Internet resources for perioperative care of burns

AORN Journal, June, 1999 by Cynthia Drake

One of this month's featured Home Study articles clearly and thoroughly explains perioperative care of patients with burn injuries (page 1211). If you want to know more about this subject, turn to the Internet. Finding articles on the various aspects of care mentioned in the article is relatively easy. Some examples of what you can find include information on primary nursing care of burn patients, explanations of percutaneous dilatational tracheostomy, and explanations of noninvasive methods of assessing intercompartmental fluid shifts.

This column walks you through the search process and shows you how to find these and other subjects. For the experienced Internet user, this column also offers some sites that may be new to you.

PUBMED

From your home page (the first web page that appears when you go online), enter the web address or universal resource locator (URL) www.ncbi.nlm.nih.gov, which is the web site for the National Center for Biotechnology Information. Choose the category "PubMed." This is a search service that allows access to abstracts and some full-text articles online. If you think you'll want to return to this source often, bookmark the site (eg, click on the "Favorites" button at the top of your browser if you have Internet Explorer).

A search for more information on the "Parkland formula" produced some interesting abstracts. An article from Nurse Practitioner discusses the primary care management of bums.(1) According to the article, there were 2.2 million bum injuries in 1993, with approximately 60,000 of those injuries requiring hospitalization. The abstract notes the importance of taking the patient's medical history and caring for the patient's bums. The full text of the article explains the physiological alterations that occur with bums, and it also explains the use of the Parkland formula for fluid resuscitation.

This same search led to an abstract explaining the noninvasive assessment of intercompartmental fluid shifts in burn victims. A research article from Sweden explains two noninvasive methods (ie, the bioimpedance technique, the impression method) used in a study.(2) The objective was to determine sensitivity of the two methods in the detection and chronicling of the development of edema and fluid resuscitation effects (ie, Parkland formula) that occur secondary to a major burn.

If you need a clearer understanding of percutaneous dilatational tracheostomy, a search of PubMed results in several references. One from Anesthesia and Analgesia discusses a study that compared two techniques--the Ciaglia method (ie, gradual dilation) or the Rapitrach method (ie, single dilation).(3) Researchers in India considered 80 patients in this clinical trial. Both techniques were successful with no significant complications, no significant scarring, and no narrowing of the trachea.

MEDSCAPE

Medscape targets primary care physicians, but it is available to anyone and is free to use. Enter the URL www.medscape.com. You will need to register to use the service. After you register, enter a search for "caring for burns."

This search produces a variety of articles, including one that discusses the effects of propofol (ie, an analgesic) in acutely burned patients.(4) The authors of this article conclude that edema and changes in albumin concentrations probably were responsible for significant alterations in the disposition kinetics of the medication when used for burn patients.

JOURNAL WEB SITES

A look at the American Journal of Nursing web site (www.ajn.org) provides valuable information. Search for "burn care" and you will see an abstract for an article titled "Initial resuscitation after burn injury: Therapies, strategies, and controversies."(5) According to the abstract,

   Thermal injury disrupts normal hemostasis and sets off a cascade of events:
   cellular alterations and release of inflammatory mediators cause
   hypovolemic and cellular shock. Current research efforts focus on
   minimizing burn edema through mediator modulation and on development of
   definitive endpoints of resuscitation monitoring.

Some journals allow you access to their abstracts only if you subscribe to the journal. Others make all their publication available online at no charge, such as The British Journal of Medicine (www.bmj.com).

BURN HOSPITALS, FREE FLIGHTS

A search of the search engine Alta Vista for "bum hospitals" provides a number of sites to choose from; most are Shriners Hospitals. The web site www.shriners.com provides not only an explanation of the Shrine of North America, but also a list of the 22 hospitals with addresses and contact numbers. The site also explains how to obtain free flights for burn patients through AirLifeLine, a nonprofit organization of more than 1,000 pilots.

ARTIFICIAL SKIN

Many plastic surgeons are using artificial skin for bum patients. More information about these new products and techniques might be valuable to you. You can return to your favorite search engine to obtain this information. Some choices are Alta Vista (www.altavista.com), Yahoo! (www.yahoo.com), Northern Light (www.northernlight.com) and Ask Jeeves (www.askjeeves.com). Enter a general search for "artificial skin." One site from Scientific American (www.sciam.com/ 1097issue/1097infocus.htmls) gives a general overview of tissue engineering.