Management of burn wounds of the head and neck region.

Management of burn wounds of the head and neck region. Management of the severely burned patient is ery often a challenge, not only due to major disturbances in anatomy and physiological processes, but also because the relatively low incidence of this pathology in both civilian and military practice results in care providers'lack of experience. The purpose of this educational document is to provide doctors confronted with these formidable trauma patients with basic management guidelines as well as some practical tips. In summary, and most importantly, these patients should be reated as any other multitrauma patient. First aid is essential and can be provided by non-medical staff. Initial medical nanagement should focus on the usual, familiar trauma algorithms of ABCDEF from the emergency management of evere burns (EMSB) manual' or the ABCDEs of the manual of advanced trauma life support (ATLS)2 or advanced burn life support (ABLS). Medical care should proceed through the following steps - Step one: establish a reliable intravenous nfusion; step two: protect the airway; step three: establish and maintain a haemodynamic state compatible with sufficient organ perfusion in order to reduce aggravation of the burn wounds and increase overall survival likelihood; step four: provide analgesia with adequate sedation and provide anaesthesia for escharotomy, fasciotomy or other surgical injuries; step five: maintain normothermia; step six: feed the patient by starting enteral nutrition as early as possible; step seven: prevent infection using antiseptic wound management, systemic antibiotics and tetanus prophylaxis. All of these intricate steps require continuous reassessment and adjustment, but the existence of other wounds (blast injuries, penetrating and blunt trauma) even further complicates the management of burn casualties.

[The hemolytic uremic syndrome: prime reason for acute renal failure in children]. / Le syndrome hémolytique et urémique. Première cause d'insuffisance rénale aiguë de l'enfant.

The Hemolytic Uremic Syndrome (HUS) is the prime cause for acute renal failure in children. The HUS is a combination of hemolytic anemia, thombopenia and acute nephropathy: all signs of a thrombotic microangiopathy. Onset occurs generally in infancy and is often associated with severe bloody diarrhea. Most of those cases are caused by Escherichia coli O157:H7 witch produces an exotoxin responsible for the microangiopathy. We discuss the treatment of HUS based on the experience acquired since 1994 in our Paediatric Intensive Care Unit (PICU), University of Liege. The frequent association of dehydration, multi-systemic impairment and reno-vascular hypertension justifies the early admission for PICU-surveillance. This allows the difficult fluid balance management in a setting of renal and pre-renal failure.

Counter-current aortography for aortic coarctation.

We describe a 1-month-old infant who developed a cardiogenic shock. Echocardiography suspected an aortic coarctation. Left brachial artery counter-current aortography gave safe and adequate imaging of the aortic coarctation. We see many advantages to this approach: (1) most complications associated with classical cardiac catheterization are significantly reduced, (2) adequate imaging of coarctation, anatomy of the aortic arch and eventually collateral circulation is obtained, (3) the volume of contrast is reduced, (3) increased risk of femoral artery injury is avoided, (4) the procedure lasts only a few minutes, and (5) no sedation is needed. We conclude that left brachial artery counter-current aortography is a safe, quick and relatively non-invasive procedure which can be used in infants in whom clinical, cross-sectional, and Doppler echocardiographic findings are suggestive but not conclusive of anomalies of the aortic arch, especially when magnetic resonance imaging is not available or cannot be performed safely because the infant is critically ill.

[Severe multiorgan psittacosis in a 10-year-old boy]. / Psittacose sévère multiviscérale chez un garçon de dix ans.

UNLABELLED: Psittacosis is rare among children and severe cases appear exceptional. We describe a child with psittacosis and multiorgan involvement. CASE REPORT: T., a ten-year-old boy, was admitted for a prolonged fever associated with meningism. Laboratory tests showed an important inflammatory response, mild renal failure and coagulation disorders. On admission, the chest X-Ray and the cerebrospinal fluid were normal. He rapidly developed shock, acute abdomen, oxygenodependency, pneumonia and bilateral pleural effusion. No improvement was observed after 48 hours of cefotaxime therapy. History revealed the presence of two parrots at home. Treatment by intravenous clarithromycin was therefore initiated. Serology for Chlamydia psittaci was strongly positive. All symptoms disappeared a few days later. CONCLUSION: The case reported was particular for two reasons: severe disease with multi-organ involvement and young age of the patient. We emphasize the need to search for a history of contact with birds in any case of unexplained pneumonia.

[Meningococcemia, recrudescence, diagnosis and treatment]. / Méningococcémie: recrudescence, diagnostic et traitement.

Meningococcemia is a severe Gram negative septicemia whose mortality may be as high as 30%. It occurs more frequently in children but the proportion of teenagers is increasing in Belgium. During the past decade, a slow but sustained rise in the incidence of this illness has been noted, with a predominance of the serogroup B. We describe the symptoms, which often are poor in the early stage, the different therapies, most of them being still under investigation, and the chemoprophylaxis. Without being alarmist, the diagnosis must be considered in any child with cutaneous rash, even atypical and tachycardia.

[Medico-surgical management of childhood cardiopathy: results of the Liège experience]. / Prise en charge médico-chirurgicale des enfants cardiopathes: résultats de l'expérience liégeoise.

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liège. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liège appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children.