Journal of burn care & research : official publication of the American Burn Association
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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.
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As a topical hemostatic agent, hydrogen peroxide (3%) has been applied to tangential excisions of burn patients. Hydrogen peroxide provides an adjunct to topical epinephrine for hemostasis and clinically has been most useful in patients with known platelet dysfunction. ⋯ In our experience, hydrogen peroxide (3%) soaks have not resulted in complications related to corrosive damage, oxygen gas formation, or lipid peroxidation that are associated with high concentrations of hydrogen peroxide (30%). We also have experienced excellent skin graft take at the wound bed after using hydrogen peroxide.
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Conflicting recommendations and clinical applications have been given concerning best practices for the management of burn blisters associated with partial-thickness burns. Arguments for the preservation of intact blisters center on the idea of naturally occurring biologic protection whereas the débridment of blisters has been advocated because of the perceived decreases in wound infection and complications. ⋯ The management of burn blisters should be supported by evidence across these six categories, should match the expertise of the provider, and should use the available resources in the practice setting. The purpose of this review is combine the findings of a comprehensive review of the published literature with respect to the management of blisters in the partial-thickness burn into a clinical guideline for best practice based on available evidence.
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Patient outcomes concerning toxic epidermal necrolysis (TEN) have improved over the years as a better understanding of the pathophysiology of the illness has been gained and enhancements have been made in the care of the acutely ill. With increase in survival, long-term complications these patients experience are beginning to be recognized. In this study, we analyzed the outcomes of a cohort of TEN survivors treated at our burn unit and sought to determine the impact of clinical variables from the initial hospitalization on mortality after discharge. ⋯ Seventy-nine percent of the patients with ocular involvement in the acute phase of TEN had long-term ocular complications, and 73% of patients with mucosal involvement had persistent mucosal lesions. Five individual factors were found to be predictors of postdischarge mortality on univariate analysis: age at diagnosis of TEN>or=60 years, SCORTEN 3 to 6, % maximal TBSA slough>or=50%, days from onset of symptoms to admission to a burn unit>or=5 days, and presence of multiple comorbidities at diagnosis of TEN. In multivariate analysis, only SCORTEN of 3 to 6 (P=.003) and days to admission>or=5 (P=.027) maintained significance as predictors of mortality and may be used to heighten surveillance during postdischarge care of patients with TEN.
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We describe a case of burns purposefully sustained in a patient performing a bizarre pub game while under the influence of alcohol. Full-thickness burns were sustained through contact with a 50-p UK currency coin essentially heated with burning paper. We discuss the nature and ease by which such burns can be sustained in the community and the increasing awareness of alcohol abuse as a factor in a significant proportion of such self-inflicted burns.