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Burns Unit (burn + unit)
Selected AbstractsPerspectives in Psychiatric Consultation Liaison Nursing The Psychiatric Nurse in the Burn UnitPERSPECTIVES IN PSYCHIATRIC CARE, Issue 1 2009Jean M. Klein DNSc First page of article [source] Bacteriotherapy with Lactobacillus plantarum in burnsINTERNATIONAL WOUND JOURNAL, Issue 1 2009Maria C Peral Abstract Bacterial colonisation and infection remain the major causes of delayed healing and graft rejection following burns. Topical treatment is necessary to reduce the incidence of burn wound infection. Silver sulphadiazine (SD-Ag) is an often used microbicidal agent. However, this treatment produces adverse reactions and side-effects. On the basis of experimental data and clinical application of lactobacilli as probiotics, we performed this exploratory study to establish the effectiveness of bacteriotherapy with topical application of the innocuous bacteria Lactobacillus plantarum cultured in De Man, Rogosa and Sharpe medium to provide an alternative method for burn treatment using SD-Ag as a reference. These innocuous bacteria would compete with other bacteria that are wound pathogens and would modify the wound environment and promote tissue repair. Eighty burned patients from the Plastic Surgery and Burns Unit were grouped into infected (delayed) second- and third-degree and non infected (early) third-degree burns and treated with L. plantarum or SD-Ag. The proportion of patients with delayed second-degree burns was 0·71 for L. plantarum and 0·73 for SD-Ag (relative rate: ,2·72%) with respect to the decrease in bacterial load (<105 bacteria/g of tissue), promotion of granulating tissue wound bed and healing. In early third-degree burns, the values were 0·75 for L. plantarum and 0·84 for SD-Ag (relative rate: ,1·07%) in preventing wound infection and promotion of granulation tissue, 0·90 in graft taking for both treatments (relative rate: 0%) and 0·75 for L. plantarum and 0·77 for SD-Ag (relative rate: ,2·60%) in healing. In delayed third-degree burns, values were 0·83 for L. plantarum and 0·71 for SD-Ag (relative rate: +16·90%) with respect to the decrease in the bacterial load (<105 bacteria/g of tissue) and providing a granulating tissue wound bed, 0·90 in graft taking for both treatments (relative rate: 0%) and 0·75 for L. plantarum and 0·64 for SD-Ag (relative rate: + 17·19%) in healing. Although the number of patients (between 12 and 15 per group) did not enable the application of a power statistical test, these results suggest that the L. plantarum treatment should be studied in greater depth and could be used as a valid alternative for the topical treatment of burns. [source] Chemical injuries: The Tasmanian burns unit experienceANZ JOURNAL OF SURGERY, Issue 1-2 2003Sophie Ricketts Background: Chemical burns account for relatively few admissions to a burns unit. These injuries, however, deserve separate consideration because of their ability to cause continuing tissue destruction, their potential to cause systemic toxicity and the value of early treatment with copious lavage. Widespread inexperience in the treatment of chemical burns highlights the potential for greater levels of general awareness and knowledge. Methods: A review of 31 patients with chemical injuries admitted to the Tasmanian Burns Unit at the Royal Hobart Hospital (RHH) was carried out for the years 1989,1999. Results: The majority of patients were men aged 20,49 years (mean age: 32 years). Fifty-one per cent of injuries occurred in a domestic and 38% in an industrial setting. The more common aetiological agents were cement (25%), sulphuric acid (16%) and hydrofluoric acid (16%). The upper and lower extremities were involved in all but four patients and the mean total body surface area affected was 3.4%. The mean length of hospital stay was 9 days with a range of 1,30 days. Management of injuries consisted of either surgical or conservative treatment. The former included debridement and split-thickness skin grafting or primary closure and the latter of topical treatment with 1% silver sulfadiazine cream and appropriate dressings. Conclusion: Widespread inexperience in the treatment of chemical injuries highlights the potential for greater levels of knowledge. This is particularly apparent in the early management of these injuries. [source] How do nurses deal with their emotions on a burn unit?JOURNAL OF CLINICAL NURSING, Issue 2 2001A hermeneutic inquiry [source] Differential in vitro activity of anidulafungin, caspofungin and micafungin against Candida parapsilosis isolates recovered from a burn unitCLINICAL MICROBIOLOGY AND INFECTION, Issue 3 2009M. A. Ghannoum Abstract Recent studies suggest that differences in antifungal activity among echinocandins may exist. In this study, the activities of three echinocandins (anidulafungin, caspofungin, and micafungin) against Candida parapsilosis isolates from burn unit patients, healthcare workers and the hospital environment were determined. Additionally, the effect of these echinocandins on the cell morphology of caspofungin-susceptible and caspofungin-non-susceptible isolates was assessed using scanning electron microscopy (SEM). The C. parapsilosis isolates obtained from patients were susceptible to anidulafungin, but were less so to caspofungin and micafungin. Isolates obtained from healthcare workers or environmental sources were susceptible to all antifungals. SEM data demonstrated that although anidulafungin and caspofungin were equally active against a caspofungin-susceptible C. parapsilosis strain, they differed in their ability to damage a caspofungin-non-susceptible strain, for which lower concentrations of anidulafungin (1 mg/L) than of caspofungin (16 mg/L) were needed to induce cellular damage and distortion of the cellular morphology. To determine whether the difference in the antifungal susceptibility of C. parapsilosis isolates to anidulafungin as compared to the other two echinocandins could be due to different mutations in the FKS1 gene, the sequences of the 493-bp region of this gene associated with echinocandin resistance were compared. No differences in the corresponding amino acid sequences were observed, indicating that differences in activity between anidulafungin and the other echinocandins are not related to mutations in this region. The results of this study provide evidence that differences exist between the activities of anidulafungin and the other echinocandins. [source] Toxic epidermal necrolysis; 15 years' experience in a Dutch burns centreJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2007B Gerdts Abstract Background, Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss. Objectives, Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN. Patients/methods, Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004. Results, Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established. Conclusions, Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival. [source] Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantationPEDIATRIC TRANSPLANTATION, Issue 6 2007Johan Arvidson Abstract:, TEN and HUS are challenging complications with excessive mortality after HSCT. We report the development of these two conditions in combination in a nine-yr-old boy after HSCT from an unrelated donor. TEN with skin detachment of more than 90% of body surface area developed after initial treatment for GvHD. Within a few days of admission to the burns unit, the patient developed severe hemolysis, hypertension, thrombocytopenia, and acute renal failure consistent with HUS, apparently caused by CSA. The management included intensive care in a burns unit, accelerated drug removal using plasmapheresis, and a dedicated multi-disciplinary team approach to balance immunosuppression and infections management in a situation with extensive skin detachment. The patient survived and recovered renal function but requires continued treatment for severe GvHD. Suspecting and identifying causative drugs together with meticulous supportive care in the burns unit is essential in the management of these patients and long-term survival is possible. [source] Chemical injuries: The Tasmanian burns unit experienceANZ JOURNAL OF SURGERY, Issue 1-2 2003Sophie Ricketts Background: Chemical burns account for relatively few admissions to a burns unit. These injuries, however, deserve separate consideration because of their ability to cause continuing tissue destruction, their potential to cause systemic toxicity and the value of early treatment with copious lavage. Widespread inexperience in the treatment of chemical burns highlights the potential for greater levels of general awareness and knowledge. Methods: A review of 31 patients with chemical injuries admitted to the Tasmanian Burns Unit at the Royal Hobart Hospital (RHH) was carried out for the years 1989,1999. Results: The majority of patients were men aged 20,49 years (mean age: 32 years). Fifty-one per cent of injuries occurred in a domestic and 38% in an industrial setting. The more common aetiological agents were cement (25%), sulphuric acid (16%) and hydrofluoric acid (16%). The upper and lower extremities were involved in all but four patients and the mean total body surface area affected was 3.4%. The mean length of hospital stay was 9 days with a range of 1,30 days. Management of injuries consisted of either surgical or conservative treatment. The former included debridement and split-thickness skin grafting or primary closure and the latter of topical treatment with 1% silver sulfadiazine cream and appropriate dressings. Conclusion: Widespread inexperience in the treatment of chemical injuries highlights the potential for greater levels of knowledge. This is particularly apparent in the early management of these injuries. [source] Burns to persons suffering from diabetes: a systemic preventive approachJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009MScN (edu), Ma'en Zaid Abu-Qamar Dnurs Aims. To report the findings of an investigation of patients with diabetes and burns, with emphasis on implications for practice: primary and secondary preventions. Background. Diabetes and burns are complex conditions with multi-system involvements, which worsen outcomes for patients, and their management. This research investigated outcomes for patients and diabetes management. Methods. Data on outcomes were obtained from records of patients hospitalised for foot burns in an Australian hospital from 1999,2004. A questionnaire survey design was employed to obtain information on how clinicians in burns units manage diabetes. SPSS was used to analyse data obtained from both resources. Comments written in the questionnaire were analysed using relational analysis. Results. Of the 64 patients, 12 were with diabetes and 52 were without diabetes. Those with diabetes were more likely to sustain contact foot burns (58·3% Diabetes Mellitus vs. 13·5% non Diabetes Mellitus ,2 = 11·487, p = 0·002). The duration of hospitalisation was statistically significantly longer among patients with diabetes compared with those without diabetes (U = 169, p = 0·014); although the two groups were not statistically significant different in terms of severity of burns and received treatment. Of the 29 clinical leaders, 21 (72%) indicated that they regularly provided care to patients with diabetes. Most respondents (n = 15; 58%) reported that new plans need to be initiated to accommodate the combined insult of diabetes and burns. Diabetes centres were located in all participating sites; but not always involved in the process of care. Conclusion. The co-existence of diabetes and burns worsens outcomes for patients, and complicates management plans. Optimal management can be achieved via a multidisciplinary approach starting with glycaemic control, and continued to aggressive management of diabetes and burns. Relevance to clinical practice. Preventive measures should start with tight glycaemic control, identification and avoidance of sources of trauma, early detection and treatment, and continue to aggressive inpatient management of patients with both diabetes and a burn injury. [source] | ||||||||||||||||||||||