Reports on vascular catheter-associated thromboembolic events in a burn unit - a gap in the literature?

Indwelling intravascular catheters are important tools in the care of critically ill patients; however, they have an inherent risk of infection or thromboembolic events. Reports on catheter associated thromboembolic events in burn units are rare, despite being well recognized that burn patients bear an increased baseline risk for thromboembolic events. We describe two catheter-associated thromboembolic complications in burn patients in a burn unit and the morbidity associated with these events. Patients with endovascular catheters in burn units may be at increased risk for severe thromboembolic events associated with intravascular catheters, but specific guidelines for prevention and management of these patients are still missing.

The Silent Threat-Alkali Foot Burn: A Case Report.

Despite current workplace protection measures, chemical burn accidents are not uncommon. Among these, alkali burn is the most challenging due to its silent behaviour and aggressive mechanism. Characterized by its initial painless onset, allowing a prolonged exposure, it tends to result in deeper and more destructive burns, creating major reconstructive and therapeutic challenges. This case concerns a 53-year-old male who sustained a full thickness burn of his left instep foot after prolonged contact with an alkali substance. The wound was submitted to several surgical debridement procedures, with preservation of the major tendinous and vascular-nervous structures. The skin defect was then repaired with skin graft. Early recognition and prompt management with copious and prolonged wound irrigation is paramount. As in this type of burn it is difficult to initially assess its true depth, even after initial surgical debridement, a more cautious approach is recommended. Chronic pain is associated with chemical burns and it should be treated early in the process with the use of multimodal analgesia in order to prevent future complications. No matter the absence of major complaints in the 4 week-postoperative evaluation, the possible long-term consequences are still unknown. Despite the prolonged exposure time and the initial presentation with a deep burn, after several surgical debridement procedures, preservation of major tendon and neurovascular structures was assured, which allowed a plain approach for reconstruction of the wound with a skin graft. The case illustrates different challenges associated with evaluation and treatment of patients with deep alkali burns. Also, usage auditing and awareness of regular users appear to be essential.

Les brûlures chimiques au travail restent relativement fréquentes malgré les mesures de protection. Les atteintes par agent alcalin sont particulièrement problématiques car elles sont insidieuses bien que très destructrices. Le temps de contact est prolongé et les destructions sont majeures, posant de difficiles problèmes de reconstruction, en raison de leur caractère initialement indolore. Nous présentons le cas d'un homme de 53 ans victime d'une brûlure du cou de pied gauche après contact prolongé avec un agent alcalin. Les excisions successives ont permis de préserver les éléments nobles et de greffer secondairement la zone touchée. Il est indispensable de diagnostiquer précisément l'atteinte et de laver la région atteinte à grande eau. La profondeur réelle est difficile à apprécier initialement si bien que les excisions doivent être prudentes. Les douleurs chroniques ne sont pas rares dans ces cas et peuvent être prévenues par la qualité de l'analgésie initiale, multimodale. A un mois, le patient ne se plaint de rien, ce qui ne préjuge pas de complications plus tardives. Malgré un temps de contact prolongé et un aspect initial profond, les éléments nobles on pu être préservés, permettant une couverture par simple greffe. Ce cas illustre les difficultés dans le diagnostic et le traitement des brûlures profondes par base. Il est essentiel d'éduquer et surveiller les usagers réguliers de ces produits.