Burns : journal of the International Society for Burn Injuries
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This review shows that hyponatremia is the most common cause of burn seizures in children, followed by a history of epilepsy, hypoxia, sepsis with high fever, unknown aetiology and drug toxicity or sudden drug withdrawal. This study also shows that burn seizure is most common in younger children and is related to size and degree of burn. ⋯ Prompt corrections of any problems in these areas can be vital. Invasive procedures for the diagnosis of seizures, including lumbar puncture and EEG, should be reserved for infrequent non-responding cases.
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The body's reaction to thermal injury is much more than an initial, local inflammatory response. The burn wound is a continuous, severe threat against the rest of the body due to invasion of infectious agents, antigen challenge and repeated additional trauma caused by wound cleaning and excision. The inflammatory mediators which control blood supply and microvascular permeability in the wound have been extensively studied and are largely understood. ⋯ The defects causing immunosuppression are still very much under consideration. An understanding of these defects is essential for the development of therapies. The increasing interest in the control of the inflammatory reactions by cytokines may, in the near future, be of great importance.
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Toxic epidermal necrolysis (TEN) is the most severe of the Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) spectrum. It is characterized by epidermal exfoliation and mucositis and carries an average mortality of 25 per cent. In this 6-year retrospective study, we reviewed 23 patients with drug-induced SJS-TEN. ⋯ The length of hospital stay was prolonged when non-ocular complications supervened. The percentage mortality in our series was 10 per cent. It is our contention that the best results are obtained with treatment of the SJS-TEN patient in a burns centre with an internist, dermatologist and infectious disease specialist as part of the management team.
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Burn injury in pregnant patients is not uncommon in developing countries. The results of the management of six pregnant burns patients, admitted during an 18-month period, were analysed. Successful management of burn injuries ranging from 25 to 65 per cent TBSA occurred in patients during the second and third trimester of pregnancy, using early burn wound excision and skin grafting in four patients and by late skin grafting of a granulating wound in one patient. ⋯ One patient with 60 per cent TBSA burns who was unsuitable for early excision, died of septicaemia. This report suggests the need for early burn wound excision and skin grafting in burns patients with pregnancy, in order to improve maternal and fetal survival. However, in developing countries early surgery is not advisable in patients with extensive burns because of the non-availability of biological skin substitutes.
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Use of the patient's hand to estimate percentage body surface area (BSA) of injury is well established in the management of burns. Exactly what constitutes "the palm of the hand' and how large an area this is, depends on whether you follow Advanced Trauma Life Support teaching. United Kingdom teaching, or use a "Lund and Browder chart'. ⋯ The conclusions challenge standard teaching and show a sex difference. The area of the palm alone is 0.5 per cent BSA in males and 0.4 per cent BSA in females, whereas the area of the palm plus the palmar surface of the five digits is 0.8 per cent BSA in males and 0.7 per cent BSA in females. Therefore if a hand alone is used to assess the size of a burn the per cent BSA could be overestimated.