Management of Thermal Burns

Most patients with burns are first seen by a physician in the emergency room of a general hospital, where the question of disposition will arise. The mortality rate of patients hospitalized in specialized burn units is approximately 14 percent, the most significant factors contributing to death are age and the total surface area of the body involved. The mortality and morbidity rates from burns in persons over 50 rise sharply.

Patients with minor burns of less than 15% of the total body surface can usually be treated initially as outpatients. Patients with moderate burns of 15% to 30% of the total body surface should be admitted to a general hospital. Patients with critical burns, greater than 30% or burns involving the face, hands, feet or perineum preferably should be treated in a major hos­pital under the care of a surgeon experienced in burn treat­ment. The presence of such medical conditions as diabetes, alcoholism, cardiac disease, or inhalation injury, pulmonary disease, as well as chemical or electrical burns, may increase the risk factor considerably and necessitate admission to a specialized hospital.

The presence of inhalation injury is a severe complication of thermal burns and may increase the mortality rate consider­ably. Inhalation injury should be suspected from a history of a fire in an enclosed space, the presence of facial burns, lesion of the pharynx and edema of the vulva, and hoarseness. Patients who are unconscious with no other demonstrable cause also should be suspected of having inhalation injury.

The most immediate threat to the patient is usually upper airway obstruction and the presence of toxic blood levels of carboxyhemoglobin. In the presence of these signs even if the patient appears to be stable, it is necessary to perform endotracheal intubation, since delay may cause considerable soft tissue swelling about the pharynx which will make intubation at a later time very difficult.

In recent years increasing emphasis has been placed on the early psychological support of the burn patient. The care of the burn patient is a team effort, the presence, as soon as pos­sible, after injury of a psychologist, a psychiatrist and skilful rehabilitation experts being essential to improve the quality of life of patients who survive the injury.

From Surgery, 1983

1. Who are most patients with burns first seen by?

2. What are the significant factors contributing to death in case of burns?

3. Who can be treated as an outpatient?

4. Who should be admitted to a general hospital?

5. The presence of such medical conditions as diabetes, alcoholism, cardiac disease, or inhalation injury, pulmonary disease, as well as chemical or electrical burns, does not increase the risk factor considerably and necessitate admission to a specialized hospital, does it?

6. Why is inhalation injury a severe complication?

7. What should unconscious patients be suspected of?

8. What has an increasing emphasis been placed on in recent years?

Exercise 22. Fill in the gaps with prepositions where necessary:

The most immediate threat _1_ the patient is usually upper airway obstruction and the presence_2_ toxic blood levels _3_carboxyhemoglobin. _4_ the presence _5_these signs even if the patient appears to be stable, it is necessary to perform endotracheal intubation, since delay may cause considerable soft tissue swelling _6_ the pharynx which will make intubation _7_ a later time very difficult.

_8_ recent years increasing emphasis has been placed _9_ the early psychological support of the burn patient. The care of the burn patient is a team effort, the presence, as soon as pos­sible, after injury of a psychologist, a psychiatrist and skilful rehabilitation experts being essential to improve the quality _10_ life of patients who survive the injury.

Exercise 23. Fill in the gaps with articles where necessary.

In 1978 _1_Gavriil Ilizarov, Director of the Kurgan Research Institute of Experimental and Clinical Orthopedics and Traumatology received Lenin Prize for developing _2_ new tech­nique of treating injuries and diseases of the locomotor sys­tem. There was _3_ time when _4_serious fractures aggravated by _5_ osteomyelitis were regarded incurable. _6_ shortened bone left _7_ patient with a permanent malfunction. Later on, however,_8_ doctors learned how to stretch _9_ bones of the hands and feet, but it was hard going for both doctors and patients, who experienced severe pain and were confined to _10_ bed for five or six months. With that technique the bone could be stretched maximum from three to five centimeters, but it was nevertheless _11_ great success.

Ilizarov's method enables one to stretch _12_ bone as much as it is necessary and it can be done at _13_ out-patient clinic. _14_method is not too painful and there is now _15_ apparatus to control the bone growth, to accelerate the healing of fractures and to rectify bone deformities.

Exercise 24. Match the following parts of the sentences in A with suitable lines in B:

Exercise 25.Fill in the missing words from the box into the idiomsbelow.

*An idiomis a group of words that has a completely different meaning from the meaning of each word on its own. Idioms really have to be learnt as complete phrases, each with its own unique and often unexpected meaning.

An explanation of each idiom is given in the right column.

Exercise 26. A fast way to expand your vocabulary is to make sure you know the different forms of the words you learn. The words in this list are all verbs. What are the noun forms?

Part A: Write them in the second column. The first one has been done for you as an example.

1. diagnose …diagnosis…

2. examine

3. prescribe

4. suffer

5. operate

6. cure

7. recover

8. analyse

9. infect

10. experience

11. replace

12. degenerate

13. refer

14. exceed

15. withdraw ……….

Part B: Rewrite the sentences below using nouns instead of verbs. Do not change the meanings of the sentences. The first one has been done for you as an example.

1. I diagnosed that the patient had a heart condition. My …………….

2. I examined the patient fully. I made ………………….

3. I prescribed a course of antibiotics. I wrote ……………….

4. He suffered very little. He experienced ………………..

5. We operated immediately. The…………………….

6. This disease cannot be cured. There is ………………….

7. He has recovered fully. He has made …………….

8. The lab analysed the blood sample. The lab made ………….

9. We found that the tissue was infected. We found ……………….

10. He has experienced six years of tropical work. He has ………….

11. We replaced the patient's hip. The patient……………….

12. His condition has degenerated. There has been……………….

13. The patient was referred to a specialist. The patient was given ………….

14. The amount of sugar in the blood sample exceeded the norm. There was ……….

15. This is the time to withdraw the drugs treatment. This is the time ………….

Exercise 27. Test your medical abbreviations. What do the following stand for? Check the ones you don't know in the dictionary.

Extension.Work with a partner and test each other. One partner closes the book, the other asks questions. For example: What does A and E stand for?

Exercise 28. Match the words in italics with their opposites in the box below

1. The opposite of back is…

2. The opposite of cure is…

3. The opposite of dead is…

4. The opposite of improve is…

5. The opposite of healthy is…

6. The opposite of open is …

7. The opposite of prevent is…

8. The opposite of reduce is…

9. The opposite of smooth is…

10. The opposite of remove is…

Part B: Complete the sentences using the words from Part A. Use one word from each pair of opposites.

1. Antidotes are created to … bacteria.

2. He became excited, causing his pulse rate to ….

3. He was very ill, but now his condition has begun to ….

4. She hurt her … working in the garden.

5. She put cream on her hands, which were … from heavy work.

6. She had an operation to … her appendix.

7. The hospital is … to visitors from noon to five o’clock.

8. The doctors arrived too late: the patient was already ….

9. There’s nothing wrong with you: you are completely ….

10. This treatment is given to … the patient’s condition from getting worse.

Exercise 29. Fill in the gaps with the necessary words that deal with healthcare and medicine. (Look through the Ex.10). The first and the last letters of each word have been given to you.

1. It is best to get c________x as a child so that you don't get it worse as an adult.

2. We only call the c_____r if we think a death is suspicious.

3. You can't see her right now; she's in c______l c_______n.

4. I'd rather hop on one foot than use c______s.

5. We're going to remove the c___s just to be on the safe side.

6. The accident left the patient both d__f and blind.

7. The tests show that you have an iron d________y.

8. It is easy for the elderly to become d________d in this heat.

9. It is hard to watch a loved one suffering with d______a.

10. People with d______s have to constantly check their blood sugar levels.

11. The doctor would prefer to share the d_______s with the patient himself.

12. This pain medication should relieve some of your d________t.

13. I understand that this d_____e runs in your family.

14. You will have to wear a sling because of your d________d shoulder.

15. It is important that children know which number to dial in case of an e_______y.

Exercise 32. Answer the following questions:

1. Have you (or any of your relatives ever) broken any bones?

2. When and how did it happen?

3. What kind of fracture was it: simple, compound or greenstick?

4. What did you do after the accident?

5. How did your routine change during your recovery?

6. Did you have a plaster (cast) put?

7. Did you need crutches or a stick to walk?

8. How did you feel after the plaster had been taken off?

9. Where are people with broken bones taken to?

10. What should be done to prevent fractures?

Date: 2016-01-03; view: 1531