RESUMO
The treatment of severe frostbite injury has undergone rapid development in the past 30 years with many different diagnostic and treatment options now available. However, there is currently no consensus on the best method for management of this disease process. At our institution, we have designed a protocol for severe frostbite injury that includes diagnosis, medical treatment, wound cares, therapy, and surgery. This study assess the efficacy of our treatment since its implementation six years ago. During this time, all patients with severe frostbite injury were included in prospective observational trial of the protocol. We found that this protocol results in significant tissue salvage with over 80.7% of previously ischemic tissue becoming viable and not requiring amputation. We also were able to improve our center's efficiency over the course of six years and now our current average time from rapid rewarming to delivery of thrombolytics is under six hours.
Assuntos
Protocolos Clínicos , Congelamento das Extremidades/terapia , Estudos Observacionais como Assunto , Adulto , Amputação Cirúrgica/normas , Desbridamento/normas , Feminino , Fibrinolíticos/uso terapêutico , Congelamento das Extremidades/patologia , Humanos , Masculino , Terapia Trombolítica/normasRESUMO
Facial burns are extremely common in the burn population, as is the need for endotracheal intubation. However, securing the endotracheal tube in these patients can be difficult. Our institution's historically preferred method of securing tubes with twill tape was effective but had a high rate of device-related pressure ulcers. The introduction of new silicone pressure-reducing strips for use in conjunction with twill tape was effective in reducing the incidence of pressure ulcers in this patient population from 21% to 5% (P = .032).
Assuntos
Queimaduras/terapia , Traumatismos Faciais/terapia , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Úlcera por Pressão/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/epidemiologia , Estudos Retrospectivos , Silicones , Fita Cirúrgica/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
For those at risk for cold-related injury, frostbite contributes significant morbidity through loss of limbs and digits. Frostbite injury generally affects distal extremities first and spreads proximally as the time of exposure increases. The Hennepin score is a tool to quantify injury and tissue loss of frostbite injury, similar to TBSA calculators in burn patients. Application of the Hennepin score allows for a clear picture of the effect of treatment through calculation of a salvage rate. The authors found high reliability between raters using the Hennepin score worksheet, suggesting consistency with applying the score to frostbite injury and outcomes (intraclass correlation, 0.93; confidence interval, 0.88-0.97). The Hennepin score allows for a standard means to accurately measure injury and outcomes, which will aid in the study of treatment outcomes of frostbite injuries.