Journal of burn care & research : official publication of the American Burn Association
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Amputations are common after severe frostbite injuries, often mediated by postinjury arterial thrombosis. Since 1994, the authors have performed angiography to identify perfusion deficits in severely frostbitten digits and treated these lesions with intraarterial infusion of thrombolytic agents, usually combined with papaverine to reduce vasospasm. A retrospective review was performed of patients admitted to the regional burn center with frostbite injury from 1994 to 2007. ⋯ Overall complete digit salvage rate was 68.6%. Angiography after severe frostbite is a sensitive method to detect impaired arterial blood flow and permits catheter-directed treatment with thrombolytic agents. Improved perfusion after such treatment decreases late amputations following frostbite injury.
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Case Reports
Oxalate Nephropathy After Continuous Infusion of High-Dose Vitamin C as an Adjunct to Burn Resuscitation.
Fluid resuscitation is the foundation of management in burn patients and is the topic of considerable research. One adjunct in burn resuscitation is continuous, high-dose vitamin C (ascorbic acid) infusion, which may reduce fluid requirements and thus decrease the risk for over resuscitation. ⋯ However, high-dose and low-dose vitamin C supplementation has been shown to cause secondary calcium oxalate nephropathy, worsen acute kidney injury, and delay renal recovery in non-burn patients. To the best of our knowledge, the authors present the first case series in burn patients in whom calcium oxalate nephropathy has been identified after high-dose vitamin C therapy.
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Silver-impregnated dressings are increasingly preferred over silver sulfadiazine cream in the management of pediatric burns. An ideal burns dressing would provide a moist, sterile environment, discourage infection, and not require painful dressing changes. This study sought to determine whether silver sodium carboxymethyl cellulose (Aquacel Ag, ConvaTec, Greensboro, NC) dressing is a superior treatment to nanocrystalline silver-coated polyethylene (Acticoat, Smith & Nephew, London, United Kingdom) dressing in pediatric patients with partial thickness burns. ⋯ This decrease in frequency of dressing changes and direct manipulation of the wound, which can be distressing or require additional intervention, identified Aquacel Ag as the superior dressing. The majority of partial thickness pediatric burns heal within 10 days; however, a considerable minority requires the wound to be dressed for a longer period of time and/or specialist intervention. To identify these patients, expert review of the wound at 10 days postburn is recommended.
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The objectives of this study are to describe the proportion, mechanism, severity, and outcomes of hot beverage scald injuries in children presenting at a major burns centre in 2013 and to compare these results with data collected at the same centre 10 years before. A cross-sectional trend analysis was performed to determine the differences in proportion, mechanism, severity, and outcomes of hot beverage scalds in 0-year to 14-year old children presenting to the Stuart Pegg Paediatric Burns Centre, Royal Children's Hospital, Brisbane, Australia, between January 1 and December 31, 2013 and compare these data to presentations at the same burns centre between 1999 and 2002. ⋯ The decrease in admissions, skin grafts, and scar management requirements can be attributed to several factors; moving from silver sulfadiazine to silver-impregnated dressings at SPBBC from 2003, changes in excision and skin grafting practices, modified referral patterns, a move to non-inpatient care for minor burns, and the increased application of first aid. However, what has not changed is hot beverage scalds remain the leading cause of childhood burns making it a major pediatric public health issue.
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For those at risk for cold-related injury, frostbite contributes significant morbidity through loss of limbs and digits. Frostbite injury generally affects distal extremities first and spreads proximally as the time of exposure increases. ⋯ The authors found high reliability between raters using the Hennepin score worksheet, suggesting consistency with applying the score to frostbite injury and outcomes (intraclass correlation, 0.93; confidence interval, 0.88-0.97). The Hennepin score allows for a standard means to accurately measure injury and outcomes, which will aid in the study of treatment outcomes of frostbite injuries.