INTRODUCTION: The management of pain following a burn is extremely complex because of the multifactorial nature of burn pain (nociceptive and neuropathic). In the pre-hospital setting and emergency department (ED), the main goal of acute pain management is to reduce the patient's pain, allowing them to maintain function and to prevent the chronification of pain. Opioids are used as first-line treatment in management of burn pain. The aim of our study was to evaluate the efficacy and adverse effects of intravenous (IV) morphine for burn pain management in the ED and to evaluate pain management in the pre-hospital setting. METHODS: In this single-center observational study, patients presenting with second- and third-degree burns were enrolled in our ED. Numerical Rating Scale (NRS) and Burn Specific Pain Anxiety Scale (BSPAS) were performed at ED admission and after 1 h. Pain medications administered before arrival in the ED were reported by the rescue team. All patients received IV acetaminophen every 8 h and IV morphine according NRS. RESULTS: Thirty patients were included in this study. At the time of arrival to the ED, > 90% of the patients reported severe pain; 95.8% of them received IV morphine to achieve pain relief. After 1 h, > 65% of patients had NRS < 3. The total amount of IV morphine was 18.12 ± 4.26 mg in the first hour. No adverse events were recorded. The BSPAS on admission to the ED was 34.8 ± 5.6, indicating severe anxiety. After 1 h, BSPAS was 12.8 ± 4.8, indicating mild anxiety. CONCLUSION: IV morphine used for burn pain management in the emergency setting significantly improves patient outcomes in terms of pain. IV morphine also reduced anxiety scores at 1 h.
The management of pain following a burn is extremely complex because of the multifactorial nature of burn pain. The main goal of acute pain management is to reduce the patient's pain, allowing them to maintain function and to prevent the chronification of pain. Opioids are used as first-line treatment in management of burn pain. In this single-center observational study, patients presenting with severe burns were enrolled in our hospital. Pain intensity and anxiety level were evaluated at admission and after 1 h. We evaluated pain treatment using intravenous (IV) morphine. Thirty patients were included in this study. At the time of arrival in hospital, almost all patients reported severe pain and received IV morphine to achieve pain relief. After 1 h, > 65% of patients had no pain. No adverse events were recorded related to morphine administration. The anxiety level improved after pain treatment. Finally, IV morphine used for burn pain management in the emergency setting significantly improves patient outcomes in terms of pain and reduced agitation.
We report five case series of obese patients with severe left ventricular ejection fraction impairment undergoing Serratus Anterior Plane Block during S-ICD Implantation. This anesthesia approach has a reduced impact on the patient's hemodynamics and adequately manages postprocedural pain. Abstract: Subcutaneous implantable cardioverter-defibrillator (S-ICD) procedures are frequently performed under analgosedation or general anesthesia, leading to prolonged postoperative hospital stays and increased costs. This anesthetic technique may also have a greater hemodynamic impact, particularly in obese and cardiac patients. However, an alternative anesthetic technique can be employed: ultrasound-guided serratus anterior plane block (US-SAPB). We analyzed the anesthetic clinical course in 5 patients, 3 males and 2 females, who were obese (BMI ≥ 30) and underwent S-ICD implantation for primary prevention using a two-incision intermuscular technique and ultrasound-guided serratus anterior plane block. All patients had a left ventricular ejection fraction less than or equal to 35%. It significantly facilitated pain control during the procedure and, especially, in the postoperative phase. However, the data available in the literature are mostly derived from case reports and small comparative studies. Therefore, further studies with a larger sample size and direct comparison with general anesthesia or deep sedation are needed.
The presence of a high number of positive SARS-CoV-2 patients is found daily in the emergency room database, finding evidence of infection also in trauma and burns. Surgical debridement remains the gold standard for eschar removal, but it does not come without complications such as bleeding and high heat loss. In recent years, there has been an increase in the use of enzymatic debridement techniques, replacing surgical escharotomy. Early eschar removal is proven to be important; it has been proved that an early and effective burn treatment in COVID-19 patients can reduce other infection. Five clinical cases of patients arrived at our COVID-19 Major Burns Intensive Care Unit. On admission, burns extension and depth were assessed by an expert burn surgeon. We evaluated eschar removal modality, adverse events, and potential side effects. Enzymatic debridement was efficient in all patients treated with complete eschar removal, and no serious adverse events. All patients were treated within 24 hours of arrival at our facility with Nexobrid by specialized personnel in deep sedation and with O2 support using a face mask or nasal goggles. The use of enzymatic debridement in COVID-19-positive burn patients within dedicated pathways through nonsurgical treatment optimizes the treatment time. We believe that the use of enzymatic debridement could be a valid therapeutic option in burn patients, even with SARS-CoV-2 infection, and its use, when indicated, is safe and effective for the patient and optimizes the use of instrumental and human resources in a pandemic emergency.
Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment and related to pathogenetic mechanisms not yet clearly recognized. We report the case of a 59-year-old post-menopausal woman, affected by bone marrow edema associated with early osteonecrosis of the femoral head with secondary appearance of a rare migrant bone edema of the hip acetabulum. Clinical evaluation and magnetic resonance imaging were used to monitor the outcome of the patient. Pre-treatment clinical evaluation revealed pain upon stepping with the left limb, reduced range of motion of spine and hip, and hip pain during passive rotation. Magnetic resonance imaging showed diffuse signal alteration of the head and neck of the left femur in relation to bone edema, associated with an unclear small cephalic area of the femoral head suggestive of initial osteonecrosis. A further computed tomography scan was performed that did not reveal any alterations in bone profile, interruption of the cortex, or trabecular bone collapse. We immediately started a multimodal conservative treatment administering neridronate (100 mg, intravenously) combined with calcium and vitamin D supplementation and biophysical therapies (magnetotherapy and extracorporeal shockwave therapy). We also instructed the patient not to bear the load on the affected lower limb during standing and walking, using crutches. After 2 months, a notable regression of pain with improvement in mobility was observed. Magnetic resonance imaging revealed complete regression of edema at the head and neck of the femur; however, the new appearance of acetabular bone edema of the ipsilateral acetabular roof was detected. After 4 months, a third magnetic resonance imaging showed the disappearance of the femoral head and acetabular roof defects as well as the complete clinical recovery of the patient. An early diagnosis and intervention are essential to conservatively treat cases of bone marrow edema syndrome.
We hypothesized that the spread of SARS-CoV-2 in urine during a severe COVID-19 infection may be the expression of the worsening disease evolution. Therefore, the aim of this study was to verify if the COVID-19 disease severity is related to the viral presence in urine samples. We evaluated the clinical evolution in acute COVID-19 patients admitted in the sub-intensive care and intensive care units between 28 of December 2020 and 15th of February 2021 and being positive for SARS-CoV-2 RNA in the respiratory tract, including repeated endotracheal aspirates (ETA), sputum, nasopharyngeal swabs (NPS) and urine. We found that those subjects with SARS-COV-2 in the urine at admittance (8 out of 60 eligible patients) had a more severe disease than those with negative SARS-CoV-2 in urine. Further, they showed an increase in fibrinogen and (C-reactive Protein) CRP serum levels, requiring mechanic ventilation. Of those with positive SARS-CoV-2 in the urine, 50% died. According to our preliminary results, it seems that the presence of SARS-CoV-2 in the urine characterizes patients with a more severe disease and is also related to a higher death rate.
We investigate the generation of magnonic thermal spin currents and their mode selective spin transport across interfaces in insulating, compensated ferrimagnet/normal metal bilayer systems. The spin Seebeck effect signal exhibits a nonmonotonic temperature dependence with two sign changes of the detected voltage signals. Using different ferrimagnetic garnets, we demonstrate the universality of the observed complex temperature dependence of the spin Seebeck effect. To understand its origin, we systematically vary the interface between the ferrimagnetic garnet and the metallic layer, and by using different metal layers we establish that interface effects play a dominating role. They do not only modify the magnitude of the spin Seebeck effect signal but in particular also alter its temperature dependence. By varying the temperature, we can select the dominating magnon mode and we analyze our results to reveal the mode selective interface transmission probabilities for different magnon modes and interfaces. The comparison of selected systems reveals semiquantitative details of the interfacial coupling depending on the materials involved, supported by the obtained field dependence of the signal.
Magnons are the elementary excitations of a magnetically ordered system. In ferromagnets, only a single band of low-energy magnons needs to be considered, but in ferrimagnets the situation is more complex owing to different magnetic sublattices involved. In this case, low lying optical modes exist that can affect the dynamical response. Here we show that the spin Seebeck effect (SSE) is sensitive to the complexities of the magnon spectrum. The SSE is caused by thermally excited spin dynamics that are converted to a voltage by the inverse spin Hall effect at the interface to a heavy metal contact. By investigating the temperature dependence of the SSE in the ferrimagnet gadolinium iron garnet, with a magnetic compensation point near room temperature, we demonstrate that higher-energy exchange magnons play a key role in the SSE.
