burr n. see bur.
The manoeuvre occurs naturally when an attempt is made to breathe out while holding the vocal cords tightly together.
This happens, for example, at the beginning of a sneeze.
When performed deliberately by pinching the nose and holding the mouth closed, the manoeuvre can prevent pressure damage to the eardrums (see barotrauma).... valsalva’s manoeuvre
Severe and extensive burns are most frequently produced by the clothes – for example, of a child – catching ?re. This applies especially to cotton garments, which blaze up quickly. It should be remembered that such a ?ame can immediately be extinguished by making the individual lie on the ?oor so that the ?ames are uppermost, and wrapping him or her in a rug, mat or blanket. As prevention is always better than cure, particular care should always be exercised with electric ?res and kettles or pots of boiling water in houses where there are young children or old people. Children’s clothes, and especially night-clothes, should be made of non-in?ammable material: pyjamas are also much safer than nightdresses.
Severe scalds are usually produced by escape of steam in boiler explosions. Cigarettes are a common cause of ?res and therefore of burns; people who have fallen asleep in bed or in a chair while smoking may set ?re to the bed or chair. Discarded, unextinguished cigarettes are another cause.
Degrees of burns Burns are referred to as either super?cial (or partial-thickness) burns, when there is su?cient skin tissue left to ensure regrowth of skin over the burned site; and deep (or full-thickness) burns, when the skin is totally destroyed and grafting will be necessary.
Symptoms Whilst many domestic burns are minor and insigni?cant, more severe burns and scalds can prove to be very dangerous to life. The main danger is due to SHOCK, which arises as a result of loss of ?uid from the circulating blood at the site of a serious burn. This loss of ?uid leads to a fall in the volume of the circulating blood. As the maintenance of an adequate blood volume is essential to life, the body attempts to compensate for this loss by withdrawing ?uid from the uninjured areas of the body into the circulation. If carried too far, however, this in turn begins to affect the viability of the body cells. As a sequel, essential body cells, such as those of the liver and kidneys, begin to suffer, and the liver and kidneys cease to function properly. This will show itself by the development of JAUNDICE and the appearance of albumin in the urine (see PROTEINURIA). In addition, the circulation begins to fail with a resultant lack of oxygen (see ANOXIA) in the tissues, and the victim becomes cyanosed (see CYANOSIS), restless and collapsed: in some cases, death ensues. In addition, there is a strong risk of infection occurring. This is the case with severe burns in particular, which leave a large raw surface exposed and very vulnerable to any micro-organisms. The combination of shock and infection can all too often be life-threatening unless expert treatment is immediately available.
The immediate outcome of a burn is largely determined by its extent. This is of more signi?cance than the depth of the burn. To assess the extent of a burn in relation to the surface of the body, what is known as the Rule of Nine has been evolved. The head and each arm cover 9 per cent of the body surface, whilst the front of the body, the back of the body, and each leg each cover 18 per cent, with the perineum (or crutch) accounting for the remaining 1 per cent. The greater the extent of the burn, the more seriously ill will the victim become from loss of ?uid from his or her circulation, and therefore the more prompt should be his or her removal to hospital for expert treatment. The depth of the burn, unless this is very great, is mainly of import when the question arises as to how much surgical treatment, including skin grafting, will be required.
Treatment This depends upon the severity of the burn. In the case of quite minor burns or scalds, all that may be necessary if they are seen immediately is to hold the part under cold running water until the pain is relieved. Cooling is one of the most e?ective ways of relieving the pain of a burn. If the burn involves the distal part of a limb – for example, the hand and forearm – one of the most e?ective ways of relieving pain is to immerse the burned part in lukewarm water and add cold water until the pain disappears. As the water warms and pain returns, more cold water is added. After some three to four hours, pain will not reappear on warming, and the burn may be dressed in the usual way. Thereafter a simple dressing (e.g. a piece of sterile gauze covered by cotton-wool, and on top of this a bandage or adhesive dressing) should be applied. The part should be kept at rest and the dressing kept quite dry until healing takes place. Blisters should be pierced with a sterile needle, but the skin should not be cut away. No ointment or oil should be applied, and an antiseptic is not usually necessary.
In slightly more severe burns or scalds, it is probably advisable to use some antiseptic dressing. These are the cases which should be taken to a doctor – whether a general practitioner, a factory doctor, or to a hospital Accident & Emergency department. There is still no general consensus of expert opinion as to the best ‘antiseptic’ to use. Among those recommended are CHLORHEXIDINE, and antibiotics such as BACITRACIN, NEOMYCIN and polymixin. An alternative is to use a Tulle Gras dressing which has been impregnated with a suitable antibiotic.
In the case of severe burns and scalds, the only sound rule is immediate removal to hospital. Unless there is any need for immediate resuscitation, such as arti?cial respiration, or attention to other injuries there may be, such as fractures or haemorrhage, nothing should be done on the spot to the patient except to make sure that s/he is as comfortable as possible and to keep them warm, and to cover the burn with a sterile (or clean) cloth such as a sheet, pillowcases, or towels wrung out in cold water. If pain is severe, morphine should be given – usually intravenously. Once the victim is in hospital, the primary decision is as to the extent of the burn, and whether or not a transfusion is necessary. If the burn is more than 9 per cent of the body surface in extent, a transfusion is called for. The precise treatment of the burn varies, but the essential is to prevent infection if this has not already occurred, or, if it has, to bring it under control as quickly as possible. The treatment of severe burns has made great advances, with quick transport to specialised burns units, modern resuscitative measures, the use of skin grafting and other arti?cial covering techniques and active rehabilitation programmes, o?ering victims a good chance of returning to normal life.
CHEMICAL BURNS Phenol or lysol can be washed o? promptly before they do much damage. Acid or alkali burns should be neutralised by washing them repeatedly with sodium bicarbonate or 1 per cent acetic acid, respectively. Alternatively, the following bu?er solution may be used for either acid or alkali burns: monobasic potassium phosphate (70 grams), dibasic sodium phosphate (70 grams) in 850 millilitres of water. (See also PHOSPHORUS BURNS.)... burns and scalds
Valsalva’s manoeuvre is involuntarily performed when a person strains to open his or her bowels: in these circumstances the passage of air to the lungs is blocked by instinctive closure of the vocal cords in the LARYNX. The resultant raised abdominal pressure helps to expel the bowel contents. The manoeuvre is also used in the study of cardiovascular physiology because the rise in pressure in the chest restricts the return of venous blood to the right atrium of the HEART. Pressure in the peripheral VEINS is raised and the amount of blood entering and leaving the heart falls. This drop in cardiac output may cause the subject to faint because the supply of oxygenated blood to the brain is reduced.... valsalva’s manoeuvre
All burns are serious. Vulnerary herbs are available to promote healing and cell growth, including: Aloe Vera, Comfrey, Fenugreek, Marigold, Marshmallow, Slippery Elm, Chickweed, Myrrh (powder).
Even hospital authorities may find these effective, enhancing healing, reducing risk of infection, and often concluding with a minimum of scar tissue. Echinacea – to mobilise the immune system.
Exclude air from affected parts as soon as possible. Remove no clothing adhering to wound; cut round. For corrosive alkalis: bathe with cider vinegar (2-4 teaspoons to teacup water). Follow with honey: apply lint and bandage. Honey has a long traditional reputation for burns. The following are analgesic and antiseptic, keeping wounds clean and free from pus. Apply sterile dressings.
Tea for internal use: Nettles 1; Valerian 1; Comfrey leaf 2. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup every 2 hours. Or, cup of ordinary tea laced with 2-3 drops Life Drops.
Topical. (1) Tea Tree oil: 1 part to 20 parts Almond oil. (2) Strong Nettle tea – pain killer. (3) St John’s Wort oil. (4) Aloe Vera – cut off piece of leaf and pulp; or, gel. (5) Slippery Elm – Powder mixed with little milk to form a paste. (6) Pierce Vitamin E capsule and anoint area. (7) Distilled extract of Witch Hazel. (8) Cod liver oil.
Compress. Apply piece of suitable material steeped in teas of any of the following: Chamomile, Chickweed, Comfrey, Cucumber, Elderflowers, Marigold, Plantain, St John’s Wort.
Alcohol should not be taken.
Supplementation. Vitamins A, B-complex, C, D, E. Potassium. Zinc. ... burns & scalds
A burn is covered with a non-stick dressing to keep the area moist. If necessary, analgesic drugs are given, and antibiotic drugs are prescribed if there is any sign of infection. For extensive 2nddegree burns, when there may be slow healing or a fear of infection, a topical antibacterial agent such as silver sulphadiazine is used. Skin grafts are used early in treatment to minimize scarring. 3rd-degree burns always require skin grafting. Extensive burns may require repeated plastic surgery.... burns
os1 n. (pl. ossa) a bone.
os2 n. (pl. ora) the mouth or a mouthlike part.... ortolani manoeuvre
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