scholarly journals Sepsis in Burns—Lessons Learnt from Developments in the Management of Septic Shock

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 26
Author(s):  
Dorothee Boehm ◽  
Henrik Menke
Keyword(s):  
Septic Shock ◽  
Screening Tool ◽  
Scientific Basis ◽  
Antimicrobial Treatment ◽  
Burn Patients ◽  
Surviving Sepsis Campaign ◽  
Effective Screening ◽  
Burn Care ◽  
The Past ◽  
Sepsis Therapy

After surviving the acute phase of resuscitation, septic shock is the cause of death in the majority of burn patients. Therefore, the management of septic shock is a cornerstone in modern burn care. Whereas sepsis therapy in general has undergone remarkable developments in the past decade, the management of septic shock in burn patients still has a long way to go. Instead, the differences of burn patients with septic shock versus general patients have been emphasized and thus, burn patients were excluded in every sepsis study which are the basis for modern sepsis therapy. However, due to the lack of evidence in burn patients, the standards of procedure for general sepsis therapy have been adopted in burn care. This review identifies the differences of burn patients with sepsis versus other septic patients and summarizes the scientific basis for modern sepsis therapy in general ICU patients and burn patients. Consequently, the results in general sepsis research should be transferred to burn care, which means the implementation of effective screening, early resuscitation, and efficient antimicrobial treatment. Therefore, on the basis of past developments and in the light of the current update of the Surviving Sepsis Campaign guidelines, this review introduces the “Burn SOFA score” and the “3 H’s of burn sepsis” as a screening tool for early sepsis recognition in burn patients.

745 Pediatric Burn Transfers: A 10 Year Analysis of Adherence to ABA Transfer Criteria

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S205-S206
Author(s):  
Janine Roller ◽  
Rebecca Courtemanche ◽  
Marija Bucevska ◽  
Sally Hynes
Keyword(s):  
Pediatric Patients ◽  
Burn Injuries ◽  
Physician Education ◽  
Accurate Estimation ◽  
Burn Patients ◽  
Burn Care ◽  
The Past ◽  
Medical Disorders ◽  
Referral Criteria ◽  
Burn Depth

Abstract Introduction Severe burn injuries require complex care at certified burn centres to minimize morbidity and mortality. The ABA Burn Centre Referral Criteria was developed to aid clinicians in determining which patients warrant transfer as physician comfort with the management of pediatric burns, accurate estimation of TBSA, and burn depth varies. We hypothesize that pediatric patients are often transferred despite not meeting referral criteria. The aim of this study was to review pediatric patients with burn injuries that were transferred to the provincial burn centre over the past 10 years to better understand the reasons for the transfer. Methods A 10-year retrospective review from January 2008 to December 2018 was performed using the provincial Burn Registry. Pediatric burn patients under 18 years old who were transferred for burn care were identified and their demographics, burn characteristics, and the basis for transfer was analyzed against the ABA Burn Referral Criteria. Results A total of 130 pediatric burn patients were transferred from 42 different hospitals of varying trauma levels. Patients on average were 5 years old, predominantly male (59%), and scalds were the most common etiology (53%). Most patients were transferred by a fixed-wing ambulance (54%) and the average transport time was 1.5 days after the initial injury. All children met 1 or more ABA Referral Criteria for transfer. The most common reasons for transfer were for a TBSA greater than 10% (42.2%), burn to the hand (27.7%) or perineum (11.5%), 3° burn depth (12.3%), or significant pre-existing medical disorders (9.2%). Conclusions Over the past 10 years, all pediatric burn patients met ABA Burn Centre Referral Criteria based on TBSA, burn depth and burn location alone. This study is limited in that we were not able to capture all pediatric burn patients to identify those that warranted a referral but were not transferred. Applicability of Research to Practice The results indicate that burn-related transfers to the provincial burn centre were appropriate. The dissemination of this information to the referring centres may serve to reinforce these positive referral patterns. Furthermore, this audit provides insight into the geographic origins of pediatric burn referrals in the province to help direct burn prevention and physician education efforts, as well as resources for initial burn care and post-discharge rehabilitation services.

scholarly journals Management of sepsis and septic shock in the emergency department

2021 ◽  
Author(s):  
Francesco Gavelli ◽  
Luigi Mario Castello ◽  
Gian Carlo Avanzi
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Patient Management ◽  
Emergency Physicians ◽  
Surviving Sepsis Campaign ◽  
Sepsis Management ◽  
Early Management ◽  
New Information ◽  
Sepsis And Septic Shock ◽  
Early Phases

AbstractEarly management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals, Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units

2021 ◽  
Vol 80 ◽  
pp. 279-285
Author(s):  
Giuseppe Loddo ◽  
Giusy La Fauci ◽  
Luca Vignatelli ◽  
Corrado Zenesini ◽  
Rosalia Cilea ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Screening Tool ◽  
Effective Screening ◽  
Confusional Arousals ◽  
Sleep Terrors

The Role of Histones and Heparin in Sepsis: A Review

2021 ◽  
pp. 088506662199232
Author(s):  
Xiaojuan Zhang ◽  
Xin Li
Keyword(s):  
Septic Shock ◽  
Multiple Organ ◽  
Clinical Settings ◽  
The Past ◽  
Life Saving ◽  
Extracellular Histones ◽  
Sepsis And Septic Shock ◽  
Development And Management ◽  
Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

Performance Assessment Study of Indian Railways – Case of Low Efficiencies in Large Government Monopoly

2021 ◽  
pp. 036119812110255
Author(s):  
Sabyasachi S. Roy ◽  
Mukul Kulshrestha
Keyword(s):  
Scientific Basis ◽  
Data Envelopment ◽  
Policy Reforms ◽  
Management Planning ◽  
Rail Network ◽  
The Past ◽  
Assessment Study ◽  
Micro Level ◽  
Global Population ◽  
Financial Losses

Indian Railways is the world’s largest government-owned monopoly, annually carrying passenger numbers that surpass the global population. It is world’s fourth largest rail network after the U.S.A., China, and Russia, and is managed by a separate Ministry of Railways. The operating ratios have consistently been around 90% in the past several years, indicating that that the capability to generate operational surplus is low. Further, its expenditure on staff and their pensions has been increasing. Consequently, capacity growth is increasingly being funded through borrowings, which threatens to further worsen the financial situation. Thus, railway services in India are often perceived as being inefficient and unsatisfactory. However, this perception of inefficient services has no scientific basis as mid- and micro-level efficiency analyses of Indian Railways have never been carried out. This paper adopts a data envelopment analysis (DEA)-based approach to evaluate the performance efficiencies of the 69 divisions of Indian Railways. Six models that deploy a range of performance indicators like operating expenditures, numbers of staff employed or passengers carried, freight carried, rail network length, and revenues generated have been employed to assess efficiencies. The results demonstrate the existence of significant inefficiencies that may possibly be attributed to lack of proper management, planning policies, and mis-governance, resulting in significant financial losses. The paper discusses these issues and the policy reforms needed in the developing country context, while suggesting some reforms that may lead to improved sector performances.

scholarly journals The effective screening tools for detecting hearing loss in elderly population: HHIE-ST Versus TSQ

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nichtima Chayaopas ◽  
Pornthep Kasemsiri ◽  
Panida Thanawirattananit ◽  
Patorn Piromchai ◽  
Kwanchanok Yimtae
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Screening Tool ◽  
Diagnostic Value ◽  
Screening Tools ◽  
Effective Screening ◽  
Hearing Disability ◽  
Test Study ◽  
Combined Test ◽  
Single Question

Abstract Background Globally increasing number of elders is concerned. Hearing loss process in older adults cannot be avoided. An effective screening tool for hearing loss is essential for proper diagnosis and rehabilitation, which can improve QOL in older adults. Methods This prospective-diagnostic test study evaluates the diagnostic value of Thai version of the Hearing Handicap Inventory for Elderly Screening (HHIE-ST) and the Thai Single Question (TSQ) surveys in screening hearing disability in 1109 Thai participants aged 60 years and older in communities in four provinces in Thailand. The HHIE-ST consisted of 10 selected questions from the validated HHIE-Thai version. A TSQ survey was developed to have the same meaning as an English Single Question survey. The participants answered both questionnaires, and a standard audiometry test assessed with air conduction from 250 to 8000 Hz was included as a gold standard. Results The prevalence of hearing disability was 38.34%. The HHIE-ST achieved a sensitivity of 88.96% (95% CI 85.77–91.64) and specificity of 52.19% (95% CI 48.24–56.13) for diagnosis hearing disability in Thai older adults, whereas the TSQ yielded a sensitivity of 88.73% and a specificity of 55.93%. A combined test including the HHIE-ST and TSQ achieved better performance with sensitivity of 85.29% and specificity of 60.13%. Conclusions Either the HHIE-ST or the TSQ is a sensitive and useful tool for screening hearing disability in Thai older adults. Using the HHIE-ST together with the TSQ resulted in a better screening tool for detecting moderate hearing loss older adults who will benefit and recommended for hearing rehabilitation. Trial registration The study is registered with the following number in the Thai Clinical Trials Registry: TCTR20151015003. Date of registration October 14, 2015.

613Pediatric Burn Bibliotherapy - An Initial Assessment of Novels About Young Burn Survivors and Their Collective Experiences

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S160-S160
Author(s):  
Philip H Chang ◽  
Antonella Barrios ◽  
Jamie Heffernan ◽  
Angela Rabbitts ◽  
Caroline Jedlicka
Keyword(s):  
Performing Arts ◽  
English Language ◽  
Psychosocial Support ◽  
Numerical Data ◽  
Recovery Phase ◽  
Initial Assessment ◽  
Burn Patients ◽  
The Past ◽  
Burn Survivors ◽  
Burn Patient

Abstract Introduction Bibliotherapy is the use of books as a therapeutic intervention for structuring interaction between facilitator and participant based on the mutual sharing of literature. Bibliotherapy has been utilized to address childhood teasing, healthy lifestyles in children, and eating disorders. With the dramatic improvements in survival of burn patients over the past decades, biographies and novels featuring pediatric burn survivors have emerged. These patients often face significant barriers in accessing psychosocial support. Our team hypothesized that bibliotherapy could benefit pediatric burn patients. In order to test this hypothesis, as a first step, our team conducted an assessment of the available burn survivor literature. Methods WorldCat book database was queried using the terms “Burn Patient Fiction” (45 results) and “Burn Patient Biography” (53 results). The authors identified 12 books out of these 98 results likely to be appropriate for adolescent and teenage burn patients based on the brief summaries. The 12 books were then read by the research team and analyzed for burn patient demographics and relevant clinical data when available. Simple descriptive statistics were utilized for numerical data Results Out of 12 books read, 5 were biographies & 7 fictional novels. Protagonists mean age at time of injury was 8.7±5.1 years (range 2–16), with 5 males and 7 females. Average injury size was 57±21% TBSA (range: 14–85). 10 of 12 protagonists suffered facial burns; 7 of 12 suffered hand burns. Oral health/dental issues were described in 4 of 12 books. Geographically, these English language novels spanned Australia (1), Canada 92), and the U.S. (9). Average page length was 237±88 pages (range: 64–372). In 11 of 12 books, mechanism of injury involved flame from car accidents (2), house fires (4), and campfires (2). With regards to sources of positive support during the recovery phase, family was the most commonly cited source (11 novels) followed by friends (10), spiritual/religious support (5), sports (3), burn survivor groups (3), hospital psychiatrists (3), and performing arts (2). Appropriate audience group for most books were teenagers (11) with 5 books deemed also appropriate for adults (only 1 book judged appropriate only for adults), and 2 books appropriate for adolescents. Conclusions Several novels and biographies with pediatric burn survivor protagonists have been written over the past 20 years. Commonalities across these books include flame burn etiology, relatively large TBSA, and burn injuries to visible body areas (face and hand). Family and friends were the most common emotional support for these protagonists. Most books were appropriate for teenagers.

scholarly journals Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines

2017 ◽  
Vol 66 (10) ◽  
pp. 1631-1635 ◽  
Author(s):  
◽  
Andre C Kalil ◽  
David N Gilbert ◽  
Dean L Winslow ◽  
Henry Masur ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Infectious Diseases ◽  
Position Statement ◽  
Critical Care Medicine ◽  
Surviving Sepsis Campaign ◽  
Diagnosis And Therapy

The Infectious Diseases Society of America elected not to endorse the Surviving Sepsis Campaign Guidelines due to lack of agreement with the Society of Critical Care Medicine regarding specific recommendations related to diagnosis and therapy for patients with apparent or documented sepsis/septic shock.

Sign in / Sign up

Export Citation Format

Share Document