[Serious burns associated with a fracture : how to react in emergency]. / Comment je traite en urgence des brûlures graves associées à une fracture.

The incidence of burns associated with one or even several fractures is rare and linked to high-energy mechanisms (traffic accidents, terrorist attacks, etc.). Treatment requires a multidisciplinary approach both at the medical and paramedical levels. The various stages of treatment require a systematic reassessment of the situation according to the patient's evolution. Detailed understanding of treatment strategies and outcomes is vital when managing these patients with multiple trauma. We will discuss about our experience with a focus on the management of burns, fractures and associated pathologies.

L'incidence des brûlures associées à une ou plusieurs fractures est rare et liée à des mécanismes à haute énergie (accidents de roulage, attentats…). La prise en charge nécessite une approche pluridisciplinaire tant au niveau médical que paramédical. Les diverses étapes de traitement nécessitent une réévaluation systématique de la situation en fonction de l'évolution du patient. La compréhension détaillée des stratégies de traitement et des résultats est vitale lors de la prise en charge de ces patients polytraumatisés. Nous allons discuter de notre expérience avec un focus sur la prise en charge des brûlures, des fractures et des pathologies associées.

Determination of energy requirements after minor burns using indirect calorimetry: A descriptive cohort study.

BACKGROUND: Minor burns could be associated with moderate hypermetabolism. In this study, the primary outcome was measured energy expenditure (mEE) determined by indirect calorimetry in patients with minor burns. We also compared mEE with predictive values and actual energy intakes. METHODS: Adults with minor burns exclusively treated on an outpatient basis were included. During the week following injury, a dietitian performed indirect calorimetry (Q-NRG in canopy mode), calculated the estimated energy expenditure (eEE) based on the Harris-Benedict (HB) and Henry formulas, and evaluated daily energy intakes using a food anamnesis. RESULTS: Forty-nine patients (59.2% male; median age: 35 [interquartile range: 29-46.5] years; body mass index [BMI]: 26.2 [22.3-29.6] kg/m2; burn surface area [BSA]: 1.5% [1%-2%]) were included 4 (2-6) days after injury. The mEE was 1863 (1568-2199) kcal or 25 (22.4-28.5) kcal/kg and 1838 (1686-2026) kcal or 26.1 (23.7-27.7) kcal/kg in patients who were respectively fasting for >10 h or not (P = 0.991 or P = 0.805). The total mEE was 104% (95%-116%) and 108% (99%-122%) of the total eEE using the HB and Henry formulas, respectively, with diet-induced thermogenesis and physical activity level. Hypermetabolism (ie, oxygen consumption at rest ≥3.5 ml/kg/min) was observed in 21/49 (42.9%) patients. Energy intakes corresponded to 71% (60%-86%) of the total mEE. CONCLUSION: Performing indirect calorimetry in adults with minor burns revealed that ≥40% of the tested adults presented a hypermetabolism and that their mEE was not covered by their energy intakes.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.

INTRODUCTION: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland. METHODS: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles. RESULTS: Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources. CONCLUSIONS: Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.