Điều Trị Bỏng Toàn Diện (Bản Expert Consult)

Index
762
Dobutamine, 394
Don not resuscitate (DNR) orders, 687
Dopamine
acute renal failure treatment, 389
cardiovascular system, 394
immunosuppression, 300
Dorsal contraction, toes, 525–526, 671
Dorsal hand burns, 523, 523f
Dorsalis pedis artery, 189
Dorsiflexion contractures, ankle, 672
Dorsum, hand care/reconstruction, 654
Draeger Fabius Tiro M, 74
Draeger Narkomed M, 74
Dressings, 164
alternative see Alternative wound coverings
ambulation, 538
blisters, 85–86
changing, 88
outpatients, 86–88
pain, 721
wound closure, 164
see also specific dressings
DRI (dietary reference index), 335, 335t
Drugs see Pharmacology
Dual X-ray absorptiometry (DEXA), 347
Duodenal feeding, 344
Duodenum, stress ulcers, 395
Dupuytren, Guillaume, 1, 2f
Duration, aerobic exercise, 543
Dynamic splints, hand deformity, 524, 524f
Dysrhythmias, electrical burns, 443
Dysthymia, 737
E
Ear deformity reconstruction, 612, 613f
Early debridement, 131
upper limb electrical burns, 657–658
Early enteral feeding, 344
gut support, 365
Early excision
historical aspects, 1–3
infections, 157
Early mobility, bronchial hygiene therapy,
240, 241f
Early wound closure, hypermetabolic
response management, 357
Earthquakes, 33
Ebb phase, stress response, 289
EBP see Evidence-based practice (EBP)
EBV (estimated blood volume), 193
Eccrine sweat glands, hypertrophic scars,
512–513, 513f–514f
Echocardiography, transesophageal, 380–381
ECM see Extracellular matrix (ECM)
ECMO (extracorporeal membrane
oxygenation), 235
Economics, prevention of burns, 50
Ecthyma gangrenosum, 141–142
Edema, 103–114
abdominal compartment syndrome, 112
cellular membranes, 107
elevation, 89–90
fasciotomy, 167
hypovolemia, 103–104
inhalation injury, 231
lungs, 111–112
lymph flow, 260
mechanisms, 104–106
non-burned tissue, 106–107, 111–112
oropharynx injury, 220, 220f
pediatric patients, 410
SIRS, 260
Education
bronchial hygiene therapy, 242
mass casualty events, 78–79
nursing, 401
prevention of burns, 50
rehabilitation, 548–549
scald prevention, 51
Egypt, ancient, 1
Elastin fibers, skin, 618
Elbow
dislocation, 561
heterotropic bone, 556–557
patient positioning, 522
Elbow contracture, 631–632
incidence, 631, 632t
patient positioning, 633, 633f
skeletal traction, 636, 637f
skin flaps, 584
splinting, 631–632, 632t, 634
surgical management, 635–636
three-point extension splint, 633f, 635
Elderly, 23–24, 47–48
abuse, 32
epidemiology (of burns), 48
intentional injuries see Intentional
injuries
mortality, 157–158
nutritional support, 337t–340t, 345
pain management, 719
scalds, 24
Electrical burns, 29, 130f, 433–440, 442f
abdominal wounds, 437
acute care, 434–436
alternating current, 433–434
amputation, 563
animal experiments, 433
arcing, 441
assessment, 436–437
cardiac monitoring, 443
chest wall, 437
compartment syndrome, 435–436, 436f,
443–444
complications, 438, 447–448
contact points, 433, 434f
creatine kinase, 435–436
current path, 433
direct destruction, 434
electrocardiographic monitoring,
434–435
electroporation, 434
evaluation, 130
flush burns, 441
high-voltage injuries, 441, 442f, 446
incidence, 446
indirect destruction, 434
initial management, 93
low-voltage, 437–438
myoglobinuria, 435
non-thermal burns, 441–442
oral commissure, 611, 612f
outpatients, 84
pain management, 436
pathophysiology, 433–434, 441–442
reconstruction, 441–448
abdomen, 445–446
amputation, 446–447
extremities, 446
mouth, 444–445
myoglobinuria, 442–443
peripheral nerve injury, 447
rhabdomyolysis, 442–443
skull, 444–445
thorax, 445–446
tissue damage assessment, 442, 442t
renal failure, 443
resistance, 433–434, 442t
scalp contact, 437, 444–445
skeletal injury, 448
trauma, 435
upper limb, 654–658
arterial injuries, 656–657
classification, 655–656
decompressive escharotomy, 657
decompressive fasciotomy, 657
early debridement, 657–658
management, 657–658
see also specific methods
type I, 656, 657f
type II, 656, 657f
type III, 656, 657f
type IV, 656, 657f
wound management, 658, 658f–659f
voltage classification, 433
wound care, 436
see also Lightning strikes
Electrocardiography (EKG)
anesthesia monitoring, 188
cyanide poisoning, 227
electrical burns, 434–435
exercise testing, 540
Electrocautery
excision of burns, 159–160
hand escharotomy, 167, 167f
Electrolyte homeostasis, acute renal failure
treatment, 389
Electronic news media, 68
Electroporation, electrical burns, 434
EM (erythema multiforme), 471, 472t
Emergency Departments
assessment, 94
emergency treatment, 94–95
fluid resuscitation, 95–96, 96b
hypothermia prevention, 97
pain control, 97
privacy issues, 98
stomach decompression, 96–97
transfer from, 97–98
transport to, 94–97
urine output requirements, 96
wound evaluation, 95
EMLA cream, 720
Emotional lability, psychosocial recovery,
747
Empirical support, pain management, 730
Employment
functional sequelae, 700
reintegration, 748
EMT (endothelial-to-mesenchymal
transition), 500–501
EMT (epithelial-to-mesenchymal transition),
500–501

Index
763
Endocarditis
multisystem organ failure prevention, 365
Staphylococcus aureus infection, 149
Endocrine system, 492, 492f
Endoscopy
cautery, stress gastritis, 425
sedation, 723–724
Endothelial cells, vascular permeability,
260–261
Endothelial nitric oxide synthases (eNOS),
262
Endothelial-to-mesenchymal transition
(EMT), 500–501
Endothelin, myofibroblast differentiation,
497–498
Endothelium
damage, pulmonary system injury, 391,
391f
permeability, SIRS, 260
Endotoxin, 484–485
multisystem organ failure, 362–363
vascular permeability, 260–261
Endotracheal tubes, 187–188, 187f
End-tidal CO2 tension, mechanical ventilation
monitoring, 385–386
Endurance stage, therapeutic exercise, 542
Enforcement, prevention of burns, 50
Engineering, prevention of burns, 50
eNOS (endothelial nitric oxide synthases),
262
Ensure™, 337t–340t
Enteral feeding
complications, 350–351
early see Early enteral feeding
formulas, 337t–340t, 342, 342t
hypophosphatemia, 316
nursing, 400
parenteral nutrition vs., 343–344
primary treatment, 66
products, 337t–340t
SIRS therapy, 258
tubes, 424t
Enterobacter infections, 151
Enterococcus infections, 150
oral treatment, 150
Environmental service workers, 10
Environmental temperature/humidity,
hypermetabolic response, 334, 357
Enzymatic wound debridement, 131–136,
134f–135f
assessment, 132–135, 133t
bacterial enzymes, 132
bromelain extracts, 133–135
chymotrypsin, 132
collagenase, 132
end of, 132–133
fibrolysin–deoxyribonuclease, 132
historical aspects, 132
plant enzymes, 132
streptokinase, 132
surgical debridement vs., 132–133
trypsin, 132
Epichlorohydrin acid, 457, 457f
Epidemiology (of burns), 19–20
age groups, 15–17, 16t–17t, 39, 48
elderly, 47–48
pediatric patients, 47–48
burn extent, 18, 39–40, 39f
ethnicity, 18
geographic location, 19
high-risk populations, 20–26
see also specific populations
housing age, 48
incidence, 15, 16t, 18t
international burden, 33–35
mobile home fires, 19–20
non-fatal injuries, 15
prevention of burns, 47–48
residential death rate, 20
single parent households, 48
smoking, 47–48
socioeconomics, 19, 48
unintentional injuries, 15, 16t–17t, 17–18
Epidermal cells, permanent skin substitutes,
212
Epidermal inclusion cysts, wound healing, 511
Epidermis
skin, 125
tissue expansion, 617
Epidural abscess, electrical burns, 444
Epinephrine
blood loss control, 160–161, 161f, 194,
279–280
cardiovascular system, 394
racemeric, 242
shock, 108, 109t
Epithelial cells, innate immune response, 267
Epithelial permeability, SIRS, 261–262
Epithelial-to-mesenchymal transition (EMT),
500–501
Epstein–Barr virus infection, 471
Erythema, radiation injuries, 463
Erythema gangrenosa, 140–141, 141f
Erythema multiforme (EM), 471, 472t
Erythroid growth factors, 284
Erythropoiesis, anemia, 279
Erythropoietin (EPO), 284
as growth factor, 283t
Escharotomies
decompressive, 657
Emergency Departments, 94–95, 95f
hand care/reconstruction, 166–167, 167f,
646, 647f
primary treatment, 66
Escherichia coli infection, 151
E-selectin, vascular permeability, 260–261
Esophageal tracheal Combitube, 188
Essential fatty acid deficiency, 336–337,
348t–349t
Estimated blood volume (EBV), 193
Estonia, 36t–37t
Ethical discourse, 684
Ethical problems, 683–688
care-provider, 684
conferences, 685
definition, 683
futility, 686
human research, 686
management, 683–685
organizational ethics, 686
patient decision-making capacity,
684–686
patient role, 684–685
persistent management, 685, 685t
scarce resources, 687
surrogate role, 684–686
Ethnicity
epidemiology (of burns), 18
pediatric patients, 23
Ethylene, ventilator sterilization/disinfection,
247
Etiology of burns see Causes (of burns)
Etomidate, 73
Europe, 36t–37t
Evaluation
extensive exercise in pediatric patients, 403
reconstructive care, 403
rehabilitation, 517
therapeutic exercise, 539–540
work-hardening programs, 402
Evaluation of burns, 125–130
mechanisms of injury, 127–130
prevention of burns, 50
secondary treatment, 66–67
Evans, L E, 5–6
Evaporative heat loss, mass casualty events,
69–70
Evidence-based practice (EBP), 711–712
nursing, 397
Excision of burns, 158–161
blood loss control, 160–161, 160f–161f
early see Early excision
face burn management, 171, 171f
fascial excision, 159–160
heterotropic bone prevention/treatment,
560, 560f
pediatric patients, 412
small burns, 158
tangential excision, 158–159, 159f–160f
wound healing, 511
Exercise see Therapeutic exercise
Exercise physiologists, 11–12
Exfoliative disorders, 471–482
clinical features, 473, 473f
complications, 473–474, 474f
etiology, 471
histopathology, 472–473
infections, 471
management, 474, 476–477
algorithm, 476f
antipyretic agents, 476–477
corticosteroids, 475
cyclosporin A, 475
fluid replacement, 477
immunomodulation therapy, 475–476
intravenous immunoglobulin, 476
mouth erosion, 477
nutritional support, 477
ocular involvement, 477
pain management, 476–477
physiotherapy, 477
stress ulceration, 477
surgical approach, 474, 475f
thalidomide, 476
topical therapy, 475
morphology, 472–473, 472f
see also specific diseases/disorders
Exotoxins, Staphylococcus aureus infection,
149
Extended-spectrum penicillin, 151–152
Extension contractural phalangeal
deformities, 652–653, 653f
Extent of burns see Burn extent
External fixation, septic arthritis, 562

Index
764
Extracellular matrix (ECM), 495–497
collagen, 495
glycoproteins, 495–497
proteoglycans, 495–497
Extracorporeal membrane oxygenation
(ECMO), 235
Extremities, electrical burns, 446
Extubation, mechanical ventilation, 246, 398
Eyebrow reconstruction, 610f, 615
Eyelids, 171–172
acute-phase reconstruction, 605, 605f
reconstruction, 609
skin flaps, 582, 585f
skin grafts, 592–593
Eyes see Ophthalmic disorders
F
Face burn management, 88, 170–171
anesthesia, 175
cosmetic units, 171
excision, 171, 171f
fibrin sealant, 171
see also Head and neck reconstruction
Facial expressions, pediatric pain assessment,
717
Facial opening, prone positioning, 519
Facial reconstruction, microvascular surgery,
592–594
Factor XII (Hageman factor), 258–259
Factor Xa, 258–259
Family
admission crisis, 745–746
distress, 750–751
mass casualty communication, 69
multidisciplinary teams, 10
pre-injury adjustment, 745
Fascial excision, 159–160
Fascial flaps, electrical burns, 446
Fasciitis, necrotizing see Necrotizing fasciitis
Fasciocutaneous (FC) flaps, 577–578
34 z-plasty, 578, 578f
z-plasty, 577–578
Fasciotomies
decompressive, 657
electrical burn compartment syndrome,
435–436
hand burn management, 166–167
primary treatment, 66
Fats, nutritional support, 336–337, 337t–340t
Fatty acids, multisystem organ failure therapy,
366
Fatty liver, 348t–349t, 349
FC flaps see Fasciocutaneous (FC) flaps
Federal Drug Administration (FDA), skin
banks, 207
Feeding tubes, pediatric patients, 411
Feet see Foot
Fellows, multidisciplinary teams, 12
Femoral artery catheters
anesthesia vascular access, 189
arterial blood pressure, 379
pediatric fluid resuscitation, 406
Femoral vein catheters, 190
Fenofibrate, 360t
Fenoldopam, 389
Fentanyl, 720–721, 723
ventilator patients, 725
FFAs (free fatty acids), liver, 303
Fiberglass casting materials, 527
Fiberoptic bronchoscopy, inhalation injury,
177, 230, 231f, 234–235
Fiberoptic intubation, 187
Fibrinogen, liver, 304
Fibrinolytic pathways, 283
Fibrin sealant, 171
Fibroblast(s)
hypertrophic scars, 497, 497t, 501–502,
514–515
origins, 500–501, 502f
wound healing, 501–502, 507–508
Fibroblast growth factor (FGF), 509
Fibrolysin–deoxyribonuclease, 132
Fibronectin, 496–497
Figure-of-eight wrapping, shoulder (axillary)
contracture, 634–635, 634f, 636f
Fire-safe cigarettes, 51–52
Fire safety engineers, 48–49
Fire sprinklers, 53–54
Fire walking, 27–28
Fireworks, 30
First aid
mass casualty events, 69
radiation injuries, 464–465
First-degree burns
pain management, 715
wound healing, 508
First-line hospitals, mass casualty events, 65
First medical treatment, mass casualty events,
65
First transport, mass casualty events, 65
First web space contracture, phalangeal
deformities, 653–654, 655f
Fish oils, 337
Fitzpatrick, C J, 6–7
Fixed-wing aircraft, 100
Flame burns, 127–128
Flammable clothing, 50–51
Flammacerium, 70
Flash burns, 127–128
Flexible fiberoptic bronchoscopy, 233, 234f
Flexural contractural phalangeal deformities,
648–652, 652f
Flow phase, stress response, 289
Flow rates, mechanical ventilation, 245–246
Flt-3 ligand, 283t, 284
Fluid creep, 112, 122–123
Fluid management, anesthesia, 192–193
Fluid overload, nutritional support
complications, 348t–349t
Fluid resuscitation, 103, 115–124, 178–179
acute renal failure treatment, 374, 374t, 389
administration rate, 120–122
choice of, 120–122
crystalloids see Crystalloids
Emergency Departments, 95–96, 96b
endpoint definitions, 122
exfoliative disorders, 477
failure, 123
following shock resuscitation, 123–124
historical aspects, 5–6, 9, 115–123
immunomodulation, 275–276
inhalation injury, 120, 233–234
mass casualty events, 70–71, 71t
monitoring, 121, 180–182, 180t
necrotizing fasciitis, 478–479
need assessment, 179t
Parkland formula, 122, 122f, 181, 181f
pediatric patients, 120, 406–408, 407f,
408t, 409f
primary treatment, 66, 66t
shock, 103
studies, 116–117
volume estimation, 118t, 181, 181t
see also Fluid creep
Fluoxetine, 739
Flush electrical burns, 441
fms-like tyrosine kinase-3 ligand (Flt3L), 275,
276f
FOG-1 (friend of GATA-1), 286
Folate requirements, 324t
Foley catheters, 661
Folliculitis, 138–139, 139f
Follow-up care, outpatients, 90
Foot
patient positioning, 525–526
plantar surface deformities, 675
sole scar deformities, 672–675
Forearm, patient positioning, 522
Formaldehyde, 225t
Formic acid, 457
Formulas
enteral feeding, 337t–340t, 342, 342t
total parenteral nutrition, 342, 343b
Fox, Charles, 4
Fractures, 422, 554–556, 554f
casts, 554–555
electrical burns, 448
incidence, 318
non-displaced, 555–556
osteomyelitis, 555
pediatric patients, 554
traction, 554, 555f
Frank–Starling curve, 391f
Free composition tissue transfer, 578
Free fatty acids (FFAs), liver, 303
Free flaps
contractures, 638, 643f–644f
electrical burns, 446
knee flexion deformities, 677
see also Microvascular surgery
Frequency
aerobic exercise, 543
resistive training, 545
Fresh frozen plasma, 119, 193–195, 195t
Friction burns, 28
Friend of GATA-1 (FOG-1), 286
Friends, mass casualty communication, 69
Frostbite, 449–454
burns vs., 450
classification, 449–450
clinical findings, 450
historical aspects, 449
imaging, 452
management, 451–452
initial management, 450–451
non-surgical therapies, 451–452
surgical management, 452
pathophysiology, 449–450
post-thaw evaluation, 451–452
Full-thickness burns
allografts (homografts), 200–201, 200b
contraction/epithelization healing, 599,
600b

Index
765
definition, 127
electrical burns, 444
pain management, 715
wound healing, 508
Full-thickness skin grafts (FTSGs), 581, 582f
contractures, 638
eyelid reconstruction, 609
hand care/reconstruction, 647
head and neck reconstruction, 603–604
mouth, 593
nipple-areola complex reconstruction, 628
Functional difficulties, 699–706
cardiovascular system, 702
employment, 700
gastrointestinal system, 702
genitourinary system, 702
heme, 702
lymphatic system, 702
musculoskeletal problems, 701
neurological system, 702
outcomes, 705
psychological problems, 703
psychosocial recovery, 748
reconstructive surgery, 572
respiratory system, 702
scars, 701
senses, 702
sensory deficits, 700–701
skin, 701
speech, 702
Functional reconstruction, hands, 658
Fungal infections, 152–153, 486, 486f
see also individual species
Furacin (nitrofurantoin), 154–155
Fusarium, 152
amphotericin-resistant, 142
Fusobacterium, 152
Futility, ethical problems, 686
G
Gabapentin, 721
itching, 726
Gain, thermoregulation, 183
Galveston formula, 335t
Γδ T cells, 269
Gamma rays, 461
Garamycin (gentamicin sulfate), 154
Gas exchange, inhalation injury diagnosis,
230
Gastric decompression, 425
Gastric feeding, intestinal feeding vs., 344
Gastric feeding tubes, 424–425, 424t
Gastric intramucosal pH, 180–181
Gastritis, stress, 425
Gastrointestinal syndrome
acute radiation syndrome, 464
exfoliative disorders, 473–474
Gastrointestinal tract, 394–395, 421,
423–428, 490–491
acalculous cholecystitis, 426–427
barrier failure, multisystem organ failure,
361–362, 364t, 365–366
blood flow, 423
clinical effects, 394–395
Curling’s ulcer see Curling’s ulcers
feeding tube problems, 424–425
functional difficulties, 702
hypermetabolic response, 423
innate immune response, 266–267
mucosal barrier breakdown, 423, 424f
necrotizing enterocolitis see Necrotizing
enterocolitis
pancreatitis, 427
paralytic ileus, 424–425
pathophysiology, 394
splanchnic hypoperfusion, 423
stress gastritis, 425
superior mesenteric artery syndrome, 427,
427f
Gastrojejunostomy, 427
Gastrostomy tubes, 424t
GATA transcription factors, 286–288
Gauze bandages, 88
Gender
geriatric patients, 415
mortality, 265
Gene expression, hypertrophic scars, 515
General anesthesia, mass casualty events, 73
Genetic predisposition, heterotropic bone,
557
Genital burns, 172
Genitourinary system
functional difficulties, 702
see also Urinary tract
Gentamicin sulfate (Garamycin), 154
Geographic location, epidemiology, 19
Geriatric patients, 415–420
cardiopulmonary reserve, 416
comorbidities, 416
drug dosages, 417–418, 417t
epidemiology, 415
gender, 415
incidence, 415
infections, 416
intentional injuries, 418–419
lean body mass, 416–417
long-term disability, 415–416
malnutrition, 416–417
mortality, 415
outcome, 415–416
perioperative optimization, 418
rehabilitation, 418
risk factors, 416, 416b
skin aging, 416
treatment, 416–418
comfort care, 417–418
initial resuscitation, 417
metabolic support, 417
nutritional support, 417
pain management, 417–418
sedation, 417–418
wound management, 417
Germany
causes of burns, 31
epidemiology, 34, 36t–37t
GFR (glomerular filtration rate), 369–371
GH see Growth hormone (GH)
Glenohumeral joint, patient positioning, 521
Glitazones, 359
Glomerular filtration rate (GFR), 369–371
GLP-1 (glucagon-like peptide-1), 359
Glucagon, 356
Glucagon-like peptide-1 (GLP-1), 359
Glucan, 275
Glucerna™, 337t–340t
Glucocorticoids
bone metabolism, 299, 316–317
glucose metabolism, 298
immunosuppression, 299–300
protein metabolism, 298–299
pulmonary system treatment, 392–393
release, 296–297, 297t
SIRS therapy, 257
Gluconeogenesis, liver, 301
Gluconeogenic amino acids, 298
Glucose intolerance, 336
Glucose metabolism
glucocorticoids, 298
hypermetabolic response, 355–356
liver, 307–308, 307f
Glutamate dehydrogenase, 304–305
Glutamine
depletion, 274
gut support, 365
multisystem organ failure therapy,
366–367
nutritional support, 340–341
Glutaraldehyde, ventilator sterilization/
disinfection, 247
Glutathione (GSH), vesicants, 468
Glycerol-preserved allografts (GPA), electrical
burns, 444
Glycogenesis, liver, 303
Glycogenolysis, liver, 301, 303
Glycoproteins, extracellular matrix, 495–497
Glycopyrrolate, with ketamine, 191–192
Glycosaminoglycans, dermis, 126
GM-CSF see Granulocyte-macrophage
colony-stimulating factor (GM-CSF)
GMPs (granulocyte-monocyte progenitors),
277–278
Goals, multidisciplinary teams, 12
Gothenburg, Sweden (30 October 1998),
60–61, 60f
Goulian knife, 158–159
GPA (glycerol-preserved allografts), electrical
burns, 444
Grafts see Skin grafting
Gram-negative organisms, 150–151
treatment, 151–152
see also individual species
Gram-positive organisms, 149–152
oral treatment, 150
see also individual species
Granulation tissue
radiation injuries, 463
wound healing, 508–509
Granulocyte colony-stimulating factor
(G-CSF), 284–285
administration, 275, 284–285
as growth factor, 283t
myofibroblast differentiation, 497–498
radiation injuries, 466
Granulocyte-macrophage colony-stimulating
factor (GM-CSF), 285
administration, 275
as growth factor, 283t
radiation injuries, 466
Granulocyte-monocyte progenitors (GMPs),
277–278
Granulocytopenia, infection, 280–281
Gray (Gy), 461–462
Grease burns, scald depth, 128

Index
766
Greece, 36t–37t
Grief therapy, 743–744
Groin flaps
hand burn management, 169, 169f–170f
neck contracture, 591–592
Ground transport, 32, 99
Growth
alterations, 553f, 563–564
delay, mitigation of, 567–569, 568f–569f
pediatric patients, 412
Growth factors, 283–286, 283t
erythroid growth factors, 284
hypertrophic scars, 515
lymphoid growth factors, 285
megakaryocyte growth factors, 285–286
myeloid growth factors, 284–285
progenitor cell growth factors, 283–284
stem cell growth factors, 283–284
wound healing, 509
see also specific growth factors
Growth hormone (GH)
bone catabolism, 318
catabolic response management, 567
growth delay mitigation, 568–569
liver, 304
Growth plates, 563
GSH (glutathione), vesicants, 468
Guide to the Evaluation of Permanent
Impairment, 703–704
H
H2O2 (hydrogen peroxide), shock, 108, 109t
HA-1A, multisystem organ failure therapy,
367
Haddon matrix, prevention of burns, 49t
Hageman factor (factor XII), 258–259
Hair follicle stem cells, 508
Hallucinations, 736
Haloperidol, 739–740
Halothane, 192
Handicap, definition, 699–700
Hands, 166–169, 645–660
aftercare, 647–648
definitive care, 647–648
dorsum, 654
escharotomy, 166–167, 167f
established deformities, 648
fasciotomy, 166–167
fourth degree burns, 169, 169f–170f
functional reconstruction, 658
initial assessment, 645
initial care, 645–647
patient positioning, 522–524, 522f–523f
skeletal suspension and traction, 527, 528f
surgical debridement, 131–132
techniques, 167–169, 168f
wound coverage, 167–168
see also Phalangeal deformities
Handwashing, 137, 247
Hansborough, J F, 3–4
Harris–Benedict formula, 335t
Hart, D W, 7
HBO see Hyperbaric oxygen (HBO)
Head, patient positioning, 519, 519f–520f
Head and neck reconstruction, 597–616, 603f
acute-phase, 605–606
aesthetic units, 602
computer-generated clear face masks,
598–599, 599f
contractures, 601–602
evaluation, 599–601, 600b, 600f
historical aspects, 597–598
hypertrophic scars, 598–599, 599f,
602–603
intermediate-phase, 606, 608f
laser therapy, 599f, 602–603, 604f
late-phase, 606, 609f
pathogenesis, 598–599
skin flaps, 604
skin grafts, 603–604
timing of, 597–598, 598f, 605–606
tissue expansion, 604–605
type I deformities, 600, 601f
type II deformities, 600, 602f
z-plasty, 601f, 602
see also Neck
Healthcare ethics committee (HEC), 683
Heart rate, 393
Heart rhythm, 393
Heat-fixed protein solutions, 119
Heating equipment, 47–48
Heimbach, David, 3–4
Helicopters, 100
Helper T-cells see T-helper cells (Th)
Hematocrit
anemia diagnosis, 278–279
blood transfusion, 193
Hematogenous osteomyelitis, 554
Hematological disorder management, 466
Hematopoiesis, 273–274, 274f, 277–278
definition, 277
lymphoid lineage, 277
myeloid lineage, 277
progenitor cells, 277–278
stem cells, 277–278, 278f
see also specific cells
Hematopoietic factor administration, 275
Hematopoietic syndrome, 464
Hematopoietic system and precursor cells
(HPSC), 466
Heme, functional difficulties, 702
Hemodynamic monitoring
intensive care units, 379
mass casualty events, 72
Hemodynamics, 110–111
exfoliative disorders, 473–474
hypophosphatemia, 329
SIRS, 260
stabilization, 291
Hemofiltration
continuous, acute renal failure treatment,
376
SIRS therapy, 257
Hemoglobin
anemia diagnosis, 278–279
carbon monoxide binding, 226
see also Carboxyhemoglobin
Hemorrhage see Blood loss
Heparin
acetylserine combination, bronchial
hygiene therapy, 242
purpura fulminans, 479–480
Hepatic clearance, pharmacodynamics,
185
Hepatobiliary tract, 490–491
Hepatocytes, 302
liver trauma, 305–306
Hepatomegaly, 303, 304f, 310, 491
Herndon, D N
inhalation injury, 6–7
nutritional support, 4
Herpes simplex virus infection, 143–144,
143f–144f
exfoliative disorders, 471
Heterotopic ossification, electrical burns, 438,
448
Heterotropic bone, 556
behavior, 557–558
burn extent, 556
burn location, 556
characteristics, 557–558
confinement period, 556
genetic predisposition, 557
osteoporosis, 556
pathogenesis, 556–557
prevention, 558–561
radiography, 558, 559f
superimposed trauma, 556–557
treatment, 558–561
HF see Hydrofluoric acid (HF) burns
HFOV (high-frequency oscillatory
ventilation), 384
HFPV see High-frequency percussive
ventilation (HFPV)
HFV (high-frequency jet ventilation), 244
HFV (high-frequency ventilation), 244
High-calorie diets, 357
High-frequency jet ventilation (HFV), 244
High-frequency oscillatory ventilation
(HFOV), 384
High-frequency percussive ventilation
(HFPV), 244, 244t, 384
inhalation injury treatment, 235
High-frequency ventilation (HFV), 244
High-mobility group protein-1 (HMGB-1),
257–258
High thermoplastic transparent masks,
535
High-voltage electrical burns, 441, 442f
Hildanus, Guilhelmus Fabricus, 1
Hip
dislocation, 562
patient positioning, 524, 525f
Hip contracture, 631–632
patient positioning, 633
Hippocrates, 1
Histamine, shock, 107, 109t, 115–116
Histamine receptor antagonists, Curling’s
ulcers, 326
Histology, hypertrophic scars, 512–514
Historical aspects, 1–8
ancient Egypt, 1
China, 1
early excision, 1–3
fluid resuscitation, 5–6, 115–123
hypermetabolic response, 7
inhalation injury, 6–7, 219
nutritional support, 4–5
skin banks, 199–200
skin grafting, 3–4
topical anti-infectives, 4
World War I, 4
World War II, 4

Index
767
HIV infection, 148
allografts (homografts), 202–203
HLA B7, heterotropic bone, 557
HMGB-1 (high-mobility group protein-1),
257–258
HO− (hydroxyl ion), shock, 108, 109t
Home exercise treadmills, pediatric patients,
23
Homografts see Allografts (homografts)
Hormones
liver, 302, 304, 310
see also specific hormones
Hospital administrators, 10
Hospitalization, incidence, 377
Hospital routine, psychosocial recovery,
746–747
Host Response to Injury Collaborative
Research Program, 311
Hot packs, scar treatment, 536
Housing age, epidemiology (of burns), 48
HPSC (hematopoietic system and precursor
cells), 466
HRpeak (peak heart rate), 542
Human amnion, 210–211
Humanitarian crises, 78
Human research, ethical problems, 686
Human resources, burn centers, 713
Humerus head dislocation, 562
Humidified oxygen, 234
Humidity, hypermetabolic response, 334, 357
Hydration status, nutritional support
monitoring, 347
Hydrocarbons, 459
Hydrochloric acid, 457, 457f
Hydrocolloid fiber dressings, 89, 211
skin donor sites, 164
Hydrofiber mats, 211
Hydrofluoric acid (HF) burns, 84, 457–458
evaluation, 129–130
Hydrogen chloride, 225t, 227
Hydrogen cyanide, 227
Hydrogen peroxide (H2O2), shock, 108,
109t
Hydrogen sulfide, 225t, 227
Hydromorphone (dilaudid), 721
Hydrotherapy, 399–400
exfoliative disorders, 475
Hydroxyl ion (HO−), shock, 108, 109t
Hydroxymorphone, 723
25-Hydroxyvitamin D, 315
Hydroxyzine, itching, 726
Hyperbaric oxygen (HBO)
frostbite, 452
radiation injuries, 466
Hypercalcemia, impaired renal function,
316
Hyperdynamic state, SIRS, 262
Hyperemia, inhalation injury, 231
Hyperglycemia, 183, 297–298, 303, 395
nutritional support complications,
348t–349t, 350
stress response, 307–308
Hyperkalemia, 348t–349t
Hypermagnesemia, 348t–349t
Hypermetabolic response, 292, 333–334,
334f, 355–360, 356f, 565–570
bone effects, 565
burn size vs., 355, 411
cytokines, 355
gastrointestinal tract complications, 423
glucagon, 356
glucose, 355–356
historical aspects, 7, 333, 334f
insulin, 355
insulin resistance, 358–359
ketosis, 356–357
lean body mass, 356–357
lipolysis, 356–357
management, 566
anabolic agents, 358
antidiabetic drugs, 359
β-adrenergic blockers, 292
early wound closure, 357
environmental support, 334, 357
exercise, 357–358
fenofibrate, 360t
infection control, 148–149
insulin, 358–359, 359f, 360t
insulin-like growth factor, 358, 359f
ketoconazole, 359f, 360t
metformin, 359
non pharmacological methods,
357–358
nutritional support, 357
outcome measurement, 709
oxandrolone, 358, 359f, 360t
pharmacological methods, 358, 359f,
360t
propranolol, 292, 358, 359f, 360t
recombinant human growth hormone,
358, 359f, 360t
results, 359f
mediators, 333–334
multiorgan dysfunction, 355
nitrogen balance, 356–357
pediatric patients, 410–412
protein metabolism, 333
time-dependency, 355
see also Nutritional support
Hypernatremia, 348t–349t
Hyperosmolarity, 348t–349t
Hyperphosphatemia, 348t–349t
Hypertension
nitric oxide, 291
septic shock, 291
Hypertonic saline, 118–119, 174
bronchial hygiene therapy, 242
colloids with, 118
lactate Ringer’s vs., 118
mass casualty events, 71
pediatric patients, 119
SIRS therapy, 258
Hypertrophic scars, 158, 495–506
cells, 497–502
fibroblasts, 497, 497t, 501–502,
514–515
keratinocytes, 502
myofibroblasts, 497–498, 498f–499f,
515
cytokines, 502–504, 503f
connective tissue growth factor (CTGF/
CCN2), 503
insulin-like growth factor 1 (IGF-1),
503–504
interferons, 504
platelet-derived growth factor, 503
transforming growth factor-β,
502–503
definition, 530–532
experimental models, 514
gene expression, 515
head and neck reconstruction, 598–599,
599f, 602–603
histology, 512–514
immunohistochemical stains, 514
inflammation, 515
keloids vs., 498–500, 501f, 513–514
large wounds, 216
morbidity, 495, 496f
normal scars vs., 514
pathological repair, 498–500, 500f–501f,
515
pulsed-dye laser, 602–603, 604f
Hyperventilation, 326
Hypnosis, pain management, 729
Hypocalcemia, 315
blood transfusions, 193–194
therapy, 315–316, 316t
Hypocaloric feeding, 346
Hypochlorite solutions, 459
Hypokalemia, 348t–349t
Hypomagnesemia
hypophosphatemia, 327–328
nutritional support complications,
348t–349t
Hyponatremia
nutritional support complications,
348t–349t
pediatric patients, 408
Hypophosphatemia, 315, 325–332, 326f
acute phase response, 327
alkalemia, 326
cardiac dysfunction, 328
catecholamines, 325
clinical manifestations, 328, 328b
consequences, 328–329
enteral feeding, 316
etiology, 325, 326b
hemodynamic dysfunction, 329
hypomagnesemia with, 327–328
metabolic support, 327
neuromuscular dysfunction, 329
nutritional support complications,
348t–349t
prevention, 329–331
resuscitation, 325–326
rickets, 316
stress response, 325
therapy, 315–316, 316t
topical therapy, 325–326
treatment, 329–331, 330f
Hypotension, 178
Hypothalamopituitary–adrenal axis, 297
Hypothalamus, thermoregulation, 183, 565
Hypothermia
blood transfusions, 193–194, 196
chemical burns, 456
Emergency Departments, 97
frostbite, 450–451
mass casualty events, 69–70
pediatric patients, 411
Hypovolemia
acute renal failure, 370–371
pediatric patients, 408

Index
768
Hypoxia, 484
central nervous system, 492–493
gastrointestinal system, 490–491
multiple organ dysfunction syndrome, 387
I
Ibuprofen, 725
ICC (International Code Council), fire
sprinklers, 53–54
ICF (International Classification of
Functioning, Disability and Health),
703
ICUs see Intensive care units (ICUs)
IFNs (interferons), hypertrophic scars, 504
see also specific interferons
IGF-1 see Insulin-like growth factor-1 (IGF-1)
IHD (intermittent hemodialysis), 375, 390
IHDs (immune-enhancing diets), 341–342
IL-1 see Interleukin-1 (IL-1)
IL-1β see Interleukin-1β (IL-1β)
IL-2 (interleukin-2), 271
IL-3 (interleukin-3), 283t
IL-6 see Interleukin-6 (IL-6)
IL-7 (interleukin-7), 283t
IL-8 see Interleukin-8 (IL-8)
IL-10 see Interleukin-10 (IL-10)
IL-12 see Interleukin-12 (IL-12)
IL-15 (interleukin-15), 271
IL-18 see Interleukin-18 (IL-18)
Imagery, pain management, 729
Imaging
frostbite, 452
radiation injuries, 463
Immobilization, surgical care, 399
Immune-enhancing diets (IHDs), 341–342
Immune response, 265–276
adaptive, 272
innate see Innate immune response
nutritional support monitoring, 347
sympathetic nervous system, 292–294
wound healing, 504
see also Infection(s); specific components
Immunoglobulin(s), production, 273
Immunoglobulin G (IgG), multisystem organ
failure therapy, 367
Immunoglobulin M (IgM), exfoliative
disorders, 472
Immunohistochemical stains, hypertrophic
scars, 514
Immunomodulation, 274–276
cytokine modulation, 275
exfoliative disorders, 475–476
hematopoietic factors, 275
immunonutrition, 274
multisystem organ failure, 367–368
vaccination, 275
Immunonutrition, 274
Immunosuppression
antibiotics, 266
glucocorticoids, 299–300
infection control, 143
medications, 266
Impact™, 337t–340t, 341
Impact 1.5™, 337t–340t
Impact Glutamine™, 337t–340t
Impaired renal function, hypercalcemia,
316
Impairment
assessment, 700–703
definition, 699
evaluation, 703–705, 704t
Implementation
extensive exercise in pediatric patients, 403
reconstructive care, 403
work-hardening programs, 402
Improvement stage, aerobic exercise, 544
IMV (intermittent mandatory ventilation),
383, 383f
Incidence of burns, 15, 16t, 18t, 421, 707
Incisional wound healing, 507
Index of occupation, burn centers, 713
India, 34
Indirect calorimetry, nutritional support,
336
Indomethacin, 558
Indoor fires, 60–61
Buenos Aires, Argentina (30 December
2004), 61
Gothenburg, Sweden (30 October 1998),
60–61, 60f
Volendam, The Netherlands (1 January
2001), 61
Warwick, Rhode Island (20 February
2003), 61
Inducible nitric oxide synthases (iNOS), 223,
262
Infection(s), 484–485, 486f–487f, 487
allografts (homografts), 202–203
blood transfusions, 197, 266
burn size vs., 265
catecholamines, 292
central venous access, 265–266, 429
definition, 140
early excision, 157
exfoliative disorders, 471
geriatric patients, 416
granulocytopenia, 280–281
incidence, 265
intensive care units, 378
invasive infections, 140–141, 141f
leukopenia, 280–281
organisms, 145–148
pathogenic organisms, 484–485
pathogens, 141–142
see also individual species
radiation injuries, 466
viral, 143–145
see also specific infections
wound healing, 511
see also Immune response; specific
infections
Infection control, 137–156
acute (resuscitative) phase, 148
bacterial infections, 149–155
see also specific organisms
best practice, 137
cultures, 142, 143b
definitions, 138–140
fascial excision, 160
handwashing, 247
hypermetabolic response, 148–149
immunocompromised patients, 143
mechanical ventilation, 246–248
multiple blood transfusions, 143
pharmacodynamics, 148–149
pharmacokinetics, 148–149
specimen collection/transport, 148
Inflammation, 174, 265, 266f
bone metabolism, 316
frostbite, 450
hypertrophic scars, 515
inhalation injury, 231
mediators, 178, 179f
multisystem organ failure, 361
shock, 107–110, 109t, 115–116
see also specific mediators
p38 MAPK, 423–424
tracheobronchial injury, 223
Informed consent, 683–684
Inframammary fold distortion, breast
reconstruction, 626
Infusion pumps, transport/transfer, 101
Inguinopudendal skin flap, penis burns,
661
Inhalation injury, 219–238, 488–489, 488f
classification, 219
clinical significance, 229, 230t
definition, 229
diagnosis, 175–177, 229–231
bronchoscopy, 397–398
epidemiology, 219, 220f
incidence, 229
historical aspects, 6–7, 219
long-term effects, 224–225
mass casualty events, 73
mortality, 157, 158t, 175, 229
obstructive/restrictive disease, 248
pathophysiology, 177, 219–225
airway epithelium, 488–489
interleukin-8, 489
lung parenchyma injury, 223–224,
224f, 488–489, 489f
oropharynx injury, 219–220, 220f
poly-adenosyl-ribose polymerase, 489
pulmonary function changes, 236–237
pulmonary insufficiency, 231–232, 232f
tracheobronchial injury, 220–223,
221f–222f, 222t
pediatric patients, 410, 411t
tracheal stenosis, 248
treatment, 232–236
airway pressure release ventilation, 235
anticoagulants, 234
bronchial hygiene therapy see Bronchial
hygiene therapy
extracorporeal membrane oxygenation,
235
fiberoptic bronchoscopy, 234–235
flexible fiberoptic bronchoscopy, 233,
234f
fluid resuscitation, 120, 233–234
high-frequency percussive ventilation,
235
humidified oxygen, 234
inhaled β agonists, 234
intubation, 232–233, 232t
mechanical ventilation, 235
nursing, 397
positive end-expiratory pressure, 235
specific toxicity, 232
spirometry, 233
tracheostomy, 235–236
volume-controlled ventilation, 235

Index
769
Inhaled nitric oxide, 385
pulmonary system treatment, 392
In-hospital recuperation phase, psychosocial
recovery, 747
Initial conditioning, aerobic exercise, 543
Initial evaluation, anesthesia, 174–175, 175t
Initial management, frostbite, 450–451
Initial resuscitation, geriatric patients
treatment, 417
Injuries see Trauma (injuries)
Innate immune response, 266–271
chemokines, 270t, 272t
complement cascade, 269–270, 269f
cytokines, 270–271, 270t
see also specific cytokines
γδ T cells, 269
natural killer cells, 269
natural killer T cells, 269
neutrophils, 268–269
phagocytes, 267–268, 267f
physical barriers, 266–267
Toll-like receptors, 267–268, 268f
iNOS (inducible nitric oxide synthase), 223
iNOS (inducible nitric oxide synthases), 262
Inotropes, 394
Inserts, scar treatment, 534–535, 535f
Inspiratory:expiratory ratio, mechanical
ventilation, 246
Inspired oxygen concentration, mechanical
ventilation, 246
Instructions, outpatients, 90
Insulin
geriatric patients, 417
hypermetabolic response, 355, 358–359,
359f, 360t
Insulin-like growth factor-1 (IGF-1), 310
glucocorticoids, 298
hypermetabolic response management,
358, 359f
hypertrophic scars, 503–504
liver, 304
Insulin receptor substrate-1 (IRS-1), liver
metabolism, 307
Insulin resistance, 183, 358–359, 395
see also Hypermetabolic response
Integra™, 161–162, 201, 212, 213f, 215,
573–574
breast mound reconstruction, 626
hand care/reconstruction, 647
large burn management, 165
pediatric patients, 412
Integumentary system, 485–486
Intensity, aerobic exercise, 542–543
Intensive care units (ICUs)
advanced cardiac life support, 379
bed number, 378
cardiovascular monitoring, 379–381
arterial lines, 379–381
cardiac output, 380
transesophageal echocardiography,
380–381
consultants, 378, 378b
equipment, 378–379, 379b
hemodynamic monitoring, 379
infections, 378
mechanical ventilation see Mechanical
ventilation
organization, 377–379
personnel, 378, 378b
physical plant, 377–378
ventilators, 74–75
Intentional injuries, 689–698
acid burns, 695
care homes, 691–693
clinical evaluation, 695–697, 696b
physician assessment, 692b, 695–696
psychosocial assessment, 696–697,
696b
clinical interviews, 697
diagnosis, 698t
elderly, 690–691, 691b
geriatric patients, 418–419
incidence, 689
indicators, 691b, 693–695, 693t, 694f
pediatric patients, 690
perpetrator characteristics, 691–693, 693b
prevalence, 690–691, 691b
professional relationships, 697
reporting of, 697
risk factors, 693t
safety issues, 698
self-inflicted, 695
types, 689, 690f
Interferon(s) (IFNs), hypertrophic scars, 504
Interferon-α (IFN-α)
hypertrophic scars, 504
SIRS, 251–252
Interferon-β (IFN-β), hypertrophic scars,
504
Interferon-γ (IFN-γ)
hypertrophic scars, 504
innate immunity, 270t, 271
SIRS, 253, 253t
wound healing, 504
Interleukin-1 (IL-1)
acute phase response, 308–309
innate immunity, 270t
liver apoptosis, 306
liver metabolism, 307
multisystem organ failure, 363, 367
SIRS, 250, 253, 253t, 256
vascular permeability, 260–261
Interleukin-1β (IL-1β)
bone metabolism, 317
multiple organ dysfunction syndrome,
387
Interleukin-1 receptor antagonist, 256
Interleukin-2 (IL-2), 271
Interleukin-3 (IL-3), 283t
Interleukin-6 (IL-6)
acute phase response, 309
adrenergic stimulation, 293
bone metabolism, 317
as growth factor, 283t
innate immunity, 270t, 271
liver metabolism, 307
multisystem organ failure, 361, 363, 387
SIRS, 250, 253, 253t, 256
Interleukin-7 (IL-7), 283t
Interleukin-8 (IL-8)
acute phase response, 309
inhalation injury, 231, 489
innate immunity, 270t
multisystem organ failure, 361, 387
SIRS, 253t
tracheobronchial injury, 223
Interleukin-10 (IL-10)
innate immunity, 270t, 271
SIRS, 253t
Interleukin-12 (IL-12)
innate immunity, 270t, 271
SIRS, 253t
Interleukin-15 (IL-15), 271
Interleukin-18 (IL-18)
innate immunity, 270t
SIRS, 253t
Intermediate-phase management
contractures, 634–635
head and neck reconstruction, 606, 608f
therapeutic exercise, 538–539
Intermittent hemodialysis (IHD), 375, 390
Intermittent mandatory ventilation (IMV),
383, 383f
Internal jugular vein access, 406
International Classification of Functioning,
Disability and Health (ICF), 703
International Code Council (ICC), fire
sprinklers, 53–54
International Society for Burn Injury (ISBI), 35
Internet, mass casualty communication, 68
Interposition skin flaps
contractures, 638–639, 640f–641f
knee flexion deformities, 675–677, 680f
Interstitial colloid osmotic pressure (πif), 106
Interstitial hydrostatic pressure (Pif), 105–106
Interstitial structure, edema, 106–107
Intestinal feeding, gastric feeding vs, 344
Intra-abdominal hypertension, acute renal
failure, 371
Intra-abdominal injuries, 422–423
Intrahepatic cholestasis, 306
Intraosseous fluid resuscitation, 407, 407f
Intrathoracic blood volume (ITBV), 180
Intravenous (IV) access, on-site-assessment,
94
Intravenous immunoglobulin (IvIg), 476
Intravenous phosphate, hypophosphatemia
treatment, 329–330, 330f
Intubation
indications, 381–385, 381t
inhalation injury treatment, 232–233,
232t
mass casualty events, 73
nursing, 398
pediatric patients, 410
Intussusception, 146–147
Inverse ratio ventilation, 384
Iran, 34
Ireton–Jones formula, 335t
IRF-3, SIRS, 254, 255f
Iron
deposition in electrical burns, 442
requirements, 324t
Irradiation, skin banks, 207
Irrigation, chemical burns, 456
IRS-1 (insulin receptor substrate-1), liver
metabolism, 307
ISBI (International Society for Burn Injury),
35
Ischemia, 484
gastrointestinal system, 490–491
Ischemic renal failure, 388
Isocyanates, 225t
Isopropyl alcohol, 247

Index
770
Isosource HN, 337t–340t
Isotonic saline, pediatric patients, 408
ITBV (intrathoracic blood volume), 180
Itching
measurement of, 718–719
outpatients, 91
psychiatric disorders, 734
vesicants, 468–469
IV (intravenous) access, on-site-assessment, 94
IvIg (intravenous immunoglobulin), 476
J
Jackson, Douglas, 1–2
Janzekovic, Zora, 2f
early excision, 1–2
Jejunal feeding, 344
Jejunostomy tubes, 424t
Joint disorders, 561–563
dislocation, 561–562, 561t
septic arthritis, 562–563
Joint mobilization, 558
K
KC (keratinocyte-derived cytokine), 271
Keloids, hypertrophic scars vs., 498–500, 501f,
513–514
Kentish, Edward, 1
Keratinocyte-derived cytokine (KC), 271
Keratinocytes
allograft template, 202
apoptosis, 472–473
genetic modification, 213
hypertrophic scars, 502
wound healing, 507–509
Keraunoparalysis (Charcot’s paralysis), 437
Ketamine, 187, 724
with glycopyrrolate, 191–192
as induction agent, 191–192, 191f
intramuscular, 191–192
mass casualty events, 73
Ketanserin, 116
Ketoconazole, 359f, 360t
Ketosis, 356–357
Kf (capillary filtration coefficient), edema,
105, 105t
Kidneys, acute renal failure see Acute renal
failure (ARF)
Kinins
diffuse alveolar damage, 488
shock, 108
Klebsiella infection, 151
Klebsiella pneumoniae infection, 428
Knaysi, G A, 5–6
Knee
flexion deformities, 675–682, 679f–681f
patient positioning, 524–525
Knee contracture, 631–632
incidence, 631, 632t
patient positioning, 633, 634f
skeletal traction, 636, 637f
skin flaps, 584
splinting, 631–632, 632t, 634
surgical management, 635–636
three-point extension splint, 633f, 635
Kuta, Bali (12 October 2002), 59
Kyle, M G, 5–6
L
Labia majora burns, 661, 663f
reconstruction, 665
Laboratory tests, mass casualty events, 72
Lactate
cardiac output, 380
fluid resuscitation monitoring, 180
Lactate Ringer’s, hypertonic saline vs., 118
Lactation, breast reconstruction, 624
Landis–Starling equation, 104
Laparotomy, stress gastritis, 425
Large burn management, 165
Large volume lavage, chemical burns, 456
Laryngeal damage, inhalation injury,
236–237, 236f
Laryngeal mask airway (LMA), 188
Laser therapy, head and neck reconstruction,
599f, 602–603, 604f
Late-phase reconstruction, head and neck,
606, 609f
Latissimus flaps, electrical burns, 445
LBM see Lean body mass (LBM)
Leadership
multidisciplinary teams, 12
nursing, 397
Lean body mass (LBM)
geriatric patients, 416–417
hypermetabolic response, 356–357
liver metabolism, 308
Leg length discrepancies, 517–518
Length of stay (LOS), outcome measurement,
708
Leukopenia, 280
exfoliative disorders, 473–474
infection, 280–281
Leukotrienes
multisystem organ failure, 363
shock, 107–108, 109t
SIRS, 254
Levo-Dromoran (levorphanol), 721
Levorphanol (Levo-Dromoran), 721
Lewisite (2-chlorovinyl-dichlorarsine), 468
Lidocaine, 720
Lightning strikes, 29–30, 437
ophthalmic injury, 448
Lindberg, Robert, 4
Linezolid, 150
Linoleic acid, 337
Lipid metabolism, liver, 303, 307–308, 307f
Lipid peroxidation
lung parenchyma injury, 223
vesicants, 468
Lipolysis, 356–357
Lipopolysaccharide (LPS), 293
Liquid silicone elastomer inserts, 534–535,
535f
Lister, Joseph, 507
Liver, 301–312, 311f
acute phase response, 303, 308–309
anatomy, 301
carbohydrate metabolism, 303
circulatory system, 302
coagulation factors, 304, 309–310
gluconeogenesis, 301, 355–356
glucose metabolism, 307–308, 307f
glycogenesis, 303
glycogenolysis, 301, 303
hormones, 302, 304, 310
lipid metabolism, 303, 307–308, 307f
metabolism, 303–304, 307–310, 307f
mononuclear phagocyte system, 302, 307
physiology, 301–302
protein metabolism, 303–304, 307–308,
307f
steatosis, 491, 491f
vitamin metabolism, 304, 309
see also under hepatic
Liver damage, 304–306
morphological changes, 304–306
Load amount, resistive training, 545
Localized radiation injuries, 463–464
Local skin slaps, neck contractures, 614f, 615
Lodoxamide, 109–110
London, England (7 July 2005), 60
Long-term disability, geriatric patients,
415–416
Long-term rehabilitation phase, 539
Long-term treatment, mass casualty events, 67
Loop diuretics, acute renal failure treatment,
389
Lorazepam, 721–722
anxiety treatment, 739
LOS (length of stay), outcome measurement,
708
Loss-of-control, psychosocial recovery, 747
Lower face deformities
skin flaps, 593–594, 594f–595f
tissue expansion, 589, 589f
Lower limb orthotics, 526
Lower limb prostheses, 530
Lower limb reconstruction, 671–682
after care, 677–682
contracture, 682
general principles, 671
hypertrophic scars, 671
rehabilitation, 677–682
skin grafting, 682
see also specific anatomical features
Lower lip reconstruction, 609
Lower Tidal Volume Trial, 235
Low-voltage electrical burns, 437–438
LPS (lipopolysaccharide), 293
Lund–Browder chart, 174–175, 176f
Lund, C C, 5–6
Lung(s)
edema, 111–112, 231, 232f
electrical burns, 445–446
parenchyma injury, 223–224, 224f,
488–489, 489f
scintigraphy, 230–231
Lymphatic system, functional difficulties, 702
Lymph flow, edema, 106, 260
Lymphocytes, β-adrenergic receptors, 293
Lymphoid cells, 281
Lymphoid growth factors, 285
Lymphoid lineage, hematopoiesis, 277
Lymphoid system, 492, 492f
Lyophilization, skin banks, 206
M
Macrophage(s), 281
Macrophage inflammatory protein-2 (MIP2),
271
Macrostomia, 605

Index
771
Madrid, Spain (11 March 2004), 60
MafB, 287–288
Mafenide acetate (Sulfamylon), 154
electrical burns, 436
historical aspects, 4
mass casualty events, 70
Magnesium
homeostasis, 313–315
metabolic actions, 313
Magnetic resonance angiography (MRA),
frostbite, 452
Magnetic resonance imaging (MRI)
amputations, 446–447
electrical burns, 442, 446–447
frostbite, 452
necrotizing fasciitis, 478
Maintenance fluids, following shock
resuscitation, 123–124
Maintenance stage, aerobic exercise, 544
Majno, Guido, 507
Major depression, 737
Major histocompatibility complex (MHC),
281
Malaysia, 38t
Malnutrition
geriatric patients, 416–417
pre-existing, 334
see also Nutritional supplements
Management of burns, 164–166
see also specific burns; specific techniques
Management plans, multidisciplinary teams,
12
Mannan-binding lectin pathway, complement
cascade, 269–270, 269f
Mannitol, 389
Maoris, 34
Mason A D, 6–7
Massage, scar treatment, 535–536
Mass casualty events, 33, 57–80
armed conflict, 78
awareness, 78–79
blood centers, 75–76
burn centers, 57
causes, 59–63
chaos and alarm phase, 64
CO intoxication, 72
communication, 68–69
critical dimensions, 63
debriefing, 68
definitions, 58–59
see also specific terms
education, 78–79
explosions, 62–63
see also specific examples
first transport, 65
home transport, 67
humanitarian crises, 78
indoor fires see Indoor fires
inhalation injury, 73
management
airway management, 72
analgesia, 73–74
anesthesia, 70–75
anesthesia machines, 74
blood transfusions, 75–76
definitive treatment, 67
first-line hospitals, 65
first medical treatment, 65
fluid resuscitation, 70–71, 71t
intubation, 73
long-term treatment, 67
medical treatment, 69–70
postoperative management, 73–74
primary treatment, 65–66, 65t, 76–77
secondary treatment, 66–67
topical treatment, 70
venous access, 72
ventilators, 74–75
natural disasters, 78
organization phase, 64
oxygen, 74
phases of, 63
physiological monitoring, 72
preparedness, 78–79
rehabilitation, 67
search and rescue, 64
secondary transport, 67
second-line hospitals, 65
strategies, 76–77
tagging, 65
terrorism see Terrorist attacks
third-line hospitals, 65
tiered response, 77
transportation fires, 61–62
see also specific examples
triage, 64–65
Massive burn management, 165–166
operating room, 165–166
Mast cells
cooling effects, 84–85
wound healing, 504
Material Safety Data Sheets (MSDS), 456
Matriderm, 215
Matrix metalloproteinases (MMPs)
hypertrophic scars, 498–500, 515
transforming growth factor-β, 502–503
Maturation, wound healing, 509
MB-CK (MB-creatine kinase), electrical burns,
435
MB-creatine kinase (MB-CK), electrical burns,
435
MC see Musculocutaneous (MC) flaps
McGill Pain Questionnaire (MPQ), 716–717
MDCTA (multidetector-row computed
tomography angiography), 592
MDR (multidrug resistance), 141–142
MDROs (multiple drug-resistant organisms),
151
Mean arterial blood pressure, intensive care
units, 379–380
Mechanical stress, myofibroblasts, 498, 499f
Mechanical ventilation, 242–246, 381–385
airway pressure-release ventilation,
384–385
alternative modes, 244–245
assist-control mode, 243, 381–382
control mode, 243, 381–382, 383f
extubation, 246, 398
flow rates, 245–246
high-frequency oscillatory ventilation, 384
high-frequency percussive ventilation, 384
infection control, 246–248
inhalation injury treatment, 235
inhaled nitric oxide, 385
inspiratory:expiratory ratio, 246
inspired oxygen concentration, 246
intermittent mandatory ventilation, 383,
383f
inverse ratio ventilation, 384
mass casualty events, 74–75
monitoring, 385–386
nursing, 398
positive end-expiratory pressure, 246
pressure control mode, 243
pressure support ventilation, 383–384,
383f
pulmonary system treatment, 392
respiratory rate, 245, 245t
settings, 245–246, 245t
sterilization/disinfection, 247–248
tidal volumes, 245
time-cycled pressure control ventilation,
382
transport/transfer, 101
ventilatory mode, 381, 382f
weaning from, 235, 385
see also specific methods
Mechanism of injury, inhalation injury
diagnosis, 230
Median nerves, electrical burns, 447
Mediators
hypermetabolic response, 333–334
multisystem organ failure, 362–364
Medical history
inhalation injury diagnosis, 230
radiation injuries, 465
Medical outposts, mass casualty events, 76
Medi-Sol™ Adhesive Remover, 86–87
Meek technique, wound closure, 161
Megakaryocyte(s), 281–283
Megakaryocyte–erythroid progenitors (MEP),
277–278
Megakaryocyte growth factors, 285–286
MEP (megakaryocyte–erythroid progenitors),
277–278
Meperidine, 97
Meshed skin autografts, 201–202, 201f
Meshing, wound closure, 161
Metabolic changes
adrenal response, 297–298
anesthesia, 182–183
post-burn trauma, 355–357
see also Hypermetabolic response
Metabolic support
geriatric patients treatment, 417
hypophosphatemia, 327
nursing, 400
Metabolism, liver, 307–310
Metal burns, 459, 459f
Metatarsophalangeal (MTP) joints, 671
Metformin, 359
Methadone, 721
Methicillin-resistant Staphylococcus aureus
(MRSA)
burn wound impetigo, 138–139
toxic shock syndrome, 140
Metoprolol, 241–242
MHC (major histocompatibility complex),
281
Microbiologic testing, skin banks, 205–206
Microcirculatory dysfunction, 178
Microcirculatory fluid exchange, 104, 104f,
115
Micrografting, allografts (homografts), 202

Index
772
Micronutrients, 342
Micropuncture techniques, cell membranes,
107
Microvascular changes
frostbite, 449–450
oropharynx injury, 220
Microvascular surgery, 578, 591–596
applications, 591, 592f
cicatricial deformities, 593
facial reconstruction, 592–594
historical aspects, 591
neck contracture free flap, 591–592
total face reconstruction, 594–596, 595f
see also Free flaps
Midazolam, 722, 724
delirium treatment, 738
mass casualty events, 73
ventilator patients, 725
Military personnel, 24–26
aeromedical transport, 25
conflicts, 24, 25t
IEDs, 25
non-combat burns, 26
waste incineration, 25
Mineral metabolism, 313–320
therapy, 315–316, 316t
see also specific minerals
MIP2 (macrophage inflammatory protein-2),
271
Mivacurium, 186
MMPs see Matrix metalloproteinases (MMPs)
Mobile home fires, 19–20
Mobility
bronchial hygiene therapy, 240, 241f
early, 240, 241f
standing and walking programs, 525, 525f
Mode, aerobic exercise, 543
Moderate burns, outpatients, 91–92, 92t
Modified (34) z-plasty see Z-plasties, 34
(modified)
MODS see Multiple organ dysfunction
syndrome (MODS)
Moist desquamation, radiation injuries, 463
Moisturizing body lotions, itching, 726
Monafo, William, 3f
early excision, 2–3
topical anti-infectives, 4
Monocytes, 281
glucocorticoid effects, 299
Monocytosis, norepinephrine, 294–295
Mononuclear phagocyte system (MPS), liver,
302–303, 307
Moore, Francis D, 5f
fluid resuscitation, 5–6
hypermetabolic response, 7
nutritional support, 4–5
Morbidity, 377
Morphine, 721
Emergency Departments, 97
long-term use, 721
pediatric patients, 413
ventilator patients, 725
Mortality, 377, 421, 422t
adults, 157
burn extent vs., 39–40, 40f–42f
changes in, 35–39, 42f–44f, 43
elderly, 157–158
gender, 265
geriatric patients, 415
hydrofluoric acid, 458
inhalation injury, 175
outcome measurement, 708, 708f
pediatric patients, 157, 158t, 405, 406f,
410
trauma, 34
Mortality Probability Model (MPM), SIRS,
249
Mortality rates, 9, 10t
burn extent vs., 18–19
Motorcycle exhaust pipe burns, 27
Motor vehicle accidents (MVAs), 421
Mound reconstruction, breasts, 626–628,
628f–629f
Mouth
electrical burns, 444–445
full-thickness skin grafts, 593
Mouth erosion, exfoliative disorders, 477
Movement restriction, musculoskeletal
problems, 701
Moyer, Carl, 4
MPM (Mortality Probability Model), SIRS,
249
MPQ (McGill Pain Questionnaire),
716–717
MPS (mononuclear phagocyte system), liver,
302–303, 307
MRA (magnetic resonance angiography),
frostbite, 452
MRI see Magnetic resonance imaging (MRI)
MRSA see Methicillin-resistant Staphylococcus
aureus (MRSA)
MSDS (Material Safety Data Sheets), 456
MSOF see Multiple system organ failure
(MSOF)
MTP (metatarsophalangeal) joints, 671
Mucor, 142, 152
Mucosal barrier breakdown, gastrointestinal
tract complications, 423, 424f
Multidetector-row computed tomography
angiography (MDCTA), 592
Multidisciplinary teams, 9–14, 11f
anesthesiologists, 11, 173
burn surgeons, 10
communication, 12
dynamics of, 10t, 12–13, 12b
environmental service workers, 10
exercise physiologists, 11–12
fellows, 12
goals, 12
hospital administrators, 10
intentional injuries, 696
leadership, 12
management plans, 12
members, 10–12
see also specific members
nurses, 10–11
nutritionists, 11
patients/families, 10
psychological experts, 11
rehabilitation therapists, 11
residents, 12
respiratory therapists, 11
students, 12
Multidrug resistance (MDR), 141–142
Multimodal analgesia, mass casualty events,
73–74
Multiple blood transfusions, infection
control, 143
Multiple drug-resistant organisms (MDROs),
151
Multiple organ dysfunction syndrome
(MODS), 386–388, 484–493
acute renal failure, 369
cytokines, 387
etiology, 386–388, 387b
hypermetabolic response, 355
mortality, 377
pathophysiology, 386–388
prevention, 388–395
SIRS, 249, 386–387
two-hit theory, 387–388
Multiple system organ failure (MSOF), 387f
definition, 386–387
Multiple z-plasty, perineal band deformity
reconstruction, 667, 667f
Multisystem organ failure, 361–368
definition, 361, 362b
etiology, 361–362
immunomodulation, 367–368
mediators, 362–364
nutritional immunomodulation, 366–367
prevention, 364–366
gut barrier failure, 364t, 365–366
oxygen delivery, 364t, 366
sepsis prevention, 364–365, 364t
see also Multiple organ dysfunction
syndrome (MODS)
Munster, Andrew M, 1, 2f
Mupirocin (Bactroban), 155
Muriatic acid, 457
Muscle flaps, contractures, 638–639,
643f–644f
Muscle necrosis, 485–486
Muscle relaxants
non-depolarizing see Non-depolarizing
muscle relaxants
pharmacology, 185–186
Musculocutaneous (MC) flaps, 577–578
hand care/reconstruction, 648, 650f–651f
lower limb reconstruction, 682
34 z-plasty see Z-plasties, 34 (modified)
z-plasty, 577, 577f
Musculoskeletal system, 492, 551–564, 552b,
701
functional difficulties, 701
movement restriction, 701
see also specific diseases/disorders
Mustard gas
clinical features, 468
historical aspects, 467
MVAs (motor vehicle accidents), 421
Mycoplasma pneumoniae infection, 471
Mycostatin, 155, 164
Myeloid cells, 281
Myeloid growth factors, 284–285
Myeloid lineage hematopoiesis, 277
Myelopoiesis, norepinephrine, 294–295
Myocardial dysfunction, 110–111
Myofibroblasts
hypertrophic scars, 497–498, 498f, 515
mechanical stress, 498, 499f
origins, 500–501, 502f
Myoglobulinuria, electrical burns, 130, 435,
442–443

Index
773
N
NAC see Nipple-areola complex (NAC)
Naloxone, 367
Nanocrystalline silver, 70
NaOCl see Sodium hypochlorite (NaOCl)
Narcotics
geriatric patients, 417t
outpatient treatment, 85
see also specific drugs
Nasal deformity reconstruction, 611–612,
611f, 613f
Nasoduodenal tubes, 424t
Nasogastric tubes, 424–425, 424t
Nasojejunal tubes, 424–425, 424t
Nasolabial skin flaps, eyelids, 582, 585f
Nasotranspyloric tubes, 424–425
National Burn Repository (NBR), 18
National Disaster Medical System (NDMS),
58
National Poison Data System (NPDS), 455
Natural disasters, 78
Natural killer (NK) cells, 269
Natural killer T (NKT) cells, 269
Navar, P D, 6–7
NBR (National Burn Repository), 18
NDMS (National Disaster Medical System), 58
Neck
airway management, 398
anesthesia, 175
patient positioning, 519, 520f
see also Head and neck reconstruction
Neck contracture, 614–615
distant skin flaps, 615
free flaps, 591–592
groin flap, 591–592
local skin slaps, 614f, 615
prevention, 614
release, 614–615
skin flaps, 584, 586f
skin grafts, 607f, 614–615
Necrosis, muscle, 485–486
Necrotizing enterocolitis, 146–147, 428, 428f
Necrotizing fasciitis, 477–479, 479f
diagnosis, 478
management, 478–479
Neglect, 689
Nerve blocks, 720
Neurologic complications
electrical burns, 438
functional difficulties, 702
lightning strikes, 437
Neuromuscular dysfunction,
hypophosphatemia, 329
Neuronal nitric oxide synthases (nNOS), 262
Neuropathic pain management, 725
Neuropathy, peripheral, 438, 447
Neuropeptides, inhalation injury, 231
Neurovascular syndrome, acute radiation
syndrome, 464
Neutropenia, norepinephrine, 294–295
Neutrophils
adherence receptors, multisystem organ
failure, 363
diffuse alveolar damage, 488
glucocorticoid effects, 299
inhalation injury, 231
innate immune response, 268–269
lung parenchyma injury, 223
pulmonary system injury, 391
wound healing, 504, 507–508
News media, mass casualty communication,
68–69
New York City, New York (11 September
2001), 59, 59f
New Zealand, 34, 38t
NF-κB (nuclear factor-κB), 254, 255f
Nigeria, 35
Nikolsky’s sign, staphylococcal scalded skin
syndrome, 478
Nilstat, 155
9/11, 59, 59f
Nipple-areola complex (NAC), 623
reconstruction, 627f, 628–629
Nitric acid, 458
Nitric oxide (NO)
hypertension, 291
inhaled see Inhaled nitric oxide
multisystem organ failure, 364, 364f
multisystem organ failure therapy, 368
shock, 108
SIRS, 262, 262f
Nitric oxide synthase (NOS), 262
inhalation injury, 224–225
see also specific types
Nitrofurantoin (Furacin), 154–155
Nitrogen balance
hypermetabolic response, 356–357
nutritional support monitoring, 346–347
Nitrous oxide, 724–725
NK (natural killer) cells, 269
NKT (natural killer T) cells, 269
NLRs (NOD-like receptors), SIRS, 250–251,
252f
nNOS (neuronal nitric oxide synthases), 262
NO see Nitric oxide (NO)
NOD-like receptors (NLRs), SIRS, 250–251,
252f
NOHA (N-(ω)-hydroxy-nor-L-arginine),
224–225
Non-accidental burn injury
outpatients, 81, 82f
scald depth, 128
Non-adhesive dressings, 646–647
Non-burned tissue, edema, 106–107
Non-combat burns, military personnel, 26
Non-depolarizing muscle relaxants, 186
altered responses, 185
Non-displaced fractures, 555–556
Non-fatal injuries, 15
Non-latex polyester materials, serial casting,
527
Non-steroidal anti-inflammatory drugs
(NSAIDs)
electrical burn compartment syndrome,
443–444
heterotropic bone prevention/treatment,
558
outpatient treatment, 85
rehabilitative phase, 725
Non-thermal electrical burns, 441–442
Noradrenaline see Norepinephrine
Norepinephrine
cardiovascular system, 394
monocytosis, 294–295
myelopoiesis, 294–295
nerve-stimulated release, 293
neutropenia, 294–295
shock, 108, 109t
Norway, 34
NOS see Nitric oxide synthase (NOS)
NPDS (National Poison Data System), 455
NSAIDs see Non-steroidal anti-inflammatory
drugs (NSAIDs)
Nuclear factor-κB (NF-κB), 254, 255f
Nurses/nursing, 397–404
acute care, 397–401
burn wound care, 398–399
discharge planning, 401
enteral feeding, 400
evidence-based practice, 397
graft donor sites, 398–399
graft loss prevention, 398
inhalation injury, 397
intensive care units, 378
intubation, 398
leadership, 397
mechanical ventilation, 398
metabolic support, 400
multidisciplinary teams, 10–11
nutritional support, 400
nutrition care, 399
pain assessment, 400–401
pain management, 400–401
patient/family education, 401
pulmonary priorities, 397–398
reconstructive care, 403
skin assessment, 399
surgical care, 399–400
systemic hydration, 399
Nutren™, 337t–340t
Nutren 1.0, 337t–340t
Nutren 20™, 337t–340t
Nutritional supplements, 274
see also specific supplements
Nutritional support, 333–354, 337t–340t
arginine, 341
assessment, 334–336
branched-chain amino acids, 341
caloric requirement formulas, 334f,
335–336, 335t
carbohydrates, 336
complications, 347–350, 348t–349t,
351f–352f
azotemia, 348t–349t, 349
carbon dioxide overproduction, 349
dehydration, 348t–349t
essential fatty acid deficiency,
348t–349t
fatty liver, 348t–349t, 349
fluid overload, 348t–349t
hyperglycemia, 348t–349t, 350
hyperkalemia, 348t–349t
hypermagnesemia, 348t–349t
hypernatremia, 348t–349t
hyperosmolarity, 348t–349t
hyperphosphatemia, 348t–349t
hypokalemia, 348t–349t
hypomagnesemia, 348t–349t
hyponatremia, 348t–349t
hypophosphatemia, 348t–349t
overfeeding, 347–350
trace element deficiency, 348t–349t
vitamin deficiency, 348t–349t

Index
774
elderly, 337t–340t, 345
exfoliative disorders, 477
fats, 336–337, 337t–340t
geriatric patients treatment, 417
glutamine, 340–341
historical aspects, 4–5, 9
hypermetabolic response management,
357
immune-enhancing diets, 341–342
indirect calorimetry, 336
infants/pediatric patients, 345
initial assessment, 334
methods, 343–346
see also specific methods
micronutrients, 342
monitoring, 346–347
necrotizing fasciitis, 478–479
nursing, 399–400
obesity, 345–346
pediatric patients, 411–412, 412t
program development, 344–346, 345f
protein, 338–340
trace elements, 342
vitamins, 342
see also Hypermetabolic response
Nutritionists, multidisciplinary teams, 11
N-(ω)-hydroxy-nor-L-arginine (NOHA),
224–225
Nystatin, 155
O
O2
− see Superoxide cation (O2
−)
Oak Ridge Institute for Science and education
(ORISE), 462
Obesity, nutritional support, 345–346
Objective data, exercise evaluation, 540
Observational Pain Assessment Scale (OPAS),
717, 717t
Observer Scale, pediatric pain assessment, 717
Obstructive/restrictive disease, inhalation
injury, 248
Occupational exposure, radiation injuries,
467
Occupational therapy, exfoliative disorders,
477
Ohmeda (FAM) Model 885A, 74
Ohmeda Universal Portable Anesthesia
Complete (PAC), 74
Oil burns, scald depth, 128
Omega-6 fatty acids, 337
Omiderm, 164–165
ONOO− see Peroxynitrite (ONOO−)
On-site assessment, 93–94
primary assessment, 93–94
secondary assessment, 94
OPAS (Observational Pain Assessment Scale),
717, 717t
Open fasciotomy, electrical burn
compartment syndrome, 443–444,
444f–445f
Open fractures, osteomyelitis, 552–553
Operant conditioning, pain management, 728
Operating room, massive burn management,
165–166
Ophthalmic disorders
electrical burn complications, 447–448
exfoliative disorders, 477
infections, 147
vesicants, 467
Ophthalmic lubricants, eyelids, 172
Opioids, 721
anesthesia, 192
mass casualty events, 73
nurses, administration by, 400–401
Optimental™, 337t–340t
Oral cavity, low-voltage electrical burns,
437–438
Oral commissure, electrical burns, 611, 612f
Oral drugs, pharmacodynamics/
pharmacokinetics, 148–149
Oral fluid replacement
hypophosphatemia treatment, 330
mass casualty events, 71–72
Oral resuscitation, radiation injuries, 465,
465t, 466f
Oral resuscitation solution (ORS), 71
Organ ischemia, 111–112
Organizational ethics, 686
Organization phase, mass casualty events, 64
Oropharyngeal exfoliative disorders,
473–474, 474f
Oropharynx injury
edema, 220, 220f
inhalation injury, 219–220
ORS (oral resuscitation solution), 71
Orthopedic injuries, 422
Osmolite, 337t–340t
Osmotic reflection coefficient (σ), 106
Osteoblasts, 316–317
Osteomyelitis, 552–554
electrical burns, 444
fractures, 555
hematogenous, 554
open fractures, 552–553
Staphylococcus aureus infection, 149
traction pins, 553
Osteopenia, hypermetabolic response, 565
Osteoporosis, 551, 552f–553f
heterotropic bone, 556
hypermetabolic response, 565
Otoform K™, 534–535
Outcome analysis, 35–45
burn extent, 35
Outcome measurement, 707–710
cost-containment, 710–714
hypermetabolic response modulation,
709
length of stay, 708
mortality, 708, 708f
quality of life see Quality of life (QoL)
Outdoor recreational fires, 27
Outpatients, 81–92
age groups, 81–82
burn depth, 82
burn distribution, 83–84, 84f
burn extent, 82
chemical burns, 84
co-morbidities see specific complications
electrical burns, 84
injuring agent, 84
non-accidental burn injury, 81, 82f
patient characteristics, 81–84
premorbid disease, 82–83
pruritus, 91
respiratory complications, 83
social circumstances, 84
therapeutic exercise, 539
trauma, 83
treatment, 84–91
biologic wound dressing, 88–89
blisters, 85–86
cooling the burn, 84–85
elevation, 89–90
follow-up care, 90
instructions, 90
local care, 85–87
major burns, 91–92, 92t
moderate burns, 91–92, 92t
pain control, 85
reepithelialized wounds, 91
rehabilitative physical care, 91
synthetic tissue-engineered dressing, 89
systemic antibiotics, 90–91
topical agents, 87–88
wound cleansing, 86–87
wound closure, 90
wound dressing, 88
Overfeeding, nutritional support
complications, 347–350
Over-resuscitation, pediatric patients, 409–410
Oxalic acid, 458
Oxandrolone
catabolic response management, 567
geriatric patients, 417
hypermetabolic response management,
358, 359f, 360t
Oxidation, chemical burns, 455
Oxycodone, 723
Oxygen
humidified, 234
mass casualty events, 74
mechanical ventilation monitoring, 386
multisystem organ failure, 364t, 366
transport alterations, blood transfusions,
196
Oxygen consumption, 182
Oxygen debt, shock, 180
Oxygen free radicals
multiple organ dysfunction syndrome, 387
multisystem organ failure, 364
multisystem organ failure therapy,
367–368
shock, 108, 109t
P
p38 MAPK, 423–424
Packed red blood cells (PRBC), 193–194
whole blood transfusions vs., 194t
PACs see Pulmonary artery catheters (PACs)
Padgett, E C, 3
PAF see Platelet-activating factor (PAF)
Pain assessment, 716–718
adults, 716–717
nursing, 400–401
pediatric patients, 717–718, 718b
Pain generation, 715–716
Pain management, 715–732
electrical burns, 436
Emergency Departments, 97
exfoliative disorders, 476–477
geriatric patients treatment, 417–418
injury pathology, 715–716

Index
775
mass casualty events, 73–74
neuropathic pain, 725
non-pharmacological methods, 726–730
classical conditioning, 726–728
cognitive interventions, 728–729
cooling effects, 84–85
empirical support, 730
hypnosis, 729
operant conditioning, 728
virtual reality, 729
virtual reality hypnosis, 730
nursing, 400–401
outpatients, 85
pediatric patients, 413
pharmacology, 719–725, 720t
acute phase, 720t, 721–725,
722b–723b
emergency phase, 719–721, 720t
rehabilitative phase, 720t, 725
ventilator patients, 725
postoperative airway management, 198
psychosocial recovery, 746
radiation injuries, 465
see also specific drugs
PALS (Pediatric Advanced Life Support), 120
Pamidronate, 318
Pancreatitis, 427, 491, 491f
Paraffin, scar treatment, 536
Paralytic ileus, 424–425
Paratenon cutaneous z-plasty, 578, 578f
modified (34) see Z-plasties, 34 (modified)
Parathyroid hormone (PTH)
bone metabolism, 316–317
resistance, 313
Paré, Amboise, 1
wound healing, 507
Parenteral nutrition
complications, 351–352
enteral nutrition vs., 343–344
Parkland formula, 112
fluid resuscitation, 122, 122f, 181
historical aspects, 5–6
PARP (poly-adenosyl-ribose polymerase),
inhalation injury, 231, 489
Partial-thickness burns
allografts (homografts), 202
breast reconstruction, 624
contraction/epithelization healing, 599,
600b
genital burns, 172
pain management, 715
scald burns, 129
wound healing, 508
Partial thickness skin grafts see Split (partial)
thickness skin grafting (STSG)
Passive range of motion exercise, 537
Passive strategies, prevention of burns, 49
Passive stretching, 536
Pathophysiology of burns, 115–117, 126,
126f, 173, 174f, 174t, 483–494
circulatory effects, 178–179
infections, 137–138
Patient-controlled analgesia (PCA)
acute phase, 721
contraindications, 721
dressing changes, 721
Patient decision-making capacity, ethical
problems, 684–686
Patient positioning, 517–527
ankle, 525–526
axilla, 521–522
burn extent, 517–518
contractures, 632–635, 633f–634f
dislocation prevention, 561–562
elbow, 522, 633, 633f
foot, 525–526
forearm, 522
glenohumeral joint, 521
hand, 522–524, 523f
head, 519, 520f
hip, 524, 525f, 633
knee, 524–525, 633, 634f
neck, 519, 520f
prone positioning, 518, 518f
serial casting, 526–527, 527f
shoulder girdle, 521–522, 521f, 633
side-lying position, 518
spine, 521, 521f
supine position, 518
wrist, 522–524, 633, 633f
Patients
ethical problems, 684–685
multidisciplinary teams, 10
PBB (protected bronchial brush), pneumonia,
145–146
Pc (capillary pressure), edema, 105
PCA see Patient-controlled analgesia (PCA)
PCIRV (pressure control inverse ratio
ventilation), 244
PCWP (pulmonary capillary wedge pressure),
121
PDGF see Platelet-derived growth factor
(PDGF)
PDL (pulsed-dye laser), hypertrophic scars,
602–603, 604f
Peak heart rate (HRpeak), 542
Peak oxygen consumption, 540
Pectoralis major muscle, 623
Pediasure Enteral™, 337t–340t
Pediatric Advanced Life Support (PALS), 120
Pediatric patients, 20–23, 47–48, 405–414
ambient humidity, 411
ambient temperature, 411
amputation, 563
carbon monoxide poisoning, 410
carboxyhemoglobin, 410, 411t
cardiac output, 409–410
contact burns, 129
cooking injuries, 23
edema, 410
electrical burns, 445
epidemiology, 405
ethnicity, 23
extensive exercise, 402–403
fractures, 554
growth, 412
hemorrhage, 410
hypermetabolic response, 410–412
hypothermia, 411
inhalation injury, 410, 411t
in-hospital psychiatric disorders, 736
initial evaluation, 405–406
intentional injuries see Intentional injuries
low-voltage electrical burns, 437–438,
438f
management, 413
airway management, 410
comfort care, 727b
dextran resuscitation solutions,
119–120, 120t
fluid resuscitation, 120, 406–408, 407f,
408t, 409f
home exercise treadmills, 23
hypertonic saline, 119
intubation, 410
nutritional support, 345, 411–412, 412t
over-resuscitation, 409–410
pain management, 413, 719
surgical management, 412–413,
412f–413f
therapeutic exercise, 566
topical antimicrobials, 412–413
mass casualty events, 71, 71t
mortality, 157, 158t, 405, 406f, 410
pain assessment, 717–718, 718b
prevention, 413–414
psychiatric disorders see Psychiatric
disorders
resuscitation assessment, 408–410
scald burns, 20–23, 405
tap-water scalds, 23
thermoregulation, 411
toe contractural deformities, 671, 672f
urinary catheters, 409
vascular access, 189
Pediatric Vionex™, 337t–340t
PEEP see Positive end-expiratory pressure
(PEEP)
PEG (polyethylene glycol), carbolic acid
(phenol), 456
Pelnac, 647
Penicillinase-resistant penicillins,
Staphylococcus aureus infection, 149
Penicillins, extended-spectrum, 151–152
Penicillium, 152
Penis burns, 661, 662f
foley catheters, 661
reconstruction, 663–665, 665f–666f
skin loss, 661, 662f
Pentoxyfylline, frostbite, 451
Peptamen AF™, 337t–340t
Percussion, chest physiotherapy, 240, 240f
Perforator skin flaps, 682
Perfusion, wound healing, 511
Perianal burns, 172
Pericapsular structures, 556–561
heterotropic bone see Heterotropic bone
Perineal injuries, 661–670
acute phase injury, 661–663
band deformity reconstruction, 665–667
deformity reconstruction, 663–667
wound coverage, 662, 663f
see also specific anatomical features
Perioperative optimization, geriatric patients,
418
Perioral deformities, 605, 606f
Peripheral neuropathy, electrical burns, 438,
447
Peripheral tissues, thermoregulation, 183
Peripheral vasoconstriction, thermoregulation,
183–184
Peritoneal dialysis, acute renal failure
treatment, 390–391
Perivate™, 337t–340t

Index
776
Permanent skin substitutes, 212–213
Peroxisome proliferator-activated receptor-γ
(PPAR-γ) agonists, 359
Peroxynitrite (ONOO−)
inhalation injury, 231
shock, 109t
SIRS, 262
Persistent management, ethical problems,
685, 685t
Personality disorders, pediatric patients, 738
Phagocytes, 267–268, 267f
Phalangeal deformities, 648–654
extension contractural deformities,
652–653, 653f
first web space contracture, 653–654, 655f
flexural contractural deformities, 648–652,
652f
web space contracture, 653–654, 654f
Phantom pain, amputation, 530
Phantom sensation, amputation, 530
Pharmacodynamics
burn effects, 184
clearance, 185
hepatic clearance, 185
infection control, 148–149
renal clearance, 185
volume of distribution (Vd), 185
Pharmacokinetics
burn effects, 184
infection control, 148–149
Pharmacology
bronchial hygiene therapy, 241–242
hypermetabolic response management,
358
immunodepression, 266
Phenol (carbolic acid), 456
Phoenix Society for Burn Survivors, 752–753
Phosgene, 225t, 227–228
Phosgene oxime, 459
clinical features, 468
Phosphate
homeostasis, 314–315
see also Hypophosphatemia
metabolic actions, 313
Phospholipids, liver, 303
Phosphoric acid, 458
Physical abuse, 689
see also Intentional injuries
Physical examination, inhalation injury
diagnosis, 230
Physician assessment, intentional injuries,
692b, 695–696
Physiological monitoring, 327
mass casualty events, 72
Physiotherapy, exfoliative disorders, 477
PiCCO (pulse contour cardiac output),
pediatric patients, 409–410
Pif (interstitial hydrostatic pressure), 105–106
Pinch grafts, historical aspects, 3
Piper Alpha, North Sea (6 July 1988), 63
πif (interstitial colloid osmotic pressure), 106
Πp (plasma colloid osmotic pressure), 106
Planning
extensive exercise in pediatric patients,
402–403
reconstructive care, 403
work-hardening programs, 402
Plantar flexion deformities, toes, 675
Plantar surface deformities, foot, 675
Plant enzymes, enzymatic wound
debridement, 132
Plasma colloid osmotic pressure (πp), 106
Plasma exchange, fluid resuscitation failure,
123
Platelet-activating factor (PAF)
multisystem organ failure, 363, 367
shock, 109t, 110
SIRS, 254
Platelet-derived growth factor (PDGF)
decorin, 495–496
hypertrophic scars, 503
wound healing, 507–508
Platelets, 281–282
Platelet transfusions, 195, 282
radiation injuries, 466
PMN (polymorphonuclear cells), lung
parenchyma injury, 223
Pneumonia, 145–146, 145f
multisystem organ failure prevention, 365
Staphylococcus aureus infection, 149
Poland, 36t–37t
Polihexanide, 70
Pollock, George David, 3
Poly-adenosyl-ribose polymerase (PARP),
inhalation injury, 231, 489
Polyethylene glycol (PEG), carbolic acid
(phenol), 456
Polymorphonuclear cells (PMN), lung
parenchyma injury, 223
Polymyxins, 164
Gram-negative organism treatment, 151
Polysporin (bacitracin/polymyxin), 154
Polyurethane membranes, scald burn
management, 164–165
Pope Army Airfield, North Carolina (23
March 1994), 62f
Portable monitors, transport/transfer, 101
Positioning see Patient positioning
Positive end-expiratory pressure (PEEP), 177,
381, 382f
applications, 243
see also specific diseases/disorders
inhalation injury treatment, 235
mechanical ventilation, 246
pulmonary system treatment, 392
Positive self-talk, pain management, 729
Post-discharge rehabilitation, psychosocial
recovery, 748–749, 751–753
Posterior tibial artery catheters, 189
Postoperative management, mass casualty
events, 73–74
Post-thaw evaluation, frostbite, 451–452
Post-traumatic Growth Inventory, 740
Post-traumatic stress disorder (PTSD), 737,
749
diagnostic criteria, 735t
in-hospital adult disorders, 735
sleep patterns, 737
treatment, 738–739
Potassium abnormalities, 196
see also Hyperphosphatemia;
Hypophosphatemia
Povidone–iodine, mass casualty events, 70
Povidone-iodine (Betadine), 154
PPIs (proton pump inhibitors), stress gastritis,
425
PRBC see Packed red blood cells (PRBC)
Pre-existing lung disease, inhalation injury,
236
Pre-existing malnutrition, 334
Pregnancy, breast reconstruction, 624
Pre-hospital care, 93
see also On-site assessment
Pre-injury adjustment, psychosocial recovery,
745
Preload, 391f, 393
adjustment, 394
Premedication, serial casting, 527
Premorbid disease, outpatients, 82–83
Preparatory prostheses, 528–529
Preparedness, mass casualty events, 78–79
Pressure control inverse ratio ventilation
(PCIRV), 244
Pressure control mechanical ventilation,
243
Pressure dressings, 634–635
Pressure garments, 572–573
Pressure support ventilation (PSV), 243–244,
383–384, 383f
Pressure therapy, nipple-areola complex
reconstruction, 628
Pre-surgical evaluation, contractures,
637–638
Prevention of burns, 47–56
burn magnitude, 47–48
epidemiology (of burns), 47–48
evaluation, 54
fire sprinklers, 53–54
flammable clothing, 50–51
frostbite, 450
general strategies, 49–50, 50t
haddon matrix, 49t
historical perspective, 47
passive strategies, 49
pediatric patients, 413–414
primary prevention, 50
risk factors, 48–49
secondary prevention, 50
smoke detectors/alarms, 52–53
tertiary prevention, 50
Primary assessment, 93–94, 422
Primary closure
alopecia correction, 618, 619t
contractures, 638
wound healing, 507
Primary prevention of burns, 50
Primary transfer, burn centers, 76
Primary treatment, mass casualty events,
76–77
Primary wound closure
hand care/reconstruction, 648
reconstructive surgery, 573
Privacy issues, Emergency Departments, 98
Procalcitonin, 256–257
Procedure Behavior Check List, 717
Professional relationships, intentional
injuries, 697
Profibrotic cytokines, 497
Progenitor cells
β-adrenergic stimulus, 295–296
growth factors, 283–284
hematopoiesis, 277–278
Progressive overload, resistive training,
546–547

Index
777
Pro-inflammatory cytokines
bone metabolism, 316
catecholamines, 293
erythropoiesis effects, 279
liver metabolism, 307
SIRS, 250, 252–253
Project Burn Prevention, 50
Proliferative stage, wound healing, 509
Prolonged anemia of critical illness, 279
Promote™, 337t–340t
Prone positioning, 518, 518f
pulmonary system treatment, 392
Propofol, 724
mass casualty events, 73
Propranolol
cardiovascular system, 394
hypermetabolic response, 292, 358, 359f,
360t, 566
post-traumatic stress disorder treatment,
739
Prostacyclin PGI2
multisystem organ failure, 363
shock, 107–108, 109t, 116
Prostaglandin(s)
frostbite, 451
shock, 107–108
Prostaglandin E2 (PGE2), 107–108, 109t, 116
Prostetic Foam™, 534–535
Prostheses, 528–530, 531f
amputation, 563
breast mound reconstruction, 626
components, 529t
cosmetic, 529
definitive, 528–529
lower extremity, 530
preparatory, 528–529
sensorimotor limitations, 528
upper extremity, 529, 530t
see also specific prostheses
Protected bronchial brush (PBB), pneumonia,
145–146
Protein, total parenteral nutrition, 342
Protein binding, drugs, 185
Protein C, 282–283
coagulation pathway, 259, 259f
Protein metabolism
glucocorticoids, 298–299
hypermetabolic response, 333
liver, 303–304, 307–308, 307f
nutritional support, 338–340
Protein S, 282–283
Proteoglycans
dermis, 126
extracellular matrix, 495–497
Proteolytic cascades, shock, 116
Proteus infection, 151
Prothrombin time (PT)
disseminated intravascular coagulation,
283
liver, 304
Proton pump inhibitors (PPIs), stress gastritis,
425
Protoplasmic poisons, chemical burns, 455
Proximal interphalangeal joint, 671
dislocation, 561
Pruitt, Basil A, 6f
inhalation injury, 6–7
Pruritus see Itching
Pseudomonas
enzymatic wound debridement, 132
infection control, 137–138
multidrug resistance, 141–142
Pseudomonas aeruginosa infection, 151
exfoliative disorders, 471
hematopoiesis, 295
necrotizing enterocolitis, 428
vaccination, 275
see also Erythema gangrenosa
PSV (pressure support ventilation), 243–244,
383–384, 383f
Psychiatric disorders, 733–742
comorbidities, 738
diagnosis, 738
in-hospital adult disorders, 734–735
itching, 734
long-term, 736–738
pediatric patients, 734, 738
in-hospital, 736
treatment, 739–740
post-traumatic growth, 740
pre-existing, 733–734
resilience, 740
self-immolation, 734
sleep problems, 734
social (family) disorders, 734
treatment, 738–740
see also specific diseases/disorders
Psychological experts, 11
Psychological interventions, psychosocial
recovery, 746
Psychological problems, 703
pain generation, 715–716
Psychosocial assessment, intentional injuries,
696–697, 696b
Psychosocial recovery, 743–754, 744f
admission crisis, 745–746
assessment, 745
critical care phase, 746–747
cultural sensitivity, 744–745
distress manifestations, 749–751
grief therapy, 743–744
in-hospital recuperation phase, 747
intervention, 745
longitudinal recovery, 745–749
physical treatment with, 743
post-discharge rehabilitation, 748–749,
751–753
pre-injury adjustment, 745
reintegration phase, 747–748
Psychotherapy, post-discharge rehabilitation,
752
PT see Prothrombin time (PT)
PTH see Parathyroid hormone (PTH)
PTSD see Post-traumatic stress disorder (PTSD)
PU.1, 286–287
Puerperal sepsis, Staphylococcus aureus
infection, 149
Pulmocare™, 337t–340t
Pulmonary artery catheters (PACs)
anesthesia monitoring, 188
cardiac output, 380
fluid resuscitation monitoring, 121
Pulmonary capillary wedge pressure (PCWP),
121
Pulmonary complications, blood transfusions,
196
Pulmonary function
anesthesia, 175–178
inhalation injury, 236–237
Pulmonary priorities, nursing, 397–398
Pulmonary system failure, 391–393
epidemiology, 391–392
pathophysiology, 391–392
treatment, 392–393
see also specific diseases/disorders
Pulmonary transvascular fluid flux, inhalation
injury, 223
Pulmonary vascular hemodynamics, fluid
resuscitation monitoring, 121
Pulmonary vascular resistance (PVR), 111–112
Pulse contour cardiac output (PiCCO),
pediatric patients, 409–410
Pulsed-dye laser (PDL), hypertrophic scars,
602–603, 604f
Pulse oximetry
inhalation injury diagnosis, 230
mass casualty events, 72
primary assessment, 422
Purpura fulminans, 477, 479–481
PVR (pulmonary vascular resistance), 111–112
Pyridoxine see Vitamin B6 (pyridoxine)
Q
QA (quality assurance), cost-containment,
711b, 711f
QALY (Quality Adjusted Life Years), 709
QoL see Quality of life (QoL)
Quality Adjusted Life Years (QALY), 709
Quality assurance (QA), cost-containment,
710–712, 711b, 711f
Quality of life (QoL), 699, 700f, 709–710,
709b, 751
evaluation, 709
predictors, 751
Quantitative wound cultures (QWC), 145–146
Quetiapine fumarate, 739
QWC (quantitative wound cultures), 145–146
R
Racemeric epinephrine, 242
bronchial hygiene therapy, 242
Radial artery catheters, 379
Radiation
electromagnetic, 461
particulate, 461
units, 461–462
Radiation absorbed dose (rad), 461–462
Radiation Emergency Assistance Center/
Training Site (REAC/TC), 462
Radiation injuries, 461–462
acute radiation syndrome, 464
complication management, 466–467
historical aspects, 461
incidence, 462–463, 462t
medical imaging, 463
occupational exposure, 467
pathophysiology, 463–464
localized injuries, 463–464
radiation effect, 463
thermal effects, 463
shielding devices, 467
terminology, 461–462

Index
778
treatment, 464–467
assessment, 465
first aid, 464–465
oral resuscitation, 465, 465t, 466f
wound care, 465–466
triage, 464, 464t
Radiography
contracture evaluation, 637
heterotropic bone, 558, 559f
Radiological dispersal device (RDD), 463
Radionuclide studies, inhalation injury,
230–231
Ramstein, West Germany (28 August 1988),
61–62, 62f
Random cutaneous skin flaps, 581, 583f
lower face deformities, 590
Range of motion
blisters, 85–86
soft casting technique, 85–86, 86f–87f
rAPC (recombinant activated protein C), 368
Rated perceived exertion (RPE)
aerobic exercise, 542–543
exercise evaluation, 540
exercise testing, 540
RDD (radiological dispersal device), 463
Reactive nitrogen species (RNS)
inhalation injury, 231
oropharynx injury, 220
Reactive oxygen species (ROS)
inhalation injury, 231
oropharynx injury, 220
stress gastritis, 425
Recombinant activated protein C (rAPC), 368
Recombinant erythropoietin, 280
Recombinant human growth hormone
(rhGH), 358, 359f, 360t
Recombinant human parathyroid hormone
(rhPTH), 319
Reconstructive surgery, 571–580
burn depth, 571
burn extent, 571, 572f
early treatment, 571, 572f
indications, 572–573
injury assessment, 571–578
nurses, 403
primary wound closure, 573
principles, 571
skin grafting see Skin grafting
techniques, 573–578
timing, 572–573
see also specific techniques/procedures
Recreational activities, 542
Rectal prolapse, 662–663, 664f
reconstruction, 667, 669f
Rectus abdominis muscle, 623
Red blood cells, generation, 278
Reduction, chemical burns, 455
REE (resting energy expenditure), 336
Reepithelialized wounds, 91
Reflex sympathetic dystrophy, electrical burns,
447
Reflex tachycardia, 408–409
Refrigeration, skin banks, 206
Regulatory T cells (Treg), cytokines, 273
Rehabilitation, 401–403, 517–550
evaluation, 517
extensive exercise in pediatric patients,
402–403
geriatric patients, 418
lower extremity orthotics, 526
lower limb reconstruction, 677–682
mass casualty events, 67
outpatient physical care, 91
patient/carer education, 548–549
pediatric patients, 413
positioning see Patient positioning
prostheses see Prostheses
splinting see Splinting
therapeutic exercise see Therapeutic
exercise
therapists, 11
work-hardening programs, 401–402
Reintegration phase, psychosocial recovery,
747–748
Reiss, E, 5–6
Rejection, allografts (homografts), 203
Relaxation monitoring, mass casualty events,
72
Relaxation techniques, pain management, 728
Release, neck contractures, 614–615
Remifentanil, 723
Remote incision, tissue expansion, 620
Renal clearance, pharmacodynamics, 185
Renal disorders, exfoliative disorders,
473–474
Renal failure
acute see Acute renal failure (ARF)
electrical burns, 443
Renal function, anesthesia, 182
Renally-excreted drugs, pharmacodynamics/
pharmacokinetics, 148–149
Renal replacement therapy (RRT), 374–376
Repetitions, resistive training, 545
Replete™, 337t–340t, 341
Reserpine, 451
Residential death rate, 20
Residents, multidisciplinary teams, 12
Resistance, electrical burns, 433–434
Resistance exercise, 566
Resistive training, 544–547
contraction type, 545
exercise order, 546, 546f
exercise type, 545
frequency, 545
load amount, 545
progressive overload, 546–547
repetitions, 545
rest periods, 546
set number, 545
Resource optimization, cost-containment,
712–714
Respiratory alkalosis, 326
Respiratory care, 239–248
bronchial hygiene therapy see Bronchial
hygiene therapy
mechanical ventilation see Mechanical
ventilation
Respiratory quotient (RQ), 336
Respiratory rate, mechanical ventilation, 245
Respiratory support, anesthesia, 177
Respiratory system, 486–487
functional difficulties, 702
innate immune response, 266–267
Respiratory system problems
lightning strikes, 437
outpatients, 83
Respiratory therapists, multidisciplinary
teams, 11
Restaurant workers, 28
Resting energy expenditure (REE), 336
Rest periods, resistive training, 546
Resuscitation
hypophosphatemia, 325–326
primary treatment, 66
Retinol see Vitamin A (retinol)
Reverdin, J P, 3
Reverse flow skin flaps, lower limb
reconstruction, 682
Rewarming, skin banks, 207
Rhabdomyolysis
acute renal failure, 371
electrical burn reconstruction, 442–443
rhGH (recombinant human growth
hormone), 359f, 360t
Rhizomucor, 152
Rhizopus, 152
rhPTH (recombinant human parathyroid
hormone), 319
Riboflavin see Vitamin B2 (riboflavin)
Rickets, 316
Rifampicin, 150
RIFLE criteria, 389
acute renal failure, 369, 370f
Ringer’s lactate, 95
Ritter’s disease, 477–478
RNS see Reactive nitrogen species (RNS)
Rocker bottom foot, 526
Rocuronium, 186
Rolyan Ezemix™, 534–535
Romania, 36t–37t
ROS see Reactive oxygen species (ROS)
Rosenberg knife, 158–159
RPE see Rated perceived exertion (RPE)
RRT (renal replacement therapy),
374–376
Rule of nines, 83t
Emergency Department assessment, 95,
96b, 96f–97f
mass casualty events, 70–71
outpatient, 82
triage, 64
Russian Federation, 36t–37t
S
Safety issues, intentional injuries, 698
SAIFE (Smoke Alarm Installation and Fire
Safety Education) Program, 20
San Juanico, Mexico (19 November 1984),
62–63
SAPS (Simplified Acute Physiology Severity),
SIRS, 249
Satellite telephone, 68
Scalds
causes, 26
depth of, 128
elderly, 24
epidemiology, 18, 51
evaluation, 128–129
genital burns, 172
management, 164–165
allografts, 413
xenografts, 413
partial-thickness, 129

Index
779
pediatric patients, 20–23, 405
prevention of, 51
Scalp burn management, 169–170
bone loss, 169–170
Scalp contact, electrical burns, 437, 444–445
Scar(s), 530–539
assessment, 532
breast reconstruction, 625–626
contracture problems see Contractures
description, 701
formation of, 571, 572f
functional sequelae, 701
historical aspects, 530–532
hypertrophic scars vs., 514
impairment, 702
release, 625–626
resurfacing, 625–626
treatment, 532–533
inserts, 534–535, 535f
massage, 535–536
pressure therapy, 532–534, 533f–534f
therapeutic exercise see above
see also Rehabilitation
wound healing, 511–515, 512f
see also Extracellular matrix (ECM); Wound
healing; specific types
Scarce resources, ethical problems, 687
SCCM (Society of Critical Care Medicine),
138
School re-entry, reintegration, 748
Scintigraphy, frostbite, 452
Scrotum, deformity reconstruction, 665
SDD (selective decontamination of the
digestive tract), 274–275
Search and rescue services, 64
Secondary on-site-assessment, 94
Secondary transport, mass casualty events, 67
Second degree burns see Partial-thickness
burns
Second-line hospitals, mass casualty events,
65
Sedation
complications, 723
endoscopy, 723–724
geriatric patients treatment, 417–418
postoperative airway management, 198
training programs, 724
see also Anesthesia
Selection, transport/transfer, 99
Selective decontamination of the digestive
tract (SDD), 274–275
Selective serotonin reuptake inhibitors
(SSRIs)
anxiety treatment, 739
pediatric anxiety treatment, 740
post-traumatic stress disorder treatment,
739
Selenium, 323
nutritional supplements, 274
requirements, 324t
Self-immolation, 31, 695
psychiatric disorders, 734
Self-inflicted intentional injuries, 695
Self-report scales, pediatric pain assessment,
717
Sensorimotor limitations, prostheses, 528
Sensory deficits, 702
functional sequelae, 700–701
Sensory nerve damage, pain generation, 715
Sepsis, 145
acute renal failure, 371–372
definition, 374–375, 374b
diagnosis, 388
multisystem organ failure, 361
prevention, multisystem organ failure,
364–365, 364t
Septic arthritis, 562–563
Septic shock, hypertension, 291
Serial casting, 526–527, 527f
Serology, skin bank donor screening, 205
Serotonin, shock, 108, 109t, 116
Serratia marcescens infection, 151
Sertraline, 739
Serum proteins, nutritional support
monitoring, 347
Set number, resistive training, 545
Severe sepsis, 250
Severe soft tissue infection (SSTI), 140
Sevoflurane, 192
Shaffer, P A, 4
Shaking, chest physiotherapy, 240, 241f
Shanghai, 24
Shielding devices, radiation injuries, 467,
467t
Ships/boating accidents, 27
Shires, G Tome, 5f
fluid resuscitation, 5–6
Shitani, K S, 6–7
Shock, 103–114
animal studies, 103
clinical studies, 103
definition, 103
development of, 178
historical aspects, 103
inflammatory mediators, 107–110, 109t,
115–116
see also specific mediators
oxygen debt, 180
pathophysiology, 115
resuscitation from, 117–120
see also Fluid resuscitation
treatment, studies, 116–117
Shoulder (axillary) contracture, 631–632
airplane splint, 634f, 635
figure-of-eight wrapping, 634–635, 634f,
636f
incidence, 631, 632t
patient positioning, 633
splinting, 631–632, 632t
surgical management, 635
Shoulder dislocation, 562
Shoulder girdle, patient positioning, 521–522,
521f
Shur-Clens® Skin Wound cleanser, 86
Sicca syndrome, 472–473
Side-lying patient positioning, 518
Sievert (Sv), 461–462
Silicone inserts, 534
Silvadene see Silver sulfadiazine cream
(Silvadene)
Silver nitrate (AgNO3), 153
mass casualty events, 70
Silver sulfadiazine cream (Silvadene),
153–154
electrical burns, 436
historical aspects, 4
mass casualty events, 70
outpatients, 87–88
Simplified Acute Physiology Severity (SAPS),
SIRS, 249
SIMV (synchronized intermittent mandatory
ventilation), 243, 383, 383f
Single parent households, burn epidemiology,
48
Sinusitis, suppurative see Suppurative sinusitis
SIRS see Systemic inflammatory response
syndrome (SIRS)
Size of burns see Burn extent
Skate flap, nipple-areola complex
reconstruction, 628
Skeletal injury, electrical burns, 448
Skeletal suspension and traction, 527–528
fractures, 554, 555f
hand burns, 527, 528f
Skeletal traction
elbow contracture, 636, 637f
knee contracture, 636, 637f
Skin
aging, geriatric patients, 416
assessment, nursing, 399
barrier function loss, 209
basement membrane zone, 125
dermis, 125–126
epidermis, 125
function, 209
functional sequelae, 701
stratum corneum, 125
stratum lucidum, 125
structure, 125–126, 209
Skin banks, 199–208
American Association of Tissue Banks,
203
cryopreservation, 206
donor screening, 204–205, 204b
FDA regulation, 207
future work, 207
growth of, 203, 204f
historical aspects, 3, 199–200
irradiation, 207
lyophilization, 206
microbiologic testing, 205–206
refrigeration, 206
rewarming, 207
skin processing, 205–206
skin recovery, 205
technical aspects, 204–207
transport, 207
viability maintenance, 206
see also Allografts (homografts)
Skin flaps, 574–575, 581–584
ankle contracture, 584, 588f
axial skin flap, 575, 575f, 581, 583f
axilla contracture, 584, 587f
elbow contracture, 584
eyelids, 582
hand care/reconstruction, 648
head and neck reconstruction, 604
interposition see Interposition skin flaps
knee contracture, 584
lower face deformities, 593–594,
594f–595f
lower limb, 671
modified (34) z-plasty, 575, 576f
neck contracture, 584, 586f

Index
780
random cutaneous see Random cutaneous
skin flaps
reverse flow, 682
transpositional, 652–653
transverse rectus abdominis myocutaneous
flap, 626
transverse upper gracilis flap, 626
trident flap technique, 653–654, 655f
wrist contracture, 584
z-plasties see Z-plasties
Skin grafting, 573–574, 581
breast reconstruction, 624
contractures, 634–635, 639f
donor sites
nursing, 398–399
skin procurement, 162–164
eyelids, 592–593
free skin graft with dermal template,
573–574, 575f
free skin graft without dermal template,
573, 574f
full thickness see Full-thickness skin grafts
(FTSGs)
ghosting, 138–139
hand care/reconstruction, 647–648,
649f
head and neck reconstruction, 603–604
historical aspects, 3–4
knee flexion deformities, 675–677, 679f
loss prevention, 398
lower limb, 671, 682
melting, 138–139
neck contractures, 607f, 614–615
outpatient treatment, 89
split (partial) thickness see Split (partial)
thickness skin grafting (STSG)
wound healing, 511
Skin-muscle flaps, contractures, 638–639,
642f–643f
Skin necrosis, radiation injuries, 463–464
Skin processing, skin banks, 205–206
Skin procurement
donor sites, 162–163
wound closure, 162–164
Skin recovery, skin banks, 205
Skin ulceration, radiation injuries, 463–464
Skull, electrical burns, 444–445
SLED (sustained low-efficiency dialysis), 375
Sleep problems
post-traumatic stress disorder, 737
psychiatric disorders, 734
treatment, 739
Small bowel feeding tubes, 424t
Small burns, excision of burns, 158
SMA (superior mesenteric artery) syndrome,
427, 427f
Smith papyrus, 1
Smoke, chemical agents, 220–221
Smoke Alarm Installation and Fire Safety
Education (SAIFE) Program, 20
Smoke detectors/alarms, 52–53
Smoking, 47–48
as cause, 19
epidemiology, 51
prevention of burns, 51–52
Sneve, H, 7
SOC-3 (suppression of cytokine signaling-3),
270–271
Social environment, psychosocial recovery,
748
Social (family) psychiatric disorders, 734
Social skill programs, reintegration, 747–748
Society of Critical Care Medicine (SCCM),
138
Socioeconomics, 707
burn epidemiology, 19, 48
Sodium hypochlorite (NaOCl), 153
historical aspects, 4
mass casualty events, 70
Sodium lactate, hypophosphatemia therapy,
325–326
Sodium nitrite, cyanide poisoning treatment,
178, 233
Soft casting technique, range of motion,
85–86, 86f–87f
Soft tissue infections, 477–481
see also specific infections
South America, 39t
South Korea, 38t
Specimen collection/transport, infection
control, 148
Speech, functional difficulties, 702
Spinal cord injury
electrical burn complications, 447
primary assessment, 94
Spine, patient positioning, 521, 521f
Spirometry, inhalation injury treatment, 233
Splanchnic hypoperfusion
gastrointestinal tract complications, 423
necrotizing enterocolitis, 428
Splenomegaly, 146–147
Splinting, 517–527, 572–573
contractures, 634–635
elbow contracture, 631–632, 632t, 634
hand burn management, 168–169
hand care/reconstruction, 647–648, 647f
knee contracture, 631–632, 632t, 634
shoulder (axilla) contracture, 631–632,
632t
three-point see Three-point extension
splint
Split (partial) thickness skin grafting (STSG),
581
contractures, 638
eyelid reconstruction, 609
head and neck reconstruction, 603
historical aspects, 3
nipple-areola complex reconstruction, 628
SPV (systolic pressure variation), 188
Sri Lanka, 31
SSRIs see Selective serotonin reuptake
inhibitors (SSRIs)
SSTI (severe soft tissue infection), 140
Stabilization, transport/transfer, 101
Staff reassurance, psychosocial recovery, 746
Standing and walking programs, 525, 525f
Staphylococcal scalded skin syndrome,
477–478, 477f
management, 478
Staphylococcus aureus infection, 149–150
burn wound impetigo, 138–139
exfoliative disorders, 471
TSS toxin-1, 140
START, triage, 64
Steatosis, liver, 491, 491f
Stem cell(s), hematopoiesis, 277–278, 278f
Stem cell factors, 283–284, 283t
Steroids, multisystem organ failure therapy,
367
Stevens–Johnson syndrome (SJS), 471, 472t
etiology, 471
Stigmatization, 749–750
Stomach
content aspiration, 400
decompression, 96–97
stress ulcers, 395
Stratum corneum, 125
Stratum lucidum, 125
Strengthening exercises, 537
Strength measurements, exercise testing,
540–541
Streptococcus agalactiae infection, 150
Streptococcus infections, 150
Streptococcus pyogenes infection, 150
Streptokinase, enzymatic wound debridement,
132
Stress gastritis, 425
Stress response, 289
hypophosphatemia, 325
Stress ulcers
duodenum, 395
exfoliative disorders, 477
stomach, 395
Strong procedure, 427
Stryker® Intracompartment Pressure
Monitoring System, 83–84
STSG see Split (partial) thickness skin grafting
(STSG)
Students, multidisciplinary teams, 12
Subclavian vein catheters, 190, 406
Subjective data, exercise evaluation, 540
Submersion burns, intentional injuries,
693–695
Substance abuse, 738
Succinylcholine, 185
Suicide, attempted, 31
Sulfamylon (mafenide acetate), 154
Sulfur dioxide, 225t
Sulfuric acid, 457
Sump nasogastric tubes, 425
Sunburn depth, 127
Sun protection, scar treatment, 536
Superficial dermal burns, 127
Superficial hemorrhagic necrosis, 490–491,
491f
Superficial partial-thickness burn treatment,
88
Superimposed trauma, heterotropic bone,
556–557
Superior mesenteric artery (SMA) syndrome,
427, 427f
Superoxide cation (O2
−)
diffuse alveolar damage, 488
shock, 108, 109t
Supine patient positioning, 518
Suppression of cytokine signaling-3 (SOC-3),
270–271
Suppressor T cells, exfoliative disorders,
472–473
Suppurative sinusitis, 148
multisystem organ failure prevention, 365
Suppurative thrombophlebitis, 146, 146f,
428–429
multisystem organ failure prevention, 365

Index
781
Supragaleal approach, alopecia correction,
619–620
Surge capacity
definition, 58
establishment, 58
Surgeons, 10
Surgical debridement
breast reconstruction, 624
complications, 131
enzymatic wound debridement vs.,
132–133
hand burns, 131–132
immediate (early), 131
indications, 131
see also Enzymatic wound debridement
Surgical excision see Excision of burns
Surgical wound management, 157–174
frostbite, 452
knee flexion deformities, 675–677
pediatric patients, 412–413, 412f–413f
special areas, 166–172
see also specific anatomic areas
wound closure see Wound closure
see also Early excision; Excision of burns;
specific interventions
Surrogates, ethical problems, 684–686
Sustained capacity, 58
Sustained low-efficiency dialysis (SLED),
375
Sustained stretch, exercise therapy, 538–539
Suxamethonium, 73
Sweden, 36t–37t
Sympathectomy, frostbite, 452
Sympathetic nervous system, 289–300
activation, 290–296
immune function, 292–294
Synchronized intermittent mandatory
ventilation (SIMV), 243, 383, 383f
Syndecans, 266
Synthetic membranes, xenografts, 211
Systemic antibiotics, outpatients, 90–91
Systemic hydration, nursing, 399
Systemic infections, purpura fulminans, 479
Systemic inflammatory response syndrome
(SIRS), 178–179, 249–265
acute renal failure, 369
anti-inflammatory therapy, 257–258
AP-1, 254, 255f
chemokines, 253–254, 254t
coagulation pathway see Coagulation
cascade
complement cascade, 254, 256f
counter anti-inflammatory response
syndrome, 251, 251f
C-reactive protein, 256
cytokines, 252–257, 253t
see also specific cytokines
definitions, 138, 249–250
edema, 260
endothelial permeability, 260
epithelial permeability, 261–262
functional alterations, 249–250
hemodynamic response, 260
high-mobility group protein-1, 257–258
historical aspects, 249
hyperdynamic state, 262
hypertonic saline, 258
initiating event, 250–251, 251f
interferon-γ, 253, 253t
interleukin-1, 253, 253t, 256
interleukin-6, 253, 253t, 256
interleukin-8, 253t
interleukin-10, 253t
interleukin-12, 253t
interleukin-18, 253t
IRF-3, 254, 255f
leukotrienes, 254
mortality, 377
multiple organ dysfunction syndrome,
249, 386–387
nitric oxide, 262, 262f
nuclear factor-κB, 254, 255f
pathophysiology, 249
pediatric patients, 250, 250t
peroxynitrite, 262
platelet-activating factor, 254
procalcitonin, 256–257
studies, 250
thromboxane A2, 254
tumor necrosis factor-α, 252–253, 253t,
261
two-hit hypothesis, 251–252
Systemic sepsis, 90
Systemic vascular resistance, 111–112
Systolic arterial blood pressure, 379–380
Systolic pressure variation (SPV), 188
T
Tachycardia
pediatric patients, 406
reflex, 408–409
Tactical field care, 78
Tagging, mass casualty events, 65
Tagliacozzi flap, 611–612, 613f
Taiwan, 38t
tal-1/SCL, 288
Talipes equines-like deformity, 675
Talipes vera and vagus-like deformity, 675
Talk test, aerobic exercise, 543
Tangential excision, 158–159, 159f–160f
Tanner, J C Jr, 3
Tanning devices, 28
Tap-water scalds, pediatric patients, 23
Tar burns, 28, 459, 459f
cleansing, 86–87
scald depth, 128–129
TBSA see Total body surface area (TBSA)
T cell(s)
function impairment, 281
glucocorticoid effects, 299
T-cell(s), activation, 272–273
Team composition, transport/transfer, 99
Telemedicine, 714
Telephones, 68
Temporal artery catheters, 189
Temporary skin substitutes, 209–211
wound closure, 164
TEN see Toxic epidermal necrolysis (TEN)
TENS (transcutaneous electrical nerve
stimulation), 726
Tension pneumothorax, central venous access,
429
Terrorist attacks, 33, 59–60
Kuta, Bali (12 October 2002), 59
London, England (7 July 2005), 60
Madrid, Spain (11 March 2004), 60
New York City, New York (11 September
2001), 59, 59f
Tertiary prevention of burns, 50
Terudermis, 647
Tetanus, 148
‘Texas City Disaster’, 1
TF (tissue factor), 258–259
TFPI (tissue factor pathway inhibitors), 260
TG (triglycerides), liver, 303
TGF-β see Transforming growth factor-β
(TGF-β)
Thalidomide, exfoliative disorders, 476
T-helper cells (Th)
burn effects, 272–273
function impairment, 281
wound healing, 504
T-helper cells type 1 (Th1), 273
T-helper cells type 2 (Th2)
cytokines, 273
wound healing, 504
Therapeutic bronchoscopy, 241
Therapeutic coughing, 239
Therapeutic exercise, 536–542, 566–567, 566f
acute rehabilitation phase, 537–538
adults, 566–567
aerobic training, 542–544
components, 541–542
contractures, 633
cool-down stage, 542
endurance stage, 542
evaluation, 539–540
see also specific tests
example, 547–548, 547t
hypermetabolic response management,
357–358
intermediate rehabilitation phase,
538–539
long-term rehabilitation phase, 539
outpatients, 539, 539f
pediatric patients, 402–403, 566
prescription, 542–547
progression, 543–544
recreational activities, 542
rehabilitation see Rehabilitation
resistive training see Resistive training
scar treatment, 536–539
warm-up, 541–542
Thermal effects, radiation injuries, 463
Thermoregulation
anesthesia, 183–184, 183f–184f
gain, 183
hypothalamus, 565
pediatric patients, 411
threshold, 183
Thiamin see Vitamin B1 (thiamin)
Thioridazine, 739–740
Third degree (full thickness) injury see
Full-thickness burns
Third-line hospitals, mass casualty events, 65
Thorax
complications, 430
electrical burns, 445–446
Three-point extension splint
elbow contracture, 633f, 635
knee contracture, 632f–633f, 635
Three Repetition Maximum Test (3RM), 541
Threshold, thermoregulation, 183

Index
782
Thrombin
coagulation pathway, 258–259
soaked pads, 279–280
wound healing, 507–508
Thrombocytopenia, 282
post-blood transfusions, 195, 195f
Thrombolytics, frostbite, 451–452
Thrombophlebitis, suppurative see
Suppurative thrombophlebitis
Thrombopoietin, 285–286
as growth factor, 283t
Thrombotic complications, anesthesia
vascular access, 190
Thromboxane
frostbite, 451
shock, 108, 109t
Thromboxane A2
multisystem organ failure, 363
shock, 116
SIRS, 254
Thumb reconstruction, 654
Tidal volumes, mechanical ventilation, 245
Tiered response, mass casualty events, 77
Tilt tables, ambulation, 538, 538f
Time-cycled pressure control ventilation,
382
TIMPs (tissue inhibitor of matrix
metalloproteinases), 498–500
Tissue damage assessment, 442, 442t
Tissue-engineered delivery systems, 89
Tissue-expansion technique, 578, 579f,
584–589
after care, 588
alopecia correction, 588–589, 589f,
620–621
blood vessels, 618
breast mound reconstruction, 626
complications, 622, 622t
contraindications, 587–588
dermis, 617–618
epidermis, 617
head and neck reconstruction, 604–605
histomorphology, 617–618
indications, 587–588
lower face deformities, 589, 589f
molecular basis, 618, 618f
techniques, 620–621
total face reconstruction, 596
Tissue factor (TF), 258–259
Tissue factor pathway inhibitors (TFPI), 260
Tissue inhibitor of matrix metalloproteinases
(TIMPs), 498–500
Tissue ischemia, frostbite, 449
Tissue plasminogen activator (t-PA), frostbite,
451–452
TLRs see Toll-like receptors (TLRs)
TNFα see Tumor necrosis factor-α (TNFα)
α-Tocopherol see Vitamin E (α-Tocopherol)
Toes
contractural deformities, 671
dorsal contraction, 671
dorsal scar contracture, 525–526
plantar flexion deformities, 675
Tolazoline, frostbite, 451
Toll-like receptors (TLRs)
innate immune response, 267–268, 268f
SIRS, 250–251, 251f
Tompkins, Ron G, 2–3
Topical agents
exfoliative disorders, 475
hypophosphatemia, 325–326
mass casualty events, 70
outpatients, 87–88
see also specific agents
Topical analgesics, 719–720
Topical anti-infectives, 4
Topical antimicrobials, 398
exfoliative disorders, 475
pediatric patients, 412–413
scald burn management, 164–165
Topical chemotherapeutics, 465–466
Topical steroids, 726
Total body surface area (TBSA), 18
fluid therapy, 174–175
Lund–Browder chart, 174–175, 176f
see also Burn extent
Total face reconstruction
microvascular surgery, 594–596, 595f
tissue-expansion technique, 596
Total parenteral nutrition (TPN)
assessment, 344–345
formulas, 342, 343b
metabolic complications, 352
Tourniquets, 194
blood loss control, 160, 279–280
Toxic epidermal necrolysis (TEN), 471, 472t
keratinocyte apoptosis, 472–473
sicca syndrome, 472–473
Toxic shock syndrome (TSS), 140
Staphylococcus aureus infection, 149
Toxic smoke compounds, 222t, 225–227,
225t
see also specific compounds
t-PA (tissue plasminogen activator), frostbite,
451–452
TPN see Total parenteral nutrition (TPN)
Trace element(s), 342
deficiency, 348t–349t
homeostasis, 321–324
see also specific trace elements
Trachea, direct injury, 486–487
Tracheal stenosis, 248
Tracheal tickle, therapeutic coughing, 239
Tracheobronchial injury, 220–223, 221f–222f,
222t
Tracheostomy, inhalation injury treatment,
235–236
Traction see Skeletal suspension and traction
Traction pins, osteomyelitis, 553
Training
sedation, 724
transport/transfer, 99
TRALI (transfusion-related acute lung injury),
197, 280
Transcription factors, 286–288
C/EBPs, 287
c-Myb, 287
c-Myc, 287
GATA family, 286–288
MafB, 287–288
PU.1, 286–287
tal-1/SCL, 288
Transcutaneous electrical nerve stimulation
(TENS), 726
Transcyte®, 212
Transesophageal echocardiography, 380–381
Transforming growth factor-β (TGF-β)
decorin, 495–496
hypertrophic scars, 502–503, 515
matrix metalloproteinases, 502–503
myofibroblast differentiation, 497–498
tissue expansion, 618, 618f
wound healing, 504, 509
Transfusion reactions, 196–197, 197t
Transfusion-related acute lung injury (TRALI),
197, 280
Transfusions see Blood transfusions
Transmembrane osmotic shift, frostbite, 449
Transport/transfer, 32–33, 98–101
air see Aeromedical transport
anesthesia, 191
assessment, 101–102
equipment, 100–101, 101f
home transport, mass casualty events, 67
to hospital, 94–97
modes of transport, 99–100
see also specific modes
skin banks, 207
stabilization, 101
team composition, 99
training and selection, 99
Transpositional skin flaps, 652–653
Transverse rectus abdominis myocutaneous
(TRAM) flap, breast mound
reconstruction, 626
Transverse upper gracilis (TUG) flap, breast
mound reconstruction, 626
Trauma (injuries), 422–423
electrical burns, 435
frostbite, 450–451
mortality, 34
outpatients, 83
pain management, 715–716
see also specific injuries
Tregs (regulatory T cells), cytokines, 273
Triage
burn centers, 77
mass casualty events, 64–65
radiation injuries, 464, 464t
Tricyclic antidepressants (TCAs)
anxiety treatment, 739
geriatric patients, 417t
pediatric anxiety treatment, 740
rehabilitative phase, 725
Trident flap technique, 653–654, 655f
Triglycerides (TG), liver, 303
TRS (trunked radio system), mass casualty
communication, 68
Trunked radio system (TRS), mass casualty
communication, 68
Trypsin, enzymatic wound debridement, 132
TSS see Toxic shock syndrome (TSS)
TSS toxin-1, Staphylococcus aureus, 140
T-suppressor cells, function impairment, 281
Tumor necrosis factor-α (TNFα)
acute phase response, 308–309
innate immunity, 270t
liver apoptosis, 306
liver metabolism, 307
multiple organ dysfunction syndrome, 387
multisystem organ failure, 361
multisystem organ failure therapy, 367
production, 293
SIRS, 250–253, 253t, 261

Index
783
surface receptors, 255–256
vascular permeability, 260–261
Tumor necrosis factor receptors, 255–256
Turkey, 31
Two-hit theory, multiple organ dysfunction
syndrome, 387–388
Two-way radio, mass casualty
communication, 68
TXP transport ventilator, 101
Type I electrical burns, 656, 657f
Type II electrical burns, 656, 657f
Type III electrical burns, 656, 657f
Type IV electrical burns, 656, 657f
U
Ulnar nerves, electrical burns, 447
Ultrasonography
acalculous cholecystitis, 426–427
scar treatment, 536
Ultrathin bronchoscopes, 187
Underhill, Frank P, 5–6, 115
Unintentional injuries, 15, 16t–17t, 17–18
Univariate probit analysis, 35
Universal contact isolation, infection control,
137
Upper airway obstruction, 93
Upper extremity prostheses, 529, 530t
Upper limb, electrical burns see Electrical
burns
Upper lip reconstruction, 603f, 609–611, 611f
Urethral catheterization, 172
Urinary catheters, pediatric patients, 409
Urinary electrolytes, acute renal failure
diagnosis, 372–373, 373t
Urinary tract, 490
infections, 147
Urine output
acute renal failure diagnosis, 372
anesthesia monitoring, 188–189
chemical burns, 456
electrical burns, 435
following shock resuscitation, 124
requirements, 96
Urokinase, frostbite, 451–452
Urosepsis, 147
Uruguay, 39t
USA, childhood burns, 20
Uvex™ masks, 519, 535
V
VAC (Vacuum Assisted Closure device), 436
Vaccination, 275
Vacuum Assisted Closure device (VAC), 436
Vancomycin, Staphylococcus aureus infection,
149–150
Vancomycin-resistant enterococci (VRE), 150
Vancouver Burn Scar Assessment, 532
VAP (ventilator-associated pneumonia),
145–146, 246–247
Varicella zoster (chickenpox), 145, 471
Varidase, 132
Vascular access, anesthesia see Anesthesia
Vascular complications, 428–430
central venous access, 429
distal limb ischemia, 429–430
suppurative thrombophlebitis, 428–429
Vascular endothelial growth factor (VEGF),
509
Vascular permeability
arachidonic acid metabolites, 261
endothelial cells, 260–261
endotoxin, 260–261
E-selectin, 260–261
interleukin-1, 260–261
tumor necrosis factor-α, 260–261
wound healing, 508–509
Vasoconstricting agents, acute renal failure,
371–372
Vasoconstriction
frostbite, 449–450
peripheral, thermoregulation, 183–184
Vasopressin
cardiovascular system, 394
shock, 109t, 110
VATS (video-assisted thorascopic surgery), 430
Vd (volume of distribution), 185
VDR (volumetric diffusive ventilation), 245
VEGF (vascular endothelial growth factor),
509
Venous access, mass casualty events, 72
Ventilation see Mechanical ventilation
Ventilator-associated pneumonia (VAP),
145–146, 246–247
Ventilator-induced lung injury (VILI), 385,
391
Ventilatory mechanical ventilation, 381
Verasjet Hydrosurgery System water dissector,
158–159
Versican, 496–497
Very low density lipoproteins (VLDL), 303
Vesicants, 459–460, 467–469
chemical burns, 455
clinical features, 468
historical aspects, 467
long-term effects, 469
mechanism of action, 467–468
ophthalmic disorders, 467
treatment, 468–469
see also specific types
Viability maintenance, skin banks, 206
Vibration, chest physiotherapy, 240, 241f
Video-assisted thorascopic surgery (VATS), 430
VILI (ventilator-induced lung injury), 385,
391
Viral infections
allografts (homografts), 202–203
see also specific infections
Virtual reality, 729
Virtual reality hypnosis, 730
Visual analog scales, 716, 716f
Vital HN™, 337t–340t
Vitamin(s)
antioxidative properties, 323
deficiency, 348t–349t
homeostasis, 321–324
see also specific vitamins
liver metabolism, 304, 309
nutritional support, 342
requirements, 324t
Vitamin A (retinol), 321
liver, 304, 309
requirements, 324t
Vitamin B1 (thiamin), 321
liver, 309
Vitamin B2 (riboflavin), 321
liver, 309
Vitamin B6 (pyridoxine), 321
liver, 309
Vitamin B12, liver, 309
Vitamin C (ascorbic acid), 109–110, 321
chromic acid, 456–457
infusions, 321
liver, 309
multiple organ dysfunction syndrome, 387
requirements, 324t
Vitamin D
calcium homeostasis, 313, 314f
deficiency, 318
infusions, 321
liver, 304, 309
requirements, 324t
Vitamin E (α-Tocopherol), 109–110, 321
antioxidative properties, 323
liver, 304, 309
multiple organ dysfunction syndrome, 387
requirements, 324t
Vitamin K, 321
liver, 304
requirements, 324t
Vivonex™ TEN, 357
VLDL (very low density lipoproteins), 303
Voice over internet protocol (VolP), 68
VoIP (voice over internet protocol), 68
Volar forearm burns, 523
Volatile anesthetics, 192
Volendam, The Netherlands (1 January 2001),
61
Voltage classification, electrical burns, 433
Volume-controlled ventilation, 235
Volume estimation, fluid resuscitation, 181,
181t
Volume of distribution (Vd), 185
Volumetric diffusive ventilation (VDR), 245
VRE (vancomycin-resistant enterococci), 150
W
Wallace, A B, 5–6
Warm-up, therapeutic exercise, 541–542
Warwick, Rhode Island (20 February 2003),
61
Washing, patient care, 399
Waste incineration, military personnel, 25
Water, mass casualty events, 69
Water baths, frostbite, 450–451
Watson knife, 158–159
WBC (white blood cell count), 280
W-Clear™ masks, 519, 535, 535f
Weaning, mechanical ventilation, 235
Web space contracture, 653–654, 654f
Weight-bearing exercise, osteoporosis, 551
Western Australia, 34
White blood cell count (WBC), 280
White blood cells, 280–281
see also specific types
WHO see World Health Organization (WHO)
Whole blood transfusions, 194
packed red blood cells vs., 194t
storage changes, 194, 194t
WISQARS Injury Mortality Report, 15
Wolfe, Robert, 7
Work-hardening programs, 401–402

Index
784
Work-related burns, 28
Work-to-quota (WTQ) program, 566–567
Work-to-tolerance (WTT) program, 566–567
World Health Organization (WHO)
Global Burden of Disease, 33–34
oral resuscitation solution, 71
World War I, 4
World War II, 4
Wound bed desiccation, 399
Wound bed preparation, alternative wound
coverings, 216, 216f
Wound care
electrical burns, 436
geriatric patients treatment, 417
radiation injuries, 465–466
upper limb electrical burns, 658,
658f–659f
Wound closure, 161–164
autografts, 161, 162f
cultured epidermal autograft, 162
dermal replacement, 161–162, 163f
dressings, 164
early, hypermetabolic response
management, 357
Meek technique, 161
meshing, 161
outpatients, 90
skin procurement, 162–164
temporary skin substitutes, 164
Wound contamination, mass casualty events,
69–70
Wound coverings
alternative see Alternative wound coverings
contractures, 638–639
hand burn management, 167–168
ideal, 215
perineal injuries, 662, 663f
see also Dressings
Wound debridement, enzymatic see
Enzymatic wound debridement
Wound dressings see Dressings
Wound evaluation, Emergency Departments,
95
Wound healing, 507–516
affecting factors, 511
biology, 508–511
blood supply, 511
cell influx, 509
collagen matrix formation, 509, 510f
compromised, 511
cytokines, 509
deficits, radiation injuries, 463
delayed closure, 507–508
excision, 511
fibroblasts, 501–502
first degree (superficial) injury, 508
grafting, 511
granulation tissue, 509
growth factors, 509
historical aspects, 507
hypertrophic scars see Hypertrophic scars
immune response, 504
incisional wounds, 507
infection, 511
keratinocytes, 509
maturation, 509
perfusion, 511
primary closure, 507
proliferative stage, 509
second degree (partial thickness) injury,
508
third degree (full thickness) injury, 508
vascular permeability, 508–509
see also Scar(s)
Wrist, patient positioning, 522–524
Wrist contracture
patient positioning, 633, 633f
skin flaps, 584
WTQ (work-to-quota) program, 566–567
WTT (work-to-tolerance) program,
566–567
X
Xanthine oxidase, 109–110
Xenografts, 164, 211–212, 211f
exfoliative disorders, 474
pediatric patients, 412
scald burns, 413
synthetic membranes, 211
Xeroform®, 88
X-rays, 461
Y
Yannas, Joannas, 3–4
Yeast infections, 152
Z
Zinc, 322–323
losses, 322
nutritional supplements, 274
requirements, 324t
supplementation, 322–323
Z-plasties, 575, 576f, 581
ankle dorsiflexion contractures, 672
contractures, 638
fasciocutaneous flaps, 577–578
hand care/reconstruction, 648, 649f–650f
head and neck reconstruction, 601f, 602
hypertrophic scars, 511–512
lower face deformities, 590
modified (34), 581–582, 583f
musculocutaneous flaps, 577, 577f
see also Z-plasties, 34 (modified)
paratenon cutaneous, 578, 578f
perineal injuries, 663
34 fasciocutaneous see Z-plasties,
34 (modified)
34 paratenon cutaneous see Z-plasties,
34 (modified)
Z-plasties, 34 (modified), 575, 576f, 581–582,
583f
fasciocutaneous z-plasty, 582, 584f
ankle contracture, 584, 588f
axilla contracture, 584, 587f
knee contraction, 677
hand care/reconstruction, 648,
649f–650f
knee flexion deformities, 675–677, 680f
musculocutaneous z-plasty, neck
contracture, 584, 586f
paratenon cutaneous z-plasty, 578, 578f
ankle dorsiflexion contractures, 672,
674f
talipes vera and vagus-like deformity,
674f, 675, 678f
phalangeal deformities, 648–652

Video clips
Clip 13.01, Debridement of Facial Burn Wound. Debridement of Skull Burn. Operating Room Setup
Clip 13.02, Tangential Excision. Procurement of Skin grafts. Application Autografts
Clip 13.03, Procurement of Autografts
Clip 13.04, Fascial Excision of Necrotic Burn Eschars
Clip 13.05, Tangential Excision and Application of Allograft to Burn Wounds Followed by
4 : 1 Autografting
Clip 19.01, General features of smoke inhalation injury
Clip 19.02, Inhalation injury viewed through the endotracheal tube
Clip 19.03, View of swollen supraglottic structures due to thermal injury
Clip 19.04a, Bronchoscopic evidence of intense smoke exposure and severe injury to large airways in a
patient with minimal pulmonary parenchymal dysfunction
Clip Figure 19.04b, Chest radiograph obtained at the time of the bronchoscopic exam shown in Clip
19.04a
Clip 19.05, Acute lung injury associated with scald injury mimics effects of smoke injury
Clip 19.06, Endoscopic evidence of thermal necrosis of laryngeal structures
Clip 19.07a, Endoscopic view of laryngeal changes from thermal injury with probable exacerbation by
the translaryngeal endotracheal tube
Clip 19.07b, A follow-up view of the patient shown in Clip 19.07a
Clip 19.08a, Endoscopic view of patient with superficial burns to the face causing extensive edema of the
face but without airway compromise
Clip Figure 19.08b, Two days after burn injury
Clip 19.09, Endoscopic view of inflammatory changes in a pediatric larynx
Clip 19.10a, Endoscopic view of young patient who ingested hot liquid
Clip 19.10b, Another endoscopic view of the larynx of the patient shown in Clip 19.10a
Clip 19.11, Laryngeal injuries in patients with thermal injury to the upper airways
Clip 47.01, Burn Hand Splint
Clip 47.02, Exercise Testing
Clip 47.03, Face Mask Fabrication
Clip 47.04, Preparatory Prosthetics
Clip 61.01, Video of Brief Physical Exam to Assess for Potential Intentional Injury
Clip 66.01, Psychosocial Recovery and Reintegration of Patients with Burn Injuries
Additional video clip (Courtesy of General Reconstructive Surgery by Gregory RD Evans
and Garrett A Wirth)
Evans & Wirth Clip 2.01, Tangential Excision and Skin Grafting
Additional online content available at expertconsult.com

PowerPoint presentations
Chapter 10, Evaluation of the Burn Wound: Management Decisions
Chapter 11, Enzymatic Debridement of Burn Wounds
Chapter 12, Treatment of Infection in Burns
Chapter 13, Operative Wound Management
Chapter 14, Anesthesia for Burned Patients
Chapter 15, The Skin Bank
Chapter 16, Alternative Wound Coverings
Chapter 17, The Role of Alternative Wound Substitutes in Major Burn Wounds and Burn Scar Resurfacing
Chapter 19, Diagnosis and Treatment of Inhalation Injury
Chapter 20, Respiratory Care
Chapter 23, Hematologic and Hematopoietic Response to Burn Injury
Chapter 24, Significance of the Adrenal and Sympathetic Response to Burn Injury
Chapter 26, Effects of Burn Injury on Bone and Mineral Metabolism
Chapter 27, Vitamin and Trace Element Homeostasis Following Severe Burn Injury
Chapter 28, Hypophosphatemia
Chapter 31, Etiology and Prevention of Multisystem Organ Failure
Chapter 32, Renal Failure in Association with Thermal Injuries
Chapter 33, Critical Care in the Severely Burned: Organ Support and Management of Complications
Chapter 36, Care of Geriatric Patients
Chapter 37, Surgical Management of Complications of Burn Injury
Chapter 40, Cold-Induced Injury: Frostbite
Chapter 41, Chemical Burns
Chapter 42, Radiation Injuries and Vesicant Burns
Chapter 43, Exfoliative Diseases of the Integument and Soft Tissue Necrotizing Infections
Chapter 44, The Burn Problem: A Pathologist’s Perspective
Chapter 45, Molecular and Cellular Basis of Hypertrophic Scarring
Chapter 47, Comprehensive Rehabilitation of the Burn Patient
Chapter 48, Musculoskeletal Changes Secondary to Thermal Burns
Chapter 54, Correction of Burn Alopecia
Chapter 55, Reconstruction of the Burnt Breast
Chapter 60, The Ethical Dimension of Burn Care
Chapter 61, Intentional Burn Injuries
Chapter 63, Cost-Containment and Outcome Measures
Chapter 64, Management of Pain and Other Discomforts in Burned Patients
Chapter 65, Psychiatric Disorders Associated with Burn Injury
Chapter 66, Psychosocial Recovery and Reintegration of Patients with Burn Injuries