Burns : journal of the International Society for Burn Injuries
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The Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. ⋯ Integrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide.
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Pruritus is a common problem seen in the healing process of a burn wound and gives great discomfort for the patient. Most research in this field has been done in the adult population, so evidence in the pediatric population is still lacking PURPOSE: The aims of this study were to assess the incidence and severity of post-burn pruritus, identify predictors for pruritus and evaluate the pharmacological treatments in a pediatric setting. ⋯ Post-burn pruritus is still a highly prevalent problem in pediatric burn care. Its intensity and frequency are higher especially in the first three months or with a deeper wound or a higher TBSA.
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Patients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. ⋯ The inevitable drop in temperature is ameliorated by sound perioperative practices, rather than just intraoperative ones. This initiative demonstrated the potential benefits of, and motivates for, the broad application of preoperative warming in the context of major acute burn surgery. Further investigations include PDSA cycles to determine whether the duration or degree of intraoperative hypothermia is more virulent. To consolidate the pre-warming initiative, we have introduced a standard order within our admission order sets to include preoperative warming for all eligible patients.
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Cultured keratinocytes play important roles in burn wound healing and scientific research studies. We aimed to modify the isolation method to avoid over-digestion, maximize the number of isolated epidermal cells and establish a more efficient and innocuous way of cell isolation. Compared to the conventional method, the modified method combines the more dynamic process of enzymatic digestion with multiple harvestings of dissociated cells via digestion. ⋯ The number of viable cells isolated per gram of adult foreskin epidermis was (18.88±13.22)×106 cells in the control group and (67.34±30.66)×106 cells in the modified group (p<0.001). No significant differences were observed in the proportion of CD49f-positive cells between the two groups (p>0.05). The modified method was significantly more efficient in dissociating keratinocytes from each unit of skin biopsy, which is particularly important for treating severe burns when donor skin is limited.
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Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients. ⋯ VV-ECMO is a useful rescue intervention in patients with burns related severe respiratory failure. Patients in our institution benefit from having both burns and ECMO centres with major expertise in the field under one roof. The results from this small cohort are encouraging, although more cases are needed to draw more robust conclusions.