502 Use of Hydrocortisone, Vitamin C, and Thiamine to Treat Burn Sepsis: A Case Series

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S87-S88
Author(s):  
Thomas R Resch ◽  
Sarah Fischer
Keyword(s):  
Vitamin C ◽  
Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Case Series ◽  
Burn Patients ◽  
Adjunct Therapy ◽  
Burn Center ◽  
Novel Treatment ◽  
Total Body

Abstract Introduction Sepsis remains a leading cause of morbidity and mortality in burn patients. Therefore, novel treatment adjuncts are of constant interest. Early studies by Marik et al. have suggested that bundled use of intravenous hydrocortisone, vitamin C, and thiamine may improve outcomes in intensive care patients diagnosed with systemic sepsis. However, to our knowledge, evaluation of this treatment modality has not been applied to burn patients. Methods Chart review of seven patients with major cutaneous injuries admitted to our burn center and treated with the adjunct therapy as per Marik et al. occurred. Baseline characteristics, treatment, and outcome variables were identified. Variables abstracted include demographics, injury characteristics, comorbidities, discharge disposition, length of stay, mechanical ventilation, use of vasopressors, acute kidney injury, blood cultures, white blood cell count, lactate, creatinine, predicted mortality (modified BAUX, APACHE II, APACHE IV, and SOFA scores), procalcitonin, quantitative culture and histology results, time to first excision, and time to final surgery and/or healing. Results Five patients sustained flame burns ranging from 24% to 46% total body surface area. One patient was admitted for road rash causing full thickness injury and one with toxic epidermal necrolysis encompassing 90% total body surface area. Ages ranged from 19 to 74 years. Modified BAUX with APACHE II and IV scores were used to predict baseline mortality risk. Four of the seven patients succumbed to their injuries, two within the first week of admission. Of the remaining cases, all required fewer vasopressors after beginning adjunct therapy. Among survivors, SOFA scores suggested greater than 95.2% predicted mortality at start of adjunct therapy and within four days, predicted mortality ranged from less than 33.3% to 50%. Conclusions The aim of this case series is to review our early experience with this novel treatment in burn patients. No conclusions can be drawn at this time. It is understood that continued research must be conducted to support correlation between intervention and outcomes. Optimism is present based upon early non-burn studies and our regional burn center experience. A prospective study is currently being developed at our burn center. Applicability of Research to Practice This case series explores a potential treatment adjunct to decrease morbidity and mortality from burn sepsis.

Total Body Surface Area Overestimation at Referring Institutions in Children Transferred to a Burn Center

2015 ◽  
Vol 81 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Douglas S. Swords ◽  
Edmund D. Hadley ◽  
Katrina R. Swett ◽  
Thomas Pranikoff
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Trauma Registry ◽  
Total Body Surface Area ◽  
Demographic Variables ◽  
Adverse Outcomes ◽  
Burn Patients ◽  
Burn Center ◽  
Total Body

Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs ( P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater ( P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

scholarly journals Prevalence and associated predictors for patients developing chronic neuropathic pain following burns

2020 ◽  
Vol 8 ◽  
Author(s):  
Kevin M Klifto ◽  
A Lee Dellon ◽  
C Scott Hultman
Keyword(s):  
Mechanical Ventilation ◽  
Neuropathic Pain ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Chronic Neuropathic Pain ◽  
Burn Center ◽  
Total Body

Abstract Background Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence of chronic neuropathic pain (CNP) and compare burn characteristics between patients who developed CNP and patients without CNP who were treated at a burn center. Methods A single-center, retrospective analysis of 1880 patients admitted to the adult burn center was performed from 1 January 2014 to 1 January 2019. Patients included were over the age of 15 years, sustained a burn injury and were admitted to the burn center. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying illness or medication. Comparisons between patients admitted to the burn center with no pain and patients admitted to the burn center who developed CNP were performed. Results One hundred and thirteen of the 1880 burn patients developed CNP as a direct result of burn injury over 5 years with a prevalence of 6.01%. Patients who developed CNP were a significantly older median age (54 years vs. 46 years, p = 0.002), abused alcohol (29% vs. 8%, p &lt; 0.001), abused substances (31% vs. 9%, p &lt; 0.001), were current daily smokers (73% vs. 33%, p &lt; 0.001), suffered more full-thickness burns (58% vs. 43%, p &lt; 0.001), greater median percent of total body surface area (%TBSA) burns (6 vs. 3.5, p &lt; 0.001), were more often intubated on mechanical ventilation (33% vs. 14%, p &lt; 0.001), greater median number of surgeries (2 vs. 0, p &lt; 0.001) and longer median hospital length of stay (LOS) (10 days vs. 3 days, p &lt; 0.001), compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months. Conclusions The prevalence of CNP over 5 years was 6.01% in the burn center. Older ages, alcohol abuse, substance abuse, current daily smoking, greater percent of total body surface area (%TBSA) burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury, compared to patients who did not develop CNP following burn injury.

scholarly journals Epidemiology and outcome of acute burn patients at a new dedicated burn centre in Nepal

2020 ◽  
Vol 23 (1) ◽  
pp. 19-29
Author(s):  
Budhi Nath Adhikari Sudhin ◽  
Sanjit Adhikari ◽  
Sushma Khatiwada
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Winter Season ◽  
College Teaching ◽  
Burn Patients ◽  
Permanent Disability ◽  
Total Body ◽  
Epidemiological Characteristics

Introduction: Burn injury remains one of the biggest health concerns in the developing world. It has been regarded as a formidable public health issue in terms of mortality, morbidity and permanent disability. We aim to provide an overview of the basic epidemiological characteristics of burn patients admitted at a dedicated burn center in Chitwan, Nepal. Methods: This was a retrospective, hospital-based observational study conducted at Chitwan Medical College Teaching Hospital (CMCTH) burn ward from September 2017 to August 2019. Patients’ records from admission/discharge book, admission/discharge summaries as well as patient’s individual files were reviewed to obtain the necessary data. Demographic data, clinical characteristics, treatments and outcomes were statistically analyzed. Results: Among the 202 patients, the number of males slightly predominated that of females with a ratio of 1.02:1. The median age was 24 years, and the median total body surface area (TBSA) burned was 15%.  Children less than 10 years comprised one third of all patients while more than one fifth were elderly. The commonest etiological factor was flame burn, closely followed by scald. The mortality rate was 12.38% for the period under review. Majority of the patients spent less than 10 days on admission and around one fifth needed surgical intervention aimed at earlier coverage. Binary logistic regression analysis showed that age, Body Mass Index (BMI) and total body surface area (TBSA) burnt were the major predictors of burn mortality. Conclusions: The outcome of burn injuries is poor. Appropriate preventive & therapeutic measures need to be taken in terms of social education & provision of quality healthcare to reduce the incidence & improve the survival outcome of burn patients which should focus on children and elderly especially during the winter season.

Evaluating Discrepancies in Percent Total Body Surface Area Burn Assessments Between Prehospital Providers and Burn Center Physicians

2021 ◽  
Author(s):  
Duy P Tran ◽  
Donald H Arnold ◽  
Callie M Thompson ◽  
Neal J Richmond ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Service Providers ◽  
Medical Center ◽  
Total Body Surface Area ◽  
Medical Personnel ◽  
Burn Center ◽  
Emergency Medical ◽  
Total Body

Abstract Burns are routinely assessed at the scene of the incident by prehospital or emergency medical services providers. The initial management of burns is based on the calculation of the extent of the injury, reported as percent total body surface area. This study evaluates discrepancies in estimation of total body surface area (TBSA) between prehospital providers and burn team physicians over a 3-year period at an academic, university medical center serving as the regional burn center. A total of 120 adult and 27 pediatric patients (less than age 16 years) were included, with 95 (65%) male, 67 (45.6%) Caucasian, 62, median age 35 years (Interquartile Range 27). The most common etiology of burns was hot liquid, 39 (26.5%). Median [IQR] and mean (SD) estimated TBSA (%) were 4[1, 10] and 8.6 (12.8) for prehospital providers, and 2 [1, 6] and 5.9 (9.9) for burn team physicians. Bland-Altman plots evaluating 2nd and 3rd degree burns separately and combined demonstrated that, as burns involved more surface area, agreement decreased between emergency medical service providers and burn physicians. Agreement between pre-hospital providers and burn physicians decreased as total body surface areas of burns increased. This finding reaffirms the need for more standardized education and training for all medical personnel.

Hand sanitiser–fuelled fire performance and thermal injury: case report

2021 ◽  
Vol 14 (6) ◽  
pp. e235106
Author(s):  
Samantha T Murphy ◽  
Leopoldo C Cancio
Keyword(s):  
Case Report ◽  
Surface Area ◽  
Body Surface Area ◽  
Performance Art ◽  
Body Surface ◽  
Thermal Injury ◽  
Total Body Surface Area ◽  
Fire Performance ◽  
Burn Center ◽  
Total Body

A 23-year-old man presented to our burn center after sustaining a 62.5% total body surface area burn during a fire performance, in which he applied alcohol-based hand sanitiser to his body and ignited it. The patient underwent 6 operations at this facility and was discharged after 41 days. Fire-performance art is a growing pastime and profession. This case demonstrates the hazards of using hand sanitiser during such activities.

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