Burns : journal of the International Society for Burn Injuries
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Although many studies have reviewed burn wound infections (BWIs) in burn patients, few have prospectively surveyed other nosocomial infections. Seriously burned patients are clearly at increased risk for infection due to the nature of the burn injury itself, immunocompromising effects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burn intensive care unit (BICU) for nosocomial infections. ⋯ Sixty per cent of all patients were intubated at some time during their BICU stay, but 88 per cent of those who developed a nosocomial infection were intubated (P < 0.001). Inhalation injury was less significant than intubation in the development of nosocomial infection. All patients who developed pneumonia or a BWI were intubated.(ABSTRACT TRUNCATED AT 250 WORDS)
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A 45-month retrospective analysis of 70 geriatric burn admissions to the Welsh Regional Burns and Plastics Unit highlighted 13 (18.6 per cent) injuries that occurred whilst the patient was in residential care (six residential care homes, seven nursing homes). The mean age overall was 83 years. The residential care patients had a TBSA of 12.5 per cent with a mortality of 46 per cent, whilst the group living in the community had a TBSA of 8.63 per cent with a mortality of 14 per cent. ⋯ All 13 patients were found to have such severe dementia that they were unable to give a reliable history. In the majority of patients a lack of supervision was in part responsible. Some basic measures are presented that could reduce the incidence of accidental burn injury in this vulnerable group of the population.
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Standard murine burn models include the administration of intraperitoneal (i.p.) saline solutions which are intended to resuscitate the animals during subsequent burn shock. Prehospital administration of small volumes of concentrated salt solutions has been recommended for the early treatment of haemorrhagic shock, and have also been utilized for burn shock. We studied the effects of bolus intravenous (i.v.) hypertonic saline (HS) or hypertonic saline/dextran-40 (HS + DEX) on animal survival and acid-base balance following 25 per cent total body surface area, full-thickness burn injury in mice. ⋯ Immediate preburn i.v. administration of HS or HS + DEX did not eliminate metabolic acidosis in this murine burn model, and markedly increased the mortality when subsequent i.p. fluids were not administered. The degree of metabolic acidosis in the murine experimental burn model has not previously been clearly described. Furthermore, adequate fluid resuscitation of these animals may be difficult to achieve without indwelling vascular catheters which could deliver continuous i.v. fluids following burn injury.
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With the aim of identifying patterns of burn injury, remediable risk factors, and policies in the overall surgical and medical management a retrospective review of 111 octogenarian burn victims admitted between 1983 and 1993 is presented. The mean age was 84 years, with the mean percentage body surface area burned (%BSAB) being 9.6 per cent (range 0.5-65 per cent). Contrary to expectations, the annual incidence appears to be declining, the possible reasons for which are discussed. ⋯ When compared to the more traditional delayed surgical approach, early surgery conveyed no benefits in either mortality (early group, 18 per cent; delayed group, 13 per cent) or length of hospital stay (early group survivors, 38 days; delayed group survivors, 42 days). Medical and social problems were very common and led to an often difficult and frequently prolonged rehabilitation, with the mean length of hospital stay for all patients being 29 days. The mortality of the whole group was 26 per cent, the patients on average faring better than their predicted mortalities as derived using either the Baux index, the Bull table or the Abbreviated Burn Severity Score.