Echocardiography assessment of myocardial function after burn injury

INTRODUCTION: Echocardiography provides noninvasive and clinically relevant assessment of left ventricle (LV) function in injury and disease. In this present study, we hypothesized that application of transthoracic echocardiography in awake mice would provide in vivo assessment of myocardial performance that correlates with in vitro assessment of LV function using isolated perfused hearts (Langendorff). METHODS: Burn over 40% of the total body surface area (or sham burn) was given in C57/BL6 mice 22 to 24 g; lactated Ringer fluid resuscitation was given intraperitoneally. Transthoracic echocardiography was performed at baseline and at designated intervals over 7 days postburn. Subgroups of mice were killed at intervals and hearts perfused to assess LV pressure and +/-dP/dt max responses to inotropic challenge (n = 8/group per time). RESULTS: Burn produced myocardial depression, evidenced by a fall in fractional shortening from 69% +/- 3% at baseline to 50% +/- 2% (12 h postburn), 58% +/- 3% (24 h), 59% +/- 2% (48 h), and 62% +/- 2% (72 h) (P < 0.05). Burn-related changes in in vivo LV performance were paralleled by in vitro evidence of myocardial contractile depression; LV pressure progressively fell from 97 +/- 2 mmHg at baseline to 84 +/- 7 mmHg (12 h), 63 +/- 2 (24 h), 79 +/- 4 mmHg (48 h postburn) (P < 0.05). Analysis of variance and multiple comparison procedure. Myocardial recovery occurred by day 8 postburn. CONCLUSIONS: Echocardiography provides measures of cardiac function in a conscious animal, which correlate with contractile depression measured in vitro using Langendorff preparations. Echocardiography is a valuable tool for noninvasive assessment of postburn myocardial function.     

A comparison of some thermoregulatory responses in healthy children and in children with burn injury

1. Changes in body heat content in five normal adults, in 30 healthy children and in 24 children who had suffered burn injury 1-5 h previously, have been studied in cool (20 degrees C) and warm (30 degrees C) environments. 2. On moving from a cool to a warm environment, the heat content rose in both normal adults and healthy children, but the increase was significantly larger in the children. 3. Much larger changes occurred in the burned children in whom the heat content rose to a new plateau within about 8 h of the accident. 4. The changes after burn injury were unrelated to the bandaging of the burn and were little affected by the environmental temperature.     

Cutaneous heat loss shortly after burn injury in children.

1. Total heat loss and its components have been studied in cool (20 degrees C) and warm (30 degrees C) environments in 30 healthy children and 21 children who had been burned (10-17% body surface area) 0.5-29 h previously. 2. In healthy naked children at 20 degrees C, the partition of total heat loss was: radiation, 64%; convection, 32%; evaporation, 4%. On transfer to the warm, total heat loss was reduced by approximately 50%, with disproportionate reductions in the contributions from radiation and convection being offset, to some extent, by an increase in evaporative heat loss. 3. In patients during the first 5.5h after injury, the magnitude and pattern of heat loss at 20 degrees C and 30 degrees C were similar to those in control subjects and were unaffected by bandaging. 4. Ten to twenty-nine hours after injury, when the patients were bandaged and body temperature and heat content were significantly higher than in control subjects, radiant and convective heat losses were increased, but as evaporative heat loss tended to be reduced; total heat loss in the warm was unchanged. However, at this time at 20 degrees C, total heat loss was reduced compared with healthy children at the same ambient temperature. 5. The findings of unchanged or reduced total heat loss and reduced evaporative heat loss in injured patients are interpreted as inappropriate responses to an increased body temperature and heat content in children after burn injury.     

Factors influencing ED care of young children at-risk for clinically important traumatic brain injury

Objectives

Care decisions for young children presenting to the emergency department (ED) with head injury are often challenging (e.g. whether to obtain neuroimaging). We sought to identify factors associated with acute management of children at-risk for clinically important traumatic brain injury (ciTBI) and describe symptom management.

The functional outcome of children after a burn injury: a pilot study.

Assessment of functional outcome can be used as a measure of the effectiveness of intervention during recovery from a burn injury. This pilot study identifies the factors that are likely to be most important for determining standardized functional outcome measures for children after a burn injury; it highlights the contribution of these factors to variations in children's postburn outcomes. A focus group of 8 parents and a self-report questionnaire administered to 12 children and 13 parents were the means of obtaining information for this exploratory study. Itching was found to be one of the primary impairments that contributed to reduced functional outcome during skin healing after a burn injury. The activities of children who had been burned that were most frequently affected by the injury (as reported by parents) were schoolwork and sports; these were closely followed by sleeping, playing with other children, and unliked activities. Least affected activities were enjoying the family, eating, seeing friends, watching television, and bathing or showering. Eighty-five percent of parents reported at least some level of interference with the listed daily activities. Burn injuries are likely to cause interference with several aspects of a patient's daily life. As a result, families require ongoing support and monitoring. Further research should longitudinally compare the performance of children who have been burned with other children and adolescents.     

Early identification of at-risk nursing students: a student support model

Due to the shortage of nurses in the health care industry, colleges offering associate-degree nursing programs are beginning to pay more attention to attrition and the factors contributing to success. Alogistic regression model was used to explain the cognitive and noncognitive variables that contribute to success in a nursing fundamentals course. Although much work is necessary to fully understand first-semester nursing students' retention and success, an early identification model is explored to better support students as they enter associate-degree nursing programs.     

Glucose metabolism in children during the first day after burn injury.

Plasma and blood metabolites were measured in 31 children over the first day after burn injury. In 14 of them blood glucose peaked, rising within 1-4h to 10-20 mmol/l and then falling, by 4-8 h, to 5-10 mmol/l. Usually the peak value preceded treatment and the fall occurred during infusion of dextrose-saline. Peak incidence was independent of burn severity. There was no evidence of similar peaks in children or adults with other injuries, or in 8 adults with burn injuries; through high glucose levels have been reported in children with head injuries. Lactate, non-esterified fatty acids, insulin, cortisol, epinephrine and norepinephrine were also measured. Values in the first 4 h were similar to those reported in adults with other injuries, except for lactate, which rose less in the children. Unexpectedly, the hyperglycemia in the children with burns was poorly related to epinephrine concentration at all times to 24h. Insulin resistance probably developed within the first hour or two; but from 8 h did not seem to depend on synergism between epinephrine and cortisol.     

Endocrine homeostasis and its correction with stress protectors in children with severe burn injury

The use of stress protection with dalargin, clofelin, and pentamine in the treatment of children with severe burn injury was ascertained to result in a reduction in the magnitude of abnormal changes in the endocrine system and in the prevention of depletion of its compensatory capacities. This treatment will assist in reducing the severity of endotoxicosis, as well as the frequency and severity of toxic and pyoseptic complications.     

Diet and behavior in at-risk children: evaluation of an early intervention program

This study describes outcomes for children enrolled in the Prevention-Oriented System for Child Health Project, an early intervention program aimed at improving health and developmental status in at-risk families. Through a series of home visits by public health nurses, 60 families received lessons on nutrition- and health-related topics determined by the child and family's needs. On two occasions, some 8 months apart, the children were evaluated using the Developmental Assessment of Young Children, and their energy intake over the previous day was recorded. Analyses of the dietary and behavioral records indicated that the children's scores on the physical subtest improved significantly. A number of nutrition-development associations were found at follow-up, suggesting that the intervention was successful. Implications of the results for at-risk children are discussed.     

Orphans and at-risk children in Haiti: vulnerabilities and human rights issues postearthquake

The vulnerability of children in Haiti has increased dramatically since the earthquake in January 2010. Prior to the earthquake, the prevalence of orphans and at-risk children was high but since the earthquake, more than 1 million people-with more than 380,000 children remaining displaced and living in over 1200 displacement sites. These existing conditions leave orphans and at-risk children vulnerable to exploitation, abuse, and increased risk of HIV/AIDS. This article will focus on the complex issues affecting orphans and at-risk children and the intersection with HIV/AIDS and human rights. Specific recommendations by United Nations Children's Fund are discussed. Nursing in Haiti must address the policy-related and population-specific approaches for the care of children living with or affected by HIV/AIDS.     

Epidemiology of pediatric burn injuries in southern Turkey

The aim of this study was to identify the epidemiological features of pediatric burn injuries in southern part of Turkey. In this retrospective study, 137 hospitalized pediatric patients (85 men and 52 women) who were admitted to our burn unit during a period of 3 years were analyzed. Pediatric patients were categorized into three groups: the infants and toddlers (0-2 years), early childhood (3-6 years), and late childhood (7-15 years). Epidemiological data included age, sex, location, the cause and type, and place of burn. In the first two groups, scalding (95.1% and 86.7%, respectively) was the predominant cause of burn whereas in late childhood electric burns (51.4%) were a more common occurrence. No differences were found between the groups with respect to mean TBSA and full-thickness burns. A total of 15 (10.1%) patients died during the study period. A total of 74.4% of burn injuries occurred at home, and almost all were preventable, with 16 % of the burns occurring in the autumn; however, 42% occurred in the summer. These findings will be used as a basis for developing targeted preventive programs to protect children from burns. We also consider it is necessary to educate children and their parents about the prevention of burn injuries.     

Implementation of a therapy group at a camp in southern Illinois for children with burn injuries

Pediatric burn injuries result in significant mortality and morbidity. Studies in which the psychosocial effects of burn injuries were investigated have produced mixed results but generally provide some promise that these children can be well-adjusted despite serious injuries. However, some children may experience psychologic and social difficulties. To address some of these difficulties, therapy groups were included as part of the programming at a fledgling camp in southern Illinois for children with burn injuries. We present our experiences with this process. Suggestions for future interventions by mental health professionals are also presented.     

Burns in school-age children: demographics and burn prevention

Epidemiologic and demographic study of burn center patients and admission patterns can be useful in tailoring burn prevention programs. Such studies can pinpoint specific high-risk areas and seasons, thus allowing more efficient expenditure of resources.     

救治成批烧伤患者的管理及护理

目的总结救治3批20例烧伤患者的护理及管理经验。方法建立应急预案、前瞻性培训护理人员;成立护理应急管理小组,对各级各类护理人员进行统筹调配、合理分工、科学管理;对患者加强液体复苏、气道管理、创面管理、疼痛护理、饮食护理等。结果 18例患者康复出院,治愈率90%,未出现1例护理并发症;护士的应急能力、专科理论与技能得到迅速提高,为医院应对突发事件提供了护理保障。结论完善、有效的护理组织管理是救治成批烧伤患者的有力保障,通过综合性护理措施能提高成批烧伤患者救治成功率。     

Sexual behaviors in children: evaluation and management

Sexual behaviors in children are common, occurring in 42 to 73 percent of children by the time they reach 13 years of age. Developmentally appropriate behavior that is common and frequently observed in children includes trying to view another person's genitals or breasts, standing too close to other persons, and touching their own genitals. Sexual behaviors become less common, less frequent, or more covert after five years of age. Sexual behavior problems are defined as developmentally inappropriate or intrusive sexual acts that typically involve coercion or distress. Such behaviors should be evaluated within the context of other emotional and behavior disorders, socialization difficulties, and family dysfunction, including violence, abuse, and neglect. Although many children with sexual behavior problems have a history of sexual abuse, most children who have been sexually abused do not develop sexual behavior problems. Children who have been sexually abused at a younger age, who have been abused by a family member, or whose abuse involved penetration are at greater risk of developing sexual behavior problems. Although age-appropriate behaviors are managed primarily through reassurance and education of the parent about appropriate behavior redirection, sexual behavior problems often require further assessment and may necessitate a referral to child protective services for suspected abuse or neglect.     

Duality in context: the process of preparedness in communicating with at-risk children

The goal of this study was to explore the cultural meaning of parent-child communication behaviors in inner-city children at risk for common behavioral problems. Following participation in a preventive intervention called Insights Into Children's Temperament, 40 parents of first and second-grade children were interviewed. The data were analyzed using a constant comparative method derived from grounded-theory techniques. Findings indicate that a complex communication process was used by parents with their at-risk inner-city school-age children. The immediacy of safety concerns for the child, the child's temperament, and the current parental state informed the choice of communication behaviors chosen by the parent. The ultimate goal of communication for these participants was to equip their children with tools to assist them to safely navigate their school and community environments. Participants also offered several recommendations that could be useful for practitioners and researchers to incorporate into their work with inner-city families.