The burnt child

2021 ◽  
pp. 179-192
Author(s):  
Suzanne Rea ◽  
Sian Falder
Keyword(s):  
Fluid Resuscitation ◽  
Enteral Feeding ◽  
Wound Care ◽  
Specific Treatment ◽  
Psychological Trauma ◽  
Burn Patients ◽  
Treatment Needs ◽  
Wound Assessment ◽  
Size Threshold ◽  
Burns Unit

Burns are a common form of trauma in children. Common mechanisms of injury include scalds from hot beverages and contact burns from household items. The physical and psychological trauma may have long-lasting effects for both child and family. Children are not just small adults; there are important anatomical and physiological differences. Paediatric burn patients have specific treatment needs that must be accounted for. Estimation of burn size, threshold for commencement of intravenous fluid resuscitation and enteral feeding, in addition to wound assessment, wound care, and treatment are all different to a similar size injury in an adult. These paediatric-specific issues are discussed in more detail. The investigation and interpretation of suspected non-accidental burn presenting to a burns unit is also outlined.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

A New Resuscitation Formula Based on Burn Index Provides More Reliable Prediction for Fluid Requirement in Adult Major Burn Patients

2021 ◽  
Author(s):  
Jianglin Tan ◽  
Junyi Zhou ◽  
Ning Li ◽  
Lili Yuan ◽  
Gaoxing Luo
Keyword(s):  
Fluid Resuscitation ◽  
Linear Regression Analysis ◽  
Fluid Volume ◽  
Multivariate Linear Regression Analysis ◽  
Burn Patients ◽  
Full Thickness ◽  
Burn Wound ◽  
Major Burn ◽  
Fluid Requirement ◽  
Actual Volume

Abstract The Third Military Medical University (TMMU) formula is widely used in fluid resuscitation in China. However, the actual volume needs usually exceed the prediction provided by the TMMU formula in major burn patients with a high proportion of full-thickness burn wounds. This retrospective study included 149 adult major burn patients (≥40% TBSA) who were admitted to the Burn Department, Southwest Hospital from 2014 to 2020 and received appropriate fluid resuscitation by the TMMU protocol. The actual volume infused in the first 48 hours postburn was compared to the estimation by the TMMU formula. A new fluid volume prediction formula was developed by multivariate linear regression analysis. The mean fluid requirements were 2.35 ml/kg/% TBSA and 1.75 ml/kg/% TBSA in the first and second 24 hours postburn, respectively. The TMMU formula underestimated the fluid requirement, and its prediction accuracy was 54.1% and 25.8% for the first and second 24 hours, respectively. The proportion of full-thickness burn wound was found to be associated with the fluid requirements postburn. A revised multifactorial formula consisting of the burn index, body weight, and inhalation injury was developed. Using the revised formula, the prediction reliability of resuscitation fluid volume improved to 65.3% and 61.1% in the first and second 24 hours, respectively. The TMMU formula showed low accuracy in predicting fluid requirements among major burn patients. A revised formula based on burn index was developed to provide better guidance for initiative fluid resuscitation for major burns by the TMMU protocol.

scholarly journals The Influence of Obesity on Treatment and Outcome of Severely Burned Patients

2019 ◽  
Vol 40 (6) ◽  
pp. 996-1008 ◽  
Author(s):  
Christian Tapking ◽  
Khosrow S Houschyar ◽  
Victoria G Rontoyanni ◽  
Gabriel Hundeshagen ◽  
Karl-Friedrich Kowalewski ◽  
...  
Keyword(s):  
Fluid Resuscitation ◽  
Chronic Conditions ◽  
Perioperative Management ◽  
Normal Weight ◽  
Burn Patients ◽  
Obese Patients ◽  
Nonalcoholic Fatty Liver ◽  
Wound Coverage ◽  
Severe Burns ◽  
Early Wound

Abstract Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.

scholarly journals Joint developmental trajectories of internalizing and externalizing disorders between childhood and adolescence

2016 ◽  
Vol 29 (3) ◽  
pp. 919-928 ◽  
Author(s):  
Michel G. Nivard ◽  
Gitta H. Lubke ◽  
Conor V. Dolan ◽  
David M. Evans ◽  
Beate St. Pourcain ◽  
...  
Keyword(s):  
Developmental Trajectories ◽  
Specific Treatment ◽  
Externalizing Disorders ◽  
Childhood And Adolescence ◽  
Multinomial Regression ◽  
Treatment Needs ◽  
Growth Mixture Models ◽  
Growth Mixture ◽  
Dsm Iv ◽  
Internalizing And Externalizing

AbstractThis study sought to identify trajectories of DSM-IV based internalizing (INT) and externalizing (EXT) problem scores across childhood and adolescence and to provide insight into the comorbidity by modeling the co-occurrence of INT and EXT trajectories. INT and EXT were measured repeatedly between age 7 and age 15 years in over 7,000 children and analyzed using growth mixture models. Five trajectories were identified for both INT and EXT, including very low, low, decreasing, and increasing trajectories. In addition, an adolescent onset trajectory was identified for INT and a stable high trajectory was identified for EXT. Multinomial regression showed that similar EXT and INT trajectories were associated. However, the adolescent onset INT trajectory was independent of high EXT trajectories, and persisting EXT was mainly associated with decreasing INT. Sex and early life environmental risk factors predicted EXT and, to a lesser extent, INT trajectories. The association between trajectories indicates the need to consider comorbidity when a child presents with INT or EXT disorders, particularly when symptoms start early. This is less necessary when INT symptoms start at adolescence. Future studies should investigate the etiology of co-occurring INT and EXT and the specific treatment needs of these severely affected children.

Facial Esthetics Classification and Gingival Pigmentation Index of Treatment Needs

2019 ◽  
Vol 11 (1) ◽  
pp. 77-88
Author(s):  
Puzhankara Lakshmi ◽  
Menon Sai Megha ◽  
Suresh Reshma
Keyword(s):  
Indian Population ◽  
Treatment Plan ◽  
Specific Treatment ◽  
Treatment Modalities ◽  
Treatment Needs ◽  
Complete Coverage ◽  
Facial Esthetics ◽  
Comprehensive Classification ◽  
Precise Assessment ◽  
Classification And Treatment

Background : The Indian population shows an extensive range of gingival pigmentation. A detailed description of the gingival pigmentation pattern would provide data for the formulation of an efficient plan for depigmentation. This article gives a novel comprehensive classification to aid in the precise assessment of the pattern and distribution of gingival pigmentation and decision regarding the methods for depigmentation. Methods : Previously existing, established indices and classifications for degree of pigmentation, facial complexion, smile line, lip colour and their modifications were used to differentiate various categories of Esthetics: Esthetic, Unaesthetic-mild, Unaesthetic-severe. Treatment needs were formulated based on the category of Esthetics. Results : The various categories of esthetics include E (Esthetic), M (Unaesthetic-Mild), N (UnaestheticSevere) and specific treatment modalities have been assigned based on the treatment needs. Discussion : The treatment for gingival pigmentation should be based on overall facial esthetics. The classification given in this article takes into consideration the components of facial esthetics: Facial Pigmentation, Degree and distribution of gingival pigmentation, smile line and lip colour. The treatment plan proposed considers the need for the treatment and the possible treatment for each category of esthetics. Conclusion : The classification proposed in this article attempts a complete coverage of combinations of facial esthetic components and the Treatment Index encompasses all the possible treatment modalities for each combination. Although a learning curve might exist, once mastered, the classification and treatment index would serve as a baseline for determining treatment needs in patients with gingival pigmentation.

203 Vasopressor Use During Acute Fluid Resuscitation in Burn Patients

2018 ◽  
Vol 39 (suppl_1) ◽  
pp. S68-S68
Author(s):  
A Adibfar ◽  
A D Rogers ◽  
F Camacho ◽  
R Cartotto
Keyword(s):  
Fluid Resuscitation ◽  
Burn Patients ◽  
Vasopressor Use

524 Effectiveness of Burns Wound Cleansing by Comparison of Prewash and Post Wash Swab Reports

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M A Sayed ◽  
S Jabeen ◽  
A Soueid
Keyword(s):  
Bacterial Load ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Burn Patients ◽  
Burn Wound ◽  
Staph Aureus ◽  
Sex Type ◽  
Total Body ◽  
Burns Unit ◽  
Type Of Injury

Abstract Aim The main aim and objective were to optimise wound healing through infection prevention. This clinical audit aimed to investigate the effectiveness of burn wound cleansing in decreasing bacterial load by comparing pre-wash and post-wash swab results against local burn wound management and aseptic non touch technique (ANTT) guidelines. Method The audit was conducted retrospectively on children admitted to Burns Unit during August 2019, excluding resuscitation burn patients. Pre- and post-wash swabs taken on admission were included and the results obtained from Chameleon database. Data were collected on excel spread sheets including demographic variables such as age, sex, type of injury, percentage total body surface area (TBSA) and mechanism of injury. Data were analysed and results compiled. Results Fifty patients were admitted over a month period; amongst those 60% were male and 40% female of ages ranging from 5 months to 14 years. Scald (50%) was found to be the most common mode of injury followed by contact burn (36%) involving 0.30 to 9% TBSA. Among 50 patients, 30 (60%) showed no growth in pre-wash and 36 (72%) in post-wash swabs. However, 6% post-wash swabs that were initially negative later showed bacillus cereus, staph aureus, Enterobacter, and Acinetobacter. Similarly, another 4% post-wash swabs developed new microorganisms as compared to pre-wash swabs. Conclusions The most common bacteria colonising both pre- and post-wash swabs was staph aureus. Overall, cleansing had reduced the bacterial load significantly around 82% very effective. It is imperative to stick to local guidelines to reduce morbidity and mortality in burn patients.

36 Developing Burn Specific Documents in the Electronic Medical Record

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S25-S25
Author(s):  
Kari Gabehart ◽  
Sara Tuvell ◽  
Christina L Cook ◽  
David Roggy ◽  
Rajiv Sood
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Fluid Resuscitation ◽  
Wound Care ◽  
Burn Wound ◽  
Monthly Basis ◽  
Team Members ◽  
Handheld Device ◽  
Burn Care ◽  
High Level

Abstract Introduction The challenge with burn documentation needs in electronic medical record systems is recognized and often limited in the foundation of commercial electronic systems. In October 2016, our institution transitioned to a new all-inclusive electronic medical record. The transition to this new Electronic Medical Record (EMR) afforded us the opportunity to develop and build burn specific documentation needs in the new EMR system. In this paper, we share our experiences and the keys to our successful builds to streamline burn patients’ documentation and information. Methods In January 2013, the EMR build team was composed of corporate contractors, dedicated clinical staff from all areas of the hospital that transitioned to the build team, and private contractors experienced in the EMR build process. To our great fortune, our burn team was provided access to four dedicated build team members that worked specifically on meeting our burn team documentation needs. With high level collaboration our team was able to assess foundation abilities of the new system, identify gaps to burn care and collaboratively create and build automated documents to meet our burn needs. In October 2016, the EMR system was implemented with our burn specific documents, flowsheets, and reports. Results Through working with our dedicated build team, we were able to create an electronic Lund-Browder Chart with an avatar that is completed with each admission by our medical team. We developed a fluid resuscitation flowsheet that is documented in real-time; displays fluid resuscitation goals; displays urine output goals. The creation of a standardized wound care note template was necessary as the wound template within the existing EMR system was too cumbersome. Burn wound photo-documentation to include inpatient, outpatient, intra-operative and emergency department needs automatically uploads into the patient’s medical record from an encrypted portable handheld device connected to the EMR. Burn specific reports were developed to meet the specific needs of inquiry whether it is for performance improvement or research. Additionally, the same EMR is used in all phases of care to include the burn clinic which allows for ease and continuity of care. Conclusions An EMR that is all-inclusive has benefitted our team and patient safety by streamlining the review and documentation of information. Having specific and dedicated EMR build specialist allocated to focusing on the needs of the burn unit was invaluable in the build, implementation, and maintenance phases. We continue to work with our EMR specialist to improve processes and documentation practices that impact patient outcomes. Our burn EMR specialist meets with the burn team on a monthly basis to evaluate and assess ongoing needs to further outcomes. Applicability of Research to Practice Within this presentation, we will share our journey, challenges, and successes.

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