Delayed treatment of frostbite with hyperbaric oxygen: a report of two cases.

Frostbite is an injury caused by the freezing of tissue, causing varied levels of tissue damage and necrosis. Case reports have shown a positive effect of hyperbaric oxygen (HBO2) in such injuries, in acute cases as well as delayed (up to 21 days) presentation with complications. In this case report we present the course of hyperbaric treatment of two patients (a brother and sister, age 58 and 62) who sustained frostbite injuries to both feet 28 days earlier while hiking in the Himalayas. They were initially treated in Nepal following local protocol; afterward their primary care in the Netherlands was managed by the Burn Centre at Maasstad Hospital in Rotterdam. Both patients were treated with daily sessions of in total 80 minutes of 100% oxygen at 2.5 atmospheres absolute. The female patient (age 62) received 25 sessions and showed a remarkable preservation of tissue and quick demarcation. Only partial surgical amputation of the second toe on the right was needed. In the male patient (age 58) both front feet were already mummified to a larger extent before start of treatment. During hyperbaric oxygen therapy 30 sessions) demarcation progressed quickly, resulting in early surgical amputation. Both patients experienced no side effects of HBO2 treatment. Given that both patients showed a quick progress and demarcation of their wounds, with remarkable tissue preservation in the female patient, we suggest that hyperbaric oxygen therapy should be considered in treating frostbite injuries, in acute as well as delayed cases, even four weeks after initial injury.

The implementation and evaluation of therapeutic touch in burn patients: an instructive experience of conducting a scientific study within a non-academic nursing setting.

OBJECTIVE: Evaluation of therapeutic touch (TT) in the nursing of burn patients; post hoc evaluation of the research process in a non-academic nursing setting. METHODS: 38 burn patients received either TT or nursing presence. On admission, days 2, 5 and 10 of hospitalization, data were collected on anxiety for pain, salivary cortisol, and pain medication. Interviews with nurses were held concerning research in a non-academic setting. RESULTS: Anxiety for pain was more reduced on day 10 in the TT-group. The TT-group was prescribed less morphine on day 1 and 2. On day 2 cortisol level before dressing changes was higher in the TT-group. The situational challenges of this study led to inconsistencies in data collection and a high patient attrition rate, weakening its statistical power. CONCLUSION: Conducting an effect study within daily nursing practice should not be done with a nursing staff inexperienced in research. Analysis of the remaining data justifies further research on TT for burn patients with pain, anxiety for pain, and cortisol levels as outcomes. PRACTICE IMPLICATIONS: Administering and evaluating TT during daily care requires nurses experienced both in TT and research, thus leading to less attrition and missing data, increasing the power of future studies.