Annals of burns and fire disasters
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Toxic epidermal necrolysis is a rare, potentially fatal disorder that involves large areas of skin desquamation. Patients with toxic epidermal necrolysis are frequently referred to burn centres for expert wound management and early comprehensive critical care as this has been shown to improve patient outcome and mortality. The authors describe the first report of medication-induced toxic epidermal necrolysis occurring in a patient during acute burn management in a tertiary burn care facility. ⋯ She required extensive debridement and allografting to manage burn injured areas and additional areas of epidermal loss from subsequent toxic epidermal necrolysis, amounting to a total body surface area of 90%. Definitive burn wound closure was achieved using autologous split-thickness skin grafting once donor sites healed and became suitable for harvest 3 weeks after the onset of toxic epidermal necrolysis. Grafts achieved complete take and the patient was discharged home following rehabilitation..
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Ann Burns Fire Disasters · Sep 2018
Electrical burn injury: a comparison of outcomes of high voltage versus low voltage injury in an Indian scenario.
Electrical burn injury (EBI) is a mutilating form of injury. The objective of this study was to evaluate the various aspects of EBI and analyse the differences between high voltage injury (HVI) and low voltage injury (LVI). A retrospective study was conducted by reviewing the medical records of all burn admissions from June 2016 to May 2017. ⋯ However, LVI cannot be overlooked as number of reconstructive surgeries and mean number of operations showed no significant difference between both groups. HVI has a disastrous impact on burn survivors but LVI cannot be underestimated. We advocate a low threshold for managing associated injuries, education on safety principles, for men at work especially, and infrastructure improvement by the state to bring changes to the present scenario.
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The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. ⋯ Mean +/- SD length of stay was 11.4±6.1 (days). 8.5% underwent amputation and there were no deaths. Diabetic foot burn patients delay seeking medical attention, have a longer length of stay, more complications and more amputations than other burn patients (compared with our previous study on burn patients). Prevention and training programs are highly needed to prevent foot burns.
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Ann Burns Fire Disasters · Jun 2018
A comparison of injury scoring systems in predicting burn mortality.
The models most widely used to predict burn patient mortality are the revised Baux score, Ryan, Smith, McGwin, Abbreviated Burn Severity Index (ABSI), Belgian Outcome of Burn Injury (BOBI), and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES). Improvements in critical care have reduced mortality resulting from severe burns, which may affect the predictive strength of older models. We conducted a cross-validation study on all burn patients (n = 114) with TBSA greater than 20%, admitted to the Arizona Burn Center between 2014 and 2016. ⋯ The revised Baux score was both accurate and easy to calculate, making it clinically useful. The older models demonstrated adequate predictive performance compared with the newer models. Even without key burn parameters, the APACHE II score performed well in critically ill patients with moderate to severe burn injuries.
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Ann Burns Fire Disasters · Mar 2018
Acute respiratory distress syndrome among severe burn patients in a developing country: application result of the berlin definition.
Our aim was to investigate risk factors and outcome of Acute Respiratory Distress Syndrome (ARDS) in severe burn patients. A descriptive study was carried out on 159 adult burn patients with burn extent ≥ 20% total body surface area, treated at the Burn Intensive Care Unit, National Institute of Burns. ARDS was defined according to the 2012 Berlin definition. ⋯ Severe ARDS was recorded in 30 of these patients, accounting for 66.7%. Inhalation injury, burn surface area over 40% and full thickness burn area over 20% TBSA were determined as risk factors for the development of ARDS. Mortality rate of patients with ARDS was extremely high (80%), especially for severe ARDS patients (p < 0.01), and deaths were mostly due to multiple organ failure.