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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 PO q4h scheduled

Step 3: Hydroxyzine 0.5 mg/kg.dose PO q6h and

Diphenydramine 1.25 mg/kg/dose PO q6h

Alternate medication so that patient is receiving one itch medicine every 3 hours

while awake.

Step 4: Hydroxyzine 0.5 mg/kg/dose PO q6h

Cyproheptadine 0.1 mg/kg/dose PO q6h and

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 PE

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:

Abd PE:

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.