Steven E. Wolf, Art Sanford
The following is included as a description of daily tasks that take place in our
burn units. Topics such as the process of daily rounds and caring for wounds will
be discussed. They are intended as guidelines for the care of burn patients.
PATIENT ADMISSION
HISTORY AND PHYSICAL
You have learned how to obtain a medical history and physical assessment
skills in medical school. Be thorough. In burned patients, a couple of points should
be emphasized. Patient evaluation includes an AMPLE history: allergies, medications,
preexisting illness, last meal, and the events of the injury including time,
location, and concomitant results. A history of loss of consciousness is sought.
When, where, and how did the injury occur? With children, stories that do not
match the injuries are suspicious for child abuse. What time did the burn occur?
What was the initial treatment, including any narcotics or sedation that was administered
and resuscitation at an outlying center? What is the immunization status,
particularly for tetanus. For electrical injuries, the voltage that caused the injury
is documented. For chemical injuries, the type of chemical and the duration
from the injury are noted.
WOUND ASSESSMENT
An accurate initial description of the wounds, including depth assessment and
extent of injury is accurately documented, preferably on a cartoon of the body
(see figures in wound management chapter). If forms cannot be found, this may
be drawn in the progress notes. Treatment that has been administered including
the type of dressing and any escharotomies and fasciotomies are recorded. The
wounds are gently debrided under sedation or anesthesia if necessary. Blisters are
removed during this process. After complete evaluation, consultation is made with
the responsible faculty, with a decision for the wound treatment. This is generally
done with either topical antimicrobials, or a biologic/synthetic dressing. If topical
antimicrobials are chosen, silvadine with mycostatin is generally the choice except
for the face, which should have neomycin/mycostatin. Ears are treated with
sulfamyalon to prevent chondritis.
ADMISSION ORDERS
These are tailored for the burn size. In general, this will require a burn size
calculation to guide resuscitation volume. For those with other trauma, x-rays
and CT scans may be needed. All special procedures such as CT scans or
arteriograms require a progress note describing their necessity. Tetanus prophylaxis
is given as appropriate. Major injuries (> 30% TBSA) receive empiric antibiotics
to cover staphylococcus and gram-negative organisms. Hypothermia should
be avoided by limiting body exposure and warming the patient’s room. Comfort
measures including sedatives and analgesics are given after the initial assessment.
Nutritional support is given immediately, either by mouth for minor burns (milk,
Resource®) or via a nasoenteric tube for major burns. For those who are mechanically
ventilated, attention must be made to the ventilator settings, particularly in
the setting of inhalation injury. Serial exams of the vascular and neurologic status
of extremities that are at risk are made. Elevation of injured limbs with topical
collagenases can be used for marginally “tight” limbs that do not clearly require
escharotomy. Labs including a blood count and electrolytes are drawn daily for
the immediate phase of care. Consults for physical and occupational therapy, nutrition,
respiratory therapy, psychiatry, photography, and social work are placed
for all patients at admission. A list of medications and their recommended doses
are included in Table 12.1.
DAILY ROUNDS
Rounds with the burn team are made daily at 7:00 AM. All burn wounds are
inspected unless there was a recent operation. In general, the operative dressings
are removed on postoperative day 3 down to the fine mesh gauze. Clinical circumstances
may dictate that the wounds be inspected earlier at the discretion of
the senior physician. All wounds are completely exposed on postoperative day 4.
Donor sites are exposed on the day of the operation after arrival to the hospital
room or on postoperative day 1, and are available for daily inspection thereafter.
Wounds that are treated conservatively should be seen daily to inspect for signs of
invasive infection. Ominous signs include a surface appearance of fungus or black
spots. Increasing edema and erythema around wounds also increase suspicion. If
there is any question, the wound should be biopsied and sent to pathology and
microbiology. The pathologists do rapid sections to look for organisms invading
into viable tissue. The microbiologists identify the organism, and the quantitative
counts. The wounds are then dressed until the following day.
All personnel who participate in the dressing changes wear gowns and gloves
which are available just outside the room. Other personnel who are only looking
at the wound take care not to touch either the patient or the furniture in the room
Table 12.1. Medication dosage guidelines
Vitamins & Minerals 0-2 Years 2-12 Years > 12 Years
Multi Vitamin Poly Vi Sol 1 ml Poly Vi Sol 1 ml Vi Deylin 5 ml
Or Chewable Tab or Theragran
Ascorbic Acid 250 mg QD 250 mg QD 500 mg QD
Folic Acid 1 mg QMWF 1 mg QMWF 1 mg QMWF
Vitamin A 2500U 5000U 10000U
Zinc Sulfate 55 mg 110 mg 220 mg
Elemental Iron < dose =" 2">
30 kg Dose = 65 mg PO TID or FeSO4 325 mg PO TID
Antifungal Prophylaxis
Mycostatin Oral Suspension 5ml QID 5ml QID 5ml QID
H-2 Blockers
Ranitidine Dose = 2 mg/kg/dose PO or IV q8h.
If gastric pH is less than 4, increase dose by 1 mg/kg up to a maximum of 8 mg/kg/
dose PO or IV q8h
Treatment with Ranitidine is for the entire period of acute burn hospitalization.
If patient has had an endoscopically documented ulcer, Ranitidine should be
prescribed for 6 weeks from the time the ulcer was documented.
Diuretics
Furosemide: IV: 0.25 mg/kg/dose q6h up to 1 mg/kg/dose
PO: 0.5 mg/kg/dose q6h up to 2 mg/kg/dose
Spironolactone: 0-2 yrs 6.25 mg PO q12h
3 yr-12 yr 12.5 mg PO q12h
> 12 yr 25 mg PO q12h
Human Growth Hormone 0.2 mg/kg/dose SQ qd
Beta-Adrenergic Blockers
Propranolol: 0.25 mg-0.5 mg/kg/dose IV q6H, titrate to decrease heart rate by 25%
Metroprolol: 0.75 mg/kg/dose IV q12h, titrate to decrease heart rate by 25%
Antibiotics:
Acyclovir: Mucocutaneous ASV 750 mg/m2/day
8 mg/kg/24h q8h IV x 7 days
Herpes Zoster in Immunocompromised Patients:
7.5 mg/kg/dose q8h IV
250-600/m2/dose 4-6 x day PO
Adult dose 800 mg 4-6 x day PO x 7-10 days
Varicella-Zester: 1500 mg/m2/day q6h or 30 mg/kg/day q8h IV
20 mg/kg/dose (max 800 mg/dose) PO 4-5 x day x 6 days
Begin treatment at earliest sign or symptom
Amikacin: 22.5 mg/kg/day q8h PO
1.5 gm max/day
Amoxicillin: 25-40 mg/kg/day q8hr PO
> 20 kg Use adult dose
Adult dose 250–500 mg PO q8hr
Amphotericin-B: Test dose: 0.1 mg/kg x 1 up to 1 mg
Initial dose: 0.25 mg/kg/day increasing by 0.125-0.25 mg/kg/day until
1 mg/kg/day as tolerated (given QD or QOD. Infuse over 6 h.
Premedicate with Acetaminophen and Diphenhyramine at dosages
based on weight.
Ampicillin: 50-100 mg/kg/day q4h IV Mild to moderate infection
150-200 mg/kg/day q4h IV Severe infection
50-100 mg/kg/day q6h PO Mild to moderate infection
> 20 kg Use adult dose
Adult dose 250-500 mg q6h PO
Augmentin: <>
> 40 kg 250-500 mg/dose q8h PO
Aztreonam: 200 mg/kg/day q6h IV
8 gm max/day
Cefazolin: 25-100 mg/kg/day q8h IV
12 gm max/day
Cefoperazone: 25-100 mg/kg/day q12h IV
16 gm max/day
Cefotaxime: <>
>50 kg 1-2 mg q6-8h IV
12 gm max/day
Cefotetan: 40-60 mg/kg/day q12h IV
Cefoxitin: 80-160 mg/kg/day q6h IV
12 gm max/day
Ceftazidime: 90-150 mg/kg/day q8h IV
6 gm max/day
Ceftriaxone: 50-75 mg/kg/day q12h IV
4 gm max/day
Cefuroxime: 50-100 mg/kg/day q6h IV
Adult dose: 750 mg-1.5 mg/dose q8h IV
Chloramphenicol: 50-100 mg/kg/day q6h IV or PO
Clindamycin: 16-40 mg/kg/day q8h IV
2.7 gm max/day
8.58 mg/kg/day q8h PO
3 gm max/day
cont’d.
Dicloxacillin: 12.5-5.0 mg/kg/day q8h PO (up to 2 gm/day)
> 40 kg should receive adult dose
Adult dose 125-250 mg q8h PO
Erythromycin: 10-20 mg/kg/day q8h IV
30-50 mg/kg/day q8h PO
Fluconazole: 3-6 mg/kg/day IV or PO
Immunocompromised: 12 mg/kg/day IV or PO
Adult doses: 200-400 mg IV or PO on Day 1
Followed by 100-200 mg PO or IV
Gentamicin: <>
> 40 kg 5 mg/kg/day q8h IV
Imipenem/Cilistatin: > 12 yrs 50 mg/kg/day q6h IV
≤ 12 yrs 75 mg/kg/day q6h IV
4 gm max/day
Itraconazole: Adult dose: Loading dose 200 mg PO TID for 3 days, then 200 mg POQD:
If ineffective may increase by 100 mg increments to 400 mg PO QD
Mebendazole: (round, hook or whipworm) 100 mg PO BID x 10 days
Metronidazole: Giardiasis–5 mg/kg/day PO TID x 10 days
Amebiasis–35-50 mg/kg/day PO TID x 10 days
Miconazole: Children > 1 yr 20-40 mg/kg/day q8h IV
Nafcillin: 100-200 mg/kg/day q4h IV
Adult dose: 500 mg-2000 mg q4-6h IV
Penicillin G: 25,000-100,000 units/kg/day q4h IV
Adult dose: 2-24 million units/day q4-6 h IV
Penicillin VK: 25-50 mg/kg/day divided 96h PO
Children ≥ 12 yrs or adult doses: 125-500 mg PO q6-8h
Piperacillin: 200-300 mg/kg/day q4h IV
24 gm max/day
Ticarcillin: 200-300 mg/kg/day q4h IV
24 gm max/day
Tobramycin: <>
> 40 kg 5 mg/kg/day q8h IV
Vancomycin: 40 mg/kg/day q6h IV
CHS infections 60 mg/kg/day
Adults 500 mg q6 h or 1 pm q12h IV
Zosyn: 100 mg/kg/days
IV q6h
in an effort to avoid passing organisms between patients. After removing the gowns
and gloves in the patient room, each participant washes their hands prior to going
to the next room.
During the wound inspection, the events of the previous day and night are
reviewed with the team, including any pertinent changes in vital signs or physical
exam. All laboratory and x-ray results are discussed (see included worksheet on
Table 12.4). After this review, plans for the day are made which should be reflected
in the physician’s orders. After rounds are complete, the operations for the day or
the outpatient schedule are attended to.
In the afternoon, brief rounds are made with the team where the events of the
day are discussed. Potential problems should be identified for the personnel on
call.
OPERATIONS
When patients are admitted, the operating room should be notified to prepare
for the operation the subsequent day. The operating theater is warmed with adequate
supplies garnered, such as multiple electrosurgical units. The burn size
should be calculated in square centimeters to give an estimate of the blood loss.
For example, a 50% TBSA burn in a 2.0 m2 man will be 1.0 m2 burn surface area.
One m2 is equal to 10,000 cm2 (100 cm x 100 cm). Blood loss is generally 0.5-1.0 ml
of blood per cm2 excised. So this man should have 20 units of whole blood or
reconstituted whole blood (one unit of packed red blood cells added to one unit
of fresh frozen plasma) available for the operation. An estimation of the amount
of cadaver skin required is made and ordered as well. For a massive burn (> 80%
TBSA), enough skin to cover the whole wound is ordered, with a decreased amount
for lesser wounds. Fresh cadaver skin is best if it is available, although frozen cadaver
skin can be used.
A preoperative note is prepared for each patient the day before his or her operation.
This note should contain the indication for the operation, the planned
procedure, documentation that appropriate consent has been obtained, NPO orders
if indicated, and that blood and skin have been requested.
On the day of the operation, the airway is secured by the anesthesia staff with
subsequent bronchoscopy and bronchoalveolar lavage specimens obtained. The
dressings are then removed in the operating theater under the supervision of the
surgeons. The entire body surface area is prepared with betadine and sterile drapes
placed under the patient. For most burns, the entire body is prepared in order to
allow for intraoperative decisions about the donor sites that are procured and the
amount of the wound to excise. A Foley catheter is then placed as dictated by the
clinical situation. The operation is then begun and completed, followed by application
of bolsters or bulky dressings to the grafted areas.
After the operation is complete, the postoperative orders are written with all
the tenets described above in the admission orders kept in mind. An operative
note is written describing the date, surgeons, operative findings, wound excised
and grafted in cm2, donor sites, estimated blood loss, intraoperative fluids, and
operative complications. Lastly, the details of the operation are dictated for later
transcription.
All bedside procedures such as central vein cannulation, Swan-Ganz catheter
placement, escharotomy, bedside sharp debridement, and bronchoscopy are documented
with both a procedure note and a dictated note.
Please find included a list of medications commonly used with their recommended
doses (Table 12.1). Also find the target serum levels for some antibiotics
(Table 12.2). Lastly, we have included some recommended medications for
anxiolytics, itching, nausea, and bowel cleansing (Table 12.3).
Table 12.2. Serum level norms
Amikacin Acetaminophen
Trough: 5-8 µg/ml (1h post dose)
Peak: 25-30 µg/ml = or <>µg/ml
Toxic: > 50 µg/ml
Vancomycin Imipramine
Trough: 5-10 µg/ml (8h post dose)
Peak: 30-40 µg/ml 150–300 µg/ml
Toxic: > 500 µg/ml
Do not advance if PR int. > 0.2
Gentamicin
Trough: <>µg/ml Phenytoin
Peak: 5-10 µg/ml neonates: 6-14 µg/ml
peds/adults: 10-20 µg/ml
Tobramycin Phenobarbital
Trough: <>µg/ml pediatric: 15-30 µg/ml
Peak: 4-10 µg/ml adult: 20-40 µg/ml
Table 12.3. Anxiolytic (after pain control)
Criteria: First—Address pain management
Second—Address posttraumatic stress disorder (PTSS) problems and then
Third—Use anxiolytics
Lorazepam dose: 0.03 mg/kg/dose PO or IV q4h
Acute patients: Taper benzodiazepines: reduce dose by 50% every 2nd day
Reconstructive patients: > 15 days on benzodiazepines, taper slowly, reduce dose every 3rd
day (may be tapered post discharge if necessary)
Itch
Step 1: Use moisturizing body shampoo and lotions.
Step 2: Diphenhydramine 1.25 mg/kg/dose
Step 3: Hydroxyzine 0.5 mg/kg.dose
Diphenydramine 1.25 mg/kg/dose
Alternate medication so that patient is receiving one itch medicine every 3 hours
while awake.
Step 4: Hydroxyzine 0.5 mg/kg/dose
Cyproheptadine 0.1 mg/kg/dose
Alternate medication so that patient is receiving one itch medicine every 2 hours
while awake.
Management of Postoperative Nausea and Vomiting
Droperidol: 0.025-0.05 mg/kg/dose IV q4-6h PRN
Bowel Regimen
Start with 1 and 2 any time narcotics are given
1) Prune juice <>
> 5 yrs-4 oz
> 10 yrs-6 oz
2) (Colace) Diacetyl sodium
Less than 6 yrs of age 10-60 mg/day
Children 6-12 yrs of age 40-120 mg/day
Children more than 12 yrs 100-200 mg/day
Then add one of these if patient becomes constipated:
3) Mineral oil 1-3 oz day
4) Mini-enema (colace-glycerine) if no B.M. by noon
5 SBI enema if no B.M. by 1500 hours.
Table 12.4. Daily rounds worksheet
Date:
Name: _____________________________ Age: _____________ Home: __________
Burn Date: _________________________ Admit Date: ______
Height: ____________________________ Weight ___________ TBSA: __________
% of Burn: _________________________ % 3rd: ____________ SA Burn: ________
PBD#: POD#: for Genitourinary
I/O summary: ( )
Overnight concerns urine output: cc/kg/h
Fluid needs calculated* (% met last 24 hours)
lytes: BUN crt Na K Cl Mg P Ca
Vital Signs foley (yes/no) issues:
T: Tmax: at GU meds:
Respiratory Wounds
RR Grafts
ABG: pH PCO2 pO2 02sat on HCO3 BE Type Location Donor site(s)
Ventilator: mode RR TV 02sat F102 PEEP PIP
CT output:
CXR:
Pulm meds: Cultures
DateAmt./OrganismLocation
Cardiovascular
P BP CVP
Cor PE State of wounds/
dressings:
Cor meds State of donor sites:
Antimicrobial meds:
Hematology
Blood given: PRBC whole other Neuro/Pain:
Colloid:
Labs: Hgb Hct WBCplt glucose ibili
TP alb AST ALT AlkP GGT osm If OR
blood ordered*:
Gastrointestinal skin ordered:
NCT residuals: NGT guaiac
Stool stool guaiac emesis:
Feeds
Caloric needs calculated*: (% met last 24 hours) Assessment:
GI meds: Plan:
*use formula card to calculate
A
Acid burn 99, 100
Airway 6-8, 14, 18
Albumin 17, 18, 87
Alkali 98, 99
Alloderm® 43
Allograft split skin graft 27
Amikacin 78, 123, 126
Amphotericin B 78
Anesthesia 24-26, 53, 60, 62, 63
Antibiotics 78, 85, 93, 112, 121, 126
Arachidonic acid 82, 83
ARDS 84, 100
Arginine 67, 84
Autologous split skin graft 25, 28, 38,
39, 46
B
Bacitracin 75, 76
Bactroban 75, 76
Biobrane® 25-27, 40, 41, 49
Biological dressing 9, 23, 26-28, 40
Blisters 9, 22, 23, 25, 26, 55, 120
Bronchoalveolar lavage 77, 78, 125
Burn alopecia 116, 117
Burn depth 22, 25
Burn resuscitation 14
Burn scar 108, 109, 113, 118
Burn size consideration 2
Burn size determination 9
Burn surgery 35, 37
Burn units 3
Burn wound assessment 9, 21, 23
Burn wound infection 72, 73, 75
Burn wound treatment 1, 2, 21,
25-34, 47, 51
Burns 1-3, 5-12, 14, 17
C
Caloric needs 66, 67, 69, 70
Carbon monoxide 6, 54, 59, 90, 91
Ceftazidime 78, 123
Cement (calcium oxide) burn 99
Cervical spine stabilization 7
Chemical burns 6, 59, 97
Cultured epithelial autograft (CEA)
43, 44
Curreri formula 67
Cytokines 56, 82, 83
D
Dermagraft TC® 26, 40, 41
Dermatome 27, 33, 35, 37, 39, 43
Dietary composition 67, 68, 71
Disseminated intravascular coagulation
(DIC) 57, 88
Duoderm® 26
E
Electrocautery 24, 37, 38, 50
Endotracheal intubation 6-8, 55, 63
Enteral feeding 69
Eschar 9, 21, 22, 29, 30, 35, 37, 38, 75,
99
Escharotomy 9, 24, 102, 105, 106, 120,
121, 126
F
Face 1, 3, 7, 21, 26, 28, 29, 33, 35-38,
40, 44, 46, 92, 105, 107,
111, 114, 116, 121
Fasciotomies 102
Flamacerium 28
Fluconazole 78, 124
Fluid resuscitation 7, 9, 10, 12, 14, 18,
19, 81, 84, 93
Formic acid 100
Full-thickness burns 3, 20, 22, 24, 28,
29, 31-33, 35, 37- 42, 44, 45,
49
Fungal infection 38, 73, 78
G
Glutamine 67
Growth hormone 48, 49, 122
H
Hemodialysis 87, 100
Hepatic failure 87
High voltage injury 101
Hydrocarbons 100, 101
Hydrofluoric acid 99, 100
Hypertonic saline 18
I
Ice 6
Immunosuppression 73, 74, 78, 79
Inflammation 76, 81, 82, 84, 85, 92
Inhalation injury 1-3, 5, 10, 11, 18,
54-56, 58, 59, 62
Initial resuscitation 11
Integra® 30, 39-43
Intraoperative monitoring 60
Intubation 55, 62, 63
Itraconazole 78, 124
IV access 7
L
Line sepsis 76
M
Mafenide acetate 75, 76
Mepitel® 26, 27
Mesh graft 31, 32, 35, 44, 45
MODS (multiple organ failure
syndrome) 82
Mycostatin 75, 76, 120-122
Myoglobin 12, 18, 57, 102
N
Nitric oxide 82-84, 95
Nutrition 44, 57, 66, 68, 70
O
Omniderm® 26
Operations 107, 109-111, 125
Oxygen 5, 6, 54, 56, 57, 63, 66, 82-84,
87, 90-92, 94, 95, 98
Oxygen free radicals 82, 83, 84
P
Pain management 55, 63
Partial thickness burns 20, 22, 24, 27,
28, 30, 31, 37, 40, 41, 48
Patient-surgeon relationship 104,
105, 108-110, 112
Peritoneal dialysis 86
Piperacillin 78, 124
Pneumonia 63, 69, 73, 74, 77, 78, 82,
83, 85, 91, 93, 94
Polymyxin B 75, 76
Pre-Hospital care 5, 8, 13
Pulmonary failure 87
R
Reconstruction 104, 105, 108-114,
116-119
Renal failure 86, 100
Resuscitation formula 11
Rounds 120, 121, 125
“Rule of Nines” 9, 14, 15, 22
S
Scar release 118
Sedation 9, 25, 48, 55, 59, 60
Sepsis 27, 29, 30, 32, 39, 51, 56,
69, 73-76, 78-81, 83-85, 88,
90
Silvadene 26, 75, 76
Silver sulfadiazine 26-28, 75, 76
Skin graft 24, 25, 27, 28, 30, 32,
34-39, 43-47, 49, 50, 52
ankle 32, 107, 118
axilla 32, 46, 117
breast 32
buttocks 32, 46
elbow 32, 107, 117
foot 32, 101, 107, 118
genitalia 21, 26, 32, 44
hand 1, 3, 21, 28, 29, 32, 33,
35, 37-39, 44, 46, 55, 101,
105-107, 111, 117, 118
knee 32, 107, 118
lower limb 31, 32
perineum 3, 21, 26, 32
upper limb 31, 32
Skin graft knives 35
Skin substitute 29, 30, 34, 38-41
Smoke inhalation 74, 77, 90, 92
Stapler 35
Systemic inflammatory response
syndrome (SIRS) 81, 82,
84, 88
T
Tegaderm® 26
Tetanus 12, 120, 121
Thrombocytopenia 79, 88
Total parenteral nutrition (TPN) 68, 69
Tracheobronchitis 77, 78
Transportation 5, 8
U
Urinary tract infection 74, 77
V
Vaseline gauze 26, 27
Ventilator management 85, 90, 94
Vivonex TEN® 68, 70, 85
X
Xenograft 26-28, 40
Z
Z-plasty 111, 114
Zones of injury 20
Dedication
We wish to recognize all those who went before us to pave the path of
burn care at UTMB and the Shriners Burns Hospital in Galveston. The
development and growth of these units was begun primarily through the
efforts and support of Truman G. Blocker, Sally Abston, and James C.
Thompson. We dedicate this work to them.
Editors
Contributors
Steven E. Wolf, MD
Assistant Professor
Department of Surgery
Clinical Fellow (1996-1997)
Shriners Burns Hospital and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapters 1, 8, 10, 12
David N. Herndon, MD
Jesse Jones Professor of Surgery
Chief of Staff,
Shriners Burns Hospital and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Juan P. Barret, MD
Clinical Fellow (1997-1999)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapters 4,11
Peter Dziewulski, MD, FRCS (Plast)
Consultant Plastic and Reconstructive
Surgeon
St. Andrews Centre for Plastic Surgery
and Burns
Essex, United Kingdom
Clinical Fellow (1997-1998)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 4
Doraid Jarrar
Research Fellow
Department of Surgery
Brown University
Providence, Rhode Island
Fellow (1996-1998)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 8
Marc G. Jeschke, MD
Fellow (1996-1999)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 9
Ron Mlcak, RT
Director of Respiratory Therapy
and Inter-Hospital Transportation
Shriners Burns Hospital
Galveston, Texas, USA
Chapter 2
Victor M. Perez, MD
Clinical Fellow (1998-1999)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 6
Edgar J. Pierre, MD
Resident in Anesthesia
University of Miami
Miami, Florida, USA
Fellow (1994-1997)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 10
Peter I. Ramzy
Fellow (1997-1999)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA (1997-1999)
Chapter 7
Art Sanford, MD
Clinical Fellow (1998-1999)
Shriners Burns Hospital
and Blocker Burn Unit
University of Texas Medical Branch
Galveston, Texas, USA
Chapters 3,12
Arjav J. Shah, MD
Resident in Anesthesia (1995-1999)
University of Texas Medical Branch
Galveston, Texas, USA
Chapter 5
Acknowledgments
We wish to acknowledge the efforts of several, without which the following
handbook could not have been developed. The burn fellows and
residents shouldered most of this work. The efforts of all the nurses and
therapists should also be recognized. Lastly, the tireless work of our partner,
Dr. Manu Desai cannot go unmentioned. His innumerable contributions
to burn care are described in these pages.
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