Burns : journal of the International Society for Burn Injuries
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Peripherally inserted central catheters (PICCs) have been used increasingly in burn patients who often have decreased intravascular volumes and obtaining intravascular access for resuscitative efforts can be difficult. A potentially serious complication is bloodstream infection. The purpose of our study is to examine the impact of antibiotic impregnated PICC lines on the bacteremia rate in a regional burn center. ⋯ Antibiotic impregnated PICC lines decrease the bacteremia rate in our burn population. This has potential benefits for both patient morbidity and mortality as well as potential cost savings for the healthcare system.
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Age-related differences in wound healing have been documented but little is known about the wound healing mechanism after burns. Our aim was to compare histological features and immunohistochemical expression of matrix metalloproteinase-9 (MMP-9), collagen IV, K6 and CD44 in the burn wound healing process in aged and young rats. Following burns the appearance of the wound bed in aged rats had progressed but slowly, resulting in a delayed healing process compared to the young rats. ⋯ K6, MMP-9 and CD44 expression was significantly increased in wounded skin compared to unwounded skin both in young and aged rats. We hypothesise that delayed burn skin wound healing process in the aged rats may represent an age dependent response to injury where K6, MMP-9 and CD44 play a key role. It is therefore possible to suggest that these factors contribute to the delayed wound healing in aged skin and that modulation could lead to a better and faster recovery of skin damage in elderly.
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We aimed to analyze whether laser Doppler imaging (LDI) can lead to earlier decision-making regarding the need for surgery in adults with indeterminate burns. ⋯ LDI can help make a decision for surgery in the early stages of care for adults with indeterminate burns.
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Bloodstream infections (BSI) and sepsis are among the most common complications occurring in severe burn patients. This study was designed to evaluate changes in BSI pathogens over almost a decade in severe burn patients at Rambam Healthcare Campus, and BSI occurrence during early and late hospitalization periods. Retrospective computerized data was retrieved from all severe burn patients hospitalized in our institution during the years 2001-2009. ⋯ However, over the 9-year study period, only CRKP increased significantly. In summary, except for the sudden appearance and increase in CRKP (8% increase; p=0.045), we did not observe a significant change in the BSI pathogen profile over the 9-year period. Nevertheless, over the hospitalization period, there is a clear change in the BSI bacteria profile, especially after 4 weeks of hospitalization.
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Burns occurring in conjunction with pregnancy can be a potentially life threatening scenario as it may lead to a rapid depletion of the already diminished maternal reserves. The management protocol in a pregnant burn female has to be tailored, taking into consideration the additional factor of fetal well being and the fetal susceptibility to various agents. For such alterations to be incorporated, it is imperative on part of the treating doctor to correctly ascertain the pregnant/non-pregnant status of an adult burn female. ⋯ Ours is a prospective study which reveals the inadequacy of history/examination as the only method of diagnosing pregnancy in adult burnt female group. We also found routine urinary hCG usage as a viable method of picking up these "hidden" cases of pregnancy and thus avert the potential catastrophe of not altering the management in accordance with pregnancy and subsequent endangering of maternal and fetal life. An ancillary observation of our study was the need of the attending doctor to be well versed in his obstetrical knowledge and skills and if not so, then an effort be taken on part of the institution to undertake a reorientation program which will help the attending resident/doctor to brush up his obstetrical attainments.