Comparison of the safety and efficacy for different regimens of pharmaco-prophylaxis among severely burned patients: a randomized controlled trial.

PURPOSE: Venous thromboembolism (VTE) is a common complication in critically ill patients, including severe burn cases. Burn patients respond differently to medications due to pharmacokinetic changes. This study aims to assess the feasibility and safety of different VTE pharmaco-prophylaxis in patients admitted to the ICU with severe burns. METHODS: A pilot, open-label randomized controlled trial was conducted on ICU patients with severe burns (BSA ≥ 20%). By using block randomization, patients were allocated to receive high-dose enoxaparin 30 mg q12hours (E30q12), standard-dose enoxaparin 40 mg q24hours (E40q24), or unfractionated heparin (UFH) 5000 Units q8hours. In this study, the primary outcomes assessed were the recruitment and consent rates, as well as bleeding or hematoma at both the donor and graft site. Additionally, secondary measures were evaluated to provide further insights. RESULTS: Twenty adult patients out of 114 screened were enrolled and received E30q12 (40%), E40q24 (30%), and UFH (30%). The recruitment rate was one patient per month with a 100% consent rate. Donor site bleeding occurred in one patient (16.7%) in the UFH group. On the other hand, graft site bleeding was only reported in one patient (12.5%) who received E30q12. Major bleeding happened in two patients, one in E30q12 and one in the UFH group. Five patients (25.0%) had minor bleeding; two patients (25.0%) received E30q12, two patients E40q24, and one patient UFH. RBC transfusion was needed in four patients, two on E30q12 and two on UFH. Only one patient had VTE, while four patients died in the hospital. CONCLUSION: The study observed a low recruitment rate but a high consent rate. Furthermore, there were no major safety concerns identified with any of the three pharmacologic prophylaxis regimens that were evaluated. TRIAL REGISTRATION NUMBER: NCT05237726.

An Emergency Adaptation of Anterolateral and Clamshell Thoracotomy for Blunt Traumatic Right Atrial Rupture: A Case Report.

The high mortality rate of blunt cardiac injuries is primarily due to the condition's severity and the challenges associated with pre-hospital survival. The absence of definitive diagnostic modalities necessitates prompt and adaptable surgical intervention. We present an 18-year-old male who sustained a right atrial blunt traumatic cardiac rupture following a motor vehicle collision. Despite initial stabilization with blood products and vasopressors and the necessitated emergent surgical exploration, the case required various surgical techniques, including anterolateral followed by an extension to a clamshell thoracotomy and laparotomy to manage the complex cardiac rupture and associated injuries. Furthermore, it underscores the critical nature of surgical incision in such patients and its impact on the overall prognosis. The successful outcome, highlighted by intraoperative decision-making and proper postoperative care, demonstrates that with timely and adaptable surgical approaches, even the most severe cases of traumatic blunt cardiac ruptures can be managed effectively.

A National Study of the Effect of Race, Socioeconomic Status, and Gender on Burn Outcomes.

Age, burn size, and inhalation injury are the major contributing variables related to burn mortality. While the female gender has been linked to higher mortality, the impact of socioeconomic status has not been well studied. The interplay between these three factors is also unknown. This study sought to clarify the effects of these variables on outcomes in a national sample of patients with burns. A retrospective review of 172,640 patient records of the National Burn Repository (version 8, 2002-2011) data was conducted. Of those records, 36,960 (21.4%) patient entries were excluded for duplicate entries, follow-up visits, readmissions, nonburn injuries, skin diseases, and incompleteness (missing date of admission, date of discharge, race, or TBSA of burn or TBSA). Univariate and multivariate analyses were performed to compare outcomes by race (Caucasian, African-American, and other minority groups). P < .05 was considered significant. The study group included 135,680 patients and was predominately Caucasian (59.0% Caucasian, 19.0% African-American, and 22.0% other minority groups). The African-American race had more females, operations, longer length of stay, ventilator days, septicemia (all P < .001), and urinary tract infections (UTIs, P < .01). Caucasians had the largest burns (9.27 ± 13.22, P <.001) and were more likely to be older, to be intubated, and to have longer intensive care unit stays and higher mortality (all P < .001). Other non-African-American minorities (other minority group) had the second largest burn sizes, most uninsured members, and lowest mortality (P < .001). On multivariate analysis, mortality was related to African-American race, female gender, TBSA, full-thickness burn injury, inhalation injury, uninsured status, and burn mechanism. African-Americans were 50% more likely to have complications (P < .001), 30% more likely to have UTIs (P = .002), and 41% more likely to get septicemia (P < .001). Other racial minority groups had more acute respiratory distress syndrome, pneumonias, septicemia, UTIs, length of stay, and hospital charges when compared with Caucasian patients. Socioeconomic status was related to mortality but inconsistently related to other outcomes. Race appears to play a significant role in burn injury outcomes. Minority groups, especially African-Americans, have a higher risk of morbidity and mortality compared with Caucasian patients with burns. Socioeconomic status and gender also play a significant role in burn outcomes. Future studies should focus on delineating the reasons for this disparity.

Obstruction and perforation of the small bowel caused by inadvertent ingestion of a blister pill pack in an elderly patient.

Perforation of the small bowel due to foreign body ingestion is a rare instance that occurs in less than 1% of all ingestions. Although rare, ingestion of blister pill packaging is becoming more recognised as a causative agent for intestinal perforation, but is very rarely reported to cause intestinal obstruction. This is a report of a 66-year-old woman who presented with intestinal obstruction and underwent laparotomy, revealing small bowel perforation by a piece of blister pill pack foil. The patient was incognisant of the ingestion.

Postcoital hemoperitoneum caused by ruptured corpus luteal cyst: a hidden etiology.

Corpus luteal rupture is a common gynecologic cause for hemoperitoneum. Recent sexual intercourse is usually a preceding factor. However, postcoital hemoperitoneum without evident vaginal injury or trauma is rarely reported. We present a 34-year-old female who presented to the emergency department with severe bilateral lower quadrant abdominal pain after sexual intercourse. CT of the abdomen and pelvis revealed an intra-abdominal hematoma with extravasation of contrast questionable to be from one of the branches of the left internal iliac artery, and no adnexal abnormalities. Left internal iliac artery angiogram was performed and revealed no active extravasation. Exploratory laparotomy was performed and revealed an actively bleeding left ovarian ruptured area that was repaired and biopsied. No evidence of cysts was observed. Histopathological examination revealed a hemorrhagic corpus luteal cyst. Suspicion for corpus luteal rupture as a cause of postcoital hemoperitoneum should be maintained despite nonevidence of cysts on CT or intraoperatively.

Isolated complete jejunal transection following abdominal blunt trauma with delayed presentation.

In blunt trauma, diagnosis of small bowel injury is infrequent and accounts for less than 1.1% of blunt trauma admissions. Of those, only 0.3% are perforated.1 Isolated transection of the jejunum following blunt abdominal trauma has rarely been reported in literature.2,3 Most cases of small bowel perforations after blunt trauma occur as a result of motor vehicle crashes and falls from heights and are often associated with multiple injuries.4 This is a report of a 26 year-old female that presented 14 h after being involved in a motor vehicle crash and was found to have complete transection of her proximal jejunum with underlying mesenteric injury. Following the crash, the patient extricated herself from the vehicle, went home, and fell asleep with no significant complaints initially reported. She woke up hours later with severe abdominal pain and presented to our emergency department. CT was performed and revealed free fluid in the abdomen. Subsequently, an exploratory laparotomy was performed that revealed complete jejunal transection with underlying mesenteric injury. Isolated complete transection of the proximal jejunum should be considered in the evaluation of patients following blunt abdominal trauma, and presentation may be delayed up to 14 h. To the best of our knowledge, this is the first case report of complete transection of the proximal small bowel following a motor vehicle crash with the longest delay in presentation reported in the literature.