Annals of burns and fire disasters最新文献

Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace. The study is a cross-sectional study that was performed on patients admitted to Shahid Motahari University Hospital in Tehran from August 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms.Of the total burn patients under study, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were not safe against the risk of burns. Failure of devices and equipment was the cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanisms in the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use of safety equipment at work, and the presence of damaged equipment are the main causes of burn accidents in the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended.

Ocular lesions in burns are common and diagnosis is often late, leading to functional impairment including loss of vision to these individuals. A retrospective study was conducted to assess ocular lesions in burns during ICU stay (01/01/2013 to 30/09/2020) in a 20-bed burn ICU in Tunis. Twenty-six cases combining burns and ocular lesions were reviewed. The average age was 26, with a sex-ratio 3.3/1. TBSA was 22±13%. Face was affected in 23 patients, and mechanical ventilation was required in 10 cases. Diagnosis of ocular lesion was noted at 4.5 H (1-33 H) after burn injury. Main clinical signs were: eye redness (n=5) and purulent eye discharge (n=5). Lesions were mainly corneal abscess and corneal ulcer. Treatment combined local antibiotics (n=16) associated to systemic antibiotics in 10 cases. Surgery was required in 2 cases. Loss of vision was noted in 2 patients. Risk factors of corneal abscess were: facial burn (p=0,01); burn depth (p=0,02) and mechanical ventilation (p=0,04).

Psychiatric hospitals and centers have more complex conditions than other hospitals in responding to emergencies, given the differences in the design of their buildings and in non-structural elements. This is a qualitative study aimed at reviewing and investigating the experiences and challenges faced by psychiatric hospital staff in response to different fire incidents. A phenomenological approach was employed to conduct the study, believing that human experiences and beliefs are substances in phenomena and can be understood and examined. The contents of interviews and focus group discussion (FGD) sessions were extracted and classified into five categories, 14 themes, and 49 sub-categories. Many psychiatric hospitals in Iran are not ready to respond properly to incidents like fires. The study revealed that in order to ensure appropriate management of incidents and disasters in the hospitals, it is necessary to focus on five areas called the 5s framework, which includes structures, staff, supplies (facilities, equipment etc.), sick persons and systems. This framework is proposed to enhance preparedness, reduce vulnerability, and provoke an effective response to incidents in psychiatric hospitals.

The early management of burn cases has always been a challenging medical problem. Skin substitutes have been consistently studied and employed as the prospective treatment modality for burn cases worldwide. However, this treatment method remains uncommon in many developing countries. This systematic review is designed to weigh the efficacy of skin substitutes compared to standard treatment for managing acute burn cases. A literature search was conducted using PubMed, Scopus and Cochrane database up to February 2020 combined with additional reference searching. Studies were restricted to randomized controlled trials (RCTs), with no date and language restrictions. We evaluated the risk of bias with a revised risk of bias tool for randomized trials (RoB2). Data were categorized based on skin substitutes with further subgroup analysis for each skin substitute. We included 13 studies with six types of skin substitutes, Biobrane®, TransCyte ®, Integra®, Glyaderm®, Suprathel® and Apligraft®. Outcomes measured included wound healing time, pain, length of hospitalization and scar formation. The findings for all skin substitutes demonstrated less severe pain compared to the control group. Faster wound healing time, scar formation and length of hospitalization were identified as heterogeneous depending on the type of skin substitutes used. All of the skin substitutes studied exhibited at least non-inferior to superior performance compared to standard treatment in terms of efficacy in treating acute burn wounds, not limited to burn depth, size, location or patient age.

Lightning strikes are infrequent but possibly deadly incidents. Their consequences on the human body vary and are still little known. Cardiac arrest is the main cause of death. Neurological and psychological sequelae should systematically be looked for. The most frequently reported signs are Lichtenberg figures and keronauparalysis. Care of a victim of a strike mainly depends on first aid. We found only case reports in the literature. We report here another case and discuss it including a literature review.

Burns in neonates are a rare pathology with a significant impact on the patient, the family and the healthcare system. At present, scarce information exists on the etiology of this type of injury. A comprehensive worldwide literature review of all publications, including our personal case series, was conducted in order to analyse the etiology of neonatal burns and summarize the available evidence. A total of 41 publications were identified in the last 4 decades, comprising of 105 cases from 20 countries, thus confirming that neonatal burns are, indeed, a rare pathology. All types of burns were recorded in neonates, the most frequent being contact burns, followed by flames and scalds. Almost 60% of burns occurred in a hospital setting due to human factors, malfunctioning devices, or hospital infrastructure deficiency. Compared to domestic burns, iatrogenic injuries occurred at an earlier age (5.4±9.1 days vs. 15.7±9.8 days, p<0.0001) and in neonates with significantly smaller weights (2102.7±1350g vs. 3197±300.8g, p<0.0001). The number of cases was almost equally distributed between developed and developing countries, but developed countries were characterised by a significantly higher preponderance of iatrogenic burns, while in developing countries domestic burns were more frequent (p<0.0001). We believe that this systematic review outlines the potential causes of neonatal burns and provides essential information for formulating prevention strategies.

Bilateral nostril stenosis resulting from deep facial burn that occurred on an oxygen-requiring patient with tobacco use is life threatening with obstruction of the airway and impossibility of oxygen supplementation use. We report the case of a deep burn involving the nose and the upper lip during oxygen and tobacco use with a severe bilateral nostril stenosis and upper lip retraction. We did a reverse bullhorn lip lift with bilateral alar base transposition realized in a one-stage surgery with nasal conformer for 4 months. Surgery allowed a significant opening of the nostril stenosis with a 9mm and 11mm major axis on the right and left side respectively. It brought restoration of the ability to nose breath and use an oxygen device, and was considered satisfactory by the patient and the operators. There was no recurrence at 18-month follow-up. Literature provides few examples of management of severe bilateral nostril stenosis following facial deep burn. Nasal conformers with progressive diameter augmentation, rhinoplasty procedure, local plasties, dermal flap, skin and composite grafts can treat this situation but there is no gold standard procedure. Reverse bullhorn lip lift with bilateral alar base transposition makes it possible to correct this severe deep burn sequela. With this clinical case, we show the possibility to treat it in a one-stage procedure through an aesthetic procedure inspiration, with an acceptable scar on the donor site.

The aim of this study was to determine the safety and impact of open lung strategy ventilation on inhalation injury patients complicated with ARDS. A prospective study was conducted in 33 inhalation injury patients with ARDS who were randomly divided into a control group (ventilated as ARDS net) and a study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning. The results indicated that open lung procedure was safe in most patients with optimal PEEP of 14.31±1.89 cm H2O. Within the first week of ventilation, respiratory system static compliances and PaO2/FiO2 ratio significantly increased in both groups (p<.05) but at a faster rate for the study group (p<.05). Ventilation duration and length of ICU stay were not significantly different across groups (p>.05). Duration time from ARDS onset to death and from admission to death were remarkably longer in the study group (p<.05). However, mortality rate and cause of death were not significantly different within 28 days post burn injury. Open lung recruitment is feasible and could be applied for inhalation injury induced ARDS to improve oxygenation and survival time. Further trials need to be conducted to find out the effectiveness of this strategy on mortality.

The objective of this study was to describe our clinical experience with the use of cultured allogeneic keratinocyte (CAK) using a simplified cell delivery method in the treatment of pediatric partial-thickness scald burns treated as outpatients in a Burn Unit. An actuator fitted onto a 3ml syringe was used for cell spray. Eighteen patients having active mixed partial-thickness burn wound areas of <10% total body surface area (TBSA), treated between 2017 and 2019, were included in the study. The wounds were managed conservatively with a combination of burn dressings using hydrogels and CAK application. The timing of the CAK application was decided by the treating plastic surgeon based on his clinical judgment and the clinical status of the wound. The primary study endpoints were the number of days and dressing changes required for complete wound reepithelialization. All of the eighteen patients' wounds reepithelialized completely with CAK application, with a mean reepithelialization time of 10.33 (±4.95) days after the application of CAK. The median value for the number of CAK applications and total dressing sessions required to achieve complete healing were 3 and 4 times, respectively. Wounds treated with CAK application between 8-21 days after burn injury required fewer cell application sessions and fewer dressing changes than wounds treated within seven days and after 21 days from the burn injury. None of the patients reported any adverse reaction related to CAK use. The present study suggests that non-extensive mixed partial-thickness scald burn in children can be successfully treated conservatively using CAK as an adjunct in addition to standard dressing in the outpatient setting.