Burns : journal of the International Society for Burn Injuries
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Advances in critical care, operative techniques, early fluid resuscitation, antimicrobials to control bacterial infections, nutritional support to manage the hypermetabolic response and early wound excision and coverage has improved survival rates in major burns patients. These advances in management have been associated with increased recognition of invasive infections caused by Candida species in critically ill burns patients. Candida albicans is the most common species to cause invasive Candida infections, however, non-albicans Candida species appear to becoming more frequent. ⋯ Treatment options for invasive candidiasis include several amphotericin B formulations and newer less toxic antifungal agents, such as azoles and echinocandins. We review the currently available data on diagnostic and management strategies for invasive candidiasis and candidemia; whenever possible providing reference to the high-risk burn patients. We also present an algorithm for the management of candidemia and invasive candidiasis in burn patients.
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Little is known about sexual attitudes and behaviors of adults burned as children. We hypothesized that survivors with large burn scars would have differences in sexual attitudes and behaviors from their unburned counterparts. ⋯ The majority of 92 young adults burned as children described sexual attitudes and behaviors comparable to the general population and the vast majority had significant sexual experience. Females reported more sexual behavior post-burn than males.
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To determine the value of training for the Emergency Management of Severe Burns (EMSB) for medical and nursing staff working in emergency care as measured by their performance in a simulated burn incident online program. ⋯ There is some evidence that medical staff members who have participated in EMSB training have a better knowledge of emergency management and are more effective in the management of a simulated burn case. However, both individuals who had participated in EMSB as well as those who had not participated in EMSB needed additional training in EMSB.
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Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill burn patients. In recent years several less invasive hemodynamic monitoring techniques (arterial waveform analysis techniques) have become available in clinical practice. These alternative techniques provide beat-to-beat cardiac output measurement and permit preload assessment using volumetric parameters. The aim of this article is to review the currently available data regarding to use of less invasive hemodynamic monitoring methods using the pulse wave analysis in burn unit setting.
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Randomized Controlled Trial
A comparative analysis of cetirizine, gabapentin and their combination in the relief of post-burn pruritus.
Post-burn pruritis is a very distressing symptom having a reported incidence between 80 and 100%. The mainstay of management of post-burn itch has been with antihistaminics and emollients but the treatment is ineffective in a very large percentage of patients. With the recognition of a distinct itch specific neuronal pathway, which has a complex interaction with pain pathway, a fresh approach to itch management has surfaced with the use of gabapentin. ⋯ The hypothetical combination of a centrally acting drug with a peripherally acting agent did not result in any better control of post-burn itch than monotherapy with gabapentin. No side effects were reported with gabapentin administration but all patients receiving cetirizine reported sedation. There is now a need to relook at the antipruritic protocols in burn management.