scholarly journals Considerations for pediatric burn sedation and analgesia

2017 ◽  
Vol 5 ◽  
Author(s):  
Alice Fagin ◽  
Tina L. Palmieri
Keyword(s):  
Pain Management ◽  
Burn Injury ◽  
Burn Injuries ◽  
Burn Patients ◽  
Injury Treatment ◽  
Sedation And Analgesia ◽  
Patients Experience ◽  
Medication Response

Abstract Burn patients experience anxiety and pain in the course of their injury, treatment, and recovery. Hence, treatment of anxiety and pain is paramount after burn injury. Children, in particular, pose challenges in anxiety and pain management due to their unique physiologic, psychologic, and anatomic status. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. The purpose of this review is to describe the challenges associated with management of anxiety, pain, and sedation in burned children and to describe the different options for treatment of anxiety and pain in burned children.

scholarly journals Epidemiological study of burn injury with special reference to its prevention- A Nine-year retrospective study from a tertiary care hospital of West Bengal, India

2015 ◽  
Vol 7 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Shib Shankar Kuiri ◽  
Bikash Chandra Ghosh ◽  
Nilay Mandal ◽  
Mintu Mohan Nandi ◽  
Tusar Kanti Saradar ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Injury Risk ◽  
West Bengal ◽  
Burn Injury ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Age Group

Aims and Objectives: We conducted a retrospective analysis among 1984 burn patients to study the incidence, prevalence of burn injury, its various types and modes (actual event behind the burn injury), risk factors and to find out the preventive measures.Materials and Methods: The retrospective study was carried out among 1984 patients having burn injuries, admitted in a tertiary care hospital of West Bengal, India over a period of nine years. The sources of information were the admission registers and the patients' folders from the medical records department. The Ethical clearance was taken from the Institutional Ethical Committee. The information obtained included age, sex, whether accidental or suicidal, etiology of burn injury and particularly the mechanism of injury. Results: Females were mostly affected (83%) in comparison to males. Among the study population, most of the burn patients were in the age group of 21-30yrs i.e. 35.3%. The number of burn patients were less in number in the age group of 11-20yrs i.e. 7.3%. Most of the burn injuries (87%) were accidental. Suicidal burns occurred in 10% cases. Of which about 1/3rd of the cases were due to dowry related issues.  A significant number of teenagers also attempted suicides due to trivial reasons (e.g. failure in examination, quarrelling with parents). Gas oven related injuries occurred in 2.7% cases. Oil lamps (‘kupi’), candles and hurricane-lanterns, diyas were also responsible to some extent in rural India for flame burns(5%). Smoking related burn injuries occurred in 1.7% cases. Scald injuries occurred in 14% cases. Chemical injuries (0.3%) were due to spillage of unlabelled bottles of acid/alkali. Electrical burn injury occurred in 4.9% cases. Conclusion: Burn injury prevention is not easy, but to avoid the significant morbidity and mortality following injury we have to prevent it by any means. A coordinated and dedicated approach among social workers , medical and paramedical personnel, administrators can only minimize the incidence of burn.Asian Journal of Medical Sciences Vol.7(1) 2015 70-75

scholarly journals Neuronal Plasticity Associated with Burn Injury and Its Relevance for Perception and Management of Pain in Burn Patients

2000 ◽  
Vol 5 (3) ◽  
pp. 205-213
Author(s):  
Terence J Coderre ◽  
Manon Choinière
Keyword(s):  
Neuronal Plasticity ◽  
Pain Perception ◽  
Burn Injury ◽  
Clinical Care ◽  
Strong Support ◽  
Burn Injuries ◽  
Burn Patients ◽  
Pain Mechanisms ◽  
Gate Control Theory

Through the introduction of the gate control theory and various subsequent works, Ronald Melzack has inspired many investigators worldwide to realize two important facts about pain. First, incoming pain messages are subject to both negative and positive modulation, which significantly affect its perception. Second, the progression of knowledge about the basic mechanisms underlying persistent and chronic pain is critically dependent on the increased understanding of the complexity of the symptoms experienced by pain patients. The present paper examines these two very important issues in an effort to understand better the mechanisms that underlie the pain suffered by burn patients. The physiological responses to burn injury involve many different mediators and mechanisms, all of which contribute to pain perception and development of neuronal plasticity underlying short and long term changes in pain sensitivity. While experimental burn injuries in humans and animals are typically well controlled and mild, in burn victims, the severity is much more variable, and clinical care involves repeated traumas and manipulations of the injured sites. Recurrent inputs from damaged and redamaged tissue impinge on a nervous system that becomes an active participant in the initiation of changes in sensory perception and maintenance of long term sensory disturbances. Recently acquired experimental evidence on postburn hyperalgesia, central hyperexcitability and changes in opioid sensitivity provides strong support that burn patients need an analgesic approach aimed at preventing or reducing the 'neural' memory of pain, including the use of more than one treatment modality. Burn injuries offer a unique opportunity to combine experimental and clinical research to understand pain mechanisms better. Over the years, Ronald Melzack has insisted that one of the most laudable enterprises in research is to span the gap between these two often separate worlds.

scholarly journals A rare Fusarium equiseti infection in a 53-year-old male with burn injury: A case report

2021 ◽  
Author(s):  
Tang Xuan Hai ◽  
Nguyen Thai Ngoc Minh ◽  
Do Ngoc Anh ◽  
Tran Ngoc Dung ◽  
Ngo Thi Minh Chau ◽  
...  
Keyword(s):  
Case Report ◽  
Susceptibility Testing ◽  
Burn Injury ◽  
Large Subunit ◽  
Antifungal Susceptibility ◽  
Herbal Product ◽  
Burn Injuries ◽  
Burn Patients ◽  
Fusarium Equiseti

Background and Purpose: Burn injuries are prone to infection caused by bacteria, fungi, or other pathogens. Fungal wound infection usually has non-specific clinical symptoms.Nevertheless, in some cases, the fungal burden is so substantial that can easily be seen by the naked eyes, but this phenomenon has rarely been reported with Fusarium. Case report: A 53-year-old patient with severe burn injury was admitted to the intensive care unit of the National Hospital of Burn, Ha Noi, Vietnam. His wound was dressed with a traditional herbal product before the hospital admission. On the 5th day after the admission, some white patches suspected of fungal colonies appeared on burn lesions where the herbal medicine was placed. Histological examination (Periodic acidSchiff) and culture of biopsy samples taken from those lesions revealed fungus that was identified as Fusarium equiseti after analysis of the internal transcribed spacer and D1/D2 region of the large subunit of the 28S rDNA. The isolated strain showed susceptibility to voriconazole but resistance to fluconazole, itraconazole, caspofungin,and amphotericin B in vitro. The patient received aggressive treatment, including IV voriconazole (400 mg daily from day five); however, he could not recover. Conclusion: Fusarium should be suspected in burn patients with white patches on lesions. Antifungal susceptibility testing is important since multidrug resistance is common among Fusarium strains.

scholarly journals The Effect of Early Tangential Excision and Split Thickness Skin Graft in Reducing Length of Stay in Burns Patients in Jakarta Islamic Hospital Cempaka Putih

2021 ◽  
Vol 8 (1) ◽  
pp. 15-20
Author(s):  
Gammaditya Adhibarata Winarno ◽  
Aditya Wardhana ◽  
Sanjaya Faisal Tanjunga ◽  
A. S Augiani ◽  
An’umillah Arini Zidna
Keyword(s):  
Length Of Stay ◽  
Skin Graft ◽  
Burn Injury ◽  
Study Groups ◽  
Cross Sectional Study ◽  
Burn Injuries ◽  
Split Thickness Skin Graft ◽  
Burn Patients ◽  
Cross Sectional ◽  
Thickness Skin

Introduction: Early tangential excision (TE) and split-thickness skin graft (STSG) have increased the outcome in burn patients treated at specialized burn centers. This study was conducted to compare the length of stay (LOS) in burn patients undergoing early TE & STSG and delayed TE & STSG. Method: This is a retrospective cross-sectional study including 42 patients with varied burn degrees, and TBSA admitted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit. Patients were assigned to two study groups, the early TE & STSG group including 32 patients and the delayed TE & STSG group including 10 patients. All data were collected from the medical record and compared between two study groups. Result: The mean of LOS in a group with early TE & STSG was shorter (9.81±6.41 days) than LOS in the delayed TE & STSG group (15.80±5.67 days). The data of LOS between these groups were compared using an independent T-test. The LOS in the early TE & STSG group was significantly shorter than the delayed TE & STSG group (p=0.012). Conclusion: In patients with burn injuries, early TE & STSG is associated with a shorter length of stay than the delayed TE & STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.

scholarly journals A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

2021 ◽  
Vol 2 (4) ◽  
pp. 293-300
Author(s):  
Stephen Frost ◽  
Liz Davies ◽  
Claire Porter ◽  
Avinash Deodhar ◽  
Reena Agarwal
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Burn Injury ◽  
Burn Injuries ◽  
Burn Patients ◽  
Review Of The Literature ◽  
Respiratory Compromise ◽  
Burn Care ◽  
Membrane Oxygenation ◽  
Regular Time ◽  
Major Burn

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

scholarly journals A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

2019 ◽  
Vol 40 (6) ◽  
pp. 983-995 ◽  
Author(s):  
Daniel E Kim ◽  
Kaitlin A Pruskowski ◽  
Craig R Ainsworth ◽  
Hans R Linsenbardt ◽  
Julie A Rizzo ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Burn Injury ◽  
The United States ◽  
Pain Severity ◽  
Controlled Trials ◽  
Burn Patients ◽  
Opioid Use ◽  
Randomized Controlled

Abstract Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S38-S39
Author(s):  
Kathleen S Romanowski ◽  
Melissa J Grigsby ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Chart Review ◽  
Burn Injury ◽  
Frailty Index ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Burn Patients ◽  
Chi Square ◽  
Frail Patients ◽  
Modified Frailty Index

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and < 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p< 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p< 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

588 Peripheral Nerve Blocks in Procedural Care for Burn Injuries Less Than 10% Total Burn Surface Area: A Retrospective Chart Review.

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S145-S146
Author(s):  
Kimberly Maynell ◽  
Khattiya Chharath ◽  
Thanh Tran ◽  
Loryn Taylor ◽  
David J Smith
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Hospital Discharge ◽  
Burn Injuries ◽  
Burn Patients ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Burn Care ◽  
Analgesic Consumption ◽  
Significant Difference

Abstract Introduction Pain control remains one of the major challenges in management of burn patients. Pain associated with procedural and post-procedural burn care such as excision and grafting, postoperative dressing changes, and postoperative physical therapies often requires patients to be on intravenous and oral analgesics leading to potential long-term dependence after hospital discharge. Peripheral nerve blocks (PNB) use for perioperative pain management in burn patients may present an alternative pain management modality to help decrease analgesic consumption and shorten length of stay following procedural care. Our hypothesis was tested by evaluating the outcomes from implementation of PNB with ultrasound guided catheter placement for burn procedural care in patients with ≤ 10% total burn surface area (TBSA) requiring excision and grafting. Methods After IRB approval, we retrospectively collected demographics, medical history, pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), postoperative analgesic consumption and time to hospital discharge of patients who underwent autografting procedures for burn injuries ≤ 10% TBSA from October 1, 2019 to December 31, 2019 (the start of our implementation of PNB for procedural burn care). Data was analyzed using chi square/Fisher exact test for categorical variables and t-test for continuous variables. Results Our preliminary data included 20 patients (10 patients had PNB) with average age of 53 years, 60% males and average TBSA of 4.8%. Patients in both PNB and non-PNB groups had unremarkable medical histories and scald and flame as mechanism of burns. There was no significant difference in TBSA (5.3% TBSA in PNB and 4.8% TBSA in non-PNB). Pain intensity before autografting procedure for both groups were reported as moderate to severe and managed with fentanyl, morphine, oxycodone, along with ibuprofen and acetaminophen. There was no significant difference in postoperative pain intensity and opioid consumptions; however, postoperative acetaminophen consumption was less in PNB group compared to non-PNB group (2762±3646 mg vs 3932±7511 mg, respectively), although not statistically significant. There was no significant difference between time from surgery to first physical therapy session; however, time to hospital discharge was shorter in PNB group compared to non-PNB group (5.7±1 days vs 10.5±9 days, respectively), although not statistically significant. Conclusions This evaluation shows a trend in reduction of inpatient postoperative analgesic consumption as well as time to hospital discharge with the use of PNB, although a bigger sample size is needed for further assessment.

scholarly journals Soluble CD163: A novel biomarker for the susceptibility to sepsis in severe burn injuries

2011 ◽  
Vol 44 (01) ◽  
pp. 118-124
Author(s):  
Andrzej Piatkowski ◽  
Gerrit Grieb ◽  
Rittuparna Das ◽  
Ahmet Bozkurt ◽  
Dietmar Ulrich ◽  
...  
Keyword(s):  
Time Course ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Burn Injuries ◽  
Burn Patients ◽  
Serum Samples ◽  
Soluble Cd163 ◽  
Bivariate Correlation ◽  
Total Body

ABSTRACT Objective: Soluble CD163 (sCD163) has been previously shown to play a role in inflammatory and infectious diseases. This study, for the first time, investigates the characteristics and potential values of sCD163 in burn patients. A first look is taken on the changes of sCD163 levels in burn patients by comparing predefined subgroups at single time points. Materials and Methods: Serum samples of 18 patients with burn injuries were collected for biochemical analysis at the time of admission and in a chronological sequence of 12, 24, 48 and 120 h after the injury and were matched to clinical parameters. Statistical analysis was performed using the Mann-Whitney test, Wilcoxon signed rank and Pearson bivariate correlation. Results: Patients with sepsis showed a significant increase of sCD163 levels. sCD163 was correlated with leukocytes (P=0.035) over the time course of 120 h. Patients characterized by a burn size exceeding 25% of the total body surface area (TBSA) showed a significant increase of sCD163 between 12 and 48 h after burn injury (P=0.038). Conclusions: The first view on the characteristics of sCD163 in the serum of burn patients points out that sCD163 seems to be an early indicator for the susceptibility to sepsis. Furthermore, the changes in sCD163 serum levels within the first hours after burn trauma have great potential for early prediction of organ failure after burn injury.

scholarly journals Burns in a Suburban Teaching Hospital: A Retrospective Record Review in Kanchipuram, India

2021 ◽  
pp. 423-429
Author(s):  
Sai Aishwarya Thakku Yoganathan ◽  
Alagar Raja Durairaj ◽  
Surya Rao Rao Venkata Mahipathy ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
...  
Keyword(s):  
Rural Areas ◽  
Burn Injury ◽  
Well Being ◽  
Economic Loss ◽  
Demographic Variables ◽  
Burn Injuries ◽  
High Morbidity ◽  
Burn Patients ◽  
Chi Square ◽  
Cultural Aspects

Background: Burn injuries rank among the most severe type of injury with high morbidity and mortality worldwide. Burn injuries not only affect patients physical health but also affects their social and psychological well being along with severe economic loss to the individual, their family and to the society. About 90% burn injuries are preventable, but poor adherence of safety measures and awareness leads to disability and disfigurement throughout their life. Hence, the need for various demographic variables to understand the cause and pattern in our region are required. Objectives: To describe the demographic and socio-cultural aspects of burn patients and to learn the cause of burn victims in our region. Materials and Methods: A record based retrospective study was conducted at Saveetha Medical College and Hospital, Thandalam, Kanchipuram district. The medical records of all patients over a period of 4 years (January 2017 to December 2020) were reviewed. Data were recorded on a pre-structured and pretested questionnaire. Chi-square test was done to study association between socio-demographic variables and burn injury and (p<0.05) was considered statistically significant. Results: A total of 208 burn cases were involved in this study out of which 56.7% were females and 43.3% were males. Most of the burn patients were 31-45 years and lived in rural areas. The majority of burn injuries were accidental; thermal burns was the most common cause of deep burns. Conclusion: Socio-demographic factors are important in raising educational programs and awareness in rural areas for improving quality of life.

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