DIETARY MANAGEMENT OF 30% TBSA FLAME BURN PATIENT WITH FACIAL BURN WITH T2DM WITH HTN IN A TERTIARY CARE HOSPITAL

In developing countries like India, burn injury is as yet a significant and regular reason for mortality and morbidity. Nutrition therapy aims to provide satisfactory and early nourishment to patients experiencing burn injuries. Metabolic help during increased inflammatory state is essential to make sure adequate treatment of burn patients. Nutritional sustain is a fundamental and indispensable part of consume care that requires an aggressive multifaceted approach. Impeded injury, dysfunction of multiple organs, increased chances of infection, and death are largely prevented by an adequate nutrition care along with proper wound management. In this study we detailed a patient having 30% TBSA flame burn with facial burn with T2DM & HTN and observed all require parameter in dietary management. The patient was suggested with high protein, moderate calorie, and moderate fat diet. As the sugar level of the patient was high i.e. ranges between 250-350 mg/dl, 5 ml Insulin was given to him at 3hr interval. With time, along with regular therapeutic diet the patient was took curd, paneer, chena etc. Albumin, globulin, total protein level of the patient was decreased so he also took coconut water, fruit juices (sugar free), milk, vegetable soups etc. As the sugar level of the patient was high i.e. ranges between 150-250 mg/dl, 3ml Insulin was given to him at 6hr interval. The wounds of the patient were started healing and he was active & fresh. The patient undertook a dietary counseling for 17 days and dietary modification was done according to the patient condition.

The Impact of Flame Burn Injuries on Patients Who Sustain Mild Injuries From Motor Vehicle Crashes

Background The purpose of this study was to determine the differences in patient outcomes between motor vehicle crash (MVC) victims with an ISS < 15 and those with a similar ISS and a flame burn injury. Methods Data for patients involved in a MVC with a GCS ≥12 and an ISS < 15 with and without flame burn injury were reviewed from the American College of Surgeons National Trauma Data Bank between 2007 and 2017. International Classification of Diseases-9 and -10 revisions and External Injury Codes were used to identify patients who were divided into MVC only (Group 1) and MVC with additional flame burn injury (Group 2). In-hospital mortality was the primary outcome whereas secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS, sepsis, deep vein thrombosis, acute respiratory distress syndrome, and pneumonia. Simple linear regression was used in the form of odds ratios to investigate risk factors for mortality and secondary outcomes. Results The mean LOS and ICU LOS were longer in Group 2 (5.9 vs 4.0 days, p-value <0.001, and 1.2 vs 0.6 days, p-value <0.001, respectively), with more patients being admitted to the ICU as well (22.9% vs 17.3%, p-value <0.001). Also, there were significantly higher rates of pneumonia (0.8% vs 0.5%, p-value 0.0014), deep vein thrombosis (0.6% vs 0.4%, p-value 0.028), and acute respiratory distress syndrome (0.5% vs 0.3%, p-value 0.004) in Group 2. Patients in Group 1 were older and more likely had hypertension, congestive heart failure, and COPD. There was no significant difference in mortality between Groups by odds ratios (OR 0.85, p-value 0.743) or raw percentages (0.3% vs 0.3%, p-value = 0.874). Conclusion MVC victims with mild injuries who also sustain a burn injury are more likely to require admission to the ICU regardless of their comorbidities and more likely to develop respiratory complications, especially pneumonia and an increase in ICU and hospital LOS.

Surviving an Extensive Burn Injury Using Advanced Skin Replacement Technologies

There have been significant improvements in the technology available for treating extensive burns in the past decade. This case presents two unique, skin replacement technologies that were used to treat an 86% surface area flame burn in a pediatric patient. A temporary dermal replacement, known as “Novosorb™ Biodegradable Temporizing Matrix” was first used to stabilize the burn injury and remained in place for approximately three months. Given the large burn size and lack of available donor skin for grafting, a permanent skin replacement product known as “Self-Assembled Skin Substitute (SASS)” was then utilized to cover the burns. SASS is a novel technology that was developed to replace skin as an autologous skin graft and is currently available in Canada through a clinical trial for major burns. Ultimately, the concurrent use of these two technologies allowed for the unprecedented survival of a child following an extensive and life-threatening burn injury.

Pattern of Burn Injury in Children Presented to Dhaka Shishu (Children) Hospital

Background: Children are mostly affected in burn injury at our country like other low and middle income countries (LMICs). Approximately 90% of the burns occur in under developed countries, which generally lack the necessary infrastructure to reduce the incidence and severity of burns. Objectives: This study was done to investigate the pattern of burn cases admitted to Dhaka Shishu (Children) Hospital (DSH). Methods: This was a retrospective study conducted over the period of one year from January 2019 to December 2019 at Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. The data was collected from the patients record section of the hospital. Patients characteristics (e.g. age, sex), causes and severity of injury, outcome, hospital stay and seasonal variation were analized in this study. Results: A total of 91 patients were admitted during study period of one year. This study consisted of 53 male patients (58.24%) and 38 female patients (41.76%) with male to female ratio of 1.3:1. The most frequently hospitalized burn patients were in the age group 3-5 years, which accounted for 30.77% of patients. Burns were more common during winter season followed by autumn season, with 43 cases (47.25%) and 18 cases (19.78%) respectively. The highest number of admissions was during the month of December. Scald burn was the most common cause of burn injury in our study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Scald burn was the most common cause of burn injury in this study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Conclusion: The most frequently hospitalized burn patients were in the age group 3-5 years and more common during winter season. Most of the burn occured in children are scald in our country due to accidental fall of worm liquid. Superficial epidermal and dermal burns are treated conservatively, but deep burns may require surgical treatment. DS (Child) H J 2020; 36(2): 134-137

A non-lethal murine flame burn model leads to a transient reduction in host defenses and enhanced susceptibility to lethal Pseudomonas aeruginosa infection

Of the 486,000 burn injuries that required medical treatment in the USA in 2016, 40,000 people were hospitalized, with > 3,000 fatalities. After burn injury, humans are at increased risk of sepsis and mortality from infections caused by Pseudomonas aeruginosa (PA), an opportunistic pathogen. We hypothesize that systemic events were initiated from the burn that increased the host’s susceptibility to PA. A non-lethal 10% total body surface area (TBSA), full-thickness flame burn was performed in CD-1 mice without and with subsequent PA (strain M2) infection. The LD 50 for subcutaneous infection with PA M2 at the burn site immediately after the burn decreased by 6-logs with mortality occurring between 18 and 26 hours, compared with PA-infected mice without burn injury. Bacteria in distal organs were detected by 18 hours, concurrent with the onset of clinical symptoms. Serum pro-inflammatory cytokines (IL-6, IL-1β, IFN-γ, and TNF-α) and the anti-inflammatory cytokine, IL-10, were first detected at 12 hours post-burn with infection and continued to increase until death. Directly after burn alone, serum levels of HMGB1, a danger-associated molecular pattern and TLR4 agonist, transiently increased to 50 ng/mL before returning to 20 ng/mL. Burn with PA infection increased serum HMGB1 concentrations >10-fold (250 ng/mL) at the time of death. This HMGB1-rich serum stimulated TLR4-mediated NF-κB activation in a TLR4-reporter cell line. Treatment of infected burned mice with P5779, a peptide inhibitor of HMGB1, increased the mean survival from 23 to 42 hours (P<0.0001). We conclude that the high level of serum HMGB1, which preceded the increase in pro-inflammatory cytokines, is associated with post-burn mortality.

A clinical study on dyselectrolytemia and changes in renal function in patients with 25% to 60% flame burn injury

Background: Severe fluid loss is the greatest problem faced following major thermal burn injuries accompanied by changes in the level of electrolytes. Standard fluid resuscitation derived from Parkland’s formula and body’s response to it is measured in terms of correction of dyselectrolytemia and urine output.Methods: A prospective cross sectional study involving 80 patients were included in the study with male patients being 28 and females being 52. Flame burns involving ≥25% - ≤60% of BSA presenting within 24 hours of flame burn injury were taken into account. Serial follow up of serum electrolytes was done on the day of presentation, day 2, day 3 and day 7 its effect on standard fluid resuscitation was studied.Results: Renal function is indirectly related to the percentage of flame burn, hence decreasing urine output and linear increase in serum creatinine is suggestive of increased surface area of burn. The mean serum sodium on the day of admission was roughly normal whereas as the days progressed there was significant hyponatremia with normalisation of day 7, whereas serum potassium was initially normal followed by hyperkalemia.Conclusions: An initial assessment involved calculation of percentage of total body surface area burn injury followed by of estimation of fluid requirement according to standard Parkland formula. Monitoring of electrolyte imbalance was noted for 2nd, 3rd and 7th day of hospitalisation. Derangements in these parameters were observed during course of admission followed by normalisation on the 7th day.

604 Epidemiology and Microbiologic Profile of Pediatric Burn Patients: Eight-years’ Experience in a Tertiary Hospital

Introduction Burn injury is major morbidity and is the third most common cause of mortality among the pediatric population. Methods This study retrospectively analyzed pediatric burn admissions from a tertiary hospital in an 8-year period from 2009–2016. A total of 218 pediatric patients were reviewed for demographics, burn incidence, characteristics, cause of burn and microbiologic profile. Results There were 107(49.08%) Infants, 47 (21.56%)Toddlers, 32 (14.68%) Preschoolers, 17 (7.79%) belonged to school age and 15 (6.88%) were adolescent. Most of the admitted patients were within the city 122 (56%) while 96 (44%) were from other localities outside the city. Scald burn was the most common cause of burn with 160 (73.39%) cases and was highest in the infant age group (49.8%). The mean total body surface area was 10%, the highest being caused by flame burn at 13% TBSA among toddlers and preschoolers having the highest total body surface area involved (12%). The most commonly involved body area is the chest (13.6%). The mean transfer time from injury to the admission of patients coming from within and outside the city was 8.8 and 28 hours respectively. The mean length of hospital stay was 9.08 days. There was also a decrease in mean transfer time and hospital stay from 2009 to 2016. Flame burn accounted for the longest hospital stay at 20.27 days. Microbiologic profile of burn wound cultures showed a predominance of gram-negative rods (90%) with Enterobacter cloacae and Klebsiella pneumonia as common isolates. Culture studies also showed amoxicillin-clavulanic, ampicillin-sulbactam, and cefuroxime have the highest resistance, while most isolates are still susceptible to Amikacin, Ertapenem, Meropenem, and Ciprofloxacin. Conclusions Patients belonging to the school-age group has the highest mean number of hospital days (27.3 days). On review of culture study results from wound tissue samples, Gram-negative rods were the most common and Enterobacter cloacae were the most common isolate. Antibiotics such as Amoxicillin clavulanic, ampicillin-sulbactam, cefuroxime, and ceftazidime had high resistance rates and therefore should not be initially used for patients suspecting of the infected burn wound.