Journal of burn care & research : official publication of the American Burn Association
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Frostbite can lead to severe consequences including loss of digits and limbs. One of the mechanisms of frostbite includes vascular thrombosis. The use of tissue plasminogen activator (tPA) in frostbite has been shown to be effective in case reports and small prospective studies. ⋯ After rapid rewarming, the use of tPA is safe and effective at reducing the number of digits amputated. Patients who had less of a response to tPA were those who had an unknown duration of cold exposure along with drug or alcohol intoxication at presentation. Utilizing a guideline with clear criteria will help facilitate determining appropriate patients to safely treat with tPA for frostbite injury.
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Review Meta Analysis
Risk Factors for Acute Kidney Injury in Patients With Burn Injury: A Meta-Analysis and Systematic Review.
Acute kidney injury (AKI) is a fatal complication of burn injury. Few systematic reviews to date have focused on the risk factors predisposing to AKI in patients with burn injury. The aim of this article is to identify the risk factors for the occurrence of AKI in burn patients, thus providing theoretical evidence for prevention and treatment. ⋯ AKI is a common complication and occurs at a remarkable rate in burn patients. We identified 10 variables as independent risk factors for the development of AKI in burn patients. Our findings may help clinicians to develop effective preventive and therapeutic strategies and provide appropriate, timely initial treatment.
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In patients with burns, a massive inflammatory response is induced which negatively affects the healing process of the burn wound and additionally exerts systemic effects. An important factor herein is the complement system. Here we analyzed the effects of burns on complement and inflammatory cells both locally and systemically after burn in time in a pig burn wound model. ⋯ In contrast to the heart, the inflammatory cell infiltrates in the lungs, liver, and kidney of burned pigs were lower than in control pigs. In pigs, following burn there is a prolonged increase in complement levels both in the burn wound and the blood and increased inflammatory cell infiltrate in the burn wound and the heart. However, complement levels in the burn wound and in the blood seem not to be correlated in time.
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Hydrocarbons are a wide-ranging group of flammable chemicals and are often used in suicide attempts either by ingestion or as an accelerant in self-immolation. In this case study, we present a 37-year-old female who suffered 6% TBSA partial-thickness burns to her perineum and buttocks, which she claims resulted from diarrhea after ingesting a bottle of lighter fluid. ⋯ To our knowledge, this is one of the first reported cases of hydrocarbon enema. We review hydrocarbon poisoning, including both ingestion and dermal exposure, and discuss medical management.
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Enteral nutrition support is a critical component of modern burn care for severely burned patients. However, tube feeds are frequently withheld during the perioperative period because of aspiration concerns. As a result, patients requiring multiple operative procedures risk accumulating significant protein-calorie deficits. ⋯ The protocol group received significantly more calculated protein and caloric requirements, 98.06 and 98.4%, respectively, compared with 70.6 and 73.2% in the standard group (P < .001). Time to goal tube feed infusion rate was achieved on average 3 days sooner in the protocol group compared with the standard group (3.35 vs 6.18 days, P = .008). Early initiation and continuation of enteral feeds in severely burned patients led to higher percentages received of prescribed goal protein and caloric needs without increased rates of aspiration, regurgitation, or mortality.