712 Title: Monitored Anesthesia Care (MAC) Burn Dressing Changes Even in Critically Ill Patients Is Incredibly Safe

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S187-S188
Author(s):  
Jeanette Lozenski ◽  
Jordan Voss ◽  
Anthony Kovac ◽  
Jennifer Parks ◽  
Kayla Northrop ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Total Body Surface Area ◽  
Low Frequency ◽  
Retrospective Chart Review ◽  
Severe Hypotension ◽  
Study Population ◽  
Total Body ◽  
Poor Outcomes ◽  
Pressure Changes ◽  
Dressing Change

Abstract Introduction Objective: Identify prevalence and factors associated with hypoxia and blood pressure changes during MAC anesthesia for inpatient burn dressing change. Methods Retrospective chart review on 112 adult inpatients undergoing 1 or more burn dressing changes under MAC from March 2014 to December 2017 at a single burn center. Results Study population was 112 burn inpatients undergoing 210 burn dressing changes under MAC. Median age was 43 years (range 18–93) with 78% male and 95% Caucasian. Average BMI was 29.7 (range 18–66). Average % total body surface area (TBSA) burn was 24% (range 1%-70%). Number of MAC dressing changes per patient was 1 to 16 with most (71.4%) undergoing 1 MAC dressing change. Among 210 MAC cases, 5 involved a hypoxemic event (defined as a % O2 saturation of < 90%) and 14 involved a blood pressure changed (defined as a mean arterial pressure (MAP) of < 60 mmHg) on 7 different patients Three of the hypoxic events were also associated with hypotension (1.4%) None of these events were associated with poor outcomes. Conclusions MAC anesthesia for dressing changes are performed on inpatients during all stages of the burn recovery. Anesthesia is involved with the initial dressing changes on the critical care individuals. The MAC anesthesia is titrated to the condition of the patient with very low frequency of hypoxia or severe hypotension. Applicability of Research to Practice Burn dressing changes are challenging anesthesias because of the often associated co-morbidities of the presenting patients. Other factors that are considered are the NPO status and nutritional requirements of the patients. The desire to accomplish the dressing changes with the least amount of disruption of this while caring for these ill patients can be safely accomplished with MAC dressing changes. This provides an incredibly safe environment for the patient with the rapidly titratable medications that allow the dressing changes to be completed efficiently.

scholarly journals High Prevalence of Hypertension in Ethiopian and Non-Ethiopian HIV-Infected Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maya Korem ◽  
Tali Wallach ◽  
Michael Bursztyn ◽  
Shlomo Maayan ◽  
Karen Olshtain-Pops
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chart Review ◽  
Pressure Rise ◽  
Retrospective Chart Review ◽  
Close Monitoring ◽  
Related Factors ◽  
The Metabolic Syndrome ◽  
High Prevalence ◽  
Study Population

Objectives. Prevalence of hypertension has not been studied in the Ethiopian HIV-infected population, which represents 60% of the patients in our AIDS unit. Our aim was to identify risk factors and characterize the prevalence of hypertension in the population monitored at our unit. Methods. A retrospective chart review categorized subjects according to their blood pressure levels. Hypertension prevalence was determined and stratified according to variables perceived to contribute to elevated blood pressure. Results. The prevalence of hypertension in our study population was significantly higher compared to the general population (53% versus 20%, P<0.0001) and was associated with known risk factors and not with patients’ viral load and CD4 levels. Ethiopian HIV-infected adults had a prominently higher rate of blood pressure rise over time as compared to non-Ethiopians (P=0.016). Conclusions. The high prevalence of hypertension in this cohort and the rapid increase in blood pressure in Ethiopians are alarming. We could not attribute high prevalence to HIV-related factors and we presume it is part of the metabolic syndrome. The lifelong cardiovascular risk associated with HIV infection mandates hypertension screening and close monitoring in this population.

720 Scalds and Contact Burns: Are They Really Different?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Adam Singer ◽  
Evyatar Baer ◽  
Henry Thode
Keyword(s):  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Full Thickness ◽  
Chi Square ◽  
Included Patient ◽  
Body Location ◽  
Total Body ◽  
Fire Flame ◽  
Burn Depth

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P&lt; 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Gregory Lifferth ◽  
Bryan Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p &lt; .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases. Applicability of Research to Practice This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.

27 Utilization of an Ethics Service in a Large Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Andrew Greenway ◽  
Jamie Heffernan ◽  
Nicole Markow ◽  
Jennifer Yang ◽  
Linda Gibbons ◽  
...  
Keyword(s):  
Palliative Care ◽  
Ethical Dilemmas ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Ethics Consultation ◽  
Pregnant Patient ◽  
Ethical Principles ◽  
Clinical Utilization ◽  
Surrogate Decision ◽  
Total Body

Abstract Introduction Ethical dilemmas arise related to tension between one or more values held by stake-holders. Identifying which ethical principles (i.e., autonomy, beneficence, non-maleficence, and justice) are in tension represents one way to categorize ethical dilemmas that arise in clinical cases. The purpose of this review is to describe the population of patients for whom Medical Ethicists (ME) were consulted and identify the primary ethical principles in tension for these cases. Methods A retrospective chart review of patients admitted from 2/2014–8/2019 (n=3701) capturing ME notes. Each note was independently rated by burn team RNs and medical ethicists to identify which two of the four common ethical principles were perceived to be in tension. Reviewers also noted if surrogate decision-making and/or goals of care were prominent themes in the case. Additional data points include circumstances of injury, total body surface area (TBSA) involved, age, mortality, length of stay (LOS), Hospital Day (HD) of ethics consult (EC), +/- psychology/psychiatry note, +/-chaplaincy, +/-palliative care, initiator of and stated reason for the EC. Results Of the 3701 patients admitted, 26 had formal EC’s (0.7%). Twelve died. Average age was 55.6 (7–85). Two patients had Calciphylaxis and four self-immolated. One EC concerned interests of fetus vs the pregnant patient. TBSA for the burned group averaged 39.7% (2–100). Average LOS was 55.6 days. Average HD of ethics consults was 20.5. For mortalities, EC was 10.8 HDs prior to death. LOS for survivors was 55.6 vs 42.33 days for non-survivors. TBSA for survivors was less than those who died (29% vs 50%). Chaplaincy was involved in 19/26 (73%), palliative care 3/26 (12%), Psychology/ psychiatry 15/26 (58%) of EC’s. The burn RNs most often characterized the ethical dilemmas as tension between beneficence and nonmaleficence while the ethicist found autonomy vs. nonmaleficence. All raters found only 1 or 2 cases involved justice. The team identified GOC tension in 20/26 cases, the ethicist, fewer than half. The burn team requested ethics consultation in all cases of self-immolation. Initiators of ethics consults were 14 burn team, 7 burn MD, 1 burn nursing, 2 chaplaincy and 2 not stated. Conclusions Circumstances of injury, the nature of wound and intensive care management and the association of significant injury with end of life care present challenges to the burn team. Many may be framed and addressed as ethical dilemmas. This pilot exploration of clinical utilization of medical ethics suggests patterns and questions that warrant further discussion and study. Value-driven tensions between the professional duties to do good, the duty to do no harm, and the duty to respect autonomous decisions by patients and by extension, surrogate decision makers, account for most triggers for ECs initiated by the burn team. Applicability of Research to Practice Directly Applicable.

scholarly journals Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study

2019 ◽  
Vol 27 (4) ◽  
pp. 334-339
Author(s):  
Nancy Coutris ◽  
Justin P. Gawaziuk ◽  
Nora Cristall ◽  
Sarvesh Logsetty
Keyword(s):  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Perioperative Period ◽  
Feeding Tube ◽  
Nutrition Support ◽  
Burn Patients ◽  
Start Time ◽  
Total Body ◽  
Injured Patients

Background: Enteral nutrition (EN) is essential to meet the increased metabolic requirements of burn-injured patients. However, feeds are often suspended for care. This study examines the interruptions in EN (IEN). Objective: To determine the frequency and duration of IEN and whether these interruptions are predictable or unpredictable. Design: This retrospective chart review of 27 adult burn patients examined age, sex, body mass index, percentage of total body surface area, length of hospital stay, predicted energy requirements from equations and indirect calorimetry, EN start time, time EN reached goal rate, and interruptions to EN. Results: Predictable interruptions accounted for 74.5% (frequency) and 81.6% (duration) of total interruptions. The most frequent and time-consuming interruptions were perioperative period, extubation, and tests/procedures (predictable) versus high gastric residual volume, emesis/nausea, and feeding tube displacement (unpredictable). Conclusions: Most IEN were due to predictable events. Based on these findings, compensating for predictable interruptions to meet nutritional requirements in burn patients is recommended.

scholarly journals Collocated burn and fracture injuries in major trauma: a 10 year experience

2020 ◽  
Vol 102 (4) ◽  
pp. 256-262
Author(s):  
D Bui ◽  
BS Sivakumar ◽  
A Ellis
Keyword(s):  
Chart Review ◽  
Major Trauma ◽  
Injury Severity ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Operative Management ◽  
Complication Rates ◽  
Cast Doubt ◽  
Operative Fixation ◽  
Total Body

Introduction Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. Methods A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis. Results Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management. Conclusion There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.

scholarly journals Evaluation of Demographic and Clinical Characteristics of Patients who Attempted Suicide by Self-Inflicted Burn Using Catalyzer

2015 ◽  
Vol 100 (2) ◽  
pp. 304-308 ◽  
Author(s):  
Hakan Yabanoglu ◽  
Huseyin Ozgur Aytac ◽  
Emin Turk ◽  
Erdal Karagulle ◽  
Sedat Belli ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Characteristics ◽  
Attempted Suicide ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Demographic Characteristics ◽  
High Morbidity ◽  
Average Percentage ◽  
Study Population ◽  
Total Body

Our aim was to assess demographic and clinical characteristics of patients treated at our units who attempted suicide by self-incineration, and to compare the results of burns with or without catalyzer use. Twenty patients who attempted suicide by self-incineration were examined in terms of clinical and demographic characteristics. Average age of the study population was 35 years (range 13−85 years). Average percentage of total body surface area burn was 53% (9%−100%). Six (30%) patients used gasoline and 5 (25%) used paint thinner in order to catalyze burning. Of these 11 patients who used a catalyzer, 5 (45.4%) had inhalation injury and 7 (63.6%) died. Among 9 patients who did not use any catalyzer, 1 (11.1%) had inhalation injury and 4 (44.4%) died. In general, inhalation injury was diagnosed in 6 patients (30%) while 11 (55%) patients died. A high morbidity and mortality rate was found in patients who used a catalyzer.

543 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Greg S Lifferth ◽  
Bryan J Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Extremity Amputation ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p &lt; .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases.

Abstract P109: A Promising Novel Hypertension Drug Candidate

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Haralambos Gavras ◽  
Joel Neutel ◽  
Ronald J Elin ◽  
Andrea Rosanoff ◽  
Rebecca B Costello ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Statistical Significance ◽  
Phase 1 ◽  
Drug Candidate ◽  
P Value ◽  
Double Blind ◽  
Group A ◽  
Study Population ◽  
Pressure Changes ◽  
Novel Drug

This study tests the hypothesis that RMJH-111b, a novel drug candidate, can improve blood pressure (BP) in hypertensive adults without the gastrointestinal distress that is often experienced with oral magnesium (Mg) treatment. A Phase 1 / 2 study tested the clinical tolerability, safety and efficacy as well as pharmacokinetics of RMJH-111b softgels. Each softgel contains 110 mg elemental Mg as inverted micellar nanodroplets designed to enhance intestinal uptake and cell delivery of active constituents. Forty-one hypertensive people were screened, twenty-two qualified to be enrolled and twenty-one completed the 10 day inpatient trial. In the study, after a 7 day washout period, participants were admitted and had a 3 day run in on only placebo followed by a 7 day double blind treatment period. Fifteen people received active treatment with 440 mg of elemental Mg BID (a total of 880 mg daily) and six received placebo. Data collected include daily seated blood pressure as well as 24h ambulatory blood pressure (ABPM) measurements. In addition, ECG, routine laboratory tests including serum Mg levels and 24h urinary Mg excretion were performed on days 3 and 10.ABPM 24h mean blood pressure changes day, night and 24° are as follows: SBP day :-6.2, DBP day :-2.3, SBP night :-4.9 , DBP night :-1.3 , SBP 24° :-6.6 , DBP 24° :-2.8 , SBP+DBP 24° :-9.4. One individual was excluded because her SBP decreased from 155 to 108 mm Hg after five days on protocol, below the 110 mm SBP protocol exclusion criteria. No symptoms of hypotension were observed. A correlation was noted between 24h levels of urinary Mg excretion and the 24h ABPM BP reduction. There were no adverse effects in the study group. A trend correlating serum Mg levels increase and BP decrease across the study population was noted. Based on retroactive statistical analysis of data presented, if 100 people had been studied using the same protocol, a statistical significance with a p value.

Electrolytes and blood pressure of rats drinking sodium chloride solutions

1962 ◽  
Vol 202 (6) ◽  
pp. 1144-1146 ◽  
Author(s):  
Arthur S. Haight ◽  
John M. Weller
Keyword(s):  
Blood Pressure ◽  
Sodium Chloride ◽  
Tissue Water ◽  
Blood Pressure Elevation ◽  
Sodium Chloride Solutions ◽  
Arterial Blood ◽  
Body Sodium ◽  
Systolic Arterial Blood Pressure ◽  
Total Body ◽  
Pressure Changes

Eighty per cent of rats surviving 8–12 weeks when given 1.75 or 2.0% sodium chloride solution in place of drinking water had at least 20 mm Hg elevation of systolic arterial blood pressure. Changes in tissue water and electrolytes were: a) a consistent increase in sodium, potassium, and chloride contents of aorta; b) an increase in sodium and extracellular water contents of muscle, more marked in skeletal than heart muscle; c) marked muscle potassium depletion in one series; and d) an increase in total body sodium and a tendency toward hypernatremia. At the time of sacrifice no consistent association was evident between blood pressure elevation and water and electrolyte changes.

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