Burns medicine

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  • Tham khảo sách 'schizophrenia in the 21 century edited by t.h.j. burne', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • This book, which you now hold in your hands, will change how medicine is practiced around the world. It is an extraordinary book written by an extraordinary medical doctor who is also a pioneering scientist in the best sense of the word. Prof. Rong Xiang Xu has a very rare spirit, for he is a man with a compassionate heart who observed the terrible suffering of his burns patients and rather than simply accepting conventional treatments (which do little to correct the burns trauma), this doctor created, with much diligence and hard work, the new standard of care for burns treatment.

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  • Ditch Medicine describes advanced medical procedures in a field setting. Should the Pre-Hospital Care Provider (PHCP) find himself in the middle of a medical disaster, his ability to use the procedures in this book can mean the difference between life and death.

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  • Accidental and war trauma, burns and all sorts of acute and chronic cutaneous infections can be proficiently treated with ozonated water. In current study, 24 burned rabbits were divided into 4 groups (6 rabbits in each group): topical treatment with saline; topical treatment with ozone; topical treatment with ozone and ozone autohemotherapy (OAHT); and topical treatment with silvirin.

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  • The source of free water loss is either renal or extrarenal. Nonrenal loss of water may be due to evaporation from the skin and respiratory tract (insensible losses) or loss from the gastrointestinal tract. Insensible losses are increased with fever, exercise, heat exposure, and severe burns and in mechanically ventilated patients. Furthermore, the Na+ concentration of sweat decreases with profuse perspiration, thereby increasing solute-free water loss. Diarrhea is the most common gastrointestinal cause of hypernatremia.

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  • Allergic contact dermatitis (ACD). A. An example of ACD in its acute phase, with sharply demarcated, weeping, eczematous plaques in a perioral distribution. B. ACD in its chronic phase demonstrating an erythematous, lichenified, weeping plaque on skin chronically exposed to nickel in a metal snap. (B, Courtesy of Robert Swerlick, MD; with permission.) As in other branches of medicine, a complete history should be obtained to emphasize the following features: 1. Evolution of lesions a. Site of onset b. Manner in which the eruption progressed or spread c. Duration d.

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  • Chương 3 tài chính kiểm toán Chương này trình bày các kết quả của kiểm toán tài chính của trường John A. Burns Y khoa của Đại học Hawaii, và cho năm tài chính kết thúc ngày 30 tháng 6 2002. Chương này bao gồm báo cáo kiểm toán viên độc lập và báo cáo về việc tuân thủ và kiểm soát nội bộ đối với báo cáo tài chính dựa trên một cuộc kiểm toán báo cáo tài chính thực hiện theo các Chuẩn mực Kiểm toán Chính phủ có liên quan đến trường. Nó cũng hiển thị các báo cáo...

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  • Neurogenic Causes Causalgic pain may occur in diseases that injure sensory nerves. It has a burning character and is usually limited to the distribution of a given peripheral nerve. Normal stimuli such as touch or change in temperature may be transformed into this type of pain, which is frequently present in a patient at rest. The demonstration of irregularly spaced cutaneous pain spots may be the only indication of an old nerve lesion underlying causalgic pain.

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  • Sympathetically Maintained Pain Patients with peripheral nerve injury can develop a severe burning pain (causalgia) in the region innervated by the nerve. The pain typically begins after a delay of hours to days or even weeks. The pain is accompanied by swelling of the extremity, periarticular osteoporosis, and arthritic changes in the distal joints. The pain is dramatically and immediately relieved by blocking the sympathetic innervation of the affected extremity.

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  • Hypovolemia Etiology True volume depletion, or hypovolemia, generally refers to a state of combined salt and water loss exceeding intake, leading to ECF volume contraction. The loss of Na+ may be renal or extrarenal (Table 46-1). Table 46-1 Causes of Hypovolemia I. ECF volume contracted A. Extrarenal Na+ loss 1. Gastrointestinal (vomiting, nasogastric suction, drainage, fistula, diarrhea) 2. Skin/respiratory (insensible losses, sweat, burns) 3. Hemorrhage B. Renal Na+ and water loss 1. Diuretics 2. Osmotic diuresis 3. Hypoaldosteronism 4. Salt-wasting nephropathies C.

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  • Extrarenal Nonrenal causes of hypovolemia include fluid loss from the gastrointestinal tract, skin, and respiratory system and third-space accumulations (burns, pancreatitis, peritonitis). Approximately 9 L of fluid enters the gastrointestinal tract daily, 2 L by ingestion and 7 L by secretion. Almost 98% of this volume is reabsorbed so that fecal fluid loss is only 100–200 mL/d. Impaired gastrointestinal reabsorption or enhanced secretion leads to volume depletion.

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  • Efficacy of SNS in Different Disease States Efficacy studies have shown that malnourished patients undergoing major thoracoabdominal surgery benefit from SNS. Critical illness requiring ICU care including major burns, major trauma, severe sepsis, closed head injury, and severe pancreatitis [positive CT scan and Acute Physiology and Chronic Health Evaluation II (APACHE II) 10] all benefit by early SNS, as indicated by reduced mortality and morbidity. In critical illness, initiation of SNS within 24 h of injury or ICU admission is associated with a ~50% reduction in mortality.

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  • Angina Pectoris (See also Chap. 237) The chest discomfort of myocardial ischemia is a visceral discomfort that is usually described as a heaviness, pressure, or squeezing (Table 13-2). Other common adjectives for anginal pain are burning and aching. Some patients deny any "pain" but may admit to dyspnea or a vague sense of anxiety. The word "sharp" is sometimes used by patients to describe intensity rather than quality.

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  • Table Cephalalgias 15-8 Clinical Features of the Trigeminal Autonomic Cluster Headache Paroxysmal Hemicrania SUNCT Gender MF F=M F~M Pain Type boring Stabbing, Throbbing, boring, stabbing Burning, stabbing, sharp Severity Excruciating Excruciating Severe excruciating to Site Orbit, temple Orbit, temple Periorbital Attack frequency 1/alternate day– 8/d 1–40/d (5/d for more than half the time) 3–200/d Duration attack of 15–180 min 2–30 min 5–240 s Autonomic features Yes Yes Yes (prominent conjunctival injection lacrimation)a and Migrai...

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  • These reactions are characterized by one or more sharply demarcated, erythematous lesions, sometimes leading to a blister. Hyperpigmentation results after resolution of the acute inflammation. With rechallenge, the lesion recurs in the same (i.e., fixed) location. Lesions often involve the lips, hands, legs, face, genitalia, and oral mucosa and cause a burning sensation. Most patients have multiple lesions. Fixed drug eruptions have been associated with phenolphthalein, sulfonamides, cyclines, dipyrone, NSAIDs, and barbiturates.

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  • Protein Catabolism The rate of endogenous protein breakdown (catabolism) to supply energy needs normally falls during uncomplicated energy deprivation. After about 10 days of total starvation, the unstressed individual loses about 12–18 g/d protein (equivalent to approximately 2 oz of muscle tissue or 2–3 g of nitrogen).

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  • Energy Requirements Total energy expenditure comprises resting energy expenditure (two-thirds) plus activity energy expenditure (one-third) (Chap. 72). Resting energy expenditure includes the calories necessary for basal metabolism at bed rest. Activity energy expenditure represents one-fourth to one-third of the total, and the thermal effect of feeding is about 10% of the total energy expenditure. For normally nourished healthy individuals, the total energy expenditure is about 30– 35 kcal/kg.

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  • Other Causes Alkaline reflux esophagitis produces GERD-like symptoms in patients who have had surgery for peptic ulcer disease. Opportunistic fungal or viral esophageal infections may produce heartburn or chest discomfort but more often cause odynophagia. Other causes of esophageal inflammation include eosinophilic esophagitis and pill esophagitis. Biliary colic is in the differential diagnosis of dyspepsia, but most patients with true biliary colic report discrete episodes of right upper quadrant or epigastric pain rather than chronic burning discomfort, nausea, and bloating.

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  • Hemorrhagic and Erosive Gastropathy ("Gastritis") Hemorrhagic and erosive gastropathy, often labeled gastritis, refers to endoscopically visualized subepithelial hemorrhages and erosions. These are mucosal lesions and thus do not cause major bleeding. They develop in various clinical settings, the most important of which are NSAID use, alcohol intake, and stress. Half of patients who chronically ingest NSAIDs have erosions (15–30% have ulcers), while up to 20% of actively drinking alcoholic patients with symptoms of UGIB have evidence of subepithelial hemorrhages or erosions.

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  • Vitamin D deficiency, impaired 1,25(OH)2D production (primarily secondary to renal insufficiency), or, rarely, vitamin D resistance also cause hypocalcemia. However, the degree of hypocalcemia in these disorders is generally not as severe as that seen with hypoparathyroidism because the parathyroids are capable of mounting a compensatory increase in PTH secretion. Hypocalcemia may also occur in conditions associated with severe tissue injury such as burns, rhabdomyolysis, tumor lysis, or pancreatitis.

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