Burns : journal of the International Society for Burn Injuries
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Case Reports
Severe heat stroke associated with high plasma levels of plasminogen activator inhibitor 1.
In a 38-year-old man, severe heat stroke caused disseminated intravascular coagulation (DIC) associated with significantly elevated plasma plasminogen activator inhibitor 1 levels. Investigation of the effects of hyperthermia on coagulation and fibrinolysis showed, in apparent conflict with previous reports, a time lag between the initial hypercoagulable and hyperfibrinolytic response (within 24 hr) and hypofibrinolysis shown by a disproportionate increase of PAI-1 (after 24 h), which possibly occurs in correspondence with the recovery of vascular endothelial integrity. The patient was discharged without sequelae although computed tomography (CT) scans indicated the likelihood of venous infarction or posterior inferior cerebellar artery area infarction secondary to DIC.
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Small amounts of excess autograft are commonly harvested during burn procedures, and typically these are discarded. However, the resources of a local skin bank may be used to preserve this tissue for a later autologous use. This has been a routine practice in our institution and we feel that it has impacted favorably on patient care. In this paper we report 42 consecutive applications of autologous frozen skin and illustrate the technique with a case report.
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Mucormycosis is an opportunistic infection occurring in the severely immunocompromised patient. A case of mucormycosis occurring in a patient who sustained an 85 per cent TBSA burn injury is reported. Diagnosis and management is reported in the paper.
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Exposure keratitis can lead to infectious keratitis, corneal perforation, blindness and disfigurement. Chronic exposure of the cornea can occur following facial burns that cause eyelid ectropion. This complication can be difficult to diagnose in the unconscious patient. ⋯ All the patients were noted to have exposure keratitis on ophthalmological review. Patients most at risk are those with large area burns that include the face, who require prolonged intensive care support. It is important to look out for the development of eyelid ectropion, which should be corrected when first diagnosed to prevent disabling, sight-threatening eye injury.
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Doubts and questions about clinical decision making need to be answered. Evidence-based medicine aims to provide answers by systematically finding information from the vast assortment of research papers in the literature and bringing it together to use in everyday practice and in the best interests of the patient. ⋯ Using contemporary information retrieval systems and the numerous establishments set up to help track down information of research in medicine relevant to health practice and policy the numbers of RCTs, systematic reviews and meta-analyses of burn care have been established. Whilst the numbers of RCTs are increasing there is little evidence that burn care is an evidence-based practice.