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Burn critical care

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https://www.readbyqxmd.com/read/29142896/sodium-variability-is-associated-with-increased-mortality-in-severe-burn-injury
#1
Soman Sen, Nam Tran, Brian Chan, Tina L Palmieri, David G Greenhalgh, Kiho Cho
Background: Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods: We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission...
2017: Burns and trauma
https://www.readbyqxmd.com/read/29140950/development-of-clinical-process-measures-for-pediatric-burn-care-understanding-variation-in-practice-patterns
#2
Lewis E Kazis, Robert L Sheridan, Gabriel D Shapiro, Austin F Lee, Matthew H Liang, Colleen M Ryan, Jeffrey C Schneider, Martha Lydon, Marina Soley-Bori, Lily A Sonis, Emily C Dore, Tina Palmieri, David Herndon, Walter Meyer, Petra Warner, Richard Kagan, Frederick J Stoddard, Michael Murphy, Ronald G Tompkins
BACKGROUND: There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#3
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29097859/quantifying-burnout-among-emergency-medicine-professionals
#4
William Wilson, Jeffrey Pradeep Raj, Girish Narayan, Murtuza Ghiya, Shakuntala Murty, Bobby Joseph
Background: Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. Methods: A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory...
October 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29049055/oxidized-regenerated-cellulose-collagen-dressings-review-of-evidence-and-recommendations
#5
Stephanie Wu, Andrew J Applewhite, Jeffrey Niezgoda, Robert Snyder, Jayesh Shah, Breda Cullen, Gregory Schultz, Janis Harrison, Rosemary Hill, Melania Howell, Marcus Speyrer, Howard Utra, Jean de Leon, Wayne Lee, Terry Treadwell
OBJECTIVE: Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN: A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations...
November 2017: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/29034127/socio-demographic-factors-which-significantly-relate-to-the-prediction-of-burns-severity-in-children
#6
Khalid Alnababtah, Salim Khan
BACKGROUND: Burns are considered one of the biggest wounds and the most devastating injuries humans can receive as they have prolonged consequences which are not only physical, but psychological in addition to the cost of treatment. The aim of the study was to explore the relationships between socio-demographic factors (SDF) and the incidence and mechanisms of burn injuries in children. The objectives were to identify the multiple and various factors responsible for the occurrence of significant burns in children; to explore and investigate the relationship between these factors; to critically analyse SDF on the incidence and mechanisms of burns and to develop a contextual model with a view to informing future health care policy and health promotion programmes...
2017: International Journal of Burns and Trauma
https://www.readbyqxmd.com/read/29032979/a-treatment-algorithm-for-the-management-of-intraoral-burns-a-narrative-review
#7
REVIEW
Steve Kang, Kenneth Kufta, Thomas P Sollecito, Neeraj Panchal
Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm...
October 9, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29029855/improving-mortality-outcomes-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-a-regional-burns-centre-experience
#8
M Nizamoglu, J A Ward, Q Frew, H Gerrish, N Martin, A Shaw, D Barnes, O Shelly, B Philp, N El-Muttardi, P Dziewulski
INTRODUCTION: Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae...
October 10, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29023905/cholangiopathy-in-critically-ill-patients-surviving-beyond-the-intensive-care-period-a-multicentre-survey-in-liver-units
#9
L Laurent, C Lemaitre, A Minello, A Plessier, G Lamblin, A Poujol-Robert, A Gervais-Hasenknopf, E-A Pariente, P Belenotti, N Mostefa-Kara, P Sogni, M Legrand, J-M Cournac, F Tamion, G Savoye, P Bedossa, D-C Valla, V Vilgrain, O Goria
BACKGROUND: The outcome of cholangiopathy developing in intensive care unit (ICU) is not known in patients surviving their ICU stay. AIM: To perform a survey in liver units, in order to clarify the course of cholangiopathy after surviving ICU stay. METHODS: The files of the liver units affiliated to the French network for vascular liver disease were screened for cases of ICU cholangiopathy developing in patients with normal liver function tests on ICU admission, and no prior history of liver disease...
December 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29022064/proinflammatory-switch-from-g%C3%AE-s-to-g%C3%AE-i-signaling-by-glucagon-like-peptide-1-receptor-in-murine-splenic-monocyte-following-burn-injury
#10
Qing-Hong Zhang, Ji-Wei Hao, Guang-Lei Li, Xiao-Jing Ji, Xu-Dong Yao, Ning Dong, Yong-Ming Yao
OBJECTIVE: Glucagon-like peptide-1 (GLP-1)-based therapy via G protein-coupled receptor (GPCR) GLP-1R, to attenuate hyperglycemia in critical care has attracted great attention. However, the exaggerated inflammation by GLP-1R agonist, Exendin-4, in a mouse model of burn injury was quite unexpected. Recent studies found that GPCR might elicit proinflammatory effects by switching from Gαs to Gαi signaling in the immune system. Thus, we aimed to investigate the possible Gαs to Gαi switch in GLP-1R signaling in monocyte following burn injury...
October 11, 2017: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#11
A Lavrentieva, N Depetris, I Rodini
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/29021724/inhalation-injury-in-a-burn-unit-a-retrospective-review-of-prognostic-factors
#12
D Monteiro, I Silva, P Egipto, A Magalhães, R Filipe, A Silva, A Rodrigues, J Costa
Inhalation injury (InI) is known to seriously affect the prognosis of burn patients, as it is strongly associated with high morbidity and mortality. Despite major advances in the treatment of burn patients in the past years, advances in the treatment of smoke InI have been somewhat limited; mortality reduction mostly results from improvements in critical care. It is difficult to separate the contribution of InI from other mechanisms that also affect respiratory tract and lungs. The aim of this study was to compare patients with and without InI and to identify prognostic factors among patients with smoke InI...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/28970179/creation-and-efficacy-of-a-cadaver-based-prosection-anatomical-course-for-critical-care-advanced-practice-providers
#13
Melissa K Stewart, Stephen Gondek, Roslyn Green, Jason Young, Raeanna C Adams, Timothy Nunez
OBJECTIVE: Intensive care units (ICUs) increasingly rely on advanced practice providers (APPs) to care for critically ill patients. Our institutional APPs perceived functional anatomical knowledge deficits. To meet this need, a cadaver-based prosection course was developed. The purpose of our study was to describe and evaluate the learner-perceived course efficacy. DESIGN: A precourse survey collected participant demographics. Precourse and postcourse surveys assessed perceived confidence in 13 anatomical areas...
September 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28963316/canada-donate-study-protocol-a-prospective-national-observational-study-of-the-medical-management-of-deceased-organ-donors
#14
Frederick D'Aragon, Sonny Dhanani, Francois Lamontagne, Deborah J Cook, Karen Burns, Aemal Akhtar, Michaël Chassé, Anne-Julie Frenette, Sean Keenan, Jean-Francois Lize, Demetrios J Kutsogiannis, Andreas Kramer, Lori E Hand, Erika Arseneau, Marie-Helene Masse, Christine Ribic, Ian Ball, Andrew Baker, Gordon Boyd, Bram Rochwerg, Andrew Healey, Steven Hanna, Gordon H Guyatt, Maureen O Meade
INTRODUCTION: Research on the management of deceased organ donors aims to improve the number and quality of transplants and recipient outcomes. In Canada, this research is challenged by regionalisation of donation services within provinces and the geographical, clinical and administrative separation of donation from transplantation services. This study aims to build a national platform for future clinical trials in donor management. Objectives are to engage collaborators at donation hospitals and organ donation organisations (ODOs) across Canada, describe current practices, evaluate the effectiveness of donation-specific interventions and assess the feasibility of future clinical trials...
September 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/28946897/undetectable-haptoglobin-is-associated-with-major-adverse-kidney-events-in-critically-ill-burn-patients
#15
François Dépret, Chloé Dunyach, Christian De Tymowski, Maïté Chaussard, Aurélien Bataille, Axelle Ferry, Nabila Moreno, Alexandru Cupaciu, Sabri Soussi, Mourad Benyamina, Alexandre Mebazaa, Kevin Serror, Marc Chaouat, Jean-Pierre Garnier, Romain Pirracchio, Matthieu Legrand
BACKGROUND: Intravascular haemolysis has been associated with acute kidney injury (AKI) in different clinical settings (cardiac surgery, sickle cell disease). Haemolysis occurs frequently in critically ill burn patients. The aim of this study was to assess the predictive value of haptoglobin at admission to predict major adverse kidney events (MAKE) and AKI in critically ill burn patients. METHODS: We conducted a retrospective, single-centre cohort study in a burn critical care unit in a tertiary centre, including all consecutive severely burned patients (total burned body surface > 20% and/or shock and/or mechanical ventilation at admission) from January 2012 to April 2017 with a plasmatic haptoglobin dosage at admission...
September 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28930947/the-mortality-ascent-hourly-risk-of-death-for-hemodynamically-unstable-trauma-patients-at-level-ii-versus-level-i-trauma-centers
#16
Juan P Herrera-Escobar, Arturo J Rios-Diaz, Cheryl Zogg, Lindsey L Wolf, Alyssa Harlow, Eric B Schneider, Zara Cooper, Carlos A Ordonez, Ali Salim, Adil H Haider
BACKGROUND: Severely injured trauma patients have higher in-hospital mortality at Level II versus Level I Trauma Centers (TCs). In order to better understand these differences, we sought to determine if there were any time-periods during which hemodynamically unstable trauma patients are at higher risk of death at Level II versus Level I TCs within the first 24 hours post-admission. STUDY DESIGN: Trauma patients aged 18-64 years, with Injury Severity Score ≥15, SBP <90 mmHg at admission, and treated at Level II or Level I TCs, were identified using the 2007-2012 National Trauma Data Bank...
September 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28924442/laser-induced-choroidal-neovascularizations-clinical-study-of-3-cases
#17
Wipada Laovirojjanakul, Thuss Sanguansak, Yosanan Yospaiboon, Supat Sinawat, Suthasinee Sinawat
BACKGROUND: We report 3 patients with laser-induced choroidal neovascularization (CNV). METHOD: Retrospective, observational case series. Medical charts and photographs were reviewed. RESULTS: Two patients with central serous chorioretinopathy who developed iatrogenic CNV after focal laser photocoagulation were treated with intravitreal ranibizumab injections. One patient with CNV secondary to thermal laser photocoagulation for diabetic macular edema was treated with photodynamic therapy (PDT)...
May 2017: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/28901207/characterizing-citizens-preferences-for-engagement-in-patient-care-and-research-in-adult-and-pediatric-intensive-care-units
#18
Karen E A Burns, Leena Rizvi, Anna Charteris, Samuel Laskey, Saima B Bhatti, Kamalprit Chokar, Karen L M Choong
RATIONALE: Engagement promotes and supports the active participation of patients and families in health care and research to strengthen their influence on decision-making. We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU). METHODS: Interviewers administered questionnaires to visitors in 3 adult ICUs and 1 pediatric ICU. RESULTS: We surveyed 202 (adult [n = 130] and pediatric [n = 72]) visitors...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28894313/need-for-a-randomized-controlled-trial-of-stress-ulcer-prophylaxis-in-critically-ill-children-a-canadian-survey
#19
Mark Duffett, Karen Choong, Jennifer Foster, Elaine Gilfoyle, Jacques Lacroix, Deborah J Cook
BACKGROUND: Stress ulcer prophylaxis is commonly used in pediatric critical care, to prevent upper gastrointestinal bleeding. The most frequently used agents are histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). The risk-benefit ratio for stress ulcer prophylaxis is uncertain, because data from randomized clinical trials (RCTs) on the effectiveness and harms of prophylaxis in children are limited. OBJECTIVE: To describe the views of Canadian pediatric intensivists about a future RCT of stress ulcer prophylaxis...
July 2017: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/28888320/wellness-and-burnout-in-burn-care-providers-professionalism-the-social-covenant-and-the-7-habits-of-highly-effective-teams
#20
REVIEW
Charles Scott Hultman, Michael W Neumeister
This article explores the functioning of highly effective teams in burn care. Critical to the success of the team is the health of burn care providers, who can experience burnout. Wellness must be promoted by health care organizations, which, in turn, are responsible for the health of the populations they serve. Professionalism not only frames the social covenant between patients and burn care physicians but may also serve as a critical force in protecting against burnout and promoting wellness.
October 2017: Clinics in Plastic Surgery
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