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Combustion and high pressure spray injury
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
A burn is a partial or full thickness damage to the skin, caused by the action of heat, electricity or a chemical reaction. Be aware of an inhalation trauma and consider bronchoscopy if there is reason to do so. The severity of the burn depends on size, depth and localization. The size is expressed in the percentage of total body surface area (TBSA). The palm of the hand is considered 1% TBSA. The depth of the burn depends on the temperature of the source, the nature of the material and the duration of the burn. The thickness of the skin is of influence: a dorsal hand burn is usually deeper than a volar burn. Ask about the duration of cooling.
Burns
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Brian Brisebois, Joyce McIntyre
Patients with <20% TBSA enter a profound and long-lasting hypermetabolic state that leads to muscle wasting, organ failure, and death if not treated. Adjusting room temperature close to 18°C, pain control, sedation, and preventing sepsis are current strategies for preventing or mitigating the hypermetabolic response (Greenhalgh). The efficacy of propranolol to mitigate catabolic muscle wasting was demonstrated in a small cohort of children (Herndon) and remains a promising therapy modality. Administration of oxandrolone and other anabolic agents like insulin, IGF-1, and GH have also demonstrated efficacy (Greenhalgh). Multimodal pain relief should be initiated within the first 24–48 hours. Use of opiates as the primary method of treating burn pain, as recommended by the Society of Critical Care Medicine (SCCM), is currently controversial considering recent evidence regarding tolerance, addiction, and opioid-induced hyperanalgesia. Useful non-opioid agents include ketamine, acetaminophen, clonidine, dexmedetomidine, benzodiazepines, and quetiapine. NSAIDs increase bleeding and rates of AKI in burn patients and should be avoided (Lundy).
Burns
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
A number of different methods are available for estimating burn depth. Accurate assessment of total burn surface area (TBSA) is important in order to direct initial fluid management and also to triage patients in need of specialist burn care. It is not essential to work out precise fluid replacement calculations in the pre-hospital arena unless this time is likely to be very prolonged. When estimating TBSA it should be remembered that only partial and full thickness burns should be included in the calculation. The methods commonly used for assessing TBSA are described next.
Safety and efficacy of Pimecrolimus in atopic dermatitis among Chinese infants: a sub-group analysis of a five-year open-label study
Published in Journal of Dermatological Treatment, 2023
Xia Dou, Lingling Liu, Xuejun Zhu, Weijing Wen, Chunya Ni, Yi Zhao, Zhixin He, Hongchun Li, Qiuning Sun, Qinping Yang, Xinfen Sun, Yifeng Guo
The treatment success for facial IGA progressively increased in the Chinese population similar to that of the overall study. At year 5, the Chinese population showed mild increase in overall IGA treatment success compared with the overall study (89.7% vs 88.7%). Similarly, progressive increase in facial IGA treatment success in the Chinese population was observed similar to the overall study. By week 3, median TBSA affected by AD decreased from 19% at baseline to 5% in PIM and 4% in TCS. In the global PETITE study, the median TBSA decreased from 16% to 3.8% in PIM and 4% in TCS by week 3. The decrease in median TBSA was comparable for the Chinese subgroup and the global PETITE study. However, it is worth noting that the baseline TBSA percentage was higher in the Chinese subgroup compared with the global study (19% vs 16%). The median TBSA affected by AD decreased to 0% after 1.5 years of ‘as-needed’ treatment and was maintained at this level for the rest of the study which was similar to the global PETITE study.
Epidemiology and etiology of blood stream infections in a Belgian burn wound center
Published in Acta Clinica Belgica, 2022
Diana Isabela Costescu Strachinaru, Jean-Luc Gallez, Pierre-Michel François, Dries Baekelandt, Marie-Sophie Paridaens, Jean-Paul Pirnay, Daniel De Vos, Sarah Djebara, Peter Vanbrabant, Mihai Strachinaru, Patrick Soentjens
In this study, Gram-negative organisms accounted for 56,36%, Gram-positives for 38,17%, and yeasts for 5,45% of the causative pathogens for BSI. Other BWC also reported a predominance of GNR in blood cultures [14,22–24]. Among the GNR, a third of the strains were at least MDR organisms (22,58% strains were MDR and 9,67% strains were XDR organisms). The overall resistance rates of the GNR to large spectrum antibiotics such as third-generation cephalosporins and meropenem were 26,66% and 23,33%, respectively. One of the possible explanations for this particular epidemiology could be a patient selection bias. Our BWC is one of the largest in the region and frequently receives patients with large TBSA burnt referred by other centers. The mean affected TBSA in this study was 38 ± 20%. Also, our BWC has agreements with some Eastern European and North African countries to accept transfers of severely burnt patients. These regions are known for reporting higher prevalences of MDR GNR [25,26]. Multidrug resistance is a known emerging problem in burn patients. In a study conducted by van Langeveld et al. [27], MDR infections resulted in longer hospitalization, longer need for mechanical ventilation, and longer duration of antibiotic treatment. Also, in their study, burn patients with MDR infections were more likely to progress into a state of sepsis or organ failure. All those factors contribute to making the treatment of MDR infections in burn patients a challenge.
Application of beta-blockers in burn management
Published in Baylor University Medical Center Proceedings, 2022
Jonathan Kopel, Gregory L. Brower, Grant Sorensen, John Griswold
Burn injuries still occur frequently, with a worldwide incidence of 0.14 to 12.3 per 100,000 population.4 Severe burn injuries that cover >35% of the total body surface area (TBSA) produce chronic inflammatory and hypermetabolic responses that increase morbidity and mortality.5,6 In otherwise healthy young adults, the energy expenditure can be as high as 5000 kcal in a 24-hour period. This leads to an increase in lipolysis, proteolysis, and gluconeogenesis resulting from elevated glucagon and insulin secretion.7–9 Additionally, the release of cytokines and proinflammatory molecules leads to severe impairments in cardiovascular, respiratory, metabolic, and immunological function secondary to the hypermetabolic-induced changes.7 The elevations in catecholamines and cytokines cause damage in adipose tissue and the dermis of the skin through activation of systemic macrophages, which in turn produce cytokines, eicosanoids, kinins, and histamines. The sustained elevations in catecholamines, corticosteroids, thyroid hormone, and growth hormones associated with the hypermetabolic response also produce hormonal abnormalities, increased liver and cardiac stress, impaired muscle function, and increased risk of sepsis, all of which increase morbidity and mortality for several months after the initial burn injury.7–9