Burns : journal of the International Society for Burn Injuries
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Successive improvements in burn care have steadily increased the survivability of many major burn injuries, however for some patients with the most severe injuries comfort care rather than active resuscitation has been seen as the correct course of action. A survey of UK burn unit directors by postal questionnaire sought details of current practice regarding comfort care, the factors involved in the decision making process and their response to eight hypothetical case histories. An 84% response to the survey showed that units would, on average, actively resuscitate thirty-seven patients a year and administer comfort care three times per year. Opinion was often divided regarding the decision to resuscitate in the cases presented.
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This is a retrospective review of all burns patients admitted to a paediatric intensive care unit (PICU) over a 7 year period. Resuscitation fluid therapy and clinical course are presented. Ninety-eight new burns victims were admitted with a mortality rate of 10.2%, all in burns of greater than 25% body surface area (BSA). ⋯ The hospital-recommended resuscitation formula consistently underestimated the fluid volume required for adequate resuscitation. No statistically significant difference in adverse effects was found between the resuscitation groups. This study is unable to recommend a definitive approach to the fluid resuscitation of burns shock in paediatrics and the best approach is one of meticulous fluid resuscitation titrated on clinical effect.
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Comparatively little attention has been given to the impact of smaller burns (less than 20% body surface area) on patients' health status after their return to normal life. The objective of this study was to investigate patients' own assessment of their physical and psychological health 3-4 months after discharge from in-patient treatment. A postal survey was employed which utilised: (a) personal and employment status questions; (b) a short health status questionnaire which was developed for use with this group of patients; (c) the hospital anxiety and depression scale (HAD); (d) the impact of event scale (IES). ⋯ Physical and social function were reported to be affected at the follow-up point in a minority of patients. The greatest impact of the injury was on levels of anxiety and response to trauma-related stress, as measured by the HAD and IES instruments - almost one third of the responders (15 patients) had clinically significant scores on either or both dimensions of the IES. Factors which may be associated with the response to trauma-related stress are discussed.
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Thinner sniffing is popular among school children in Asian countries because it is readily available at low cost. Besides its toxicity to major organs, thinner inhalation is associated with various burn accidents. Four teenagers were admitted to the Burns Unit of the Prince of Wales Hospital over the period of 1996-1997. ⋯ None of them had evidence of thinner intoxication as shown by blood tests. In the management of their acute burn injuries, their hidden social and family problems were explored. With the cooperation of different disciplines, early psychosocial intervention was given and their behavioral and psychological disturbances were successfully managed.
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Failure of GI tract mucosa to act as a barrier against bacterial translocation (BT) has been proposed as a potential source of sepsis and subsequent multiple organ failure post thermal injury. Nitric oxide (NO) is an inorganic radical produced by NO synthase (NOS) from L-arginine. Gut mucosal constitutive NOS (cNOS) provides protection for itself. ⋯ Nitrotyrosine immunostaining of the intestinal mucosa showed a decrease in the SMT-treated group. These findings suggest that SMT, a specific inhibitor for iNOS improves the barrier function after burn by suppression of the intestinal mucosal iNOS activity. The decrease in NO production resulted in decreased formation of peroxynitrite and subsequently decreased damage of mucosal tissue.