Annals of burns and fire disasters最新文献

Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare but serious drug-like toxiderma. Treated as a recent extensive burn in intensive care, its management must be urgent, and adapted in order to improve the vital prognosis of patients and reduce their mortality. We report a severe case of Lyell's syndrome occurring 24 hours after oral administration of an anti-inflammatory drug (ibuprofen) as a self-medication in an eight-year-old child.

Airway edema following burns is a typical occurrence. It poses a threat, independent of percent Total Burn Surface Area (TBSA), to the life of the patient. Fiber optic bronchoscopy is the gold standard in its diagnosis and is preferred if the facilities are present. Its availability remains a problem in the majority of burn centers in developing countries like India. Ascoring system based on clinical findings, if formulated in a manner that reflects bronchoscopy results, may help not only with diagnosis but also with airway management in inhalation burns. One hundred patients suffering from facial burns were included in the study. They were observed clinically and bronchoscopically and airway was managed on the basis of clinical, biochemical and bronchoscopic findings. Fifty patients who showed significant bronchoscopic findings on day 1 were followed up. Clinicobronchoscopic correlation revealed a positive correlation of various clinical variables as well as bronchoscopic grading with subsequent need for endotracheal intubation. Edema of tongue/floor of the mouth and palatal edema showed a positive correlation with subsequent need for tracheostomy. This clinicobronchoscopic correlation was then used retrospectively to formulate the Safdarjung Hospital 'INHALATION' score. This score can be used for predicting impending airway compromise when bronchoscopy facilities are not readily available.

Electrical burn injuries can cause various acute manifestations that require surgeons to make an early decision, such as fasciotomy for compartment syndromes. Early decompression can become a 'golden period'for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation. A cross-sectional study was performed on medical records. Inclusion criteria were patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria were patients whose extremities were already non-vital on admission and those lost to follow up. Demographic information, burn surface area and B-F time for patients amputated above the elbow (group A amputation), below the elbow (group B amputation), and no amputation (non-amputated) were investigated. More than 50% patients underwent amputation and 60% had less than 18 hours B-F time. Mean B-F time for non-amputated patients was 18 hours and for amputated patients 20.38 hours. Mean burn to amputation (B-A) time and fasciotomy to amputation (F-A) time in group B was about double compared to group A. The B-A time range of group Awas 4.2-7.3 days. Our study showed 18 hours maximum to be the golden period of burn to fasciotomy. The window period of muscle injury evaluation is maximum 7 days to permit limb salvation at the lowest level possible.

Thanks to the Medical Information Service of our institution, we obtained the data on burns during 2019, saved in the national database. We found 10,913 reports, among them 10,347 metropolitan and 566 overseas. When compared to the French population on January 1^st 2020, the incidences were 16 (global population); 15.7 (metropolitan) and 27.1 (overseas)/100,000 inhabitants respectively. The majority (62.95%) of the patients were taken care of in Burn Centres (BCs). However, 4,043 patients were never seen by a burn specialist. Nevertheless 88.54% of skin grafts were performed in BCs and 71.86% of the burns with high seriousness (levels 3 and 4) were in BCs. One hundred and seventy-nine patients (1.64%) died. For the first time, we obtained the intensive care activity, through the scoring actions. Intensive care was held for 958 patients (8.96%), 90.81% of them in a BC. Only 28.57% were associated with major (>30% BSA) burns, but these major burns accounted for 63.78% of the organ failure treatments.

Burn injuries are significant sources of morbidity and mortality globally. Despite the advances in the management of burn injuries, a great number of victims still develop complications. This study aimed at determining the prevalence and management outcomes of burn injuries in a Teaching Hospital in Ekiti State, Nigeria. The study was retrospective in nature. A total of 203 hospital records of burn patients seen between January 2015 and December 2019 were collected and analyzed, using descriptive and inferential statistics. Findings from the study revealed that half (51.7%) of the respondents were within ages 0-10 years and more than half (63.1%) were males. The study findings also revealed a relative decline in the prevalence of burn injury as the average prevalence in the years under review. Some of the reported complications were wound infection (4.9%), delayed healing (4.4%), residual wound (4.4%) and death (9.4%). In addition, the study revealed that there was no relationship between gender, age, socioeconomic factors and prevalence and management outcomes of burn in the study setting. The study recommends that efforts should be made by health workers to equip themselves with knowledge of the complex needs of burn victims and also to keep abreast with the advances in critical care.

The danger of fire and electric current is underestimated by many people. The associated severe burn injuries are mainly treated in special burn centers because they are challenging and tend to have a strong impact on health-related quality of life. This case report describes a 20-year-old female severe burn victim who suffered second- to third-degree burns to approximately 80% of her total body surface. During in-patient care, we focused on inhalation trauma and anti-infective therapy, surgical management, physiotherapeutic and occupational therapy, in-patient rehabilitation measures, compression therapy and accompanying psychological co-treatment. This interdisciplinary treatment focused on restoring the best possible quality of life for burn victims.

Nutrition screening is an initial procedure in which the risk of malnutrition is identified. It plays a role in and can incur costs to health systems and patients. A customized nutrition screening tool for burn patients (NSTB) was formulated and the nutritional risk score of 22 patients from a burn unit in Bahrain using NSTB and MUST was compared. The samples selected were adult patients aged 18 years or over; pregnant and mentally retarded patients were excluded. Mean age of the total sample was 29.40, and 90.9% were male. Mean BMI was 26.96. The mean and SD for NSTB was 2.18±1.65, and for MUST 2.0±0.0. A difference in the nutritional screening risk score of the same group of patients was observed. In the MUST group, 100% patients were classified as high risk, while in the NSTB group 50% patients were classified as high risk, 36.36% as moderate risk and 13.63% as low risk respectively. The variability of the risk score in the NSTB group helps prioritize the patients based on high, medium, and low risk, whereas MUST categorizes all patients as high risk. A unique screening tool for burns will be more effective in determining risk patients due to tailor-made characteristics. Even though the data sample is small, the difference gives scope for extensive study.

Post-burn leukoderma, commonly affecting the African and Asian communities, results from deep dermal burns. The associated stigma exacerbates the condition and significantly affects the rehabilitation and reintegration of post-burn survivors into society. Melanocyte-keratinocyte transplantation (MKTP) is a promising single-stage treatment for repigmentation in vitiligo. However, its use in post-burn leukoderma is undetermined. This study aims to evaluate the MKTP treatment in post-burn leukoderma patches. Six patients (five males and one female, mean age = 29±5.51 years) with ten patches of post-burn leukoderma underwent single-stage MKTP without adjuvant pigmentation therapy. The postoperative follow-up period ranged from twelve to twenty-four months for all the patients. The average size of leukoderma treated was 16.25±9 cm². Repigmentation was observed in 92.16±11.05% of the total treated area by the end of one year after MKTP application. All six patients were satisfied with the treatment outcome. MKTP without adjuvant therapy is an effective surgical treatment to treat post-burn leukoderma patches. Future studies should cover a larger sample over a longer follow-up period.

Securing an endotracheal tube (ETT) in a patient with facial burns poses many challenges. There is no standard practice and the existing literature provides solutions to this problem with limited detail outlining the specifics of their techniques. The teeth offer a rigid point of fixation and are an adaptable method to secure the ETT. For their dental insight, oral and maxillofacial surgeons are often tasked with the procedure of fixing the ETT to the dentition. The aim of this technical note is to review the previously published methods of securing an ETT in burns patients and to present a logical technique to secure the ETT to the dentition for critical care clinicians without dental experience.

Excessive axillary sweating is a frequent reason for seeking consultation in aesthetic medicine. Botulic toxin therapies have been used for years for this condition. A microwave-based treatment (MiraDry^®) has been used in France since 2011. We present the case of a patient who developed complications following such a treatment for excessive axillary sweating, namely dermal detachment, subcutaneous collections, dermal thickening, retractile scars responsible for pain and limitation of axillary amplitudes. These complications mimic the natural evolution of deep axillary burns. In this paper, we propose a management method for patients with this type of complication.