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Burn Patients (burn + patient)
Kinds of Burn Patients Selected AbstractsThe Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn VictimsACADEMIC EMERGENCY MEDICINE, Issue 4 2010Adam J. Singer MD Abstract Objectives:, Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. Methods:, This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. Results:, There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Conclusions:, Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia. ACADEMIC EMERGENCY MEDICINE 2010; 17:456,459 © 2010 by the Society for Academic Emergency Medicine [source] Raynaud's phenomenon in a child presenting as oxygen desaturation during transfusion with cold bloodPEDIATRIC ANESTHESIA, Issue 12 2008XIAOPENG ZHANG MD Summary We report a case of Raynaud's phenomenon (RP) triggered by transfusion of cold blood to a pediatric burn patient under general anesthesia. The child was febrile so a decision was made to not use a blood warmer. When the blood was rapidly administered the child suddenly developed ,desaturation'. The child was placed on 100% oxygen, adequate ventilation assured, and the color of his oral mucosa assessed as ,pink'. Placement of the oximeter on the opposite hand revealed 100% saturation. To our knowledge, this is the first case of apparent RP reported in a pediatric patient triggered by transfusion of cold blood. [source] Population pharmacokinetics of imipenem in burn patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2003Eric Dailly Abstract The interindividual variability of imipenem pharmacokinetic parameters in burn patients suggest that these parameters have to be estimated with a large number of patients. The aim of this study is (i) to estimate these parameters with a population pharmacokinetic approach, and (ii) to test the influence of factors on pharmacokinetics parameters. Data are provided by therapeutic drug monitoring (n = 47, 118 samples) and analysed by a nonlinear mixed effect modelling method. Among the tested covariates (age, gender, body weight, height, size of burn and creatinine plasma level) creatinine plasma level affects imipenem pharmacokinetic parameters substantially. The best fit is obtained with a two-compartment model integrating a linear,inverse relationship between imipenem clearance and creatinine plasma level. The estimates of imipenem clearance (16.37 ± 0.204 L/h) and of the distribution volume of the central compartment (0.376 ± 0.039 L/kg) are higher in the population of burn patients than the estimates in healthy subjects. This result is connected with high values of glomerule filtration rate and confirms the interest of therapeutic drug monitoring of imipenem in burn patients and particularly for patients with extreme values of creatinine clearance. [source] The Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn VictimsACADEMIC EMERGENCY MEDICINE, Issue 4 2010Adam J. Singer MD Abstract Objectives:, Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. Methods:, This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. Results:, There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Conclusions:, Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia. ACADEMIC EMERGENCY MEDICINE 2010; 17:456,459 © 2010 by the Society for Academic Emergency Medicine [source] Evaluation of negative emotional care experiences in burn careJOURNAL OF CLINICAL NURSING, Issue 14 2008Björn Wikehult MSc Aim and objective., To assess recollection of negative emotional experiences during burn care. Background., Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences. Design., Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face-to-face interview. Methods., Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms. Results., Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post-traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent. Conclusions., Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction. Relevance to clinical practice., Although relatively uncommon, negative emotional care experiences should be monitored more closely during care. [source] Application of a virtual reality prototype for pain relief of pediatric burn in TaiwanJOURNAL OF CLINICAL NURSING, Issue 4 2007Engle Angela Chan PhD Aim., This study examines the usability and effectiveness of virtual reality in reducing pain in wound-care procedures for pediatric burn patients in Taiwan. Background., Virtual reality has continuously gained prominence in the medical arena, for instance, the telepresence for surgery, the management of mental health disorders and pain control of the paediatric burn. Notwithstanding an increased application of virtual reality in the medical arena in North America, there have been no studies investigating its use for paediatric burn patients in Asia. Methods., This descriptive study has two phases: Phase I: the development of a virtual reality prototype. Phase II: the implementation of the prototype to discern its usability and efficacy with paediatric burn patients at a local hospital. Results., The findings suggest that a significant difference is found in the children's reported pain, with or without the virtual reality intervention, over the three phases: before, during and after the dressing change. However, less pain was noted in the intervention group during and after the dressing change. Conclusion., Adding to the existing clinical value of virtual reality identifies the nature of and different children's responses to pain with the use of virtual reality. Relevance to clinical practice., This study is significant since it demonstrates a difference in the child's response to pain based on the nature of presence and distraction. Moreover, given the evidence that a decrease in anxiety was experienced after the dressing change with virtual reality intervention, timing of using the virtual reality intervention before the child develops conditioning anxiety and anticipated pain for the procedure would be of importance. [source] Use of caudal morphine in pediatric burn patientsPEDIATRIC ANESTHESIA, Issue 7 2009James F. Mayhew No abstract is available for this article. [source] Propofol,ketamine vs propofol,fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes,PEDIATRIC ANESTHESIA, Issue 1 2008ZEYNEP TOSUN MD Summary Background:, The aim of this study was to compare propofol,ketamine (PK) and propofol,fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes. Methods:, Thirty-two ASA physical status II and III inpatients with a second degree total burn surface area ranging from 5% to 25% were studied in a randomized, double blind fashion. Heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either PK or PF: PK group (n = 17) received 1 mg·kg,1 ketamine + 1.2 mg·kg,1 propofol, and PF group (n = 15) received 1 ,g·kg,1 fentanyl + 1.2 mg·kg,1 propofol for induction. Additional propofol (0.5,1 mg·kg,1) was administered when the patients showed discomfort in both groups. If the patient showed discomfort and/or increase in heart rate or systolic arterial pressure, despite additional propofol dose, additional bolus of 0.5,1 mg·kg,1 ketamine or 0.5,1 ,g·kg,1 fentanyl was administered. Results:, There were no significant differences in heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and sedation scores during the procedure between the groups. Restlessness during the procedure was seen in seven (47%) patients in Group PF and one (5.9%) patient in Group PK (P = 0.013). Conclusions:, Both propofol,ketamine and propofol,fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol,ketamine combination was superior to propofol,fentanyl combination because of more restlessness in patients given propofol,fentanyl. [source] | ||||||||||