Causes and treatment of burns from grease.

A large number of burns are sustained every year as the result of kitchen grease. A review of a 13-month period at the Joseph M. Still Burn Center in Augusta, Georgia, revealed 60 cases (9.4% of acute burn admissions). Forty-five (75%) of these patients were adults and 25% were children. There were 23 females and 37 males. Forty-two percent of the adults and 33% of the children had some percentage of third-degree injury. The average total body surface area burn in adults was 5.9% and in children 6.3%. There were no deaths in this series. Burns usually occurred as the result of scalds with grease while cooking. Spilling grease on children in the kitchen was a frequent problem. Burns due to ignition of grease was also a cause of injury. Most of the injuries were potentially preventable, and therefore the importance of burn appropriate safety programs is stressed.

Experience with necrotizing fasciitis at a burn care center.

Necrotizing fasciitis is a soft tissue infection that causes necrosis of subcutaneous tissue and fascia but usually spares skin and muscle. Management of this condition consists of early diagnosis, broad-spectrum antibiotic coverage, aggressive surgical debridement, wound closure, and intensive supportive care. Mortality estimates reported in the literature have ranged from 20 to 75%. We report the cases of 12 patients treated at the Joseph M. Still Burn Center in Augusta, GA. Because aggressive surgical debridement combined with medical support is required for successful treatment, we recommend that treatment be administered at a burn care center. We performed a retrospective chart review of all patients admitted to our center with a diagnosis of necrotizing fascitis between May 1, 1995, and June 1, 2000. Patients were managed collaboratively by burn surgeons and critical care intensivists in consultation with other appropriate specialists. The mean time from initial diagnosis until transfer to the burn center was 14 days (range, 0-60 d). Complications included pneumonia, heart failure, metabolic abnormalities, anemia, and sepsis. Four (33%) of the 12 patients died, with the primary cause of death being multiorgan failure. Although our sample size is too small to reach statistical significance, the data suggest that early referral to a burn or wound care center improves patient outcome.

A retrospective study to determine the incidence of pressure ulcers in burn patients using an alternating pressure mattress.

In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

A retrospective study to determine the incidence of pressure ulcers in burn patients using a low air loss pressure relieving mattress.

In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

Toxic epidermal necrolysis due to administration of celecoxib (Celebrex).

A 41-year-old woman was given celecoxib (Celebrex) for the treatment of carpal tunnel syndrome. An erythematous rash developed that progressed to exfoliative dermatitis, and the patient was diagnosed with toxic epidermal necrolysis. After transfer to the burn unit, she was treated with topical mupirocin calcium cream and bismuth tribromophenatein petrolatum gauze dressings. Her wounds healed well. This is the first case report of toxic epidermal necrolysis due to treatment with celecoxib of which we are aware.

A comparison of the effect of early insertion of standard latex and silver-impregnated latex foley catheters on urinary tract infections in burn patients.

A retrospective study was designed to compare the incidence of urinary tract infections during two different time periods in burn patients treated with two different types of Foley catheters. In time period 1, latex catheters present on admission were not changed. In time period 2, catheters were replaced on admission with silver alloy-impregnated catheters. In time period 1, the rate of symptomatic urinary tract infections was 7.2 per 1,000 catheter-days. In time period 2, the rate was 4.4 per 1,000 catheter-days. Results, compared using Fisher's exact test, revealed a statistically significant P value of .029. The use of silver-impregnated catheters significantly lowered the rate of urinary tract infection at our burn center.