Burns : journal of the International Society for Burn Injuries
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We describe a semi-open approach to percutaneous tracheostomy as an effective and potentially safer alternative to open tracheostomy or percutaneous techniques in burn patients. ⋯ The semi-open modification of the percutaneous tracheostomy combines the convenience and minimally invasive advantages of the percutaneous technique with the better surgical control of the airway afforded by the traditional open technique.
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With increasing numbers of illicit drug users in both urban and rural communities, users and producers are becoming increasingly enterprising in their sourcing of mind altering drugs. An example of this is the 'amateur' production of methamphetamine in domestic dwellings. We describe the mechanism of burn seen in methamphetamine production, the pattern of clinical injury, and the difficulties in treating these patients. ⋯ Methamphetamine laboratory explosion burns are difficult injuries from the start. Invariably the true circumstances surrounding the injury are not clear, and clinicians should be suspicious of a meth lab explosion in suspect individuals with burns plus airway injury. Patient management is complex and often requires substantial analgesic and anxiolytic medication in conjunction with clinical psychology and psychiatry as an inpatient.