CME : Your SA Journal of CPD - Volume 26, Issue 9, 2008
Volume 26, Issue 9, 2008
Author Bridget FarhamSource: CME : Your SA Journal of CPD 26 (2008)More Less
As this issue of CME goes to press another 800 people in Masiphumelele, an informal settlement near Noordhoek, Cape Town (close to where I live), are homeless as a result of a fire. Inevitably, several people, including children, were injured. Such is the situation in the Western Cape every winter - burn season. We used to dread it as surgical interns at Red Cross Children's Hospital.
Source: CME : Your SA Journal of CPD 26 (2008)More Less
It is a wonderful opportunity to devote this edition of CME to burn care and management. It is also an honour and privilege to be invited as guest editor. Burns are a frequent injury in South Africa, still claiming too many lives with unnecessary deaths and leaving patients with lifelong disability. Every opportunity to promote better care and to assist the health care worker with sound knowledge should be used.
Source: CME : Your SA Journal of CPD 26, pp 424 –426 (2008)More Less
Traditionally mortality has been the most important outcome measure in burn care. This is fitting, as the overriding concern in medical care is the preservation of life. In developed countries the LD50 (body surface area burned that kills 50% of people) in children and young adults is over 90% of total body surface area (TBSA) full-thickness burns, and in the elderly it is more than 40%. However, in developing countries survival of patients with burns over 40% TBSA is minimal. Because of the advancement in medical care, many patients survive burn injuries. Therefore the focus of outcome measurement has shifted to the quality of life of these patients. Useful measuring instruments in burn care are the Burn Specific Health Scale and the Short Form Health Survey.
Source: CME : Your SA Journal of CPD 26, pp 428 –430 (2008)More Less
Recent reports reveal a 50% decline in burn-related deaths and hospital admissions in the USA over the last 20 years. The reduction is probably a result of prevention efforts resulting in a decreased number of patients with potentially fatal burns, and improved critical care and wound management of those still sustaining severe burns. Among those suffering moderate to severe burns and treated in First-World hospitals, most will require critical care for at least part of their hospitalisation, and some will require it for months. As many as 10% may die from complications related to the burn.
Author Arina PrinsSource: CME : Your SA Journal of CPD 26, pp 432 –435 (2008)More Less
Burn injury, the most severe type of injury from a metabolic point of view, is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. When the burn injury exceeds 15 - 20% total body surface area (TBSA) it results in systemic disturbances including a major stress response, impaired immunity and massive fluid shifts. The severe muscle wasting due to accelerated proteolysis results in muscle weakness that predisposes the patient to pneumonia by limiting his or her ability to cough and clear secretions.
Author Salathiel Z. MzezewaSource: CME : Your SA Journal of CPD 26, pp 436 –438 (2008)More Less
Electrical burns are the most devastating of all thermal injuries on a size-for-size basis, usually involving both the skin and deeper tissues. These injuries have multiple acute and chronic manifestations not seen with other types of thermal injury. Morbidities, length of hospital stay and number of operations are much higher than expected, based on burn size alone. The spectrum of injuries ranges from mild injuries due to shock of low voltage (battery-driven radios) to disastrous injuries seen in high-voltage injuries.
Source: CME : Your SA Journal of CPD 26, pp 440 –443 (2008)More Less
Infection remains a common cause of death in burn patients and is responsible for 75% of all deaths in patients with burns exceeding 40% total body surface area (TBSA). Current techniques of burn wound care and infection control measures have significantly reduced the incidence and mortality resulting from burn wound infection (BWI), changed the bacterial profile, and increased the time interval from injury to the onset of infection. Additional factors associated with improved outcome of infection include early burn eschar excision and grafting.
Scar management during rehabilitation of burn patients : an occupational therapist's perspective : more about ... burnsAuthor Rogini PillaySource: CME : Your SA Journal of CPD 26, pp 444 –445 (2008)More Less
Rehabilitation of the burn patient is a long and intensive process that requires a dedicated team approach starting with inpatient care. In the South African setting the role of the occupational therapist (OT) during outpatient rehabilitation is integral to enhancing function and quality of life of the burn survivor. There are no designated burn rehabilitation centres in South Africa. This article describes an OT's perspective as experienced at the Tygerberg Hospital Pressure Therapy Outpatient Department.
Author J.J.K. (Kotze) EngelbrechtSource: CME : Your SA Journal of CPD 26, pp 445 –448 (2008)More Less
Author Adelin MuganzaSource: CME : Your SA Journal of CPD 26, pp 448 –449 (2008)More Less
Antiretroviral treatment (ART) has increased life expectancy and the quality of life of many patients infected with the human immunodeficiency virus (HIV). As patients live longer many are admitted with conditions not related to HIV infection, for example trauma and burns. Practitioners are challenged by decisions regarding the management of immunocompetent burns patients. There are no randomised trials and no consensus guidelines for the management of HIV and burns.
Author Paul C. PotterSource: CME : Your SA Journal of CPD 26, pp 454 –458 (2008)More Less
Asthma has increased in nearly every part of the world studied, even in populations where the gene pool has not altered much in recent years.
The interplay between the genes and environment is an intriguing one. Migration studies have shown that asthma prevalence and bronchial hyperreactivity increase as a Western lifestyle is adopted. This has not only been shown in Africa, but also in other parts of the world, e.g. China (Hong Kong), South America and the Middle East.