Aspectos Clínicos E Epidemiológicos De Pacientes Queimados Internados Em Um Hospital De Ensino Aspectos Clínicos Y Epidemiológicos De Pacientes Quemados Internados En Un Hospital De Enseñanza Resumo

The objectives of this study were to characterize burned patients according to epidemiological and clinical variables and identify the treatments, invasive procedures and complications. This is a retrospective, descriptive and quantitative study. The sample consisted of 138 burned patients hospitalized in a teaching hospital from January 2003 to December 2007, in Uberaba-MG. Of the 138 hospitalized patients, 98 (71.0%) were male, and the average age was 26.1 years. The average length of stay was 16.2 days; 93 (67.4%) of the burns were caused by accidents and the main cause (68; 49.3%) was an open flame. The average burned body surface was 20.8% and most (122; 88.4%) had second degree burns. The most common topic treatment (93; 67.4%) was silver sulfadiazine. Forty-seven (34.0%) patients had indwelling catheters; 30 (21.7%) underwent tissue transplantation, and 28 (20.3%) underwent debridement; the lesions in 14 (10.1%) patients became infected. DESCRIPTORS Burns Epidemiology Nursing Hospitals, teaching RESUMEN Los objetivos fueron caracterizar al paciente quemado según las variables epidemiológicas y clínicas e identificar los tratamientos, procedimientos invasivos y complicaciones. Estudio retrospectivo, descriptivo, cuantitativo. Muestra de 138 pacientes quemados internados en hospital de enseñanza, en período de enero 2003 a diciembre 2007, en Uberaba-MG. De los 138 pacientes internados, 98 (71%) eran de sexo masculino, la media de edad fue de 26,1 años. El tiempo medio de internación fue de 16,2 días, 93 (67,4%) presentaban quemaduras accidentales y la principal causa, 68 (49,3%) fue la llama abierta. La superficie quemada media fue de 20,8% y la mayoría, 122 (88,4%) presentó quemaduras de segundo grado. La terapia tópica más utilizada, 93 (67,4%) fue la sulfadiacina de plata. El sondaje vesical de demora se instaló en 47 (34,0%) pacientes; 30 (21,7%) fueron sometidos a injerto y 28 (20,3%) a desbridamiento; 14 (10,1%) presentaron infección de la lesión. DESCRIPTORES Quemaduras Epidemiología Enfermería Hospitales escuela Received: 01/18/2010 Approved: 05/27/2010 Portugue e / English: www.scielo.br/reeusp 366 Rev Esc Enferm USP 2011; 45(2):365-9 www.ee.usp.br/reeusp/ Clinical and epidemiological aspects of burned patients hospitalized in a Teaching Hospital in Minas Gerais Montes SF, Barbosa MH, Sousa Neto AL INTRODUCTION Burns are cutaneous lesions caused by the direct or indirect action of heat and the main causes are direct flame, contact with boiling water or fluids, which is called scalding, contact with hot surfaces, electricity and chemical agents. These lesions can compromise different organic structures and are evaluated in degrees according to the depth of tissue trauma. A first-degree burn compromises the epidermis; the lesion presents redness (erythema), heat and pain, progresses rapidly with scaling, and its systemic impact is minimal. A second-degree burn involves not only the entire epidermis but it also affects the dermis; the lesion site presents pain, erythema, edema, blisters, erosion and ulceration; the healing process is slower and sequelae may occur such as dyschromia or scarring. The epidermis and dermis are destroyed in a third-degree burn, which may reach the subcutaneous tissue, tendons, ligaments, muscle and bones. The lesion is white or black, dry, hard and inelastic. There is no pain due to the destruction of nervous endings and no capillary return, while blood vessels are compromised by coagulation; there is no spontaneous regeneration and grafting is indicated; when it is healing, there is edge retraction . Another important aspect to evaluate is the Total Body Surface Area involved (TBSA), which should be evaluated as precisely as possible because it is one of the factors that has the greatest influence on systemic repercussion and patient survival. The site of lesions is also an important indicative to be considered when delivering care to patients because burns on the face, neck and hands should receive more attention to reduce aesthetic and functional impairment. Often burn victims have their airways burned by smoke inhalation, one of the main causes of mortality both due to the direct thermal action and inhalation of toxic substances and the presence of toxins on the site A burn harms the integrity of the skin, the functions of which are compromised. Local response is first to the emergency of coagulative necrosis, due to thrombosis of blood vessels that eventually leads to systemic repercussions of varied intensity. One of the most expressive complications for burned patients is sepsis, which in many cases, leads to death. Other complications, also common in these patients, are cardiovascular complications and renal disease directly associated with hypovolemia. Among the cardiovascular complications there are hypotension, increased heart rate and shock. Therefore, treatment for these patients involves both local and systemic treatments. The local treatment of the lesion includes coverage with bacterial and/or bacteriostatic action and debridement of devitalized tissue. Among the topical agents the following are highlighted: silver sulfadiazine at 1% and essential fatty acids (EFA). Natural products include papain and honey, while solutions include silver nitrate, chlorhexidine gluconate and povidoneiodine, though these are currently seldom used. Another alternative is the use of temporary skin substitutes indicated to protect the lesion until completion of a graft or only to protect it until it is healed, when it is free of infection. Skin substitutes can be of animal origin such as a homologous graft, amniotic membrane, or collagen and also synthetic such as silicone or polyurethane, and finally associated with organic matter such as collagen and silicone. The identification of epidemiological and clinical aspects of victims of burns can contribute to the development of care protocols to ensure the quality of care delivered to this population.