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= = Production = =
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" We 'll Always Have Paris " is named in reference to the Humphrey Bogart and Ingrid Bergman film Casablanca . As well as the title of the episode and the love triangle in the story , the Blue Parrot Café from the film is directly mentioned by Captain Picard . Casablanca was also the basis for the earlier Star Trek : The Original Series novel The Entropy Effect , and would be so again in the Deep Space Nine episode " Profit and Loss " .
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The story was originally pitched by Hannah Louise Shearer and Deborah Dean Davis , who were also given the job of developing the script . The writing of the episode suffered from the timing of the 1988 Writers Guild of America strike , with Shearer and Dean Davis completing the script in five days . The premise of the story was a combination of their idea of a story " about a professor whose work wasn 't appreciated and had to go off on his own " and that of Maurice Hurley who wanted a story with a time anomaly . The final draft was dated 22 February and featured numerous differences from the filmed version , including Jenice being called Laura , a number of different interactions for the crew , and Riker , Worf and Data all being involved in shutting down Manheim 's equipment . The script was finalised a week before the episode was filmed , but the writers strike caused further issues when it was discovered during filming that the scene where Data was to fix the time distortions hadn 't been completed .
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Robert Legato and Rick Berman spent forty minutes on the telephone with Shearer during the strike . While she refused to write the lines during the strike , Berman suggested dialogue and Shearer would give opinions with Legato taking down handwritten notes . Legato decided on the directing notes himself , and used a whip pan shot instead of an effects shot to film the three Datas as director Robert Becker had never used effects shots previously . Shearer wasn 't happy with the final result , saying " we were writing the most romantic episode in the world " but that " it was toned down 75 % " .
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Shearer later complained of a lack of chemistry between Michelle Phillips and Patrick Stewart , which Phillips blamed on the conflicted nature of the character in that she was committed to her husband but also wanted to see Picard once more . Phillips , a Star Trek fan , is better known for being a member of the 1960s group The Mamas & the Papas . Rod Loomis ' previous science fiction outing was in Bill and Ted 's Excellent Adventure as Sigmund Freud , and Lance Spellerberg would later return in " The Icarus Factor " where his transporter chief gained the name Ensign Herbert . The image of 24th century Paris was a matte painting which was re @-@ used in Star Trek VI : The Undiscovered Country where it was hung outside the office of the Federation president .
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= = Reception = =
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" We 'll Always Have Paris " aired in broadcast syndication during the week commencing May 5 , 1988 . It received Nielsen ratings of 9 @.@ 7 , reflecting the percentage of all households watching the episode during its timeslot . This was the same ratings received as the previous episode , " Skin of Evil " .
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Several reviewers re @-@ watched the episode after the end of the series . Michelle Erica Green reviewed the episode on behalf of TrekNation in September 2007 , comparing certain elements of the episode to Casablanca and the series finale " All Good Things ... " . These included the ending where time distortions caused Data to be replicated three time in " We 'll Always Have Paris " compared to the similar situation with three Picards in " All Good Things ... " . Overall she thought that the episode was better than she recalled previously . Jamahl Epsicokhan at his website " Jammer 's Reviews " described the episode as too simple , especially the ending which he said was " they give Data a canister , which he sticks into a hall of mirrors ; problem solved " .
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Zack Handlen , reviewing the episode for The A.V. Club in May 2010 , said that he enjoyed the " time blips " in the episode , but that he wasn 't a fan of the romance between Jenice and Picard . He also felt that there wasn 't much follow up on Manheim 's experiments and that he seemed to be left to cause a more serious accident in the future . Keith DeCandido watched the episode for Tor.com in July 2011 . He thought that Michele Phillips was " incredibly radiant " , and said , " there ’ s nothing I can point to at this episode and say is wrong , but it ’ s one of the more forgettable episodes " , giving it a score of four out of ten .
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= = Home media release = =
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The first home media release of " We 'll Always Have Paris " was on VHS cassette was on July 1 , 1992 in the United States and Canada . The episode was later included on the Star Trek : The Next Generation season one DVD box set , released in March 2002 , and was released as part of the season one Blu @-@ ray set on July 24 , 2012 .
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= Burn =
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A burn is a type of injury to skin , or other tissues , caused by heat , cold , electricity , chemicals , friction , or radiation . Most burns are due to heat from hot liquids , solids , or fire . Among women in many areas of the world the risk is related to the use of open cooking fires or unsafe cook stoves . Alcoholism and smoking are other risk factors . Burns can also occur as a result of self harm or violence between people .
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Burns that affect only the superficial skin layers are known as superficial or first @-@ degree burns . They appear red without blisters and pain typically lasts around three days . When the injury extends into some of the underlying skin layer , it is a partial @-@ thickness or second @-@ degree burn . Blisters are frequently present and they are often very painful . Healing can require up to eight weeks and scarring may occur . In a full @-@ thickness or third @-@ degree burn , the injury extends to all layers of the skin . Often there is no pain and the burn area is stiff . Healing typically does not occur on its own . A fourth @-@ degree burn additionally involves injury to deeper tissues , such as muscle , tendons , or bone . The burn is often black and frequently leads to loss of the burned part .
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Burns are generally preventable . Treatment depends on the severity of the burn . Superficial burns may be managed with little more than simple pain medication , while major burns may require prolonged treatment in specialized burn centers . Cooling with tap water may help pain and decrease damage ; however , prolonged cooling may result in low body temperature . Partial @-@ thickness burns may require cleaning with soap and water , followed by dressings . It is not clear how to manage blisters , but it is probably reasonable to leave them intact if small and drain them if large . Full @-@ thickness burns usually require surgical treatments , such as skin grafting . Extensive burns often require large amounts of intravenous fluid , due to capillary fluid leakage and tissue swelling . The most common complications of burns involve infection . Tetanus toxoid should be given if not up to date .
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In 2013 , fire and heat resulted in 35 million injuries . This resulted in about 2 @.@ 9 million hospitalizations and 238 @,@ 000 dying . Most deaths due to burns occur in the developing world , particularly in Southeast Asia . While large burns can be fatal , treatments developed since 1960 have improved outcomes , especially in children and young adults . In the United States , approximately 96 % of those admitted to a burn center survive their injuries . Burns occur at similar frequencies in men and women . The long @-@ term outcome is related to the size of burn and the age of the person affected .
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= = Signs and symptoms = =
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The characteristics of a burn depend upon its depth . Superficial burns cause pain lasting two or three days , followed by peeling of the skin over the next few days . Individuals suffering from more severe burns may indicate discomfort or complain of feeling pressure rather than pain . Full @-@ thickness burns may be entirely insensitive to light touch or puncture . While superficial burns are typically red in color , severe burns may be pink , white or black . Burns around the mouth or singed hair inside the nose may indicate that burns to the airways have occurred , but these findings are not definitive . More worrisome signs include : shortness of breath , hoarseness , and stridor or wheezing . Itchiness is common during the healing process , occurring in up to 90 % of adults and nearly all children . Numbness or tingling may persist for a prolonged period of time after an electrical injury . Burns may also produce emotional and psychological distress .
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= = Cause = =
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Burns are caused by a variety of external sources classified as thermal ( heat @-@ related ) , chemical , electrical , and radiation . In the United States , the most common causes of burns are : fire or flame ( 44 % ) , scalds ( 33 % ) , hot objects ( 9 % ) , electricity ( 4 % ) , and chemicals ( 3 % ) . Most ( 69 % ) burn injuries occur at home or at work ( 9 % ) , and most are accidental , with 2 % due to assault by another , and 1 @-@ 2 % resulting from a suicide attempt . These sources can cause inhalation injury to the airway and / or lungs , occurring in about 6 % .
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Burn injuries occur more commonly among the poor . Smoking is a risk factor , although alcohol use is not . Fire @-@ related burns are generally more common in colder climates . Specific risk factors in the developing world include cooking with open fires or on the floor as well as developmental disabilities in children and chronic diseases in adults .
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= = = Thermal = = =
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In the United States , fire and hot liquids are the most common causes of burns . Of house fires that result in death , smoking causes 25 % and heating devices cause 22 % . Almost half of injuries are due to efforts to fight a fire . Scalding is caused by hot liquids or gases and most commonly occurs from exposure to hot drinks , high temperature tap water in baths or showers , hot cooking oil , or steam . Scald injuries are most common in children under the age of five and , in the United States and Australia , this population makes up about two @-@ thirds of all burns . Contact with hot objects is the cause of about 20 @-@ 30 % of burns in children . Generally , scalds are first- or second @-@ degree burns , but third @-@ degree burns may also result , especially with prolonged contact . Fireworks are a common cause of burns during holiday seasons in many countries . This is a particular risk for adolescent males .
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= = = Chemical = = =
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Chemicals cause from 2 to 11 % of all burns and contribute to as many as 30 % of burn @-@ related deaths . Chemical burns can be caused by over 25 @,@ 000 substances , most of which are either a strong base ( 55 % ) or a strong acid ( 26 % ) . Most chemical burn deaths are secondary to ingestion . Common agents include : sulfuric acid as found in toilet cleaners , sodium hypochlorite as found in bleach , and halogenated hydrocarbons as found in paint remover , among others . Hydrofluoric acid can cause particularly deep burns that may not become symptomatic until some time after exposure . Formic acid may cause the breakdown of significant numbers of red blood cells .
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= = = Electrical = = =
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Electrical burns or injuries are classified as high voltage ( greater than or equal to 1000 volts ) , low voltage ( less than 1000 volts ) , or as flash burns secondary to an electric arc . The most common causes of electrical burns in children are electrical cords ( 60 % ) followed by electrical outlets ( 14 % ) . Lightning may also result in electrical burns . Risk factors for being struck include involvement in outdoor activities such as mountain climbing , golf and field sports , and working outside . Mortality from a lightning strike is about 10 % .
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While electrical injuries primarily result in burns , they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions . In high voltage injuries , most damage may occur internally and thus the extent of the injury cannot be judged by examination of the skin alone . Contact with either low voltage or high voltage may produce cardiac arrhythmias or cardiac arrest .
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= = = Radiation = = =
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Radiation burns may be caused by protracted exposure to ultraviolet light ( such as from the sun , tanning booths or arc welding ) or from ionizing radiation ( such as from radiation therapy , X @-@ rays or radioactive fallout ) . Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall . There is significant variation in how easily people sunburn based on their skin type . Skin effects from ionizing radiation depend on the amount of exposure to the area , with hair loss seen after 3 Gy , redness seen after 10 Gy , wet skin peeling after 20 Gy , and necrosis after 30 Gy . Redness , if it occurs , may not appear until some time after exposure . Radiation burns are treated the same as other burns . Microwave burns occur via thermal heating caused by the microwaves . While exposures as short as two seconds may cause injury , overall this is an uncommon occurrence .
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= = = Non accidental = = =
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In those hospitalized from scalds or fire burns , 3 – 10 % are from assault . Reasons include : child abuse , personal disputes , spousal abuse , elder abuse , and business disputes . An immersion injury or immersion scald may indicate child abuse . It is created when an extremity or the lower body ( buttock or perineum ) is held under the surface of hot water . It typically produces a sharp upper border and is often symmetrical . Other high @-@ risk signs of potential abuse include : circumferential burns , the absence of splash marks , a burn of uniform depth , and association with other signs of neglect or abuse .
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Bride burning , a form of domestic violence , occurs in some cultures , such as India where women have been burned in revenge for what the husband or his family consider an inadequate dowry . In Pakistan , acid burns represent 13 % of intentional burns , and are frequently related to domestic violence . Self @-@ immolation ( setting oneself on fire ) is also used as a form of protest in various parts of the world .
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= = Pathophysiology = =
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At temperatures greater than 44 ° C ( 111 ° F ) , proteins begin losing their three @-@ dimensional shape and start breaking down . This results in cell and tissue damage . Many of the direct health effects of a burn are secondary to disruption in the normal functioning of the skin . They include disruption of the skin 's sensation , ability to prevent water loss through evaporation , and ability to control body temperature . Disruption of cell membranes causes cells to lose potassium to the spaces outside the cell and to take up water and sodium .
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In large burns ( over 30 % of the total body surface area ) , there is a significant inflammatory response . This results in increased leakage of fluid from the capillaries , and subsequent tissue edema . This causes overall blood volume loss , with the remaining blood suffering significant plasma loss , making the blood more concentrated . Poor blood flow to organs such as the kidneys and gastrointestinal tract may result in renal failure and stomach ulcers .
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Increased levels of catecholamines and cortisol can cause a hypermetabolic state that can last for years . This is associated with increased cardiac output , metabolism , a fast heart rate , and poor immune function .
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= = Diagnosis = =
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Burns can be classified by depth , mechanism of injury , extent , and associated injuries . The most commonly used classification is based on the depth of injury . The depth of a burn is usually determined via examination , although a biopsy may also be used . It may be difficult to accurately determine the depth of a burn on a single examination and repeated examinations over a few days may be necessary . In those who have a headache or are dizzy and have a fire @-@ related burn , carbon monoxide poisoning should be considered . Cyanide poisoning should also be considered .
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= = = Size = = =
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The size of a burn is measured as a percentage of total body surface area ( TBSA ) affected by partial thickness or full thickness burns . First @-@ degree burns that are only red in color and are not blistering are not included in this estimation . Most burns ( 70 % ) involve less than 10 % of the TBSA .
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There are a number of methods to determine the TBSA , including the Wallace rule of nines , Lund and Browder chart , and estimations based on a person 's palm size . The rule of nines is easy to remember but only accurate in people over 16 years of age . More accurate estimates can be made using Lund and Browder charts , which take into account the different proportions of body parts in adults and children . The size of a person 's handprint ( including the palm and fingers ) is approximately 1 % of their TBSA .
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= = = Severity = = =
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To determine the need for referral to a specialized burn unit , the American Burn Association devised a classification system . Under this system , burns can be classified as major , moderate and minor . This is assessed based on a number of factors , including total body surface area affected , the involvement of specific anatomical zones , the age of the person , and associated injuries . Minor burns can typically be managed at home , moderate burns are often managed in hospital , and major burns are managed by a burn center .
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= = Prevention = =
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Historically , about half of all burns were deemed preventable . Burn prevention programs have significantly decreased rates of serious burns . Preventive measures include : limiting hot water temperatures , smoke alarms , sprinkler systems , proper construction of buildings , and fire @-@ resistant clothing . Experts recommend setting water heaters below 48 @.@ 8 ° C ( 119 @.@ 8 ° F ) . Other measures to prevent scalds include using a thermometer to measure bath water temperatures , and splash guards on stoves . While the effect of the regulation of fireworks is unclear , there is tentative evidence of benefit with recommendations including the limitation of the sale of fireworks to children .
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= = Management = =
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Resuscitation begins with the assessment and stabilization of the person 's airway , breathing and circulation . If inhalation injury is suspected , early intubation may be required . This is followed by care of the burn wound itself . People with extensive burns may be wrapped in clean sheets until they arrive at a hospital . As burn wounds are prone to infection , a tetanus booster shot should be given if an individual has not been immunized within the last five years . In the United States , 95 % of burns that present to the emergency department are treated and discharged ; 5 % require hospital admission . With major burns , early feeding is important . Hyperbaric oxygenation may be useful in addition to traditional treatments .
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= = = Intravenous fluids = = =
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In those with poor tissue perfusion , boluses of isotonic crystalloid solution should be given . In children with more than 10 @-@ 20 % TBSA burns , and adults with more than 15 % TBSA burns , formal fluid resuscitation and monitoring should follow . This should be begun pre @-@ hospital if possible in those with burns greater than 25 % TBSA . The Parkland formula can help determine the volume of intravenous fluids required over the first 24 hours . The formula is based on the affected individual 's TBSA and weight . Half of the fluid is administered over the first 8 hours , and the remainder over the following 16 hours . The time is calculated from when the burn occurred , and not from the time that fluid resuscitation began . Children require additional maintenance fluid that includes glucose . Additionally , those with inhalation injuries require more fluid . While inadequate fluid resuscitation may cause problems , over @-@ resuscitation can also be detrimental . The formulas are only a guide , with infusions ideally tailored to a urinary output of > 30 mL / h in adults or > 1mL / kg in children and mean arterial pressure greater than 60 mmHg .
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While lactated Ringer 's solution is often used , there is no evidence that it is superior to normal saline . Crystalloid fluids appear just as good as colloid fluids , and as colloids are more expensive they are not recommended . Blood transfusions are rarely required . They are typically only recommended when the hemoglobin level falls below 60 @-@ 80 g / L ( 6 @-@ 8 g / dL ) due to the associated risk of complications . Intravenous catheters may be placed through burned skin if needed or intraosseous infusions may be used .
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= = = Wound care = = =
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Early cooling ( within 30 minutes of the burn ) reduces burn depth and pain , but care must be taken as over @-@ cooling can result in hypothermia . It should be performed with cool water 10 – 25 ° C ( 50 @.@ 0 – 77 @.@ 0 ° F ) and not ice water as the latter can cause further injury . Chemical burns may require extensive irrigation . Cleaning with soap and water , removal of dead tissue , and application of dressings are important aspects of wound care . If intact blisters are present , it is not clear what should be done with them . Some tentative evidence supports leaving them intact . Second @-@ degree burns should be re @-@ evaluated after two days .
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In the management of first and second @-@ degree burns , little quality evidence exists to determine which dressing type to use . It is reasonable to manage first @-@ degree burns without dressings . While topical antibiotics are often recommended , there is little evidence to support their use . Silver sulfadiazine ( a type of antibiotic ) is not recommended as it potentially prolongs healing time . There is insufficient evidence to support the use of dressings containing silver or negative @-@ pressure wound therapy .
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= = = Medications = = =
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Burns can be very painful and a number of different options may be used for pain management . These include simple analgesics ( such as ibuprofen and acetaminophen ) and opioids such as morphine . Benzodiazepines may be used in addition to analgesics to help with anxiety . During the healing process , antihistamines , massage , or transcutaneous nerve stimulation may be used to aid with itching . Antihistamines , however , are only effective for this purpose in 20 % of people . There is tentative evidence supporting the use of gabapentin and its use may be reasonable in those who do not improve with antihistamines . Intravenous lidocaine requires more study before it can be recommended for pain .
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Intravenous antibiotics are recommended before surgery for those with extensive burns ( > 60 % TBSA ) . As of 2008 , guidelines do not recommend their general use due to concerns regarding antibiotic resistance and the increased risk of fungal infections . Tentative evidence , however , shows that they may improve survival rates in those with large and severe burns . Erythropoietin has not been found effective to prevent or treat anemia in burn cases . In burns caused by hydrofluoric acid , calcium gluconate is a specific antidote and may be used intravenously and / or topically . Recombinant human growth hormone ( rhGH ) in those with burns that involve more than 40 % of their body appears to speed healing without affecting the risk of death .
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= = = Surgery = = =
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