Burns : journal of the International Society for Burn Injuries
-
Observational Study
Paediatric burn unit in Portugal: Beds needed using a bed-day approach.
Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. ⋯ Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed.
-
Randomized Controlled Trial
Controlling intraoperative hemorrhage during burn surgery: A prospective, randomized trial comparing NuStat(®) hemostatic dressing to the historic standard of care.
One of the primary intraoperative challenges during burn surgery is to adequately excise the burn while avoiding massive hemorrhage. This has become increasingly important, as we see more burn patients that are older and with more medical comorbidities. While adequate excision down to healthy tissues for deep burns is essential for skin graft to take, it also leads to active bleeding that can be a challenge to control. Good hemostasis is imperative as a hematoma is the most common cause of graft loss. Several new products have become available to help control intraoperative hemorrhage. A new hemostatic dressing, NuStat(®), is available and approved by FDA in United States. ⋯ Based on these findings, NuStat(®) hemostatic action should be comparable to the historic standard of care, and these newer hemostatic agents evaluated further in burn surgery and bleeding during other procedures such as trauma surgery.
-
Clinical Trial Observational Study
Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm.
Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid(®) (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands. ⋯ EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation.
-
A major fire occurred on January 27, 2013, at 02:30 at Kiss nightclub in the city of Santa Maria, State of Rio Grande do Sul, in Southern Brazil. In this retrospective report, we aimed to describe the nightclub fire event, its immediate consequences, and evaluated its impact on legislation. Our objective was to disseminate the lessons we learned from this large-scale nightclub fire disaster. ⋯ As we push for enactment of the national law of prevention and fire fighting in Brazil, we will continue emphasizing fire prevention, fire protection, fire fighting, means of escape and proper management. All similar events in this and other countries remind us that similar tragedies may occur anywhere, and that the analysis of facts, previous mistakes, during and after the incident are crucial to our understanding, and will help us lessen the chance of future occurrences.
-
The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. ⋯ Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated bedside dressings changes for burned patients.