowed greater flexibility in the clinical uses of autologous skin and allogenic skin harvested from cadavers. Because a clear clinical need for a skin-replacement material was evident by 1981, a bilayer artificial skin for permanent wound closure was developed, and preliminary clinical results of its use were reported (12,13). This material has been studied in an 11-center clinical trial comparing the artificial dermis to conventional grafting techniques after the early excision of the burns in patients with major thermal injuries (14). This artificial skin provided a permanent wound cover that was at least as satisfactory as currently available skin-grafting techniques. The take of the “thin” epidermal grafts on the artificial skin was 80% successful, and at the completion of the study less hypertrophic scarring was seen with artificial dermis. Furthermore, patients preferred the artificial skin to conventional grafting methods. Continued experience with this artificial skin has been extremely favorable, and a potential survival benefit has been associated with its use in massive burns (15). The use of “sheet” autografts to cover larger surface areas has been described (16). Extremities and the trunk were more often grafted with mesh graft. Sheet grafts were often the sole coverage in patients with burns up to 55%. With larger burns, sheet grafts were used to cover the face and hands. Because of its superior cosmetic and functional outcome, sheet autografting is now considered for covering moderately sized burns and is important in the cosmetic and functional areas, such as the face and hands. To substantiate an observation that donor sites harvested from the back scar less than those harvested from thighs, donor sites from both areas were evaluated for the extent of scarring (17). From this study, it was concluded that back donor sites had significant improvement in scar height, color, and edema. Thus, the back is now the preferred donor site for skin grafts in the pediatric burn population. From 1984 through 1989, researchers studied 24 patients with 30 acute palmar burns that required skin grafting to compare the efficacy of split-thickness versus full-thickness autografting (18). The results demonstrated improved function and a decrease in the need for reconstructive procedures when full-thickness skin grafts are used for the treatment of deep palm burns in young pediatric patients. Back to TOC Metabolism and Nutrition Fundamental questions regarding the metabolic demands of the thermally injured patient have been evaluated, and several practical answers have emerged. The metabolic and nutritional questions include (1) how many calories do thermally injured patients require? (2) how many carbohydrate (glucose) calories should these injured patients be given to avoid starvation and to promote protein synthesis? and (3) how many protein calories should these patients be given in order to achieve net protein synthesis? The solution to the first issue, as others have reported, is that the metabolic rate, measured by indirect calorimetry, rarely exceeds twice the basal metabolic rate as calculated by standard correlations. Therefore, twice the basal energy expenditure is a generous estimate of the total caloric requirement in burn patients. Carbohydrate metabolism has been found to be greatly altered in these patients, and burn centers have pursued studies to consider how best to compensate for these changes (19,20). One of the more dramatic alterations is that glucose uptake rates and glucogenesis are greatly increased after burn injury. Despite these increased rates, researchers have demonstrated a practical limit in the glucose infusion rate (5 mg/kg/min) beyond which the excess glucose is not oxidized for energy but simply becomes stored as fat (20). The excess fat is stored in the liver and results in fatty livers, which elevate the diaphragm and compromise breathing. At glucose infusion rates above 5 mg/kg/min, the respiratory quotient exceeds unity and causes excess CO 2 production and increases minute alveolar ventilation requirements. The combination of diaphragmatic elevation and increases in CO 2 makes the respiratory failure frequently seen in these patients more severe. Marked changes in organ and whole-body protein metabolism often accompany a severe thermal injury. Much of the knowledge about the nature of whole-body protein metabolism after trauma has been obtained from nitrogen-balance studies. These studies uncovered changes in total body nitrogen content without revealing the pathways in which these changes occurred. Many studies using stable isotopes and steady-state kinetic models have greatly contributed to understanding these changes in whole-body protein metabolism, and these studies have suggested how best to compensate for these changes in total body nitrogen content (21). A source of energy is one of the most critical requirements to the patient recovering from a severe burn. The processes of wound healing, growing replacement tissue, and supporting normal metabolism require huge energy demands from the body. Large amounts of carbohydrates and fat must be converted to energy to satisfy the requirements needed to nourish the traumatized body and fuel the rapid growth of new cells. An unbalanced diet, therefore, can be extremely detrimental to the burn patient. One major cause of mortality in burn patients is respiratory failure. Decreased respiratory and peripheral muscle mass reduces the ability to breathe and exercise. Excessive carbohydrate administration may increase CO 2 production and further complicate the respiratory status. Unlike most research, these experiments do not use laboratory animals or in vitro studies but are performed on humans. This is research made possible through the use of nonradioactive isotopic tracers (stable isotopes) which are naturally occurring atoms that possess an extra neutron that distinguish them from their more abundant natural form. By collecting expired air, blood, or tissue samples containing these stable isotopes, research scientists can track the transformation of amino acids into protein used to build muscle tissue. While the body of a burn victim undergoes many changes, the rampant acceleration of metabolism places an increased load on the heart, liver, kidneys, lungs and other vital organs that provide normal body stability. Massively burned children are similar in many aspects to long- distance runners, where both heart rate and catecholamine levels are two to three times elevated, resulting in the body digesting peripheral muscles in order to support the voracious need for building materials necessary to heal wounds. Part of this high metabolic rate is useful as it helps the body provide building materials for the wound-healing process. There are, however, some adverse effects where the elevated metabolic rate may complicate respiratory problems. In addition, not all of the increased energy mobilized peripherally goes to wound healing. Burn patients show muscle wasting and become centrally fat as the liver is apparently unable to process the large amount of peripheral fuel presented to it. In many cases the metabolism in non-injured areas is so high that wound healing becomes retarded. Researchers have demonstrated a very high level of the hormone epinephrine (adrenaline) in thermally injured patients (22,23). This hormone can increase metabolism by stimulating the b -adrenergic receptors. Propranolol, a drug that is a competitive antagonist of b -adrenergic receptors, has been shown to lower heart rates in burned children from 200 beats per minute to 120, decrease the amount of oxygen needed to keep the heart pumping and reduce the anxiety caused by burn released epinephrine without impairing the ability of the patient to respond to stresses (24,25). Fat is metabolized 2.5 times the normal rate in thermally injured patients, a process that is apparently the result of elevated catecholamines and b -adrenergic stimulation since it has been shown to be blocked by propranolol (26,27). Researchers have also studied protein metabolism in which tissues, such as muscle, are constantly being built up and broken down into basic components or amino acids. After thermal injury, protein breakdown exceeds build-up, causing a net release of amino acids (28). When elevated in the serum, these amino acids are converted in the liver to glucose, a process known as glucogenesis, and then broken down to smaller compounds in peripheral tissues by anaerobic or aerobic metabolism. When the energy-producing process is anaerobic, the smaller sugars are converted into lactate and pyruvate; this appears to be the process in thermally injured patients (29,30). The elevation of these substances can be detrimental to the patient. In addition to the acidosis created, other compensatory changes occur involving the utilization of glutamine, which is an essential fuel for the cells that line the gastrointestinal tract and of the immune system. Depletion of this amino acid causes the starvation of these cells, allowing toxic materials and bacteria from the gut to enter the systemic circulation. A potential therapy to combat this is being tested is the administration of a compound that stimulates the incorporation of amino acids into protein. Exogenously administered growth hormone reverses the protein breakdown produced by thermal injury and stimulates the use of amino acids (31,32). This not only redirects metabolism away from glucogenesis but also causes an increased incorporation of amino acids into healing wounds. An increase in rate of donor site healing and a decrease in length of hospital stay have been shown when growth hormone is used to treat burn children. Patients with 60% burn wounds had a decrease in length of hospital stay from 46 to 32 days (33). After a thermal injury there is also a reorganization of protein synthesis. Several enzymes and proteins involved in the body’s defense system, such as blood coagulation factors, proteolytic enzyme inhibitors, and enzymes involved in the destruction of bacteria are increased at the same time other proteins such as albumin are reduced. A reduction in albumin can be detrimental since this plasma protein plays an important role in prevention of edema. Investigators are now beginning to identify the genetic mechanisms responsible for these changes and have identified several factors that play a role in the regulation of these genes. Back to TOC Pressure Garments and Scarring Pressure garments, which are used to reduce scarring, were developed 30 years ago. Traditionally, elastic bandages were placed on the legs of the burn patients to improve venous return and decrease bruising or blood blister formation. These bandages were also applied to splints to reduce and prevent contractures. Therapists observed that burn patients rarely developed hypertrophic scars when these pressure garments were applied (34,35). Unsightly scars could be prevented if the pressure garments were continuously worn and if hypertrophic scars had already formed, they could be reversed if the pressure garments were applied. Investigators studying scar formation found that collagen fiber deposition in non-hypertrophic scars were parallel, whereas those of the hypertrophic scar formed predominantly nodular or whorl-like patterns (35-38). With the application of pressure, these diffuse, disorganized fibers became parallel. The relationship of the whorl-like fibers was found to depend on the quantity of proteoglycan that make up the scar tissue. In hypertrophic scars, this material is more abundant. Several researchers concluded that the pressure application reduced the scar by limiting the blood supply to the wound. It has now been determined that the macrophages of patients with keloids and hypertrophic scars produce elevated levels of the cytokines interleukin 6, b interferon, and tumor necrosis factor (39,40). Contractions of the burn wound have produced orthopaedic deformities in some patients as a result of lack of pressure application. To prevent or treat these contractions, a practice of bone pinning and skeletal traction was instituted (41). At the time, few surgeons would have placed bone pins into a thermally injured patient because of possible bone infections. A survey taken 17 years after the institution of the pinning procedures revealed that of the 626 patients that had been subjected to the procedure only 50 (8%) developed bone infections, and these were easily managed by removal of the pins and antibiotic therapy (42). In recent times the use of skeletal traction has been enhanced with the advent of the Ilizarov fixator (43). These procedures to reduce scarring and contractures are important developments in improving the quality of life of the thermally injured patient. The frequency of inadequate decompression and its complications have been studied and it was concluded that compartment pressures should be followed in burn patients since pressures may increase over time and pulses are not predictive of ischemia. Failure to decompress extremities with elevated pressures may lead to significant, but preventable, complications (44). Back to TOC Air-Fluidized Bed The first air-fluidized bed was developed in 1969. The introduction of this new concept in the care of burn patients has been especially important in treating posterior burns or massive burns where posterior donor sites are required (45). Back to TOC Fluid Resuscitation In the early 1960’s, formulas for fluid resuscitation for adults were already established. There was, however, a major controversy concerning the use of colloids as a part of the fluid resuscitation regimen (46). Studies led to the development of a resuscitation formula that was based upon body surface area and body weight (47), which proved to be more appropriate for the care of pediatric patients (48,49). This formula is now used around the world and has made a substantial contribution to survival of thermally injured pediatric patients, decreasing mortality from renal failure from 100% before 1984 to 56% after 1984 (50). Studies have further shown that patients with smoke inhalation injury require 2 cc per kg per percent TBSA burn more fluid than equivalent size burns without smoke inhalation injury. Investigations have shown that after thermal injury there was a massive systemic vasoconstriction that occurred independent of sympathetic nervous system activity (51). These studies implicated antidiuretic hormones and the renin angiotensin systems as probable vectors of this response (52). The changes discovered from these investigations bear an important relationship to bacterial translocation (the passage of bacteria from the intestine into the circulation) after thermal injury, which may contribute to the development of multiorgan failure (53). Back to TOC Anesthetic Agents Most surgical patients in the 1960’s were given halothane for anesthesia. This agent was associated with liver damage and malignant hyperpyrexia (54, 55). During this same time, dissociative anesthetics were being released for clinical trials and the use of ketamine in children became standard worldwide (56,57). The salutary cardiovascular actions of the drug were described (58,59), and the drug has been extremely useful in critically ill children (60,61). During anesthesia laryngeal reflexes are maintained intact and there is no respiratory depression. Ketamine can be used without intubation in acute burns in children with contracted necks who need to have reconstructive surgery (61-63) and has little or no effect on the immune system when given multiple times (64). This drug was also shown to be an excellent induction agent in patients with unstable cardiovascular systems (65). Anesthesia, when given repeatedly, can result in some psychological trauma but it was demonstrated that ketamine was well tolerated by children (66). The safe and effective use of haloperidol to treat severe agitation and delirium in the critically ill pediatric patient has also been described. The intravenous route appears to be more effective than the enteral route and is now considered when rapid, acute control of agitation is required (67). Back to TOC Bacterial Translocation The finding of a high incidence of gram-negative sepsis in thermally injured patients without an obvious source of bacteria led to the development of the hypothesis that the source was from the gastrointestinal tract. The concept that the burn wound became infected as a result of organisms from the gut entering into the circulation was proposed. To test this hypothesis, the gastrointestinal tract of a group of dogs was infected with Pseudomonas labeled with a fluorescein tag. Bacteria crossing the mucosal barrier in burned animals were identified from fluorescence tags in the plasma. Later, this tagged material was found in the burn wound itself (68). Recently, the importance of bacterial translocation has been recognized after cutaneous thermal injury, endotoxin administration, or an inhalation injury (53,69). Bacterial translocation associated with reduced blood flow was prevented by the use of vasodilators (70). These changes may be clinically important since a reduction in blood flow to abdominal organs is associated with the release of myocardial depressants (71-73). This could also explain the increase in mortality seen in patients with combined thermal and inhalation injury, since these two insults in combination produce a greater increase in abdominal vascular resistance than either insult alone. The need to prevent “under resuscitation” of burned patients has been well recognized (74-76). Most recently, a drug that inhibits the formation of one of the vasoconstrictive mediators (a thromboxane synthetase inhibitor), which was previously shown to be released by burn injury (77), has been shown to reverse the bacterial translocation of a thermal injury (78) and to reverse the myocardial depression that occurs with the administration of endotoxin (79). Preliminary data also indicate that compounds with anti thromboxane activities may also be effective in preventing the mesenteric vasoconstriction and myocardial depression observed with inhalation injury (79,80). Back to TOC Mediators of Burn Injury Metabolites of arachidonic acid, known precursors to prostaglandins, are released after thermal injury (81, 82). Reducing the formation of these prostaglandins is known to reduce burn-induced edema (83). Researchers demonstrated that the blood flow to the renal papillae was remarkably reduced in burned dogs that were treated with the materials which block the formation of prostaglandin (83). Studies have also demonstrated that if prostaglandin synthetase inhibition was combined with the osmotic diuretic mannitol, the papillary blood flow could be restored. When this technique was added to the fluid resuscitation of the thermally injured patient, there appeared to be much less edema formation, and these patients required less fluid resuscitation (81). The early agent used for the blockade of prostaglandin synthesis was nicotinic acid. In laboratory investigations, nicotinic acid was shown to reduce the edema formation that resulted from thermal injury; however, the animals in the study developed liver damage (84). The latter work has led to more selective and successful inhibition of prostanoid vasoconstrictors. Back to TOC Inhalation Injury Inhalation injury studies often follow two main pathways, one relating to parenchymal injury and the other to damage of the airway of the tracheobronchial tree (85-87). Inhalation injury was found to be associated with a marked increase in a transvascular fluid flux across the lungs (88). This fluid flux occurred as the result of changes in both microvascular pressure and permeability to protein (88, 89). Later studies revealed that lung edema formation was associated with polymorphonuclear cells (90). These cells induced their injury to the lungs as the result of the release of proteolytic enzymes (91) and free oxygen radicals (90). It was determined that the amount of fluid resuscitation required after smoke inhalation was greater than that required for a burn alone and that appropriate fluid resuscitation would reduce, rather than enhance, transvascular fluid flux (92, 93). These studies have resulted in an enhancement of fluid resuscitation in patients with concomitant thermal and inhalation injury. Techniques for measuring extravascular lung water by the thermal dilution technique have been applied to patients to evaluate the extent of their pulmonary edema (94). Hyperemia (excessive amounts of blood) of the tracheobronchial tree after an inhalation injury is a characteristic used for the diagnosis of an inhalation injury (95). Investigators have shown that hyperemia is associated with a 10-fold increase in bronchial blood flow (96-100) and an increase in the permeability of the tracheobronchial areas involved. Reducing the hyperemia has been shown to reduce the pulmonary edema seen after smoke inhalation (98,101). Treating animals with capsaicin, a compound that depletes sensory nerves of their neuropeptides, markedly reduced both the elevation in bronchial blood flow and transvascular fluid flux commonly associated with an inhalation injury. There are several concomitant changes in the systemic circulation related to an inhalation injury. The heart muscle is depressed, there is an increase in the vasomotor tone of the gut, and systemic microvascular permeability is elevated. Initial investigations have shown that the blockade of a potent arachidonic acid derivative, thromboxane A 2 , could markedly reduce these changes (102). With inhalation injuries presently accounting for the majority of the deaths in thermally injured patients (103,104), research and clinical advances in these areas have become the new horizons for improved patient outcomes. The association of the airway damage with the pulmonary changes noted with inhalation injury has changed just how patients with an inhalation injury are treated. It was first reasoned that the placement of an endotracheal tube into a patient with existing damage to the airway would only aggravate the injury. Therefore, endotracheal tubes were not used in patients with bronchoscopic evidence of inhalation injury and the placement of tubes was avoided, even for anesthetic procedures. Endotracheal tubes are now used only if there is a marked reduction in arterial oxygen, an increase in carbon dioxide, or evidence of severe respiratory distress. The practice of avoiding endotracheal intubation has resulted in a decline in the number of ventilator days and a reduction in morbidity (unpublished data). Back to TOC Early Enteral Feeding Malnutrition and burn injuries have been associated with infection and death. Burn physicians in various cities began continuous feeding of milk to reduce the incidence of gastric and duodenal ulcers (105,106). As a result, stress ulcers rarely occurred in milk-fed patients. It was further shown that milk could prevent weight loss in children who were recovering from severe burns. This led to the practice of milk feeding up to one hour before any surgical procedure. Accurate formulas for the precise amount of calories required to maintain weight in burned children of different ages have continued to develop (107-110). The use of supplemental parenteral hyperalimentation, however, was shown not only unnecessary but also detrimental (111, 112). Early enteral and continuous feeding has now decreased mortality in burned children and is now accepted practice in burn units around the world. Back to TOC Rehabilitation and Psychosocial Adjustment Models of burn treatment strongly emphasize the integration of basic science, clinical research, and clinical treatment that share information in a continuous feedback loop. It is customary for each clinical innovation to be based on empirical data and to be evaluated for effectiveness through scientific study. Through research grants from Shriners Hospitals for Children, a database has been developed to follow patients longitudinally on specific measures of physical and psychosocial recovery. Four hundred patients have been entered into a database, which includes longitudinal assessments of cardiopulmonary functions, physical growth and maturation, bone density, measures of functional capability, including range of motion and activities of daily living, scar formation, reconstructive needs, and several measures of the psychosocial adjustment of the child/patient and parent(s). One important finding from these data is that the long-term successful psychosocial adjustment of burned children largely depends on the enduring qualities of the families in which they live (113-115). Based on these data, a treatment program has been developed that centers on strengthening the welfare of the family/patient unit. We emphasize the importance of having at least one parent/guardian available. Studies consistently indicate that, regardless of burn size, the majority of the children eventually function satisfactorily as socially integrated, behaviorally well-adjusted individuals with positive self-regard; only about 20-30 percent of each sample have moderate behavior problems. These outcomes have been consistent even for survivors of the most massive injuries, many of who have now grown into young adults with careers and families of their own. In terms of physical impairment, the children, even those with the most severe injuries, are remarkably independent in their capabilities (116,117). Back to TOC References Cited 1. Cope, O., Laugohr, H., Moore, F.D., Webster, R. Expeditious care of full-thickness burn wounds by surgical excision and grafting. Annals of Surgery 125: 1-22, 1947. 2. Janzekovic, A. A new concept in the early excision and immediate grafting of burns. Journal of Trauma 10:1103-1108, 1970. 3. Burke, J.F., Bondoc, C.C., Quinby, W.C. Primary burn excision and immediate grafting: A method of shortening illness. Journal of Trauma 14: 389-395, 1974. 4. Engrav, L.H., Heimbach, D.M., Reus, J.L., Harnar, T.J., Marvin, J.A. A randomized prospective study of early excision and grafting of indeterminant burns less than 20 percent TBSA. Journal of Trauma 23: 1001-1004, 1983. 5. Demling, R.H. Improved survival after massive burns. Journal of Trauma 23: 179-184, 1983. 6. Herndon, D.N., Parks, D.H. Comparison of serial debridement and autografting and early massive excision with cadaver skin overlay in the treatment of large burns in children. Journal of Trauma 26(2): 149-152, 1986. 7. Herndon, D.N., Barrow, R.E., Rutan, R.L., Rutan, T.C., Desai, M.H., Abston, S. A comparison of conservative versus early excision: Therapies in severely burned patients. Annals of Surgery 209(5): 547-553, 1989. 8. Desai, M.H., Herndon, D.N., Broemeling, L., Barrow, R.E., Nichols, R.J., Jr., Rutan, R.L. Early burn wound excision significantly reduces blood loss. Annals of Surgery 211(6): 753-762, 1990. 9. Burke, J.F., Quinby, W.C., Bondoc, C.C. Primary excision and prompt grafting as routine therapy for the treatment of thermal burns in children. Surgery Clinics of North America 56: 477-494, 1976. 10. Heimbach, D.M. Early burn excision and grafting. Surgery Clinics of North America. 67: 93-107, 1987. 11. Bondoc, C.C., Burke, J.F. Clinical experience with viable frozen human skin and a frozen skin bank. Annals of Surgery 174: 371-382, 1971. 12. Burke, J.F., Yannas, I.V., Quinby, W.C., Bondoc, C.C., Jung, W.K. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Annals of Surgery 194: 413-428, 1981. 13. Yannas, I.V., Burke, J.F., Orgill, D.P., Skrabut, E.M. Wound tissue can utilize a polymeric template to synthesize a functional extension of skin. Science 215: 174-176, 1982. 14. Heimbach, D., Luterman, A., Burke, J., Cram, A., Herndon, D., Hunt, J., Jordan, M., McManus, W., Solem, L., Warden, G., Zawacki, B. Artificial dermis for major burns: A multi-center randomized clinical trial. Annals of Surgery 208: 313-320,1988. 15. Tompkins, R.G., Hilton, J.F., Burke, J.F., Schoenfeld, D.A., Hegerty, M.T., Bondoc, C.C., Quinby, W.C., Behringer, G.E., Ackroyd, F.W. Increased survival after massive thermal injuries in adults: a preliminary report using artificial skin. Critical Care Medicine 17: 734-740, 1989. 16. Archer, S.B., Henke, A., Greenhalgh, D.G., Warden, G.D. The use of sheet autografts to cover extensive burns in patients. Journal of Burn Care and Rehabilitation 19: 33-38, 1998. 17. Greenhalgh, D.G., Barthel, P.P., Warden, G.D. Comparison of back versus thigh donor sites in pediatric patients with burns. Journal of Burn Care and Rehabilitation 14: 21-25, 1993. 18. Schwanholt, C., Greenhalgh, D.G., Warden, G.D. A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient. Journal of Burn Care and Rehabilitation 14: 29-33, 1993. 19. Wolfe, R.R., Burke, J.F. Effect of burn trauma on glucose turnover, oxidation, and recycling in guinea pigs. American Journal of Physiology 233: E80-E85, 1977. 20. Burke, J.F., Wolfe, R.R., Mullany, C.J., Mathews, D.E., Bier, D.M. Glucose requirements following burn injury: Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake. Annals of Surgery 190: 274-285, 1979. 21. Kien, C.L., Young, V.R., Rohrbaugh, A.M., Burke, J.F. Increased rates of whole body protein synthesis and breakdown in children recovering from burns. Annals of Surgery 187: 383-391, 1987. 22. Goodall, M.G. Sympathetic nerve and adrenal medullary response to thermal burn. Clinical analysis of adrenaline and noradrenaline depletion. American Surgeon;32:448-452, 1966. 23. Goodall, M. Sympatho-adrenal medullary response to thermal burn. Annals of the New York Academy of Science 150:685-689, 1968. 24. Minifee, P.K., Barrow, R.E., Abston, S., Desai, M., Herndon, D.N. Improved myocardial oxygen utilization following propranolol infusion in adolescents with postburn hypermetabolism. Journal of Pediatric Surgery 24:806-810, 1989. 25. Herndon, D.N., Barrow, R.E., Rutan, T.C., Minifee, P., Jahoor, F., Wolfe, R.R. Effect of propranolol administration on hemodynamic and metabolic responses of burned pediatric patients. Annals of Surgery 208:484-492, 1988. 26. Wolfe, R.R., Herndon, D.N., Peters, E.J., Jahoor, F., Desai, M.H., Holland, O.B. Regulation of lipolysis in severely burned children. Annals of Surgery 206:214-221, 1987. 27. Aarsland, A., Chinkes, D., Wolfe, R.R., Barrow, R.E., Nelson, S.O., Pierre, E.J., Herndon, D.N. Beta-blockade lowers peripheral lipolysis in burned patients receiving growth hormone: Rate of hepatic VLDL triglyceride secretion remains unchanged. Annals of Surgery 223(6): 777-789, 1996. 28. Jahoor, F., Desai, M., Herndon, D.N., Wolfe, R.R. Dynamics of the protein metabolic response to burn injury. Metabolism 37:330-337, 1988. 29. Wolfe, R.R., Jahoor, F., Herndon, D.N., Miyoshi, H. Isotopic evaluation of the metabolism of pyruvate and related substrates in normal adult volunteers and severely burned children: Effect of dichloroacetate and glucose infusion. Surgery 110:54-67, 1991. 30. Gore, D.C., Honeycutt, D., Jahoor, F., Rutan, T., Wolfe, R.R., Herndon, D.N. Effect of exogenous growth hormone on glucose utilization in burn patients. Journal of Surgical Research 51:518-523, 1991. 31. Gore, D.C., Honeycutt, D., Jahoor, F., Wolfe, R.R., Herndon, D.N. Effect of exogenous growth hormone on whole-body and isolated-limb protein kinetics in burned patients. Archives of Surgery 126: 38-43, 1991. 32. Cioffi, W.G., Gore, D.C., Rue, L.W., Carrougher, G., Guler, H-P., McManus, W.F., Pruitt, B.A. Insulin-like growth factor-1 lowers protein oxidation in patients with thermal injury. Annals of Surgery 220(3): 310-319, 1994. 33. Herndon, D.N., Barrow, R.E., Kunkel, K.R., Broemeling, L., Rutan, R.L. Effects of recombinant human growth hormone on donor-site healing in severely burned children. Annals of Surgery 212:424-429, 1990. 34. Linares, H.A., Kischer, C.W., Dobrkovsky, M., Larson, D.L. On the origin of the hypertrophic scar. Journal of Trauma 13:70-75, 1973. 35. Linares, H.A., Kischer, C.W., Dobrkovsky, M., Larson, D.L. The histiotypic organization of the hypertrophic scar in humans. Journal of Investigative Dermatology 59:323-331, 1972. 36. Linares, H.A., Larson, D.L. Early differential diagnosis between hypertrophic and nonhypertrophic healing. Journal of Investigative Dermatology 62:514-516, 1974. 37. Baur, P.S., Larson, D.L., Stacey, T.R., Barratt, G.F., Dobrkovsky, M. Ultrastructural analysis of pressure-treated human hypertrophic scars. Journal of Trauma 16:958-967, 1976. 38. Linares, H.A., Larson, D.L. Proteoglycans and collagenase in hypertrophic scar formation. Journal of Plastic and Reconstructive Surgery 62:589-593, 1978. 39. Xue, H., McCauley, R.L., Zhang, W., Martini, D. Altered interleukin-6 expression in fibroblasts from burn hypertrophic scars. Journal of Burn Care & Rehabilitation 19 (1): S189, 1998. 40. McCauley, R.L., Chopra, V., Li, Y.Y., Herndon, D.N., Robson, M.C. Altered cytokine production in black patients with keloids. Journal of Clinical Immunology 12:300-308, 1992. 41. Larson, D.L., Evans, E.B., Abston, S., Lewis, S.R., Artz, C.P. Skeletal suspension and traction in the treatment of burns and what \'s new in burns. Annals of Surgical Medicine Times 104:128-141, 1976. 42. Youel, L., Evans, E.B., Heare, T.C., Herndon, D.N., Larson, D.L., Abston, S. Skeletal suspension in the management of severe burns in children A sixteen-year experience. Journal of Bone and Joint Surgery [Am] 68:1375-1379, 1986. 43. Calhoun, J.H., Evans, E.B., Herndon, D.N. Techniques for the management of burn contractures with the Ilizarov fixator. Clinical Orthopedics and Related Research 280:117-124, 1992. 44. Brown, R.L., Greenhalgh, D.G., Kagan, R.J., Warden, G.D. The adequacy of limb escharotomies-fasciotomies after referral to a major burn center. Journal of Trauma 37(6): 916-920, 1994. 45. Hargest, T.S., Artz, C.P. A new concept in patient care: The air-fluidized bed. Association of Operating Room Nurses Journal 10:50-53, 1969. 46. Wilson, R.D., Nichols, R.J., Poth, R. A clinical and laboratory evaluation of a \"disaster mixture \" in cardiovascular resuscitation. Southern Medical Journal 60:875-881, 1976. 47. Carvajal, H.F., Linares, H.A., Brouhard, B.H. Relationship of burn size to vascular permeability changes in rats. Surgical Journal of Gynecology and Obstetrics 149:193-202, 1979. 48. Carvajal, H.F. Fluid therapy for the acutely burned child. Comprehensive Therapy 3:17-24, 1977. 49. Carvajal, H.F. A physiologic approach to fluid therapy in severely burned children. Surgical Journal of Gynecology and Obstetrics 150:379-384, 1980. 50. Jeschke M.G., Barrow R.E., Wolf S.E., Herndon D.N. Mortality in burned children with acute renal failure. Archives of Surgery 134: 752-756, 1998. 51. Turner, R., Carvajal, H.F., Traber, D.L. Effects of ganglionic blockade upon the renal and cardiovascular dysfunction induced by thermal injury. Circulatory Shock 4:103-113, 1977. 52. Traber, D.L., Bohs, C.T., Carvajal, H.F., Linares, H.A., Miller, T.H., Larson, D.L. Early cardiopulmonary and renal function in thermally injured sheep. Surgical Journal of Gynecology and Obstetrics 148:753-758, 1979. 53. Morris, S.E., Navaratnam, N., Herndon, D.N. A comparison of effects of thermal injury and smoke inhalation on bacterial translocation. Journal of Trauma 30:639-643, 1990. 54. Wilson, R.D., Traber, D.L., Allen, C.R., Priano, L.L. Malignant hyperpyrexia: A re-examination. Southern Medical Journal 64: 411-414, 1971. 55. Wilson, R.D., Dent, T.E., Traber, D.L., McCoy, N.R., Allen, C.R. Malignant hyperpyrexia with anesthesia. Journal of the American Medical Association 202: 183-186, 1967. 56. Wilson, R.D., Traber, D.L., Barratt, E., Creson, D.L., Schmitt, R.C., Allen, C.R. Evaluation of CL-1848C: A new dissociative anesthetic in normal human volunteers. Anesthesia and Analgesia 49: 236-241, 1970. 57. Wilson, R.D., Nichols, R.J., McCoy, N.R. Dissociative anesthesia with CI-581 in burned children. Anesthesia and Analgesia 55: 719-724, 1976. 58. Traber, D.L., Wilson, R.D., Priano, L.L. Differentiation of the cardiovascular effects of CI-581. Anesthesi