Total burn care

Burns ◽  
1997 ◽  
Vol 23 (3) ◽  
pp. 274
Author(s):  
Peter G. Shakespeare
Keyword(s):  
1986 ◽  
Vol 13 (1) ◽  
pp. 151-159 ◽  
Author(s):  
Irving Feller ◽  
Claudella A. Jones
Keyword(s):  

1992 ◽  
Vol 19 (3) ◽  
pp. 561-568 ◽  
Author(s):  
Joseph M. Rees ◽  
Alan R. Dimick
Keyword(s):  

1986 ◽  
Vol 13 (1) ◽  
pp. 95-105 ◽  
Author(s):  
Richard P. Harmel ◽  
Dennis W. Vane ◽  
Denis R. King
Keyword(s):  

2021 ◽  
Vol 10 (3) ◽  
pp. 476
Author(s):  
Ioana Tichil ◽  
Samara Rosenblum ◽  
Eldho Paul ◽  
Heather Cleland

Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.


Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 380
Author(s):  
Deepak K. Ozhathil ◽  
Michael W. Tay ◽  
Steven E. Wolf ◽  
Ludwik K. Branski

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S142-S142
Author(s):  
Theresa L Chin ◽  
Rita Frerk ◽  
Victor C Joe ◽  
Sara Sabeti ◽  
Kimberly Burton ◽  
...  

Abstract Introduction The COVID19 pandemic has led to anxiety and fears for the general public. People were concerned about coming to a medical facility where the virus might be transmitted. Furthermore, stay-at-home orders that were implemented during the pandemic did not apply to clinic visits but contributed to people staying at home even for medical care. We hypothesized that there were delays in burn care due to the pandemic. Methods We queried our clinic data for number of clinic visits and new burn evaluations by month. Patients referred to our clinic from March 15, 2020 to Sept 15, 2020 were reviewed for time of presentation after injury. Days from injury date to clinic referral date and days from clinic referral date to appointment date were calculated. Patients who were referred but did not show and were not seen in our ED were not included because injury date could not be determined. Univariate analysis was performed. Results As seen in Figure 1, our in-person clinic volume decreased in April and May 2020 but rebounded in June 2020 as compared to the number of clinic visits for the same months last year. Similarly, in Figure 2, our new burn evaluations decreased in April and May 2020 compared to our new burn volume from 2019. However, our video telehealth visits increased in March and April then decreased in June-August. Conclusions Our burn clinic remained open to see patients with burn injury throughout the pandemic, however, clinic visits were delayed early in the pandemic. While we had an increase in video telehealth, it does not account for the decrease in clinic visits. This may be due to low enrollment in the electronic medical record encrypted communication platform and/or limited knowledge/access to the technology. Additional care may have been informally given via telephone but not well captured. Furthermore, burn care was delivered in the following months. Additional investigation is necessary to see if the incidence of burn injury decreased.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Zachary J Collier ◽  
Yasmina Samaha ◽  
Priyanka Naidu ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
...  

Abstract Introduction Despite ongoing improvements in burn care around the world, the burden of burn morbidity and mortality has remined a significant challenge in the Middle East due to ongoing conflicts, economic crises, social disparities, and dangerous living conditions. Here, we examine the epidemiology of burn injuries in the Middle East (ME) relative to socio-demographic index (SDI), age, and sex in order to better define regional hotspots that may benefit most from sustainability and capacity building initiatives. Methods Computational modeling from the 2017 Global Burden of Disease (GBD17) database was used to extrapolate burn data about the nineteen countries that define the ME. Using the GBD17, the yearly incidence, deaths, and Disability-Adjusted Life Years (DALYs) from 1990 to 2017 were defined with respect to age and sex as rates of cases, deaths, and years per 100,000 persons, respectively. Mortality ratio represents the percentage of deaths relative to incident cases. Data from 2017 was spatially mapped using heat-mapping for the region. Results Over 27 years in the ME, an estimated 18,289,496 burns and 308,361 deaths occurred causing 24.5 million DALYs. Burn incidence decreased by 5% globally but only 1% in the ME. Although global incidence continued to decline, most ME countries exhibit steady increases since 2004. Compared to global averages, higher mortality rates (2.8% vs 2.0%) and DALYs (205 vs 152 years) were observed in the Middle East during this time although the respective disparities narrowed by 95% and 42% by 2017. Yemen had the worst death and DALY rates all 27 years with 2 and 2.2 times the ME average, respectively. Sudan had the highest morality ratio (3.7%) for most of the study, twice the ME average (1.8%), followed by Yemen at 3.6%. Sex-specific incidence, deaths, and DALYs in the ME were higher compared to the global cohorts. ME women had the worst rates in all categories. With respect to age, all rates were worse in the ME age groups except in those under 5 years. Conclusions For almost three decades, ME burn incidence, deaths, DALYs, and mortality rates were consistently worse than global average. Despite the already significant differences for burn frequency and severity, especially in women and children, underreporting from countries who lack sufficient registry capabilities likely means that the rates are even worse than predicted.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Sandrine O Fossati ◽  
Beth A Shields ◽  
Renee E Cole ◽  
Adam J Kieffer ◽  
Saul J Vega ◽  
...  

Abstract Introduction Nutrition is crucial for recovery from burn injuries, as severe weight (wt.) loss can lead to impaired immunity and wound healing, infections, skin graft failure, and mortality. Previous studies recommended avoiding more than 10% wt. loss, as this level resulted in increased infection rates. However, wt. loss is often not quantifiable during the critical illness phase, with severe edema masking non-fluid related body wt. changes. Energy (kcal) deficits can be used to estimate wt. loss until the edema has resolved, but previous studies in non-burn patients indicate that actual wt. loss is less than the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat). The objective of this performance improvement project was to evaluate nutritional intake and the resulting dry wt. change in severely burned patients. Methods This performance improvement project was approved by our regulatory compliance division. We performed a retrospective evaluation on patients with at least 20% total body surface area (TBSA) burns admitted for initial burn care to our intensive care unit over a 7-year period. Patients who died or who had major fascial excisions or limb amputations were excluded. Patients who did not achieve a recorded dry wt. after wound healing were not included in this analysis. Retrospective data were collected, including sex, age, burn size, kcal intake, kcal goal per the Milner equation using activity factor of 1.4, admission dry wt., dry wt. after wound healing (defined as less than 10% TBSA open wound), and days to dry wt. after wound healing. Descriptive statistics and linear regression were performed using JMP. Significance was set at p< 0.05. Results The 30 included patients had the following characteristics: 90% male, 30 ± 11 years old, 45% ± 15% TBSA burn. They received 2720 ± 1092 kcal/day, meeting 68% ± 24% kcal goal, and took approximately 53 ± 30 days from injury to achieve dry wt. after wound healing. These patients had wt. loss of 8 ± 8 kg from the kcal deficit of 69,819 ± 51,704 during this time period. The kcal deficit was significantly associated with wt. change [p < 0.001, R2 = 0.49, wt. change in kg = (-0.000103 x kcal deficit) – 1]. This translates to one kg of body wt. loss resulting from 9709 kcal deficit. Conclusions This performance improvement project found that an energy deficit of approximately 9700 kcal in our patients equates to 1 kg of body mass loss (4400 kcal deficit equates to 1 pound of body mass loss). These findings are similar to wt. loss studies in other patient populations and contrary to the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat).


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S193-S193
Author(s):  
Samantha Huang ◽  
Justin Dang ◽  
Clifford C Sheckter ◽  
Haig A Yenikomshian ◽  
Justin Gillenwater

Abstract Introduction Current methods of burn evaluation and treatment are subjective and dependent on surgeon experience, with high rates of inter-rater variability leading to inaccurate diagnoses and treatment. Machine learning (ML) and automated methods are being used to develop more objective and accurate methods for burn diagnosis and triage. Defined as a subfield of artificial intelligence that applies algorithms capable of knowledge acquisition, machine learning draws patterns from data, which it can then apply to clinically relevant tasks. This technology has the potential to improve burn management by quantitating diagnoses, improving diagnostic accuracy, and increasing access to burn care. The aim of this systematic review is to summarize the literature regarding machine learning and automated methods for burn wound evaluation and treatment. Methods A systematic review of articles available on PubMed and MEDLINE (OVID) was performed. Keywords used in the search process included burns, machine learning, deep learning, burn classification technology, and mobile applications. Reviews, case reports, and opinion papers were excluded. Data were extracted on study design, study objectives, study models, devices used to capture data, machine learning, or automated software used, expertise level and number of evaluators, and ML accuracy of burn wound evaluation. Results The search identified 592 unique titles. After screening, 35 relevant articles were identified for systematic review. Nine studies used machine learning and automated software to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid requirements, 18 estimated burn depth, 5 estimated need for surgery, 6 predicted mortality, and 2 evaluated scarring in burn patients. Devices used to estimate %TBSA burned showed an accuracy comparable to or better than traditional methods. Burn depth estimation sensitivities resulted in unweighted means >81%, which increased to >83% with equal weighting applied. Mortality prediction sensitivity had an unweighted mean of 96.75%, which increased to 99.35% with equal weighting. Conclusions Machine learning and automated technology are promising tools that provide objective and accurate measures of evaluating burn wounds. Existing methods address the key steps in burn care management; however, existing data reporting on their robustness remain in the early stages. Further resources should be dedicated to leveraging this technology to improve outcomes in burn care.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S176-S177
Author(s):  
Alexa Barwick ◽  
Dana Y Nakamura ◽  
James H Holmes ◽  
Joseph Molnar

Abstract Introduction Facial burns can be complicated by the development of scar tissue and contractures, resulting in decreased flexibility of the tissue involved in swallowing, facial expression, and verbal communication. Maximizing functional range of motion is an important preventative measure for improving functional outcomes for swallowing, communication, and for the prevention of microstomia. A range of therapy interventions including stretching, massage, compression, and use of appliances has been reported in the literature; however, there is limited to no information on current practice patterns amongst North American providers (MD, DO, PA, NP, etc.) or therapists (PT, OT, and SLP). Methods A RedCap survey was developed by a Speech-Language Pathologist and Occupational Therapist involved in burn care. The survey consisted of 18 total questions, with participants responding to between 12–13 questions due to branching logic. Questions were related to demographic and service provision related to facial massage and stretching. Survey questions were multiple choice, multiple answer multiple choice, or contained text boxes. The survey was distributed to Providers and Therapists from the United Stated of America and Canada who were members of the American Burn Association (ABA). Results A total of 69 surveys were collected, with 57 surveys meeting criteria for inclusion. Respondents consisted of therapists 68%, providers 23%, and other health professionals 9%. Forty-six ABA burn centers from across the United States and Canada were represented. The majority of respondents had over 10 years of experience working with burn patients. 91% of respondents reported that facial massage and stretching was used as a tool at their facility. Respondents, who report facial massage is utilized at their facility, report OT as being the primary discipline responsible for assessing (67%) and completing (65%) facial massage, with 85% reporting additional discipline(s) also participating in facial massage. 9% of respondents report that facial massage and stretching is not utilized at their facility following facial burns. Of those who responded that facial massage and stretching is not utilized following facial burns, 40% felt this would be beneficial to patients, while 60% were unsure. Conclusions Facial scar management is an important part of burn care, with the majority of respondents reporting completion of facial massage and stretching as part of the services provided to patients who have suffered facial burns. OTs are the primary service providers for facial massage and stretching post facial burn. Practices for facial massage varies greatly, with the majority of respondents reporting no specific protocol for facial massage and stretching is followed.


Sign in / Sign up

Export Citation Format

Share Document