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By B. Julio. Southwestern College, Kansas.

Establish intravenous access through large peripheral catheters ( 2) and administer intravenous fluids through a warming system order calan 120mg line. Protect wounds from the environment with application of clean dressings (topical antimicrobials not necessary). It may over- or underestimate the extent of the injury; therefore, a more accurate assessment is necessary on arrival at the admissions or emergency department, or burn center (see Fig. In this method, the areas burned are plotted in the burn diagram, and every area burned is assigned an exact percentage. The Lund and Browder method takes into consideration the differences in anatomical location that exist in the pediatric population and therefore does not over or underestimate the burn size in patients of different ages. After the burn size is determined, the individual characteristics of the patient should be plotted in a standard nomogram to deter- mine the body surface area and burned surface area of the patient (see Fig. Measuring and weighing the patient in centimeters and kilograms provides the surface area of the patient in square meters. This measurement will help to calcu- late metabolic needs, blood loss, hemodynamic parameters, and skin substitutes. At this point, the specific anatomical location of the burn should be noted as well as the depth of the burn per location. These measurements are to be noted also in the burn diagram, and will help in planning individual treatment for the patient. The eyes are explored with fluorescein and green lamp to rule out corneal damage; the oral cavity and perineum are explored to rule out any obvious internal damage. FIGURE 3 The Lund and Browder Chart is a good estimate of burn surface area (A). It is strongly advised to use the chart together with the rest of the initial assessment documentation (B).

Some journals request that you check your spelling using the Oxford English Dictionary 240 mg calan, others specify the Macquarie Dictionary or Webster’s Dictionary. It is best to know about the quirks of your journal of first choice so that you can adopt their format early in the piece. To expedite the publication of your work, try to be realistic and choose the right journal first time. However, if your paper is rejected and you decide to submit it to a second journal, then keep in mind that some journals request that you also send the previous reviewers’ comments plus your responses. The editor will want to be assured that you have addressed and/or amended any problems that have already been identified. There are no published statistics about journal shopping 20 Getting started practices, but an editor will obviously not be interested in a paper that has been rejected from other journals on the basis of fundamental problems with study design. Remember that if you do submit to another journal, reading the instructions to authors and modifying the manuscript accordingly will improve your chances of publication. This may also save you time because many journals will automatically return papers that do not meet their standards. A study by researchers at Stanford University suggested that prestige, whether the journal usually publishes papers on a particular topic, and reader profiles are important factors that influence decisions about where to send a manuscript. In the end, your decision on where to send your paper will be based on many factors and, in deciding, you will need to respect the advice of your colleagues and coauthors. Uniform requirements The Uniform Requirements are instructions to authors on how to prepare manuscripts, not to editors on publication style. International Committee of Medical Journal editors (www3) All draft papers should be prepared in a format that is consistent with the “Uniform requirements for manuscripts submitted to biomedical journals”. The group naturally became known as the Vancouver group and the standard format is still referred to as Vancouver format. The first uniform requirements for manuscripts and recommendations for formatting references were published in 1979, and an updated version can now be accessed via the world wide web (www3). The Vancouver group eventually evolved into the International Council of Medical Journal Editors (ICMJE) who publish the uniform requirements on their website.

This rigid anatomy of pain in the 1950s led to attempts to treat severe chronic pain by a variety of neurosurgical lesions 40mg calan visa. Descartes’s specificity theory, then, determined the “facts” as they were known up to the middle of the 20th century, and even determined therapy. Specificity theory proposed that injury activates specific pain receptors and fibers, which, in turn, project pain impulses through a spinal pain path- way to a pain center in the brain. The psychological experience of pain, therefore, was virtually equated with peripheral injury. In the 1950s, there was no room for psychological contributions to pain, such as attention, past experience, anxiety, depression, and the meaning of the situation. He wrote: “If for example fire (A) comes near the foot (B), the minute particles of this fire, which as you know move with great velocity, have the power to set in motion the spot of the skin of the foot which they touch, and by this means pulling upon the delicate thread CC, which is attached to the spot of the skin, they open up at the same instant the pore, d. THE GATE CONTROL THEORY 15 stead, pain experience was held to be proportional to peripheral injury or pathology. Patients who suffered back pain without presenting signs of or- ganic disease were often labeled as psychologically disturbed and sent to psychiatrists. The concept, in short, was simple and, not surprisingly, often failed to help patients who suffered severe chronic pain. To thoughtful clini- cal observers, specificity theory was clearly wrong. The major opponent to specificity was labeled as “pattern theory,” but there were several differ- ent pattern theories and they were generally vague and inadequate (see Melzack & Wall, 1996). Gold- scheider (1894) proposed that central summation in the dorsal horns is one of the critical determinants of pain. Livingston’s (1943) theory postulated a reverberatory circuit in the dorsal horns to explain summation, referred pain, and pain that persisted long after healing was completed. Noorden- bos’s (1959) theory proposed that large-diameter fibers inhibited small- diameter fibers, and he even suggested that the substantia gelatinosa in the dorsal horns plays a major role in the summation and other dynamic proc- esses described by Livingston. However, in none of these theories was there an explicit role for the brain other than as a passive receiver of mes- sages.

Sensory focus is another cognitive strategy that has been applied to acute pain order calan 80 mg with visa. This strategy is based on theoretical work indicating that the cognitive schema used in interpreting pain stimuli can be either sensation focused or emotion focused, with activation of the latter type of schema more likely to lead to a more intense pain experience (Leventhal, Brown, Shacham, & Enquist, 1979). Based on this theory, sensory focus interven- tions encourage patients to focus exclusively on the sensations they are ex- periencing, thereby preventing activation of the emotional schema and re- sulting in a less intense pain experience (Logan, Baron, & Kohut, 1995). Distraction is another common cognitive strategy used for management of acute pain. Distrac- tion techniques consume part of an individual’s limited capacity for atten- tion, thereby reducing the attentional resources that can be directed at the painful stimulus (McCaul & Malott, 1984). Review of the distraction litera- ture indicates that it is more likely to be effective for brief and lower inten- sity pain, and become less effective as the stimulus becomes longer lasting or more intense (McCaul & Malott, 1984). Moreover, distraction techniques that require more attentional capacity appear to inhibit the experience of pain more than techniques requiring less attentional capacity (McCaul & Malott, 1984). For brief clinical pain of relatively low intensity, regular imple- mentation of distraction techniques may be pragmatically appealing, given the low degree of effort required to provide them. PSYCHOLOGICAL INTERVENTIONS FOR ACUTE PAIN 251 CONTROLLED TRIALS Laboratory Studies Studies using controlled laboratory stimuli as an analog of acute clinical pain have evaluated the efficacy of psychological acute pain interventions presumably under ideal conditions—intervention procedures are well stan- dardized with no limitations on amount of time and effort that can be in- vested in implementing the techniques. Laboratory studies indicate that specific psychological interventions including distraction (Clum, Luscomb, & Scott, 1982; Fanurik, Zeltzer, Roberts, & Blount, 1993; Farthing et al. Early qualitative reviews of the efficacy of various psychological techniques under controlled laboratory conditions indicate that there is at least modest support for the efficacy of such inter- ventions (Tan, 1982; Weisenberg, 1987). Definitive conclusions from this lit- erature are limited by the variety of interventions, acute pain stimuli used (e. Although laboratory studies suggest that psy- chological interventions can be effective for reducing acute pain, they may tell little about whether these interventions will be effective in the clinical context due to the limited generalizability of laboratory analog studies. Se- lection of interventions for use in the clinical environment should therefore be based primarily on results of clinical trials. Clinical Trials in Adults Empirically supported generalizations regarding the efficacy of specific psy- chological interventions for clinical acute pain are made difficult by the number of different techniques used alone or in a variety of combinations, the multitude of clinical acute pain stimuli differing substantially in inten- sity, and the relatively small number of studies examining any one tech- nique for use with any given type of clinical situation. For these and a vari- ety of methodological reasons, truly integrative reviews of the clinical literature have been limited.