Journal of burn care & research : official publication of the American Burn Association
-
Burn patients require careful consideration of their post-discharge needs to maximize their recovery. Patient-specific variables or a combination of variables that might allow clinicians to develop pathways and objective endpoints for appropriate discharge would assist in expediting the patient's post-discharge care. While there have been numerous studies examining a single variable and its ability to predict outcomes, these studies may not be directly applicable to burn patients. ⋯ The only variable that could strongly predict those patients that went home versus another setting was the FIM locomotion score. Of the patients who went home, 87.2% were at or above a supervision level for locomotion, whereas 85.2% of the patients not discharged to home were at or below a maximal assist level. The level of functional independence at the time of a patient's discharge as assessed by the patient's ability to walk was the most powerful identifier of their ongoing needs.
-
The estimation of burn depth, which is essential in the management of burns, has traditionally been conducted using clinical evaluation, which has problems of subjectivity. A number of studies have been conducted assessing the use of laser Doppler to estimate burn depth. ⋯ Although many studies suggest that the use of laser Doppler may be a useful adjunct to clinical evaluation, in a climate of evidence-based medicine when strict scientific principles are considered further studies are needed to show the tool to be valid and consistently reliable for the assessment of burns. Until such time, laser Doppler should remain as a research tool.
-
This case describes a 2-year-old boy who developed multiple giant pyogenic granulomas on his left upper extremity secondary to a burn injury caused by boiling milk. Here, we present multiple pyogenic granulomas in a burn patient and discuss the possible etiologies of the entity. The pyogenic granulomas were excised and wounds closed with sutures (primary repair) (primary closure). ⋯ The case presented here was a burn injury caused by hot milk. The burn etiology, not the burn injury itself, is important because all similar cases have the same etiology. We thought that this may not be a coincidence and that milk proteins or other components of the milk might cause the development of pyogenic granuloma.
-
Despite significant advances in burn care, infection remains a major cause of morbidity and mortality in burn patients. We sought to determine accurate infection rates, risk factors for infection, and the percentage of infections caused by resistant organisms. In addition, we attempted to identify interventions to decrease the use of antimicrobial drugs. ⋯ By multiple logistic regression analysis, body surface area burned, comorbidities, and use of invasive devices were significantly related to acquisition of nosocomial infections as identified by both the burn surgeons and the infection control criteria. Staphylococcus aureus and Pseudomonas were the most common resistant organisms identified. In our population, surgeons could decrease antimicrobial use by using explicit criteria for identifying patients with hospital-acquired infections, limiting perioperative prophylaxis to patients at highest risk of infection, and decreasing the incidence of nosocomial infection with reduced use of devices and strict adherence to aseptic technique.
-
Ketamine is an effective agent when used for sedation during painful bedside procedures. We developed a ketamine administration protocol for nonanesthesiologists for the purpose of establishing safe monitoring and documentation during ketamine sedation procedures. From June 1, 2002, through June 30, 2003, a total of 522 sedation events using ketamine were performed; 347 of these events were analyzed. ⋯ Two patients had a decrease in blood pressure, which responded to fluid administration. Total doses of ketamine administered were between 6 and 800 mg, for procedures ranging from 1 to 105 minutes, in patients weighing between 3 and 111 kg. The development of a strict protocol ensures the safe administration of ketamine for the pediatric burn patient.