Burns : journal of the International Society for Burn Injuries
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Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. ⋯ Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented.
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Randomized Controlled Trial
An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial.
Burns remain extremely painful and distressing in young children. The consequences of poorly managed pain and anxiety can be life-long. Whilst Child Life Therapy (CLT) has been shown to be effective in many situations, few studies have looked at the effectiveness of CLT in regard to reducing pain and anxiety in children undergoing burn dressing changes. ⋯ The presence of a Child Life Therapist, with their ability to adapt to the environment, the child and their family, significantly reduced the experience of pain during paediatric burn dressings.
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This study was a component of a broader review to evaluate burn care in South Africa. A prospective audit of 353 children with thermal injuries admitted to the Red Cross War Memorial Children's Hospital in Cape Town was performed during 2012/2013. The audit was based to assess the adherence of initial burn management to the provincial policy guidelines on the clinical management of the burn wound. ⋯ Forty-four children with burns greater than 10% did not receive i.v. fluids. The audit identified six factors that were inadequately addressed during the pre-admission period: first aid, cooling of the wound, early covering of the wound, resuscitation, pain management and transfer. If these could be readdressed, basic burn care would be substantially improved in the study area.
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Creation of functional skin substitutes within a clinically acceptable time window is essential for timely repair and management of large wounds such as extensive burns. The aim of this study was to investigate the possibility of fabricating skin substitutes via a bottom-up nanofiber-enabled cell assembly approach and using such substitutes for full-thickness wound repair in nude mice. ⋯ Treatment of the full-thickness wounds created on the back of nude mice with various grafts (acellular nanofiber meshes, dermal substitutes, skin substitutes and autografts) revealed that 14-day-cultured skin substitutes facilitated a rapid wound closure with complete epithelialization comparable to autografts. Taken together, skin-like substitutes can be formed by L-b-L assembling human skin cells and biomimetic nanofibers and they are effective to heal acute full-thickness wounds in nude mice.
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Burn recovery is a difficult process full of physical and psychological challenges. With increasing survival rates, there has been renewed interest in the psychological aspects of burn recovery. As men represent over 70% of all burn patients, it is particularly important to study how men experience and interpret this process. ⋯ In our discussion, we compare these complex storylines to coping strategies identified in the literature and discuss why men may choose these strategies. Based on our findings we argue that it is important for health care providers to be aware of societal pressures which may influence burn survivors to minimize affective elements of burn recovery. Additionally, we encourage exploring and capitalizing on men's "fighting" stories during rehabilitation in order to foster an active role which men can take in their recovery.