Resuscitation tables: a useful tool in calculating pre-burns unit fluid requirements.

BACKGROUND: There is considerable variation in the standard of initial burn management, particularly burn surface area assessment and application of resuscitation formulae. Early aggressive management of major burns improves survival. Internationally, the Parkland formula employing lactated Ringer's solution is used for fluid resuscitation. This study aimed to assess whether Parkland fluid resuscitation tables could improve the accuracy of initial fluid requirement calculations. METHODS: The burn size had first to be determined for an adult and a child using a preshaded Lund and Browder chart. Fluid requirements then had to be calculated using the conventional Parkland formula. The burn size had to be similarly calculated for two further cases and fluid requirements calculated using resuscitation tables. The study had a sample size of 50, consisting of plastic surgery trainees, anaesthetists and burn nurse specialists. RESULTS: All the participants found the resuscitation tables to be quicker and easier to use. The burn size was correctly calculated in 72% of cases. Fluid resuscitation requirements were correct in only 55% when using the Parkland formula. The use of resuscitation tables improved the accuracy in calculating fluid requirements to 75%. CONCLUSIONS: The use of Parkland fluid resuscitation tables can improve accuracy and ease of calculation of fluid resuscitation requirements.

Scrubbing brush decontamination--cement burn treatment.

Use of a pre-operative scrubbing brush to decontaminate cement burns is described. As cement particles are removed, further damage is prevented and patients derive great relief.

Median nerve contusion during endoscopic carpal tunnel release.

Median nerve contusion occurred in two patients treated by endoscopic carpal tunnel release. We discuss the possible cause of this complication and how to avoid it.

How would you like your tea, vicar?

INTRODUCTION: Scald injuries are the commonest cause of paediatric burns leading to hospital admission both in the United Kingdom (National Burn Care Review Committee Report; 2001) and around the world. The cost and significant morbidity resulting from scald injuries reiterates the need for effective prevention campaigns for primary caregivers. The majority of scalds in children occur in the kitchen (49%) at home. Three children a day under the age of 5 (1100/year) are involved in scalds resulting from pulling on a cup of beverage onto themselves. We therefore aim to study the temperature of common beverages made at home and their potential to cause significant thermal injury. MATERIALS AND METHODS: Common household beverages were formulated to assess the thermal characteristics. Each beverage was made in a standardized environment with constant ambient temperature of 22 degrees C. Beverages were made in 230 ml ceramic mugs, using boiled water from an electric kettle, instant coffee granules and teabags. Hot milk and hot water were prepared for comparison. Temperature readings were taken from 0 to 10 min. Cooling curves were then plotted. RESULTS: Milky beverages had the lowest starting temperatures (75-77 degrees C). Black tea and black coffee remained at temperatures greater than 65 degrees C despite cooling for 10 min. The addition of sugar did not alter the cooling rate. Similarly there was very little difference in cooling rates for skimmed and full fat milk. Addition of 10 ml rather than 5 ml of milk lowered the starting temperature and increased the cooling rates. DISCUSSION/CONCLUSION: Hot beverages can cause significant scald injuries especially in the paediatric population. We demonstrated the potential for a full thickness burn despite cooling for 10 min or the addition of cold milk. Thus the complacent attitude surrounding beverages under such conditions should be abolished. Our work also reiterates the need for education amongst caregivers regarding the handling of hot beverages in order to reduce the number of household injuries.

Potential subtherapeutic linezolid and meropenem antibiotic concentrations in a patient with severe burns and sepsis.

Altered pharmacokinetics in patients with major burns may result in serum antibiotic concentrations below those required to be effective against the common pathogens encountered in burns patients. The major changes in the fluid volumes of key body compartments, which occur with a large burn, may increase the apparent volume of distribution of a drug, thereby lowering its concentration when a standard dose is given. In addition, the observed increase in renal blood flow reported in burns patients, because of the change in cardiac output, may result in a higher drug clearance and a shorter elimination half-life. As a consequence, studies have recommended higher doses or more frequent dosing or both for some antibiotics in patients with major burns, but data are lacking for many of the antibiotics reserved for treatment of life-threatening infections. The authors measured serum concentrations of two antibiotics, linezolid and meropenem, in an immunosuppressed patient who presented with a severe burn to determine whether therapeutic concentrations were achieved, thereby improving the likelihood of infection control.

Return to work after burns: a qualitative research study.

As yet no qualitative research studies looking at return to work following burns have been published. The aim of this study was to investigate the "hows" and "whys" of return to work, by purposively selecting a cross-section of burns patients who returned to the same/similar job, those who returned to work but either on a part-time basis or in a different role/job and those who became or remained unemployed, and using semi-structured interviews to explore their experiences. Using matrix analysis methodology, and with the general themes that emerged from these transcripts, it was possible to place patients into 5 broad groups, the "defeated", the "burdened", the "affected", the "unchanged" and the "stronger". We anticipate that use of these general groups will be useful in targeting multi-disciplinary return to work strategies, and discuss how this qualitative research has changed practice at the Queen Victoria Hospital Burns Centre.