Nonthermal surgical complications in burn patients

Patients with severe burn injuries are generally admitted to specialized units and managed by physicians who specialize in burn care. Complications requiring operative intervention and not directly related to the burn wound occur frequently but are easily overlooked. To determine the nature and frequency of these complications, we conducted a retrospective study of all burn cases in our burn unit over a 5-year period. Twenty-three of the 309 patients (7%) had 45 complications not related directly to the burn wound and required surgical intervention or consultation. The population with surgical complications was generally older (52 vs 42 years), more severely burned (36% vs 25% total body surface area), and had a higher mortality (44% vs 13%). Sixteen of the 23 patients with complications had a single surgical problem, while seven patients sustained multiple complications. In six of the 10 deaths, the surgical complication was believed to be either directly related or significantly contributory to the cause of death. Because the number of burn patients requiring surgical intervention is high, burn patients must be thoroughly examined for possible complications.     

The utility of D-dimer levels in screening for thromboembolic complications in burn patients

Recent studies confirm that thromboembolic complications in burn patients are higher than previously reported. Swelling, pain, and erythema are not useful indicators of deep venous thrombosis (DVT) in burned extremities. We propose that D-dimer levels may be useful in determining which patients would benefit from further screening for DVT. Thirty adult hospitalized burn patients were screened for DVT with duplex ultrasound on admission and then weekly until discharge. D-dimer levels were measured at the same intervals. Seven patients developed 11 cases of DVT. The mean time to DVT diagnosis was 6.7 days. D-dimer levels were elevated in 86% of DVT patients at week 1, with a negative predictive value of 94%. The evaluation of elevated D-dimer levels at week 1 may be a useful screening tool for detecting DVT in the burn population.     

严重烧伤病人肠内营养并发症的护理

对于严重烧伤病人肠内营养是一种安全、方便和符合人体生理的营养支持方法,其成效决定于肠内营养的途径与方法适当,否则可影响病人的耐受性及产生不良的并发症。我科自2 0 0 1年以来,为严重烧伤病人行肠内营养67例,现将护理体会介绍如下。1　临床资料1.1　一般资料　67例中男5     

Neurologic and musculoskeletal complications of burn injuries

As more people survive burn injuries, there is an increasing focus on managing the complications of burn injuries with the ultimate goal of improving survivors' quality of life. Musculoskeletal and neurologic sequelae are significant complications of burn injury. Electrical injury is a subcategory of burns with multiple musculoskeletal and neurologic complications. Knowledge of these complications helps clinicians provide optimal long-term care for burn survivors and enables survivors to attain maximal recovery.     

Sexual satisfaction in burn patients

One of the most frequent concerns of convalescent burn patients is that of sexual functioning. Using the degree of agreement between current performance and ideal performance as a measure of satisfaction with current performance, we have found a sex-related difference in 54 postburn patients. Postburn sexual functioning in males appears to be excellent; no specific factors could be identified by which this could be improved. However, in female patients, a much less satisfactory level of postburn sexual functioning is evident, which appears to be strongly correlated with physical dysfunction and with body image.     

Zinc supplementation in burn patients

Micronutrient supplementation is a common practice throughout many burn centers across North America; however, uncertainty pertaining to dose, duration, and side effects of such supplements persists. The authors prospectively collected data from 23 hospitalized patients with burn sizes ranging from 10 to 93% TBSA. Each patient received a daily multivitamin and mineral supplement, 50 mg zinc (Zn) daily, and 500 mg vitamin C twice daily. Supplements were administered orally or enterally. Albumin, prealbumin, C-reactive protein, serum Zn, and serum copper were measured weekly during hospital admission until levels were within normal reference range. Our study concluded that 50 mg daily dose of Zn resulted in normal serum levels in 19 of 23 patients at discharge; 50 mg Zn supplementation did not interfere with serum copper levels; and Zn supplements, regardless of administration route, did not result in gastrointestinal side effects.     

Cytomegalovirus infection in burn patients

We studied the seroepidemiology of cytomegalovirus (CMV) infection in 59 patients with thermal injuries. Among the 31 patients who were initially CMV seronegative, seven (22.5%) seroconverted. Patients who seroconverted had longer hospital stays (mean, 27 +/- 23.9 days v 14.9 +/- 8.8 days in seronegative patients [P = 0.03]) and they received more blood products (mean, 10.7 +/- 17.9 units v 1.8 +/- 2.8 units [P = 0.02]) than patients who remained seronegative. Among 18 patients who were initially seropositive for CMV, 10 (56%) had a fourfold or greater rise in CMV antibodies, evidence of CMV reactivation. Patients who had reactivated CMV infection tended to be younger, to have a larger burn area, and to have a longer hospital stay. No patient who experienced CMV infection, whether primary or reactivated, had serious complications attributable to CMV.     

Acute renal failure in intensive care burn patients (ARF in burn patients).

The purpose of this study was to establish the incidence and mortality of burn patients with acute renal failure (ARF) at the Helsinki Burn Centre and to analyze the associated factors. The files of 238 intensive care (ICU) patients of a total of 1380 burn patients admitted to our institution between November 1988 and December 2001 were studied retrospectively. Of all admitted burn patients, 17.2% needed ICU. According to our criteria (S-Cr >120 micromol/l = 1.4 mg/dl), 39.1% of the ICU patients suffered from ARF and one in three of these required renal replacement therapy. The proportion of all admitted burn patients requiring renal replacement therapy was 2.3%. The mortality of ICU patients with ARF was 44.1% whereas that of patients without ARF was only 6.9%. Renal function recovered in all survivors. The nonsurvivors had a larger burned total body surface area, were older, and had more inhalation injuries and a higher abbreviated burn severity index score. The prognosis for patients with early ARF was worse than that for patients with late ARF. Rhabdomyolysis caused by flame injury was associated with high mortality. In this study we observed that ARF is associated with higher mortality even in minor burns when compared with patients without ARF. Flame burn with rhabdomyolysis and subsequent ARF predicts very poor survival. If a patient with severe ARF survives, the renal failure recovers over time.     

Is tracheostomy warranted in the burn patient? Indications and complications

Considerable controversy exists as to whether a tracheostomy (TT) is ever indicated in burn patients. Eighty-eight tracheostomies were performed over a 48-month period. An inhalation injury was present in 59.6% of the patients, and 96% had preceding endotracheal intubation (ET). The mean duration of ET was 14 days. Seven percent, 17% and 58% of the TTs were performed within the 1st, 8th, and 14th postburn day, respectively. The indications for TT were: emergency airway access, 7%; complications secondary to ET, 8%; pulmonary sepsis, 75%; pulmonary failure, 10%. The mean duration of TT was 33 days (range: 1-209). Major complications associated with TT included: tracheomalacia, tracheostenosis, tracheoinnominate artery and tracheoesophageal fistulae, and posttracheostomy dysphagia. The decision to perform a TT or to continue with ET should not be predicated on an arbitrary number of days, but must be individualized and based on the clinical condition of the patient. The complications associated with a TT are related to previous ET and to the underlying pulmonary pathology necessitating ventilatory support.     

Haloperidol in palliative care

Haloperidol is one of 20 'essential' medications in palliative care. Its use is widespread in palliative care patients. The pharmacology of haloperidol is complex and the extent and severity of some of its adverse effects, particularly extrapyramidal adverse effects (EPS), may be related to the route of administration. Indications for the use of haloperidol in palliative care are nausea and vomiting and delirium. Adverse effects include EPS and QT prolongation. Sedation is not a common adverse effect of haloperidol. It is important that palliative care practitioners have a comprehensive understanding of the indications, doses, adverse effects and pharmacology of haloperidol. This review is intended to address these issues.