Principles and Practice of Burn Care

Investigations
587
Investigations
DIFFERENTIAL DIAGNOSIS FOR ALTERED BLOOD VALUES
1. SERUM PHOSPHORUS
Normal
Children: 4-7 mg/100 ml
Adults: 3-4 mg/100 ml
Elevated
Renal insufficiency
Decreased
Hyperparathyroidism
Hypoparathyroidism
Rickets/osteomalacia
Hypervitaminosis-D
Steatorrhea
Antacid ingestion
2. SERUM TRIGLYCERIDE
Normal
Below 165 mg/100 ml
Elevated
Hyperthyroidism
Decreased
Malabsorption
Diabetes mellitus
Malnutrition
Nephrotic syndrome
Primary hypolipo-
Biliary obstruction
proteinemias
Primary hyperproteinemias
3. SERUM BILIRUBIN
Normal total
0.3 to 1.1 mg/100 ml
Direct
0.1 to 0.4 mg/100 ml
Indirect
0.2 to 0.7 mg/100 ml
Rise of indirect serum bilirubin
In hemolytic diseases
Gilbert’s disease
Acute/chronic hepatitis
Rise of total serum bilirubin
Biliary tract obstruction
Cancer of head of pancreas
Gallstones

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Principles and Practice of Burn Care
Elevation of both conjugate and nonconjugate levels (with the conjugate levels more elevated)
Hepatic metastasis
Hepatitis
Lymphoma
Cirrhosis
Cholestasis secondary to drugs
4. SERUM CALCIUM
Normal
9.6 to 10.9 mg/100 ml
Elevated
Hyperparathyroidism (20 mg)
Decreased
Hypoparathyroidism
Osteomalacia/rickets
Hypervitaminosis D (17 mg)
Malabsorption syndrome
Multiple myeloma
Cushing’s syndrome
5. SERUM CHLORIDE
Normal
350 to 375 mg/100 ml
Increased
Excessive salt in diet
Decreased
Abnormal loss due
Overtreatment with saline solution
to vomiting and diarrhea
Decreased excretion in urinary
Excessive sweating
tract obstruction
Acute/chronic nephritis
Decompensated heart disease
6. SERUM CHOLESTEROL
Normal
150-250 mg/100 ml
Increased
Xanthomatosis
Decreased
Hyperthyroidism
Pregnancy
Acute infections
Alcohol and fatty diet
Anemia with malnutrition
Myxedema
Diabetes mellitus
Obesity
Nephrotic syndrome
7. SERUM ALBUMIN
Normal
3.5 to 5.5 gm/100 ml
Increased
Hemoconcentration
Decreased
Malnutrition
Shock
Starvation
Dehydration
Glomerulonephritis
Hepatic insufficiency
Leukemia
Other malignancies
8. SERUM GLOBULIN
Normal
1.5 to 3 gram/100 ml
Increased
Hepatic disease
Decreased
Starvation with
Multiple myeloma
malnutrition
Bacterial and viral infection
Lymphatic leukemia
Typhus and malaria
Agammaglobulinemia

Investigations
589
9. NITROGEN COMPOUND
Normal
Net protein nitrogen
15 to 35 mg/100 ml
Blood urea nitrogen
10 to 40 mg/100 ml
Serum creatinine
0.7 to 1.5 mg/100 ml
Increased
Nephritis
Decreased
Hepatic failure
Acute renal failure
Nephrosis
Urinary tract obstruction
Low protein diet
Dehydration
Shock, congestive cardiac failure
Adrenal insufficiency.
10. BLOOD UREA
Normal
10-15 mg/100 ml
Increased
Impaired and renal function
Decreased
Liver failure
Shock/dehydration
Malnutrition
Diabetes
Impaired absorption
Acute myocardial infection
In celliac disease
Gout
Nephrotic syndrome
Excessive protein intake
Overhydration
11. BLOOD URIC ACID
Normal
2.2 to 8 mg%
Increased
Gout
Decreased
Aspirin
Metastatic cancer
Sulfinpyrazone
Starvation/shock
Alcoholism
Multiple myeloma
Diabetic ketosis
Leukemia
12. SERUM ALKALINE PHOSPHATASE
Normal
5 to 13 KA or 2 to 5 Bodansky units per 100 ml.
Increased
Severe osteomalacia
Decreased
Hypothyroidism
Osteogenic sarcoma
Growth retardation
Metastasis to bones
Paget’s disease
Myeloid leukemia
Hyperthyroidism
Pregnancy
13. SERUM AMYLASE
Normal
0.5 to 2 Bodansky units
Increased
Acute pancreatitis
Decreased
Necrotising hepatitis
Carcinoma of pancreas
Severe burns
Perforated peptic ulcer
Toxemia of pregnancy
Acute cholecystitis
Cirrhosis liver
Mumps
Renal failure

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Principles and Practice of Burn Care
14. SERUM IRON
Normal
75 mcg/100 ml.
Increased
Hemochromatosis
Decreased
Iron deficiency anemia
Aplastic anemia
Nephrosis
Hemosiderosis
Chronic renal insufficiency
Hemolytic anemias
Paroxysmal nocturnal hematuria
Pernicious anemia
15. SERUM FIBRINOGEN
Normal
0.2 to 0.4 gm/100 ml
Increased
Rheumatic fever
Decreased
Eclampsia of pregnancy
Arthritis
Severe anemia
Glomerulonephritis
Typhoid
Fibrinolysis
Metastases from carcinoma
of prostate
Hepatic insufficiency
16. ESTROGENS
Premenopausal women:
4-60 ng/dl
Postmenopausal
women:
3-14 ng/dl
Increased
Feminizing tumors
Decreased
Turner’s syndrome
Masculanizing tumor
Menopausal
True precocious puberty
Hypothalamic disorder
Liver cirrhosis
Anovulatory bleeding
Corpus luteum cyst
Inadequate luteal phase
17. FASTING BLOOD SUGAR
Normal
60 to 100 mg percent
Increased
Diabetes
Decreased
Over dose of insulin
Cushing’s disease
Addison’s disease
Acute stress
Bacterial sepsis
Pheochromocytoma
Islet cell carcinoma
Hyperthyroidism
Hepatic necrosis
Pancreatitis
Hypothyroidism
Chronic liver disease
Psychogenic causes
Chronic malnutrition
18. SGPT
Normal
5-35 Sigma frankel/ml, 4-24 IU/liter
Increased
Hepatocellular disease
Active cirrhosis
Metastatic liver tumor
Obstructive liver tumor
Obstructive jaundice
Liver congestion
Pancreatitis
Hepatic injury in myocardial infarction

Investigations
591
19. SGOT
Normal
5-40 Sigma Frankel u/ml, 0-36 IU/liter
Increased
Myocardial infarction
Decreased
Beri beri
Liver diseases
Uncontrolled diabetes
Acute pancreatitis
Acute hemolytic anemia
Acute renal disease
Severe burns
Recent brain trauma
20. LACTIC ACID DEHYDROGENASE (LDH)
Normal
63-155 units
Increased
Acute myocardial infarction
Decreased
Good response to cancer
Acute leukemia
Hepatic disease
Extensive cancer
Shock and anoxia
21. HDL CHOLESTEROL
Normal
44 mg/dl in men and 55 mg/dl in women
Increased
Chronic liver disorder
Decreased
Smokers
Increased physical activity
High risk patients of MI
Moderate intake of alcohol
22. THYROXINE TOTAL T4
Normal
5-12.5 ug/dl
Increased
Hyperthyroidism
Decreased
Cretinism
Acute thyroiditis
Myxedema
Subacute thyroiditis
Simmonds’ disease
Hepatitis
Hypothyroidism
Nephrosis
23. TRIIODOTHYRONINE (T3)
Normal
110-230 ng/100 ml.
Increased
Hyperthyroidism
Decreased
Hypothyroidism
T3 thyrotoxicosis
Starvation
Acute thyroiditis
Acute illness
Idiopathic TBG elevation
Idiopathic TBG decrease
24. CAROTENE (VIT. A RETINOL)
Normal
50-300 ug/100 ml
Increased
Myxedema
Decreased
Fat malabsorption syndrome
Diabetes mellitus
Streatorrhea
Hypothyroidism
Febrile illness
Chronic nephritis
Liver disease
Hyperlipidemia
Poor dietary intake

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Principles and Practice of Burn Care
25. LIPASE
Normal
4-24 IU/dL
Increased
Pancreatitis
Pancreatic carcinoma
Acute cholecystitis
Cirrhosis
Severe renal disease
Obstruction of pancreatic duct.
26. CALCIUM
Normal Calcium values
1 week to 2 years — 9.0-11.0 mg/dl
2 to 18 years — 8.8-10.2 mg/dl
Adult — 8.6-mg/dl
Hypercalcemia
Hypocalcium
Increased
Decreased
Excessive IV fluids will decrease
Metastatic bone cancer from lung,
albumin and thus calcium because
kidney, breast, liver and pancreas
50% calcium is bound to proteins.
Multiple myeloma
Malabsorption due to sprue,
Sarcoidosis
pancreatic dysfunction
Hyperthyroidism
Osteomalacia
Prolonged rest in bed as in
Renal failure
burns/fracture
Vitamin D deficiency
Excassive intake of vitamin-D
Calcium levels above 13 mg/dl may cause
Calcium below 6 mg/dl may cause
(i) Cardiotoxicity
(i) Tetany
(ii) Arrhythmias
(ii) Convulsions
27. CHLORIDE
Normal chloride values
New born 98–113 mmol/L
Adult 98–106 mmol/L
Chloride maintains
Cellular integrity
Acid-base balance
Water balance
Increased blood chloride level
Decreased blood chloride levels
Dehydration
Burns
Diabetes incipidus
Severe vomiting
Hyperparathyroidism
Diabetes
Hyperventilation
Overhydration
Metabolic disorder
Diuretic therapy
Excessive saline infusions
28. MAGNESIUM
Child — 1.4-1.7 mEq/L
Adult — 1.3-2.1 mEq/L
Increased blood magnesium levels
Decreased blood magnesium levels
Dehydration
Severe burns
Renal failure
Excessive loss of body fluids
Hyperthyroidism

Investigations
593
Severe diabetic acidosis
Colitis
Use of antacids containing magnesium
Prolonged gastric drainage
• Magnesium deficiency may cause muscle tremors, hyperactive deep reflexes lethargy, insomnia and hypocalcemia
• Too much magnesium will cause lethargy, slurred speech, weak/absent deep tendon reflexes, hypotension drowsiness
and respiratory depression.
29. POTASSIUM
Normal values 1-18 years—3.4-4.7 mEq/L
Adult—3.5-5.3 mEq/L
Potassium is needed in nerve conduction muscle
function and acid-base balance. It controls rate and
force of contraction of heart with calcium.
Increased potassium levels
Decreased potassium levels
Cell damage in burns
Starvation
Acidosis
Severe burns
Uncontrolled diabetes
Respiratory alkalosis
Renal failure
Renal tubular acidosis
Accident/Surgery
Draining wounds
30. SODIUM
Normal values 135-145 mEq/L
Adult
It maintains acid-base balance and transmit nerve impulses
Increased sodium level
Decreased level of sodium
Dehydration
Severe burns
Diabetes insipidus
Excessive fluid loss
Coma
Excessive IV glucose
Anabolic steroids
Severe nephritis
High triglycerides
Diabetic acidosis
Large amount of water orally
31. LEUKOCYTOSIS
An increase of WBC above 10,000/cu mm
Increased
Any infection
Decreased
Viral infection
Hemorrhage
Hypersplenism
Trauma/tissue injury
Bone marrow depression due
Serum sickness
to drugs
Malignancy
Leukemia
Tissue necrosis
32. EOSINOPHILIA
Normal absolute value 50-250/cu.mm
Eosinophilia—increase more than 5% or more than 500.
Increased eosinophil
Decreased eosinophils
Allergies
Infectious mononucleosis
Parasitic diseases
Hypersplenism
Lung and bone cancer
Congestive cardiac failure
Chronic skin infections
Cushing’s syndrome
Hodgkin’s disease
Aplastic anemia
Use of ACTH

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Principles and Practice of Burn Care
33. LYMPHOCYTES
Normal
20-40% of total leukocyte count.
Increased
Upper respiratory infections
Decreased
Hodgkin’s disease
Viral diseases mumps etc
LE
Bacterial infections, i.e. TB etc.
After ACTH
Hypothyroidism
After burns and trauma
Lymphocytic leukemia
Chronic uremia
34. BLEEDING TIME
Normal
3-10 minutes
Increased
Thrombocytopenia
Platelet dysfunction syndrome
Severe liver disease
Leukemia
Aplastic anemia
35. PROTHROMBIN TIME
Normal
11-16 seconds
Increased
Prothrombin deficiency
Vit K deficiency
Hemorrhagic diseases
Liver disease
Biliary obstruction
Hypervitaminosis A
36. PLATELET COUNT
Normal
150000-350000 per cmm.
Increased
Cancer
Decreased
Thrombocytopenic purpura
Chronic leukemia
Pernicious anemia
Polycythemia vera
After massive blood transfusion
Splenectomy
Allergic condition
Heart disease
Pneumonia
Rheumatoid arthritis
Infection
37. MCV
Normal
83-103 cu m/red cell
Increased
Liver disease
Decreased
Iron deficiency anemia
Alcoholism
Pernicious anemia
Sprue
Thalassemia
Deficiency of folate or B12
Chlorosis
38. MCHC
Normal
32-36%
Increased
spherocytosis
Decreased
Iron deficiency
Macrocytic anemia
Pyridoxine responsive anemia
Thalassemia

Investigations
595
URINE ANALYSIS
Specific Gravity
Normal
—1.010 to 1.025
Concentrated urine
—1.025 +
Diluted urine
—1.001 to 1.010
Specific gravity increases if excretion of urine
decreases
Low Specific Gravity

Diabetes insipidus

Glomerulonephritis and pyelonephritis

Severe renal damage
Increased Specific Gravity

Diabetes mellitus or nephrosis

Excessive water loss, i.e. sweating, fever,
vomiting or diarrhea
Interfering Factors

Specific gravity is highest in the first morning
specimen

Drug causing false positive elevation are
dextran and radio-opaque contrast media
Color of Urine

Colorless urine
•
Large fluid intake
•
Untreated diabetes mellitus
•
Diuretic therapy
•
Reduction in perspiration
•
Alcohol ingestion
•
Nervousness

Orange colored urine
•
Concentrated urine
•
Excessive sweating
•
Restricted fluid intake
•
Fever

Red or reddish dark brown
•
Hemoglobinuria
•
Myoglobin
•
Porphyrias

Brown black
•
Lysol poisoning
Yellow foam due to biliverdin bile pigment, green foam,
also is due to biliverdin bile pigment.
Interfering Factors

Darkens on standing

Beet will turn urine maroon red, rhubarb to
red

Orange may be due to pyridium, amidopyrin

Orange yellow due to salicylasulfapyridine

Rust yellow due to sulfonamides, nitrofura-
ntoin

Dark colored due to iron salts
Odor

Sweet smell of acetone can be recognized in
diabetic ketosis

Heavy infected urine has unpleasant odor

Long standing gives ammonia flavor
Turbidity

Fresh urine is clear

Urine becomes turbid due to urinary tract
infection

Urine may be cloudy due to the RBCs WBCs
or bacteria
Interfering Factors

After consumption of food, urate or phos-
phates may produce cloudiness

Vaginal contamination from female patients is
a common cause of turbidity

Greasy cloudiness may be caused by large
amounts of fat

After refrigeration it will develop hazziness
Hemoglobinuria is found in:

Extensive burns and crushing injuries

Transfusion reactions to incompatible blood

Febrile intoxication

Malaria

Hemolytic anemias
Drugs Which may Cause Positive Result

Bacitracin

Coumarin
Aspirin
Interfering Factors

High doses of vitamin C may give false
negative result.

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Principles and Practice of Burn Care

Drugs causing false positive results are
bromide, copper, iodides and oxidizing agents
Protein Normal Values 2-8 mg/dl
Proteinuria due to Kidney Diseases

TB and cancer of kidney
Nephritis

Polycystic kidney
Ascites

Nephrosis
Proteinuria due to Non-renal Causes

Fever
Toxemia

Coumarin
Trauma

Severe anemias
Aspirin
Interfering Factors

Transitory proteinuria may be caused by:
•
Violent exercise
•
Cold bath
•
Severe emotional stress

Increased protein in urine occurs:
•
After eating large amount of protein
•
In newborn infants
•
In pregnancy or following delivery
•
In premenstrual state
Sugar Normal Values 100 mg/24 Hours

Increased glucose in urine found in diabetes
mellitus, brain injury, myocardial infarction
Interfering Factors

Pregnancy and lactation may cause false
positive

Ascorbic acid, creatinine, streptomycin may
cause false positive

Stress, excitement, testing after heavy meal
may give positive result
Ketone Bodies Normal Values—Negative

Ketosis and ketonuria may occur whenever
increased amounts of fats are metabolised,
carbohydrate intake is restricted or diet is
rich in fat

Ketone bodies in urine appears first than
blood
Ketonuria is Associated

Fever

Gastrointestinal

Prolonged vomiting
disturbances

Fasting, starvation

Anorexia
Drugs that may Cause False Positive

Levodopa

Insulin

Pyridium

Ether

Paraldehyde
Red Cell Cast

These may be the only manifestations of:
•
Acute glomerulonephritis
•
Collagen disease
•
Renal infarction
•
Endocarditis

Increased red cells occur in:
•
Pyelonephritis
•
Renal stones
•
Trauma to the kidney
•
Hemophilia
•
Lupus vulgaris
•
Cystitis
•
TB and malignancy

Red cells in excess of WBCs indicate bleeding
into the urinary tract and in:
•
Trauma
•
Aspirin
•
Anticoagulant therapy
•
Tumor
•
Thrombocytopenia
Interfering Factors

Increased number of RBCs can be found
following exercise, traumatic catheterization,
passage of stone or contamination by men-
strual fluid
White Blood Cells

Large number of white cells indicate bacterial
infection urinary in tract

If infection is in kidney there may be associ-
ated cellular or granular casts, bacteria
epithelial cells and few RBCs
White Blood Cells and Casts

Pyelonephritis

Acute glomerulonephritis

Interstitial inflammation of kidney

Investigations
597
Epithelial Cells and Casts

Renal epithelial cell casts are formed by cast
of tubular cells, hence occasional renal epi-
thelial cells are found. More are found in:

Amyloidosis

Poisoning from heavy metals
Hyaline Casts
Occasional hyaline casts per low power are found. These
are clear, colorless casts formed when protein within the
tubules precipitates and gels. Hyaline casts may be a
temporary phenomenon due to:

When large number of hyaline casts appear in
urine along with heavy proteinuria, fine granular
casts or fat droplet, nephrotic syndrome may be
suggested.
Granular Casts
Occasional granular casts are found. But excessive may be
found in:

Acute tubular necrosis

Pyelonephritis

Chronic lead poisoning

Advanced glomerulonephritis

Malignant nephrosclerosis

Chronic lead poisoning
Waxy Casts
Waxy costs found in:

Chronic renal disease

Tubular inflammation and degeneration
STOOL
Diarrhea mixed with mucus and blood is associated with:

Typhus

Amebiasis

Typhoid

Large bowel cancer

Cholera
Diarrhea with mucus and pus mixed is due to:

Ulcerative colitis

Shigellosis

Regional enteritis

Salmonellosis

In obstruction of common bile duct the fat gives
a putty like appearance

In sprue and celiac disease the stool resembles
aluminium

In cystic fibrosis the increase of neutral fat gives
a greasy butter stool appearance
Alteration in shape and size

Narrow ribbon like stool suggests spastic bowel,
rectal narrowing, decreased elasticity or partial
obstruction

Excessive hard stool due to increased absorp-
tion of fluids, constipation

Very large caliber stool indicate dilatation of
viscus

Small, round, hard stool accompany habitual,
moderate constipation
Color of feces

Yellow to yellow green diarrhea during
breastfeed

Green color occurs in chlorophyll rich vegetables

Black color may be due to iron charcoal and
bismuth

Light colored stool with little odor may be due
to diets high in milk and low in meat

Clay like color may be due to excessive fat

Red color may be due to beets
Certain Color Changes due to Drugs
Black iron salts, Charcoal
Green Mercurous chloride, Calomel
Green to blue Diathiazanine
Yellow Santonin
Yellow to brown Senna
Orange red Phenazopyridine
Occult Blood in Stool

Meat in diet can give false positive test

Vitamin C more than 500 mg may give false
negative test

Drugs which may cause false positive test
•
Boric acid
•
Iodine
•
Bromides
•
Iron
•
Colchicine
•
Oxidizing agent

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Principles and Practice of Burn Care
DRUGS
Drugs Affecting Color of Stool
Black
Iron salts, bismuth, charcoal
Green
Indomethacin
Greenish blue
Diathiazanine
Red
Tetracycline syrups
Yellow
Santonin
Yellow-brown
Senna
Whitish
Antacids
Orange red
Phenazopyridine
Pink to black
Anticoagulant
Drugs Changing Color of Urine
Chloroquine
Brown
Furazolidine
Brown
Indomethacin
Green
Methyldopa
Red darkens on standing
Metronidazole
Dark brown
Phenacetin
Dark brown
Primaquine
Rust yellow
Mepacrine
Deep yellow
Rhubarb
Yellow brown
Riboflavin
Yellow
Rifampicin
Red orange
Salicylates
Pink red
Sulphonamides
Rust yellow
Drugs Causing Hyperglycemia
Corticosteroid
Indomethacin
Isoniazid
Drugs causing False Positive Test by
Reducing with Benedict’s Solution
Acetylsalicylic acid

PAS
Chloral hydrate

Nitrofurantoin
Streptomycin

Sulphonamides
Drugs causing Urine Urobilinogen
Aminosalicylic acid

Antipyrine
Cascara

Chlorpromazine
Phenothiazines

Sulfonamides
Drugs that may cause Positive Test for Urine
Porphyrins
Acriflavin

Phenazopyridine
Sulfamethoxazole

Tetracycline
Drugs which may Precipitate Porphyria
Antipyretics
Barbiturates
Sulfonamides
Drugs which cause Increased Urine Calcium
Anabolics/androgens
Corticosteroids
Vitamin D
Parathyroid injection
Drugs Affecting Rate of ESR
Increased ESR
•
Dextran
•
Methyldopa
•
Vitamin A
•
Theophylline
Decreased ESR
•
Acetylsalicylic acid •
Dextran
•
Alcohol
•
Streptokinase
Drugs causing Increased Values of Alkaline
Phosphatase
Albumin

Anabolics
Colchicine

Ergosterol
Isoniazid

PAS
Rifampicin

Tolbutamide
Sulfonamides

methyl testosterone
Drugs Increasing Values of Amylase
ACTH

Chlorides
Corticosteroids

Diuretics
Histamine

Methylcholine
Tetracycline

Sulfamethazole
Drugs Increasing Serum Bilirubin
Acetazolamide

PAS
Anabolics

Barbiturates
Chloroquine

Dextran
Diazepam

Erythromycin
Papaverine

Phenacetamine
Vitamin A

Rifampicin
Drugs Increasing Blood Urea Level
Alkaline antacid

Bacitracin
Vitamin C

Arsenicals

Investigations
599
Chloral hydrate

Dextran
Gentamicin

Salicylates
Sulfonamides
Drugs causing Increased
Values of Cholesterol
ACTH

Androgens
Aspirin

Chlorpromazine
Iodides

Phenothiazines
Progestin

Salicylates
Vitamin A and D
Drugs Increasing Values of T4
Diethylstilbestrol

Estrogen
Oral contraceptives

Progestine
Sulfamethoxazole
Drugs Increasing Values of T3
Anabolic agents

Androgens
Anticoagulants

Estrogens
Phenylbutazone

Salicylates
Drugs Increasing Values of Uric Acid
Ampicillin

Aspirin
Buscalfan

Coffee
Dextran

Diuretics
Ethambutol

Methyldopa
Nicotinic acid

Penicillin
Phenothiazines

Rifampicin
Diuretics
Drugs Increasing Values of 17 Ketosteroids
Androgenic steroid

Ascorbic acid
Chlorpromazine

Digotoxin
Erythyromycin

Quinine
Testosterone

Morphine
Nalidixic acid
Drugs causing Pregnancy Test Positive
Aspirin

Chlorpromazine
Phenothiazines

Gravindex
Fluphenazine
Drugs causing Positive Result for
Occult Blood in Stool
Boric acid

Bromide
Cholchicine

Iodides
Iron

Pyridium
Drugs Increasing Bleeding Time
Acetyl salicylic acid

Dextran
Streptokinase

Alcohol derivatives
Drugs Resulting in Decrease of
Leukocyte Count
Chloramphenicol

Chloroquine
Diazepam

Gold compound
Methyldopa

Nitrofurantoin
Penicillin

Rifampicin
Sulfonamide

Chloxacillin
Amidopyrine
Drugs Increasing Prothrombin Time
ACTH

Alcohol
Amidopyrine

Chloramphenicol
Heparin

Indomethacin
Morphine

Quinidine
Salicylates

Streptomycin
Drugs causing Decreased Values of Platelets
Busalphan

Cyclophosphamide
Arsenicals

Chloroquine
Heparin

Gentamicin
Quinine

Rifampicin
Tolbutamide

Index
A
Abdomen 283
Accelerated acute rejection 76
Accidental burns 520
Acetic acid 301
Acid-base balance 140
metabolic acidosis 140
metabolic alkalosis 141
respiratory acidosis 141
Acidosis 146
Activities of burn unit 543
Acute care area 538
Acute hand burns 362
Acute hospital management 136
Acute radiation syndrome 315
Acute rejection 76
Acute renal failure 142
causes 143
intrinsic renal failure 144
prerenal failure 143
diagnostic approach 144
biomarkers 144
serum creatinine 144
serum cystatin C 144
urinary indices 144
urine volume 144
dialysis modalities 147
types 147
etiological factors 142
management 146
mode of renal replacement therapy 147
anticoagulation 147
vascular access 147
prevention 144
non-pharmacological strategies
144
other therapeutic measures and
novel therapies 145
pharmacological strategies 145
prognosis 148
quantifying and classifying 143
supportive treatment 146
acidosis 146
fluid balance 146
hyperkalemia 146
nutritional support 147
pulmonary edema 146
wound evaluation 153
Acute stage 346
Adjuvant therapy to modulate energy
requirement
and
promote
wound healing 445
hormonal therapy 446
immunotherapy 446
role of albumin in burns 446
severely burned ICU patients
447
role of early physiotherapy 449
role of environmental and clinical
factors 448
role of immunonutrition/immuno-
modulators in burns and critically
ill patients 448
Adjuvant therapy to modulate energy
requirement
and
promote
wound healing 445
Admission criteria 104
Aftercare of burned hands 371
Age and sex distribution 10
Aims of local burn wound care 156
Air Zimmer dermatome 184
Airway patency 108
Alcohol burns 307
Alkali (strong) 301
Allograft skin bank program 543
Amniotic membrane 223
Amputations 378, 507
Anabolic phase 435
Anatomical and physiological basis for
excision 197
Anatomical considerations 362
Anatomy of dermis 21
Anatomy of epidermal appendages 20
hair follicle 20
sebaceous glands 20
sweat glands 21
Anatomy of epidermis 18
Anemia in burn patient 40
Anesthesia and analgesia for burn
dressing 220
Anesthesia during excision 200
Anesthesia for thermally injured 208
anesthetic management 210
hypermetabolic stabilization phase
211
induction of anesthesia 214
maintenance of anesthesia 215
monitoring 216
reconstructive phase 217
resuscitation phase 210
local and regional anesthesia 220
pathophysiology 208
cardiovascular changes 208

602
Principles and Practice of Burn Care
immunologic changes 210
metabolic changes 210
respiratory system changes 209
Anesthetic management 210
Angiogenesis 58
Antemortem and postmortem burns 518
Antibacterial therapy 89
Antibiotics for deep infections 91
Anticoagulation 147
Apligraft 227
Application of graft 188
Arterial pressure 115
Assessment of burn injury 393
Assessment of nutritional support 444
Associated local conditions in patients
with contractures 474
Assorted acids 301
Autologous keratinocyte culture 236
Automation in culture and sensitivity 88
B
Bacitracin 171
Bacteremia 243
Balancing oxygen supply and demand
426
Baseline body weight 115
Basic principle underlying burn prevention
strategies 14
Basics of radiation 313
Basis for topical therapy 167
Behavior of transplanted tissue 74
Biobrane 226
Biological analysis of wounds 83
antibacterial therapy 89
antibiotics for deep infections 91
systemic antibiotic use and its
guidelines 90
topical therapy 89
automation in culture and sensitivity
88
gas liquid chromatography 89
polymerase chain reaction 88
culture and sensitivity of wound
specimens 85
other microbiological methods 87
processing of wound specimens 84
sample transport 84
wound-sampling methods 83
wound fluid sampling 83
wound tissue sampling methods 83
Biological dosimetry 316
Biological dressings 163
Biomarkers 144
Biopsy 236
Blast injury 27
Blood gases 115
Blood loss during excision 204
Blood loss from donor areas 190
Blood supply of skin 22
Bodenheim knife 184
Body temperature 115
Bone and joint deformities 508
Boutonniere deformity 461
Braithwaite knife 184
Breast 499
Breathing 110
Buprenorphine 123
Burns associated with building fires 8
Burn deaths 8
Burn disaster response team 553
Burn disasters 547
Burn disfigurement and physical impair-
ment calculations 527
impairment and disability 527
Indian legal enforcements 531
legal rights of burn survivors to
compensation 531
plight of burn survivor 529
prevention of disability 532
Rehabilitation Council of India Act,
1992 532
Burns of all levels of severity occurring
in a community 8
Burn index 518
Burn injuries in married female 526
Burn injury management in disasters 546
burn disasters 547
fire disasters 547
Burn prevention program 543
Burn problem 9
Burn rates 9
Burn registry 8
Burn surface area assessment 104
Burn unit admission criteria 107
Burn unit antibiogram 256
Burn unit referral 106
Burn wound 196
advantages 205
complications 205
problems 205
anatomical and physiological basis for
excision 197
criteria for early excision 198
indications 198
blood loss during excision 204
en block excision 205
advantages 205
problems 205
general principles 198
investigations 199
tangential excision 200
anesthesia during excision 200
technique of tangential excision
201
types of burn wound excision 197
primary excision 197
secondary excision 197
types of primary excision 197
escharectomy and delayed skin
grafting 197
sequential excision 197
subfascial excision 197
suprafascial full thickness excision
197
tangential excision 197
Burn wound impetigo 258
Burn wound infection 241
burn unit antibiogram 256
surgical treatment 256
clinical features 245
local signs 245
etiopathogenesis 241
fungal infection in burns 248
management 248
primary 250
secondary 251
tertiary 252
microorganisms and their sources in
burn wound contamination 242
types of organisms 243
terminology 243
bacteremia 243
colonization 243
non-invasive wound infection 243
septicemia 243
viral infection in burns 248
Burn wound infections 95
Burns disasters in India 548
epidemiology 548
Burns during pregnancy 405
etiology 405

Index
603
management 406
medical treatment 406
surgical treatment 408
pathophysiology 405
Burns of perineum and external genitalia
383
etiology 383
management 385
pathogenesis 383
prevention of contractures 386
prevention of infection 385
urinary diversion 385
wound management 385
Burns of special sites 283
abdomen 283
scalp 283
management 283
upper extremity and lower extremity
284
Butorphenol 124
C
Calcaneal deformity 465
Calculating nutrient requirement 439
Carbohydrates 438
Carbon monoxide poisoning 132
Cardiac output, mixed venous oxygen
tension 115
Cardiovascular and pulmonary compli-
cations 281
Cardiovascular changes 208
Cardiovascular system 427
Casualty 537
Causes of death in burns 519
Cellular response and inflammation 55
Cement 301
Central venous pressure 115
Chemical burn 28, 102, 299
Chemical classes 292
Chemical mediators of inflammation 55
Chemotherapeutic agents 52
Chest radiograph 116
Chromic acid 302
Chronic rejection 76
Chronic unhealed areas 508
Cigarette 16
Circumstances of injury 11
Classification according to burn depth
estimating burn depth 31
Classification according to severity of
burns 35
critical burn 35
grading of burns 35
minor burns 35
moderate burns 35
Classification of burn according to
etiology 25
chemical burn 28
electrical burn 28
friction burns 30
laser burns 30
radiation burn 30
thermal burns 25
blast injury 27
flame burns 25
scald burns 26
thermal contact burn 27
Classification of burns 516
Dupuytren’s classification 516
Clinical classification 517
Clinical features 128, 245, 336
Coal tar burns 307
Collagen 224
Colonization 243
Common element in successful burn
prevention programs 14
Communications 560
Complications of parenteral nutrition 443
Complications of skin grafting 193
Composite epidermal and dermal
replacement 229
Conservative management 175
Conservative treatment 173
Consider possible strategies 14
Constructional considerations 540
Continuity of care program 543
Contractures of axilla 489
Control of inflammatory stimuli 426
Control of wound/scar contraction and
scar contracture 479
Convalescent care area 539
Corium 21
Corrosive burns 518
Creatinine and blood urea nitrogen 116
Criminal negligence 526
Criteria for a good antimicrobial agent 167
Criteria for early excision 198
Critical burn 35
Crowded places (theater) 16
Cryopreservation 232
Culture and sensitivity of wound
specimens 85
Cultured allogenic keratinocytes 229
Cultured keratinocytes 229
Cultured keratinocytes allograft 77
Cutaneous radiation syndrome 318
Cyanide poisoning 133
D
Debridement 156
Deep dermal and full thickness burns 174
Deep fascia 22
Deep freezing or cryopreservation 232
Delayed application of graft 190
Dependency exercise 467
Dermal replacement 227, 228
biological 228
synthetic 227
Dermoepidermal 517
Design of burn unit 538
Design the intervention 15
Development of malignancy 509
Diagnostic approach 144
Dialysis modalities 147
Diclofenac 124
Disaster management in India 550
Disaster plan in action 564
Disasters 546
Distal interphalangeal joint problems 376
District control rooms 560
Document the problem 14
Donor areas 183
Dressing change 190
Dressing room 541
Dressing technique 162
Dupuytren’s classification 516
Duration of exposure 517
Duration of use 467
Dysregulated apoptosis 421
E
Ear burn 121, 352
Early management of major burn 108
primary survey 108
airway patency 108
breathing 110
secondary survey 111
Early rehabilitative care 124
Early surgery for burns of hand 364

604
Principles and Practice of Burn Care
Early versus late enteral nutrition 440
Ebb or shock phase 435
Eccrine glands 21
Ectropion of eyelids 486
Effect of current supply on human body
265
Effects of burns 517
Electric arc 265
Electric current 264
Electric shock or electrocution 269
Electrical burn 16, 28, 103, 220, 263
complication 281
cardiovascular and pulmonary
complications 281
neurological complications 281
effect of current supply on human
body 265
epidemiology 263
physics of electricity 264
electric arc 265
electric current 264
resistance 264
type of current 264
unit of current 264
voltage 264
treatment 278
local wound management 278
types of electrical injuries 268
electric shock or electrocution 269
flame injuries 269
flash burns 268
lightning 269
true electrical injury 268
Electrical burns and pregnancy 285
Electrocardiographic monitoring 115
Electrolytes 116
Elemental sodium, potassium and lithium
burns 305
Emergency operations center 560
En block excision 205
Endotoxin 70
Energy 438
Enteral nutrition by tube feeding 441
Environment control 540
Enzymatic debridement 176
Epidemiology of burns 7
burn registry 8
sources of burn data 8
burn deaths 8
burns associated with building
fires 8
burns of all levels of severity
occurring in a community 8
less severe burns 8
serious burns 8
uses of burn data 8
Epidemiology of burns in India 10
age and sex distribution 10
circumstances of injury 11
epidemiology of pediatric burns 11
etiology 10
extent of problem 10
national burns registry 10
sociocultural factors 10
Epidemiology of pediatric burns 11
Epidermal 517
Epidermal allograft culture 239
Epidermal replacement 229
Epithelialization 157
Escharectomy and delayed skin grafting
197
Escharotomy 119
principles 119
Escharotomy/fasciotomy 163
Essential criteria for skin grafting 182
Estimation of burn size 34
Etiological factors 142
Evaluate program 15
Evaluation of burn wound 153
Evaluation of success 9
Excision of burns 367
Experimental design 13
Exposure of open technique 159
Extent and part of body 517
Extent of problem 10
Eye burns 121
Eyebrow burn 359
Eyebrows 493
Eyelid and globe burn 350
F
Face burns 121
Facial burns 345
acute stage 346
management 346
management of burns in different parts
of face 349
ear burn 352
eyebrow burn 359
eyelid and globe burn 350
perioral burns 357
scalp burn 358
post burn facial scarring 349
Factors affecting 51
Failure to secure intravenous lines 114
Fasciotomy 120
Fats 439
Feet burns 122
Fetal vs adult 60
Fifth degree burns 516
Fire disasters 547
Fire work/fire crackers 16
Firework and firecracker injuries 333
clinical features 336
epidemiology 335
management 340
prevention 340
types of firecrackers 334
Firework/firecracker scenario in modern
times 333
First degree burns 516
clinical classification 517
full thickness burns 517
partial thickness burns 517
effects of burns 517
age 517
duration of exposure 517
extent and part of body 517
temperature 517
rule of nine classification 517
Flame burns 25
Flame injuries 269
Flammable fabrics 15
Flap cover to the deep burns of the hand
369
aftercare of burned hands 371
Flash burns 268
Flexion contractures of elbow 490
Flow phase/recovery phase 435
Fluid balance 146
Fluid therapy in burn injury 111
Foot drop or tight tendo Achilles 464
Formation of granulation tissue 157
Formation of the extracellular matrix 58
Formic acid 302
Fourth degree burns 516
Free amino acids versus intact proteins
444
Freeze drying 232
Friction burns 30, 326
epidemiology 326
etiology 327
management 330

Index
605
pathogenesis 326
prevention 331
types 329
Full thickness burn wounds 118
Full thickness burns 517
Functioning of burn unit 543
Functions of skin 23, 42
Fundamentals of burn disaster planning
558
Funding 544
Fungal infection in burns 248
Fungal infections 95
Further burn wound care 173
conservative management 175
enzymatic debridement 176
modes of management 173
conservative treatment 173
deep dermal and full thickness
burns 174
indeterminate depth of burns 174
superficial dermal burns 174
surgical management 173
G
Galveston formula 114
Gas gangrene and tetanus 283
Gas liquid chromatography 89
Gastrointestinal syndrome 315
General guidelines for potentially
effective burn prevention
activities 15
cigarette 16
crowded places (theater) 16
fire work/fire crackers 16
flammable fabrics 15
hot liquids 16
kerosene lamps and stoves 15
liquid petroleum gas leak 16
General physiotherapy of burn patients
467
Gentamicin 171
Grades of cutaneous radiation injury 319
Grading 318
Grading of burns 35
Graft maturation 193
Graft revascularization 192
Graft survival 191
Graft versus host disease 76
Grafting procedure and postgrafting care
238
Gram stain 86
H
Hair bulb 20
Hair follicle 20
Hand burns 122, 362
acute hand burns 362
anatomical considerations 362
assessment 363
initial management 364
early surgery for burns of hand 364
excision of burns 367
tangential excision 364
timing of surgery 368
Harvesting 232
Hematological 427
Hematoma 193
Hematopoietic syndrome 315
Hemoglobin and hematocrit 115
Hepatic conditions 445
Heterograft 226
High dependency area 539
Histopathology of burn wounds 43
History of burns in the ancient ages 3
Indian history 4
world history 3
History of burns in middle ages 4
Indian history 5
world history 4
History of burns in modern age 5
Indian history 6
world history 5
History of topical antimicrobial agents 166
Homograft 224
Homograft skin banking 232
cryopreservation 232
harvesting 232
rewarming 233
Hormonal therapy 446
Hot liquids 16
Hot metal burns 308
Hydrocarbons 302
Hydrofluoric acid burns 303
Hydrotherapy 165
Hydrotherapy facility 541
Hyperacute rejection 76
Hypercalcemia 140
Hyperkalemia 139, 146
Hypermetabolic stabilization phase 211
Hypernatremia 139
Hypertrophic scars and keloids 62
clinical 64
etiology 64
management 65
other potential therapies 66
prevention 65
radiation therapy 65
recent innovations 65
standard treatments 65
pathophysiology 64
surgical management of hypertrophic
scars and keloids 66
excision 66
laser therapy 66
Hypocalcemia 140
Hypokalemia 139
Hypomagnesemia 140
Hyponatremia 138
Hypophosphatemia 140
Hypovolemia and oliguria 137
I
Ibuprofen 124
Identification of risk factors 425
Immediate versus gradual release 483
Immune profile of extensively burnt
patient 244
Immunobiology of skin 73
mechanism of graft rejection 74
recipient in the graft 74
scientific basis of transplantation 73
behavior of transplanted tissue
74
transplantation and genetic barriers 74
immunogenic elements 74
Immunogenic elements 74
Immunologic changes 210
Immunological responses to burn injury
69
immunomodulatory therapies 70
endotoxin 70
interleukins 70
other potential immunomodulatory
therapies 71
tumor necrosis factor alpha 70
immunotherapy 71
nutritional immunomodulation 71
Immunomodulatory therapies 70
Immunotherapy 71, 446
Impaired chest wall compliance 118
Impaired distal perfusion and need for
escharotomy 119
Impairment and disability 527
Implement program 15

606
Principles and Practice of Burn Care
Incision versus excision 483
Indeterminate depth of burns 174
India disaster resource network 551
Indian legal enforcements 531
Indian legal scene 524
Indications for admission to hospital 394
Indications for skin grafting 182
Induction of anesthesia 214
Industrial and chemical burns 290
epidemiology 290
management 296
chemical burns 299
on site emergency care of burn
victims 296
mechanism of action 291
chemical classes 292
pathophysiology 291
specific agents 301
acetic acid 301
alcohol burns 307
alkali (strong) 301
assorted acids 301
cement 301
chromic acid 302
coal tar burns 307
elemental sodium, potassium and
lithium burns 305
formic acid 302
hydrocarbons 302
hydrofluoric acid burns 303
light metals 305
phenol burns 306
phosphorus burns 305
sulfur mustard gas 306
surgical treatment 309
surgical procedure 310
Ineffective immobilization 193
Infection 52, 193
Infection control program 543
Inflammatory phase 54
Information about larger populations 9
Inhalation injury management in patients
without cutaneous burns 130
Initial care of burn wound 159
escharotomy/fasciotomy 163
hydrotherapy 165
management of blisters 159
biological dressings 163
dressing technique 162
exposure of open technique 159
Initial evaluation and resuscitation of
burn patient 101
admission criteria 104
burn surface area assessment 104
major burn injuries 106
moderate, uncomplicated burn
injuries 107
burn unit admission criteria 107
burn unit referral 106
first aid 101
chemical burns 102
electrical burns 103
thermal burns 101
inpatient management 108
outpatient wound care strategies 108
transportation 103
Initial management of burn wound 116
wound care 116
Initial management of burns involving
special areas 121
ear burns 121
eye burns 121
face burns 121
feet burns 122
hand burns 122
perineal burns 122
Initial over resuscitation 114
Initial under resuscitation 114
Initiating treatment 450
Innervation of skin 23
Inpatient management 108
Instruments for grafting 183
Intake-output 115
Interaction schedule 544
Interleukins 70
Interstitial edema 40
Intralesional steroids 482
Intrinsic renal failure 144
J
Joule’s law 264
K
Keratinocyte culture 235
autologous keratinocyte culture 236
biopsy 236
disadvantages 238
grafting procedure and postgrafting
care 238
keratinocyte isolation 236
patient selection 236
technique of culture 236
epidermal allograft culture 239
Keratinocyte isolation 236
Keratinocyte migration 55
Keratinocyte proliferation 57
Kerosene lamps and stoves 15
L
Laboratory measurements of major burn
115
chest radiograph 116
creatinine and blood urea nitrogen 116
electrolytes 116
hemoglobin and hematocrit 115
partial thromboplastin time 116
plasma myoglobin 116
plasma proteins 116
platelets 116
prothrombin time 116
white blood cell 116
Langerhans cells 19, 77
Laser burns 30
Laser therapy 66
Late complications of inhalational injury
132
Legal requirements in managing burn
patients 524
burn injuries in married female 526
criminal negligence 526
Indian legal scene 524
mode of information 525
situations 524
social civic and moral duty 524
Legal rights of burn survivors to
compensation 531
Less severe burns 8
Levels of disaster 555
Light metals 305
Lightning 269
Liquid petroleum gas leak 16
Local and regional anesthesia 220
Local wound management 278
Localized exposure 316
Lund and Browder’s chart 104
Lymphatic drainage of skin 23
M
Mafenide 170
Maintenance of anesthesia 215

Index
607
Major burn injuries 106
Male external genitalia 505
Mallet finger 462
Management at disaster scene 560
Management of
ankle burns 453
blisters 159
burns in different parts of the face 349
burns of lower extremities 462
chest and axilla burns 452
elbow and hand burns 453
grafted axillary burn wounds 457
grafted elbow burn wounds 458
grafted neck burn wounds 456
grafted wrist burn wounds 459
hand burns 459
knee burns 453
lower limb burns 453
neck burns 451
perineal burn contractures/recons-
truction 386
pruritis 482
Massage 481
Mechanical ventilation 131
Mechanism of action 291
Mechanism of graft rejection 74
Medical preparedness and mass casualty
management 555
Medical research council 73
Medicolegal assessment of burn victim
519
accidental burns 520
identification 520
suicidal burns 520
Meek grafting 182
Melanocytes 19
Members of burn team 537
Mentosternal or flexion contractures of
neck 486
Merkel cells 20
Meshing of graft 185
Metabolic acidosis 140
Metabolic alkalosis 141
Metabolic changes 210
Metacarpophalangeal joint contractures
372
Methods for skin storage 231
deep freezing or cryopreservation 232
freeze drying or lyophilization 232
refrigeration 231
Meticulous medical records 125
Meticulous medical records 125
Microbiology in burns 79
Microbiology in burns 79
etiology 80
pathogenesis 80
quantitative microbiology 81
significance of microbial numbers
81
significance of specific micro-
organisms 82
Microorganisms and their sources in burn
wound contamination 242
Microvascular coagulopathy 421
Minor burns 35
Mode of application 170
Mode of information 525
Mode of injury 390
Mode of renal replacement therapy 147
Moderate burns 35
Moderate, uncomplicated burn injuries
107
Modes of feeding/nutritional support 440
Modes of management 173
Modulation of hormonal and endocrine
response 428
Molten plastic burns 308
Morphine 123
Moustaches 498
Multiple organ dysfunction syndrome
243, 417
Multiple organ failure 413
N
NAC reconstruction 503
National burn mass casualty management
system 566
National burns registry 10
National disaster management Act, 2005
566
National disaster management guidelines-
medical preparedness and mass
casualties management 554
levels of disaster 555
medical preparedness and mass
casualty management 555
role of emergency operation center 556
National disaster mitigation resource
centers 554
National disaster response force 553
National institute of disaster management
551
Nature of data needed to study burn
epidemiology 9
burn problem 9
burn rates 9
evaluation of success 9
information about larger populations
9
prevention 9
usefulness of burn data from a single
hospital 9
Neurological complications 281
Newer modes of mechanical ventilation
132
Nonexperimental descriptive study 12
Non-invasive wound infection 243
Non-pharmacological strategies 144
Nutrient requirement and dietary
management 437
complications of parenteral nutrition
443
re-feeding syndrome 443
warnings and precautions for PN
use 443
weaning of parenteral nutrition 443
modes of feeding/nutritional support
440
enteral nutrition by tube feeding
441
oral dietary support 440
parenteral nutrition 442
protein and energy requirements 437
calculating nutrient requirement
439
carbohydrates 438
energy 438
fats 439
proteins 439
vitamins and minerals 440
time to start nutrition 440
early versus late enteral nutrition
440
Nutrition 52, 428
Nutrition in special conditions 445
hepatic conditions 445
pulmonary conditions 445
renal conditions 445
Nutritional assessment chart 445
Nutritional immunomodulation 71
Nutritional support 147

608
Principles and Practice of Burn Care
O
Objectives of treatment 450
Objects producing burns 517
Ohm’s law 264
Omniderm 227
Operation theater 541
Opsite/cling film/via film 227
Oral dietary support 440
Organization of burn unit 537
activities of burn unit 543
allograft skin bank program 543
burn prevention program 543
continuity of care program 543
infection control program 543
performance improvement program
543
research program 543
casualty 537
constructional considerations 540
design of burn unit 538
acute care area 538
convalescent care area 539
high dependency area 539
dressing room 541
environment control 540
functioning of burn unit 543
funding 544
hydrotherapy facility 541
interaction schedule 544
members of burn team 537
monitors 542
operation theater 541
physiotherapy unit 542
utilization and cost containment 542
Other microbiological methods 87
Other potential immunomodulatory
therapies 71
Other potential therapies 66
Other therapeutic measures and novel
therapies 145
Outpatient wound care strategies 108
Overhydration 138
Overhydration 138
Oxygen 52
Oxygenation 115
Oxygenation of tissues 156
P
Padgett-hood dermatome 184
Pain management 123
buprenorphine 123
butorphenol 124
diclofenac 124
ibuprofen 124
morphine 123
paracetamol 124
pentazocine 124
tramadol 124
Papillary dermis 21
Paracetamol 124
Paralytic ileus 40
Parameters to assess nutritional status of
burn patient 436
Parenteral nutrition 442
Partial thickness burn wound 118
Partial thickness burns 517
Partial thromboplastin time 116
Pathophysiology of burn shock 37
Patient selection 236
Pediatric burns 221, 390
complications 403
first aid 392
management 393
assessment of burn injury 393
indications for admission to
hospital 394
initial management 395
mode of injury 390
pathophysiology 392
prevention 403
prognosis 403
Pentazocine 124
Performance improvement program 543
Perineal burns 122, 357
Permanent skin substitutes 227
Pharmacological strategies 145
Phases in wound healing 54
fetal vs adult 60
formation of extracellular matrix 58
inflammatory phase 54
cellular response and inflammation
55
chemical mediators of inflammation
55
proliferative phase 55
angiogenesis 58
keratinocyte migration 55
keratinocyte proliferation 57
reconstitution of dermis 57
reepithelialization 55
restoration of basement membrane
zone 57
remodeling phase 59
Phenol burns 306
Phosphorus burns 305
Physical dosimetry 316
Physics of electricity 264
Physiologic and metabolic responses to
burn injury 434
anabolic phase 435
EBB or shock phase 435
flow phase/recovery phase 435
Physiologic measurements of major burn
115
arterial pressure 115
baseline body weight 115
blood gases 115
body temperature 115
cardiac output, mixed venous oxygen
tension 115
central venous pressure 115
electrocardiographic monitoring 115
intake-output 115
oxygenation 115
pulmonary artery wedge pressure 115
urine output 115
Physiotherapy for burn patients 450
Boutonniere deformity 461
initiating treatment 450
mallet finger 462
calcaneal deformity 465
foot drop or tight tendo-Achilles
464
management of burns of lower
extremities 462
valgus deformity 465
varus deformity 466
objectives of treatment 450
primary goal 450
physiotherapy in acute stage 451
ankle burns 453
chest and axilla burns 452
elbow and hand burns 453
knee burns 453
lower limb burns 453
neck burns 451
physiotherapy in later stages 454
stages of treatment 450
acute 450
follow-up 451
subacute 450
swan neck deformity 461
treatment of wounds/scars/grafts in
physiotherapy 455
grafted axillary burn wounds 457
grafted elbow burn wounds 458

Index
609
grafted neck burn wounds 456
grafted wrist burn wounds 459
hand burns 459
Physiotherapy in acute stage 451, 454
Physiotherapy unit 542
Pigment changes in skin following burns
61
Pinch grafts 182
Pinna 498
Piriform alveoli 20
Pitfalls in initial fluid resuscitation 114
failure to secure intravenous lines 114
initial over resuscitation 114
initial under resuscitation 114
striving for ideal numbers 114
Plasma myoglobin 116
Plasma proteins 116
Platelets 116
Plight of burn survivor 529
Polymerase chain reaction 88
Post burn contractures 473
associated local conditions in patients
with contractures 474
deeper tissues 474
skin 474
contractures of axilla 489
control of wound/scar contraction and
scar contracture 479
intralesional steroids 482
management of pruritis 482
massage 481
pressure garments 479
silicones 481
skin grafting 479
splintage and exercises 480
ectropion of the eyelids 486
mentosternal or flexion contractures
of the neck 486
flexion contractures of the elbow 490
mechanism 473
prevention of wound/scar contraction
and scar contractures 478
priority of release in cases of multiple
contractures 476
surgical intervention 482
immediate versus gradual release
483
incision versus excision 483
provision of skin cover 483
release of contracture 482
timing of surgery in post burn
contractures 474
wrist and knee 490
Post burn facial scarring 349
Post burn hand deformities and their
management 372
amputations 378
distal interphalangeal joint problems
376
metacarpophalangeal
joint
contractures 372
proximal interphalangeal joint problems
375
volar contractures 378
web space problems 376
Post burn losses 491
amputations 507
breast 499
NAC reconstruction 503
reconstruction of areola 504
reconstruction of nipple 504
reconstruction of the burned breast
500
reconstruction of the mound 500
release alone versus excision-
release 501
timing of NAC reconstruction 504
eyebrows 493
male external genitalia 505
moustaches 498
nose 495
pinna 498
scalp 491
Post burn scars 469
Postoperative care of graft 194
Predisposing factors 418
Pre-experimental design 13
Preparation of wound for grafting 178
Prerenal failure 143
Present and future of skin allograft 77
Pressure garments 466, 479
Prevention of burns in India 12
risk factors 12
at home 12
at play 12
at work 12
Prevention of contractures 386
Prevention of disability 532
Prevention of infection 385
Prevention of wound/scar contraction
and scar contractures 478
Primary excision 197
Primary goal 450
Primary healing 53
Primary line of management 250
Primary survey 108
Principles of disaster management 566
Principles of wound management 156
debridement 156
epithelialization 157
formation of granulation tissue 157
oxygenation of tissues 156
wound contraction 158
Priority of release in cases of multiple
contractures 476
Processing of wound specimens 84
Program of rehabilitation for burn patient
124
Proliferative phase 55
Protein and energy requirements 437
Proteins 439
Prothrombin time 116
Provision of skin cover 483
Proximal interphalangeal joint problems
375
Psychological disorders 513
Pulmonary artery wedge pressure 115
Pulmonary edema 146
Q
Quality and maintenance 467
Quantifying and classifying 143
Quantitative microbiology 81
Quasi-experimental design 13
R
Radiation 52
Radiation biology 314
Radiation burn 30, 313
acute radiation syndrome 315
localized exposure 316
whole-body exposure 315
basics of radiation 313
cutaneous radiation syndrome 318
grading 318
investigations 316
biological dosimetry 316
for dose estimation 316
physical dosimetry 316
medical treatment 317
radiation biology 314
radiation injuries 314
radiation units 314
surgical management 324
types of accident 313

610
Principles and Practice of Burn Care
Radiation injuries 314
Radiation protection programs 324
Radiation therapy 65
Radiation units 314
Recent innovations 65
Recipient in the graft 74
Reconstitution of the dermis 57
Reconstruction of
areola 504
burned breast 500
mound 500
nipple 504
Reconstructive phase 217
Re-feeding syndrome 443
Refrigeration 231
Rehabilitation council of India Act, 1992
532
Rehabilitation issues in hand burns 380
Reinnervation of graft 193
Release alone versus excision-release 501
Release of contracture 482
Remodeling phase 59
Renal and hepatic 428
Research designs for burn prevention 12
experimental design 13
purpose 13
tasks 13
nonexperimental descriptive study 12
purpose 12
tasks 12
pre-experimental design 13
cautions 13
purpose 13
tasks 13
quasi-experimental design 13
purpose 13
tasks 13
Research program 543
Resistance 264
Respiratory 427
Respiratory acidosis 141
Respiratory complications of smoke
inhalations 129
Respiratory system changes 209
Respiratory tract injury in burns 127
clinical features 128
diagnosis 128
grade features 129
respiratory complications of smoke
inhalations 129
management 130
carbon monoxide poisoning 132
cyanide poisoning 133
inhalation injury management in
patients without cautaneous
burns 130
late complications of inhalational
injury 132
mechanical ventilation 131
newer modes of mechanical
ventilation 132
weaning and discontinuation of
mechanical ventilation 132
pathogenesis 127
pathophysiology 128
Restoration of the basement membrane
zone 57
Resuscitation phase 210
Reticular dermis 21
Rewarming 233
Role of albumin in burns 446
Role of early physiotherapy 449
Role of environmental and clinical factors
448
Role of immunonutrition/immunomodu-
lators in burns and critically ill
patients 448
Role of the emergency operation center
556
Rule of nine classification 517
S
Sample transport 84
Scald burns 26
Scalp 283, 491
Scalp burn 358
Scientific basis of transplantation 73
Scoring 422
Sebaceous glands 20
Second degree burns 516
Secondary excision 197
Secondary healing 53
Secondary line of management 251
Secondary survey 111
Sepsis 417
balancing oxygen supply and demand
426
control of inflammatory stimuli 426
etiopathology 418
immunotherapy 428
management 425
nutrition 428
pathogenesis 419
dysregulated apoptosis 421
microvascular coagulopathy 421
tissue hypoxia 420
uncontrolled infection 419
uncontrolled
systemic
inflammation 419
predisposing factors 418
prevention 425
identification of risk factors 425
scoring 422
specific organ support 427
cardiovascular system 427
hematological 427
renal and hepatic 428
respiratory 427
specific therapeutic interventions 428
modulation of hormonal and
endocrine response 428
Sepsis syndrome 243
Septicemia 243
Sequence of tasks for burn prevention
programs 14
consider possible strategies 14
design the intervention 15
document the problem 14
evaluate program 15
implement program 15
Sequential excision 197
Sequential system failure 413
Serious burns 8
Serum cystatin C 144
Severely burned ICU patients 447
SGOT 298
SGPT 298
Sheet grafting 182
Sick cell syndrome 138
Significance of microbial numbers 81
Significance of specific microorganisms
82
Silicones 481
Silver nitrate solution 169
Silver sulfadiazine 168
Sixth degree burns 516
Skin allograft rejection and acceptance 75
Skin grafting 479
Skin grafting of burn wound 177
application of graft 188

Index
611
complications of skin grafting 193
hematoma 193
ineffective immobilization 193
infection 193
delayed application of graft 190
donor areas 183
dressing change 190
blood loss from donor areas 190
essential criteria for skin grafting 182
graft survival 191
graft maturation 193
graft revascularization 192
reinnervation of graft 193
indications for skin grafting 182
instruments for grafting 183
meshing of graft 185
advantages 186
disadvantages 188
postoperative care of graft 194
preparation of wound for grafting 178
technique of harvesting split skin
graft 185
types of skin grafts 181
based on size and technique 182
based on the anatomy 181
based on thickness 181
wound swabs 180
Skin substitutes in burns 223
composite epidermal and dermal
replacement 229
epidermal replacement 229
cultured allogenic keratinocytes
229
cultured keratinocytes 229
permanent skin substitutes 227
dermal replacement— biological
228
dermal replacement—synthetic
227
temporary skin substitutes (synthetic)
226
apligraf 227
biobrane 226
omniderm 227
opsite/cling film/via film 227
transcyte 227
temporary skin substitutes biological
223
amniotic membrane 223
collagen 224
heterograft 226
homograft 224
Social civic and moral duty 524
Sources of burn data 8
Specific agents 301
Specific organ support 427
Specific therapeutic interventions 428
Splint selection 466
Splintage and exercises 480
Stages of treatment 450
Stamp grafts 182
Standard coding of burn injury data 8
Standard treatments 65
Steroids 52
Stratum basale 19
Stratum corneum 18
Stratum granulosum 18
Stratum lucidum 18
Stratum spinosum 18
Striving for ideal numbers 114
Subfascial excision 197
Suicidal burns 520
Sulfur mustard gas 306
Superficial dermal burns 174
Supportive treatment 146
Suppurative thrombophlebitis 258
tetanus in burns 258
tetanus prophylaxis 258
treatment of tetanus in burns 259
Suprafascial full thickness excision 197
Surge capacity of health care units 557
Surgical management of hypertrophic
scars and keloids 66
Swan neck deformity 461
Sweat glands 21
Systemic antibiotic use and its guidelines
90
Systemic inflammatory response syndrome
417, 243, 423
T
Tangential excision 197, 200, 364
Technique of culture 236
Technique of harvesting split skin graft
185
Technique of tangential excision 201
Temperature 517
Temporary skin substitutes 226
synthetic 226
biological 223
Tertiary line of management 252
Tetanus in burns 258
Tetanus prophylaxis 258
Thermal burns 25, 101
Thermal contact burn 27
Third degree burns 516
Time to start nutrition 440
Timing of NAC reconstruction 504
Timing of surgery in post burn
contractures 474
Tissue hypoxia 420
Topical antimicrobial therapy in treatment
of burn wound 166
bacitracin 171
basis for topical therapy 167
criteria for a good antimicrobial agent
167
gentamicin 171
advantages 171
disadvantages 171
mode of action 171
history of topical antimicrobial agents
166
mafenide 170
advantages 170
disadvantages 170
mode of application 170
silver nitrate solution 169
advantages 169
disadvantages 169
mode of action 169
silver sulfadiazine 168
advantages 168
disadvantages 168
mode of action 168
Topical therapy 89
Tramadol 124
Transcyte 227
Transplantation and genetic barriers 74
Transportation 103
Treatment of tetanus in burns 259
Treatment of wounds/scars/grafts in
physiotherapy 455
Triage 559
Triage criterion and care plan 563
True electrical injury 268
Tumor necrosis factor alpha 70
Type of current 264
Types of accident 313
Types of burn wound excision 197
Types of electrical injuries 268
Types of firecrackers 334
Types of organisms 243
Types of primary excision 197

612
Principles and Practice of Burn Care
Types of rejection 76
accelerated acute rejection 76
acute rejection 76
chronic rejection 76
hyperacute rejection 76
Types of skin grafts 181
based on size and technique 182
based on the anatomy 181
based on thickness 181
Types of splints 466
pressure garments 466
dependency exercise 467
duration of use 467
quality and maintenance 467
splint selection 466
U
Uncontrolled infection 419
Uncontrolled systemic inflammation 419
Unit of current 264
Upper extremity and lower extremity 284
Urinary diversion 385
Urinary indices 144
Urine output 115
Urine volume 144
Usefulness of burn data from a single
hospital 9
Uses of burn data 8
Utilization and cost containment 542
Utilization of medical triage 559
communications 560
district control rooms 560
emergency operations center 560
management at disaster scene 560
triage 559
V
Valgus deformity 465
Varus deformity 466
Vascular access 147
Viral infection in burns 248
Viral infections 95
Vitamins and minerals 440
Vitamins and trace elements 52
Volar contractures 378
Voltage 264
Vulnerability assessment and risk analysis
549
W
Wallace’s rule of ‘nine’ 104, 393
Warnings and precautions for PN use 443
Watson’s modification 184
Watson’s skin grafting knife 184
Weaning
and
discontinuation
of
mechanical ventilation 132
Weaning of parenteral nutrition 443
Web space problems 376
White blood cell 116
White graft rejection 75
Whole-body exposure 315
Wilson’s classification 517
deep 517
dermoepidermal 517
epidermal 517
World history 3, 4, 5
Wound care 116
Wound contraction 158
Wound evaluation 153
Wound fluid sampling 83
Wound healing in burns 51
factors affecting 51
age 51
chemotherapeutic agents 52
infection 52
nutrition 52
oxygen 52
radiation 52
steroids 52
vitamins and trace elements 52
general 52
types 53
primary healing 53
secondary healing 53
Wound management 385
Wound swabs 180
Wound tissue sampling methods 83
Wound-sampling methods 83
Wrist and knee 490