Mechanisms of  burn injuryThermal, chemical, electrical, and radiation

2021 ◽  
pp. 129-138
Author(s):  
Ravi F. Sood ◽  
Nicole S. Gibran
Keyword(s):  
Heterogeneous Group ◽  
Burn Injuries ◽  
Injury Patterns ◽  
Burned Patient ◽  
Burn Care ◽  
Adequate Care ◽  
Specific Factors

Burns comprise a highly heterogeneous group of injuries resulting from a variety of mechanisms. In order to provide adequate care for the burned patient, providers must be familiar with mechanism-specific factors. This chapter reviews common types of burn injuries requiring burn-centre admission, including those resulting from heat, cold, electricity, chemicals, and radiation. Specifically, the chapter focuses on clinically relevant differences in epidemiology, injury patterns, and pathophysiology. These considerations directly inform management and prevention of burn injuries and provide an essential framework for modern burn care.

82 The Significant Burden of Burn Injuries in the Middle East: An Epidemiological Study of Nineteen Countries over 27 Years

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Zachary J Collier ◽  
Yasmina Samaha ◽  
Priyanka Naidu ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
...  
Keyword(s):  
Middle East ◽  
Age Groups ◽  
Mortality Rates ◽  
Burn Injuries ◽  
Burn Care ◽  
Life Years ◽  
Significant Burden ◽  
Mortality Ratio ◽  
Incident Cases ◽  
Age And Sex

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.

556 The Use of a Concentrated Surfactant Based Gel to Promote Burn Wound Healing

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S126-S127
Author(s):  
Rebecca Coffey ◽  
Rachel Penny
Keyword(s):  
Wound Healing ◽  
New Product ◽  
Ease Of Use ◽  
Burn Injuries ◽  
Full Thickness ◽  
Burn Wound ◽  
Burn Wounds ◽  
Burn Care ◽  
Product Trial ◽  
Burn Wound Healing

Abstract Introduction Strategies to remove necrotic tissue from burn wounds include excisional and non-excisional debridement. Alternative treatments could promote burn wound healing while minimizing patient discomfort and the need for surgery. We evaluated the usage of a concentrated surfactant gel (CSG) to promote burn wound healing in those with indeterminate depth and full thickness burn injuries. Methods An IRB approved retrospective study was conducted during a 10-patient new product trial period with enrollment between September and October 2019. Patients included in this study had indeterminate or full thickness burn wounds and were treated with a concentrated surfactant-based gel. Patients with non-burn diagnoses were excluded. Data collected included demographic information, injury descriptors, and additional burn wound characteristics. Results A total of 10 patients were included in this study as part of a new product trial. The subjects were 80% male with an average TBSA of 7.5%. 40% had indeterminate and 60% had full thickness burn wounds. Prior to initiation of the CSG, the burn wounds had been open for an average of 41 days. There were no infections or complications with usage of the CSG. 90% of patients reported less pain than the standard of care topical agents for burns. Average duration of treatment with the CSG until healing was 28 days. After usage of the CSG, no patients required surgery. Conclusions Our findings support the usage of a concentrated surfactant-based gel in patients with burn wounds. Patients reported decreased pain during dressing changes and ease of use compared to the standard topical agent in burn care. It also prevented surgical debridement in those with indeterminate and full thickness burn injuries.

41 Enhancing Burn Medical Care During a Disaster Using a Novel Augmented-Reality Application

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S31-S31
Author(s):  
Sena Veazey ◽  
Maria SerioMelvin ◽  
David E Luellen ◽  
Angela Samosorn ◽  
Alexandria Helms ◽  
...  
Keyword(s):  
Decision Support ◽  
Augmented Reality ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Burn Injuries ◽  
Medical Decision ◽  
Support Tool ◽  
Burn Care ◽  
Clinical Decision Support Tool

Abstract Introduction In disaster or mass casualty situations, access to remote burn care experts, communication, or resources may be limited. Furthermore, burn injuries are complex and require substantial training and knowledge beyond basic clinical care. Development and use of decision support (DS) technologies may provide a solution for addressing this need. Devices capable of delivering burn management recommendations can enhance the provider’s ability to make decisions and perform interventions in complex care settings. When coupled with merging augmented reality (AR) technologies these tools may provide additional capabilities to enhance medical decision-making, visualization, and workflow when managing burns. For this project, we developed a novel AR-based application with enhanced integrated clinical practice guidelines (CPGs) to manage large burn injuries for use in different environments, such as disasters. Methods We identified an AR system that met our requirements to include portability, infrared camera, gesture and voice control, hands-free control, head-mounted display, and customized application development abilities. Our goal was to adapt burn CPGs to make use of AR concepts as part of an AR-enabled burn clinical decision support system supporting four sub-applications to assist users with specific interventional tasks relevant to burn care. We integrated relevant CPGs and a media library with photos and videos as additional references. Results We successfully developed a clinical decision support tool that integrates burn CPGs with enhanced capabilities utilizing AR technology. The main interface allows input of patient demographics and injuries with step-by-step guidelines that follow typical burn management care and workflow. There are four sub-applications to assist with these tasks, which include: 1) semi-automated burn wound mapping to calculate total body surface area; 2) hourly burn fluid titration and recommendations for resuscitation; 3) medication calculator for accurate dosing in preparation for procedures and 4) escharotomy instructor with holographic overlays. Conclusions We developed a novel AR-based clinical decision support tool for management of burn injuries. Development included adaptation of CPGs into a format to guide the user through burn management using AR concepts. The application will be tested in a prospective research study to determine the effectiveness, timeliness, and performance of subjects using this AR-software compared to standard of care. We fully expect that the tool will reduce cognitive workload and errors, ensuring safety and proper adherence to guidelines.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

scholarly journals Epidemiology of burn injury in older adults: An Australian and New Zealand perspective

2020 ◽  
Vol 6 ◽  
pp. 205951312095233
Author(s):  
Lincoln M Tracy ◽  
Yvonne Singer ◽  
Rebecca Schrale ◽  
Jennifer Gong ◽  
Anne Darton ◽  
...  
Keyword(s):  
Older Adults ◽  
New Zealand ◽  
Older Adult ◽  
Surgical Management ◽  
Surgical Procedure ◽  
Burn Injury ◽  
Burn Injuries ◽  
Younger Patients ◽  
Care Community ◽  
Burn Care

Introduction: The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand. Methods: The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated. Results: There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013–1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft. Discussion: Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people. Lay Summary The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients. We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit. Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part). This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.

15 Nutrition Therapy in the Burn Care Setting: What Is Best Achievable Practice?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S12-S13
Author(s):  
Daren Heyland ◽  
Luis A Ortiz ◽  
Warren L Garner ◽  
Samuel P Mandell ◽  
Kirsten Colpaert ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Oral Intake ◽  
Nutrition Therapy ◽  
Burn Injuries ◽  
Artificial Nutrition ◽  
Apache Ii Score ◽  
Burn Patients ◽  
Nutrient Deficiencies ◽  
Nutritional Adequacy ◽  
Burn Care

Abstract Introduction The fourth most common injury worldwide are burn injuries. The uncontrolled inflammation, hyper-catabolism, and nutrient deficiencies associated with burn injuries can translate into worse clinical outcomes. Accordingly, CPGs recommends increasing energy requirements from 25–35 kcal/kg/day and provide 1.5–2 grams of protein/kg/day. Thus, the aim of this research is to evaluate the adherence level to CPGs recommendations in adult burn patients and describe the nutritional variability intake across Burn Units (BU) in North America (NA), Latin America (LATAM), and Europe (EU). Methods In a multi-national, multi-centre (n=43), double-blinded, controlled RCT of adult burn patients randomly allocated to receive either L-glutamine (0.5g/kg/day) or placebo via enteral nutrition (EN), we explored the nutritional adequacy. Patients with a deep 2nd-3rd degree burns were enrolled. Patients with renal failure, electrical injuries, BMI &lt; 18 or &gt; 50, liver cirrhosis, contraindication for EN, pregnancy, or moribund were excluded. BUs with &gt;5 burn patients with completed data were included in this analysis. Patient demographics, nutritional intake and clinical outcomes were collected. Nutritional adequacy was calculated from all sources (glucose and oral intake no collected). Descriptive analyses for quantitative data were performed. The data is presented as mean and standard deviation (±) or median with interquartile range [25th to 75th percentile] Results Six hundred and eight burn patients from 32 BUs were included. Overall, 75% (n=455) of the patients were male and Caucasians (78% [n=477]) with a median age of 51 [34–64] years, moderately ill (12 [8–19] APACHE II score), and the most common type of burn was fire (87% [n=530]) with a %TBSA of 27 [20–40], Table 1. Overall, 242 (40%) patients received artificial nutrition. The proportion of patients receiving EN alone at each BU averaged 84% [worst: 7% to best site:88%]. Overall, time from admission to start of EN was an average of 0.7 [0.4 – 0.9] days across all BUs [best:0.2 to worst site: 1.7 day]. PN+EN was used on 13% (n=31) of the patients [site range, 5–89%]. Average adequacy of calories at all sites was 71 % (site average range, 22–82 %) and 72 % (29%– 97%) for protein with greater adequacy observed in LATAM BUs and worst adequacy observed in NA BUs, Figure 1. At the site level, a total of 7 (21%) and 9 (28%) BU successfully achieved &gt;80% of calories and protein via artificial nutrition, respectively, Figure 2. The average use of motility agents in patients receiving &gt;80% at site level was 72 [60–85 %]. Conclusions The actual energy and protein intake remains suboptimal in burn patients worldwide but tremendous variability exists across BU worldwide. Efforts to standardize and enhance EN delivery are warranted. Applicability of Research to Practice Compliance with clinical guidelines recommendations might improve clinical outcomes in burn victims.

scholarly journals Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study

2019 ◽  
Vol 17 (3) ◽  
pp. 315-319
Author(s):  
Santosh Bikram Bhandari ◽  
Sujit Kumar Sah ◽  
Khakindra Bahadur Bhandari ◽  
Jaswan Sakya ◽  
Laxmi Raj Pathak ◽  
...  
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Service Providers ◽  
Burn Injury ◽  
Good Practice ◽  
First Aid ◽  
Burn Injuries ◽  
Burn Care ◽  
Health Service Providers ◽  
Community People

Background: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. Methods: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted.Results: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. Conclusions: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.Keywords: Burn injuries; community practice; hospitals; incident and types.

scholarly journals Demographic Profile of Electrical Burns in a Tertiary Burn Care Centre

2016 ◽  
Vol 4 (2) ◽  
pp. 284
Author(s):  
S K S Sutha S Sellamoni ◽  
U. Rasheedha Begum ◽  
Vinoth Kumar ◽  
G Karthikeyan Karthikeyan
Keyword(s):  
Renal Damage ◽  
Early Mobilization ◽  
Burn Injuries ◽  
Burn Victims ◽  
Burn Care ◽  
The Family ◽  
Fluid Requirement ◽  
Authentic Care ◽  
Electrical Burns

<div><p><em>               Electrical burn injuries are challenging burns that require multi disciplinary approach. It is a major cause of morbidity among burn victims and requires more number of interventions and hospital stay. Certain unique features that are to be kept in mind while treating electrical burn patients are the differences in fluid requirement, assessment of cardiac involvement, other associated injuries like head spine or bony injuries and renal damage. Aim of treatment of these victims is to prevent infection, to achieve skin cover to allow early mobilization, to optimize function and to minimize long term scarring. Special effective authentic care and proper rehabilitation can make the electrical burn victim a useful productive member of the family/society.</em></p></div>

scholarly journals Epidemiology of Cracker (Fire Works) Injuries in a Tertiary Burn Care Centre

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
B. Rajeswari ◽  
B. Shankari ◽  
Angeline Selvaraj
Keyword(s):  
Hand Function ◽  
Burn Injuries ◽  
Tissue Loss ◽  
Vulnerable Groups ◽  
Multiple Fractures ◽  
Burn Wounds ◽  
Burn Care ◽  
Number Of Patients ◽  
Function Loss ◽  
The Face

<div><p><em>Fireworks related burns are one of the causes of recurring incidences of burn injuries every year during festivals. Sporadic events are reported in family and communal celebrations / temple festivals and in funerals. These burns are different from other burns as the burn percentage is not the major burden,  but the increasing number of patients with cracker burn injuries with loss of hand function, loss of vision and at times blast injury of the face with major tissue loss and multiple fractures (shattered tissues), which are challenging for the reconstructive surgeon, are major concern. The vulnerable groups are innocent children who sustain injuries due to ignorance, negligence and lack of supervision. These fire cracker burn wounds are to be classified separately as the wounds are more like traumatic wounds than burn wounds. They are also associated with more morbidity than mortality.<sup>(1,2,3)</sup></em></p><p><em> The management of these wound is multidisciplinary, with involvement of various specialists like paediatricians, ophthalmologists, psychiatrists, orthopaedic surgeons and specialists in rehabilitative medicine along with plastic and reconstructive surgeons.Reconstruction of blast hand and face needs multiple surgeries and prolonged period of physiotherapy and rehabilitation. The effective and appropriate decision made in the acute phase is important to reduce their morbidity.<sup>(4)</sup></em></p></div>

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