Journal of burn care & research : official publication of the American Burn Association
-
Case Reports
Thermal injuries caused by medical instruments: a case report of burns caused by a pulse oximeter.
Pulse oximeters have been widely used since the 1980s as they are considered to provide a safe, convenient, noninvasive method of estimating blood oxygen saturation. Initially used in the operating room by anesthesiologists, pulse oximetry has become ubiquitous in the healthcare setting. ⋯ These include blistering or full-thickness burns of distal phalanges, in some cases requiring amputation and/or grafting; thermal burns in the setting of poor peripheral circulation;, and extremity burns on infants with cases of gangrene and digit loss. We present a case of a full-thickness burn arising in a 17-month-old child, which required further therapy for resolution.
-
This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. ⋯ The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.
-
The routine use of high-dose opioids for analgesia in patients with acute burns and soft-tissue injuries often leads to the development of opioid-induced constipation. The opioid antagonist methylnaltrexone (MLTX) reverses narcotic-related ileus without affecting systemic pain treatment. The authors' burn center developed a bowel protocol that included administration of MLTX for relief of opioid-induced constipation after other methods failed. ⋯ MLTX was given after an average of 52 hours since the last bowel movement. As this experience has evolved, it has been incorporated into an organized bowel protocol, which includes MLTX administration after other laxatives have failed. MLTX is an effective laxation agent in patients with burn and soft-tissue injuries, who have failed conventional agents.
-
Randomized Controlled Trial
Gabapentin is ineffective as an analgesic adjunct in the immediate postburn period.
Successful treatment of burn pain requires a multimodality approach. Although opioid agents are the mainstay, other nonopioid agents, such as anticonvulsants, are frequently employed for pain control, with unknown benefits. The authors sought to determine the efficacy of gabapentin in acute burn pain management. ⋯ There was no difference in psychosocial functioning in either treatment group. In this randomized, double-blind, placebo-controlled study, the use of gabapentin in acute burn pain management did not decrease pain scores or lessen opioid requirements. Further research into nonopioid alternatives for burn pain analgesia is needed.
-
White phosphorus is a common industrial and military compound, which can cause severe thermal and chemical burns beyond what would be predicted from body surface area alone. The authors present a rare case of a 45-year-old male patient who suffered white phosphorus burns combined with arsenic inhalation because of an industrial accident. The presented case is used to review the history and the toxicities of these chemicals as well as current methods of treatment. ⋯ This case highlights the risk of burns and inhalation injury present in industrial manufacturing jobs, as well as the potential severity of these conditions. The systemic effects of chemicals absorbed across burned skin and via inhalation were the main contributors to our patient's severe illness, and required more intensive treatment than the burns themselves. Arsenic toxicity is rare and could easily have been missed without the appropriate patient history.