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3.
Isr Med Assoc J ; 22(2): 83-88, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043324

RESUMEN

BACKGROUND: Rapid and selective bromelain-based enzymatic debridement provides a non-surgical alternative for the eschar removal in deep burns, which allows for early debridement of large surface areas, accurate evaluation of burn and wound depth, and the need for skin grafting. OBJECTIVES: To evaluate the efficacy of application of a bromelain-based selective enzymatic debridement (Nexobrid®) beyond the manufacturer's guidelines for use in burns > 48 hours as well as chemical, electrical, and pediatric burns, and chronic wounds. METHODS: This retrospective review included records collected between January 2017 and April 2019, from male and female patients aged 8 months to 99 years with deep burns or wounds treated with bromelain-based selective enzymatic debridement. RESULTS: Of the 33 patients who received the bromelain-based selective enzymatic debridement agent beyond the manufacturer's guidelines, 25 (76%) were observed to have successful debridement of the eschar, 8 (24%) were observed to have little effect on the burn eschar. Sixteen required further surgery after debridement. Clinical data on the use of bromelain-based selective enzymatic debridement agents are limited, but these results suggest the capacity to effectively debride burns > 48 hours (late presentation burns), use for pediatrics and for chemical and electrical burns, and apply to hard to heal full thickness chronic wounds. CONCLUSIONS: Bromelain-based selective enzymatic debridement was found to be an effective treatment modality beyond the recommended guidelines including late presentation burns and chronic wounds. This debridement method warrants further consideration when making clinical decisions concerning burn and wound care.


Asunto(s)
Bromelaínas/administración & dosificación , Quemaduras , Terapia Enzimática/métodos , Cicatrización de Heridas/efectos de los fármacos , Heridas y Traumatismos , Administración Tópica , Adulto , Quemaduras/diagnóstico , Quemaduras/terapia , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Estudios Retrospectivos , Tiempo de Tratamiento , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia
5.
FP Essent ; 489: 27-31, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31995352

RESUMEN

Burns, whether caused by thermal, chemical, or electrical exposure, are common and often preventable. Burn injuries are most common in children. All patients with burns should undergo primary and secondary assessment, including assessment of airway, breathing, and circulation. Evaluation of the location, size, and depth of burns can help to determine the optimal setting for management. Patients with full-thickness burns, circumferential burns, or burns on the face, hands, feet, genitals, or perineum should be referred to a burn subspecialist. Minor acute pain can be managed with irrigation of the burn area with cool water, acetaminophen, or a nonsteroidal anti-inflammatory drug. Acetaminophen is the first-line treatment for pain associated with minor burns. Opioids are a mainstay of pain management for patients with severe burns. Prophylactic antibiotics are not indicated for most patients. Silver sulfadiazine is used widely as a topical therapy, and is a standard treatment for partial-thickness burns. Many other topical therapies are available but comparative data are limited. Goals of therapy are to manage pain, facilitate healing, minimize scarring, and achieve return to function.


Asunto(s)
Antiinfecciosos Locales , Quemaduras , Pacientes Ambulatorios , Quemaduras/terapia , Niño , Humanos , Sulfadiazina de Plata , Cicatrización de Heridas
6.
J Surg Res ; 245: 183-197, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421361

RESUMEN

In the management of indeterminate-depth burns (IDB), common challenges include the ability to predict time to healing and regenerative potential, risk of burn wound progression, and timing of excision. Several technologies exist to aid in determination of the depth of a burn injury, yet surgeons continue to rely on the naked eye-visual assessment-as the standard of care. Newer and improved imaging technologies are closing in on the goal of inexpensive, accurate, noninvasive modalities for depth determination. Likewise, management of IDB is becoming more sophisticated as newer wound healing technologies continue to be developed. By describing what is meant by "indeterminate" depth burns, and their associated challenges, we hope to stimulate interest in research to develop new therapies and management strategies. The ultimate goal is to treat IDB without the need for autografts.


Asunto(s)
Quemaduras/diagnóstico , Quemaduras/terapia , Índice de Severidad de la Enfermedad , Incertidumbre , Quemaduras/patología , Desbridamiento/métodos , Progresión de la Enfermedad , Humanos , Selección de Paciente , Piel/diagnóstico por imagen , Piel/patología , Trasplante de Piel/métodos , Piel Artificial , Nivel de Atención , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas
7.
Rev Assoc Med Bras (1992) ; 65(11): 1405-1412, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31800905

RESUMEN

OBJECTIVE: to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns. METHODS: integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns. RESULTS: ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited. CONCLUSION: the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.


Asunto(s)
Vendajes , Quemaduras/terapia , Colagenasas/administración & dosificación , Desbridamiento , Membranas Artificiales , Sulfadiazina de Plata/administración & dosificación , Humanos
8.
Medicine (Baltimore) ; 98(51): e18188, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860965

RESUMEN

AIM: We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing. METHODS: In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6). RESULTS: The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%). CONCLUSION: N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.


Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Ansiolíticos/uso terapéutico , Quemaduras/terapia , Óxido Nitroso/uso terapéutico , Administración por Inhalación , Adolescente , Adulto , Anciano , Analgésicos no Narcóticos/administración & dosificación , Ansiolíticos/administración & dosificación , Ansiedad/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Óxido Nitroso/administración & dosificación , Manejo del Dolor , Método Simple Ciego , Adulto Joven
9.
Rev. bras. cir. plást ; 34(4): 504-508, oct.-dec. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047913

RESUMEN

Introdução: Lesões geradas por queimaduras representam um importante problema de saúde pública, constituindo a quarta causa de morte na infância no Brasil e Estados Unidos. Além disso, poucas são as doenças que trazem prejuízos tão importantes, com considerável morbidade pelo desenvolvimento de sequelas físicas e psicossociais. Diante disso, o objetivo deste estudo é traçar o perfil epidemiológico de crianças de 0-18 anos atendidas em um hospital escola de Curitiba, Paraná. Métodos: Estudo transversal e retrospectivo realizado através da análise de 625 prontuários de internação de crianças de 0-18 anos vítimas de queimaduras, entre janeiro de 2010 a dezembro de 2017. Foram coletadas informações sobre idade, sexo, tempo de internação, óbito, região corporal atingida, extensão da superfície corporal, grau de profundidade, agente etiológico e abordagem terapêutica. Resultados: A maior parte da amostra era composta por lactentes (43%), com média de idade de 12,6 anos. O sexo mais afetado foi o masculino e os pacientes permaneceram cerca de 14,5 dias internados. No estudo, 98% das queimaduras apresentaram como etiologia o agente térmico, principalmente por líquido quente. Em relação ao grau de profundidade, a maioria das queimaduras foram de 2º grau (61,3%), atingindo até 25% de superfície corporal queimada (SCQ), sendo o tronco o mais afetado. Dentre as modalidades de tratamento, 44% dos pacientes necessitaram de intervenção cirúrgica com debridamento e enxertia. Conclusão: Crianças mais novas são mais propensas a sofrerem queimaduras principalmente no ambiente domiciliar e, além disso, uma equipe preparada e capacitada é de crucial importância no prognóstico destes doentes.


Introduction: Injuries caused by burns represent a significant public health problem, constituting the fourth leading cause of childhood death in Brazil and the United States. In addition, few diseases carry such substantial losses as burns, with considerable morbidity due to the development of physical and psychosocial sequelae. This study aimed to outline the epidemiological profile of 0­18-year-old children treated for burns at a teaching hospital in Curitiba, Paraná. Methods: This cross-sectional, retrospective study involved analysis of 625 medical records of 0­18-year-old children who were victims of burns from January 2010 to December 2017. Information was collected on age, sex, length of hospitalization, death, body region affected, burned body surface area (BSA), depth, etiologic agent, and therapeutic approach. Results: A plurality of the sample were infants (43%), and the average age of the sample was 12.6 years. Most of the sample was comprised males, and the patients remained hospitalized for an average of 14.5 days. Of the burns, 98% were caused by thermal agents, particularly hot liquids. Most burns were second-degree burns (61.3%), reaching up to 25% of the BSA, and the most affected region was the trunk. Among the treatment modalities, 44% of the patients needed surgical intervention with debridement and grafting. Conclusion: Younger children are more prone to burns, especially in the home environment. A prepared and qualified team is of crucial importance for optimizing outcomes in these patients.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Cirugía Plástica , Perfil de Salud , Quemaduras , Traumatismo Múltiple , Encuestas Epidemiológicas , Cirugía Plástica/métodos , Cirugía Plástica/estadística & datos numéricos , Quemaduras/cirugía , Quemaduras/terapia , Traumatismo Múltiple/cirugía , Traumatismo Múltiple/terapia , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/estadística & datos numéricos
10.
Rev. bras. cir. plást ; 34(4): 509-516, oct.-dec. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047916

RESUMEN

Introdução: O suicídio é um sério problema de saúde pública. Estima-se que para cada óbito existam 10 tentativas. Dentre os meios utilizados, as queimaduras têm destaque devido à gravidade das lesões, a alta taxa de letalidade e os grandes prejuízos funcionais, estéticos e psicológicos. As mulheres, por constituírem a maioria dos pacientes com história de tentativa de suicídio e morte por queimaduras, representam um grupo vulnerável que merece recorte para aprofundamento do estudo. Métodos: Estudo retrospectivo, de caráter descritivo de série temporal. Foi desenvolvido na Unidade Tratamento de Queimados e no Instituto de Medicina Legal em Brasília (DF), entre os anos de 2010 e 2015. Resultados: Foram identificadas 42 mulheres com história de suicídio por queimaduras, tentado ou consumado. Houve 15 óbitos relacionados diretamente à lesão térmica. Houve um predomínio da faixa etária entre 30 e 44 anos, seguida por 15 a 29 anos. Em 64,3% dos casos o evento aconteceu no DF. Em relação aos agentes etiológicos, o mais comum foi o álcool (71,4%). A média de superfície corporal queimada foi de 34,38%, sendo que as pacientes que faleceram apresentaram áreas queimadas maiores (59,53%) do que as que sobreviveram (20,4%). Conclusão: Os dados obtidos no DF corroboram informações da literatura. Apesar do progresso envolvendo manejo e tratamento dos pacientes queimados, a prevenção continua sendo a melhor atitude.


Introduction: Suicide is a serious public health problem. For every death, there are an estimated 10 suicide attempts. Among the means of suicide, burns are prominent due to the lesion severity, the high mortality rate, and the severe functional, aesthetic, and psychological damage. Women comprise the majority of patients with a history of attempting suicide and death by burns and represent a vulnerable group that deserves attention. Methods: This retrospective descriptive time-series study was performed in the Burn Treatment Unit at the Institute of Legal Medicine in Brasília, Distrito Federal (DF) between 2010 and 2015. Results: A total of 42 women with a history of suicide by burns, attempted or consummated, were identified; 15 deaths were directly related to the thermal injury. Suicide by burns was the most predominant among patients aged 30 to 44 years was observed, followed by those aged 15 to 29 years. In 64.3% of cases, the event occurred in the Brasília, Distrito Federal (DF). Alcohol was the most common etiological agent (71.4%). The average burned body surface area was 34.38%, and the patients who died presented larger burned areas (59.53%) than that in those who survived (20.4%). Conclusion: The data obtained from the Brasília, Distrito Federal (DF) corroborate information from the literature. Despite progress involving the management and treatment of burn patients, prevention remains the best strategy.


Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Historia del Siglo XXI , Suicidio , Intento de Suicidio , Unidades de Quemados , Quemaduras , Salud Pública , Funciones Esenciales de la Salud Pública , Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Unidades de Quemados/normas , Unidades de Quemados/estadística & datos numéricos , Quemaduras/mortalidad , Quemaduras/psicología , Quemaduras/terapia
11.
Rev Infirm ; 68(256): 18-20, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31870471

RESUMEN

Pre-hospital management of a severe burn begins with an early assessment of the burn (burned skin surface, depth, location) and the concerned patient (age, comorbidities, injury associations). The immediate vital prognosis is more often due to associated injuries (trauma or poisoning) rather than burns. The patient must be referred by medical regulation to a burn treatment centre.


Asunto(s)
Quemaduras , Servicios Médicos de Urgencia , Unidades de Quemados , Quemaduras/terapia , Hospitales , Humanos , Pronóstico
12.
Rev Infirm ; 68(256): 21-22, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31870472

RESUMEN

The evaluation of the patient and his burned body surface is one of the fundamental prerequisites for his care on site as well as for the initiation of his care journey. New tools such as the E-burn application and telemedicine improve this assessment and remote medical assistance management by reducing the risk of under-sorting or over-sorting. Telemedicine limits inappropriate secondary inter-hospital transfers and the resulting increased mortality. It is carried out according to standards that ensure safety and confidentiality for the patient and caregivers.


Asunto(s)
Quemaduras , Telemedicina , Quemaduras/terapia , Humanos
13.
Rev Infirm ; 68(256): 25-27, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31870474

RESUMEN

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image.


Asunto(s)
Quemaduras , Vendajes , Quemaduras/psicología , Quemaduras/rehabilitación , Quemaduras/terapia , Humanos , Autoimagen
14.
Rev Infirm ; 68(256): 30-31, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31870476

RESUMEN

Dressings are a real challenge in the care of patients with thermal burns. They help to heal and prevent or treat possible skin infections. Paramedical teams must have a perfect strategy for organizing, managing pain and optimizing hygiene and asepsis rules. The purpose is to facilitate the understanding and implementation of this treatment by suggesting protocols that can be applied by all. It remains essential to mobilize specialized services to promote the evolution of burns.


Asunto(s)
Vendajes , Quemaduras , Adulto , Quemaduras/complicaciones , Quemaduras/terapia , Dermatitis/etiología , Humanos , Dolor , Cicatrización de Heridas
17.
Saudi Med J ; 40(10): 1027-1031, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31588482

RESUMEN

OBJECTIVES:   To investigate the prevalence and associated risk factors for venous thromboembolism (VTE) in burn patients.  Methods: This is a cross-sectional study eliciting the risk factors in burn patients who developed thromboembolism. The study took place at the Adult  Burn Unit, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Charts of all patients admitted to the burn unit from January 2010 to December 2016 were reviewed. Only patients 16 years of age and older were included. The research team with a consultant plastic surgeon developed the data sheet. A total of 304 patient records met the inclusion criteria. Logistic regression analysis was used to determine the risk factors for developing VTE. Results: Out of the entire study group of 304 patients, the majority (88.8%) of the participants received prophylactic anticoagulation. Twelve patients (3.9%)  developed VTE. All patients who developed VTE received prophylactic anticoagulation. Age, gender, body mass index, and degree of burn were not risk factors for VTE. However, electric burns were found to be an independent significant risk factor for developing VTE using a multivariate logistic regression. Conclusion: Electric burns were found to be the only independent significant risk factor of developing VTE.


Asunto(s)
Unidades de Quemados/estadística & datos numéricos , Quemaduras/complicaciones , Tromboembolia/etiología , Adulto , Anticoagulantes/uso terapéutico , Quemaduras/terapia , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Factores de Riesgo , Arabia Saudita/epidemiología , Tromboembolia/epidemiología , Tromboembolia/prevención & control
18.
Zhonghua Shao Shang Za Zhi ; 35(9): 697-700, 2019 Sep 20.
Artículo en Chino | MEDLINE | ID: mdl-31594190

RESUMEN

Telemedicine refers to two or more medical institutions using communication, computer, and network technology to provide remote diagnosis, treatment, and care for patients. The necessity and feasibility of applying telemedicine are determined by the characteristics of burn injury. This paper reviewed the application of telemedicine in burn surgery at home and abroad, then analyzed the significance and problems of using this technology in the field of burns, finally forecasted the future of application of telemedicine in burn surgery.


Asunto(s)
Quemaduras/terapia , Telemedicina/tendencias , Humanos
19.
Zhonghua Shao Shang Za Zhi ; 35(10): 712-714, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31658540

RESUMEN

Children are a special group, which have unique physiological characteristics and are still in the period of physical and mental growth and development, thus the prevention and treatment of scar in children are different from that in adults. Scar management in children is a complex and multifaceted system engineering. The grade of scar in children needs to be adjusted according to the age, period, and severity. Corresponding method needs to be chosen for the treatment of scar in children according to the classification of the scar. The compliance of children is poor, and the key to scar treatment is the persistence and cooperation of the parents, so doctors should strengthen propaganda and education to the parents of children with scar. For children with scar, individualized and comprehensive treatment should be used according to the characteristics of children to achieve good results.


Asunto(s)
Quemaduras/terapia , Cicatriz/rehabilitación , Adulto , Quemaduras/complicaciones , Niño , Cicatriz/etiología , Humanos , Padres , Pediatría
20.
Zhonghua Shao Shang Za Zhi ; 35(10): 720-725, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31658542

RESUMEN

Objective: To preliminarily observe the effects of application of micro-negative pressure in children with small-area deep partial-thickness burn. Methods: From January 2016 to August 2018, 64 children with small-area deep partial-thickness burn who were admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University were recruited in this prospective randomized controlled study. According to the random number table, they were divided into negative pressure group [18 boys and 14 girls, aged (3.9±1.6) years with total burn area of (5.5±2.2)% total body surface area (TBSA)] and conventional group [20 boys and 12 girls, aged (3.8±1.7) years with total burn area of (5.8±1.6)% TBSA], with 32 patients in each group. After admission, simple debridement was performed in the patients of 2 groups. After that, the children in negative pressure group were treated with micro-negative pressure with negative pressure material replaced every 3 to 5 days. Children in conventional group were treated with silver sulfadiazine cream with dressing change every other day. On post injury day (PID) 14 and 21, general wound observation was performed, the wound healing rate was calculated, the exudates from the wounds were cultured and the positive detection rate was calculated. The number of patients requiring surgical skin grafting was recorded and the rate of surgical skin grafting was calculated, and the complete wound healing time was recorded in the patients of 2 groups. Scar formation was evaluated by the Vancouver Scar Scale (VSS) in 3, 6, and 12 months after wound healing. Data were processed with chi-square test, t test, Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) On PID 14, all the necrotic tissue in the wounds of patients in negative pressure group was removed, with few exudates, and most of the wounds had been epithelialized; most of necrotic tissue in the wounds of patients in conventional group was removed, with more exudates and smaller wound healing area than those in negative pressure group. On PID 21, most of the wounds of patients in negative pressure group were healed, and the exudates were rare, while the wound healing area of patients in conventional group was significantly smaller than that in negative pressure group with more exudates. (2) On PID 14 and 21, the wound healing rates [(49.8±3.3)% and (95.8±2.4)%] of patients in negative pressure group were significantly higher than those in conventional group [(40.0±3.2)% and (75.3±2.5)%, t=11.899, 33.461, P<0.01]. (3) On PID 14 and 21, the positive detection rates of wound bacteria of patients in negative pressure group were significantly lower than those in conventional group (χ(2)=6.275, 5.741, P<0.05). (4) The rate of surgical skin grafting of patients in negative pressure group was significantly lower than that in conventional group (χ(2)=5.333, P<0.05). (5) The complete wound healing time of patients in negative pressure group [(23.9±2.3) d] was significantly shorter than that in conventional group [(27.9±1.8) d, t=-7.806, P<0.01]. (6) In 3, 6, and 12 months after wound healing, the VSS scores [(6.9±1.8), (5.6±1.4), (3.4±1.5) points] of patients in negative pressure group were significantly lower than those in conventional group [(9.0±1.5), (7.4±2.0), (5.7±1.6) points, t=-4.987, -4.127, -5.988, P<0.01]. Conclusions: In comparison with routine dressing change, the treatment of application of micro-negative pressure in children with small-area deep partial-thickness burn can significantly improve the wound healing rate and rate of surgical skin grafting, decrease the wound infection rate, shorten the wound healing time, and improve the wound healing quality.


Asunto(s)
Quemaduras/terapia , Cicatriz/terapia , Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Quemaduras/complicaciones , Niño , Preescolar , Desbridamiento , Femenino , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Cicatrización de Heridas
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