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S H Imbus

Publications and source records attributed to S H Imbus.

4 recordsLinked to original sources
PubMed1986

Encouraging dialogue and autonomy in the burn intensive care unit.

Developing a systematic, rigorous approach to one major ethical issue--autonomous decision making by patients--as part of a standardized burn protocol ensures that the ill and injured persons we care for are given respect and a sense of control over their destiny. We cannot document a clinical, physiologic benefit to this particular approach but do find that early, frank discussions with patients, when combined with careful, active listening, help form strong care-giver-patient bonds. The patient's designation of a spokesperson to be consulted if the patient becomes unable to speak for himself prevents a great deal of anguish should the patient become comatose. The patient's wishes concerning limitations, if any, of maximal treatment are noted and respected. We believe that our approach is legally and ethically sound and can serve as one model for establishing informed consent in an intensive care setting.

Burn Units↗
PubMed1979

Multifactorial probit analysis of mortality in burned patients.

Burn mortality statistics may be misleading unless they account properly for the many factors which may influence outcome. In reviewing such factors in our patients, we identified age, total burn area, third degree burn area, prior bronchopulmonary disease, abnormal Pao2, and airway edema as the factors present on admission which best distinguished survivors from nonsurvivors. Using multifactorial probit analysis, we then calculated the contribution of each to the probability of fatal outcome. The resultant six-factor model significantly improved estimation of the probability of fatal outcome when compared to probit analysis based only on the traditional factors of age and total burn area. It also revealed a spectrum of mortality probabilities varying with the additional factors present. Although crucial in comparing different approaches to burn care, consideration of such prognostic factors will not eliminate the need for randomized treatment trials, because other factors, some of which are obscure, may also influence mortality rates in burned patients.

Adult↗
PubMed1977

Autonomy for burned patients when survival is unprecedented.

Altered states of consciousness often exclude the seriously burned patient from decision making in his own case. During the first few hours of hospitalization, however, even the most severely burned patient is usually alert and mentally competent. When burns are so severe that survival is unprecedented, we use an aggressive approach to decision making to preserve patient autonomy. While still lucid, and with sufficient information, the patient is asked if he wishes to choose between a full therapeutic regimen or ordinary care, reassured that with either choice, the burn team will provide the constant presence of human caring and full use of its professional skills. This approach has not changed the mortality rate of such patients, but has increased both the self-determination that they exercise and the empathy that they receive.

Aged↗