Specialty Certification for Burn Nursing: Value, Beliefs, and Benefits.

Specialty certification for burn nursing will be available in 2023. This review outlines the path taken from specialty recognition by the American Nurses Association to the Certified Burn Registered Nurse certification. Clinical expertise, knowledge, skill, mastery of professional issues, and competence are hallmark features of a nurse specialty certification. A review of resources will illustrate the evolution of burn nursing practice with the development of burn nursing standards, competencies, and characteristics of the professional burn nurse. Resources are identified which outline the value of specialty certification, providing an overview for the impact of burn nursing certification on professional development, nurse satisfaction, and patient outcomes. Burn nurses play a key role in the care and recovery of the burn-injured patient. Since 2017, members of the burn nurse community have taken steps to confirm the role of the modern burn nurse and document standards. As a community, we are now poised to advance our specialty one step further and support the development of a national burn nurse certification examination. This paper provides a historical account of the path taken for burn nurse specialty recognition and national certification to date. The value and impact of specialty certification in general is outlined, thus providing a comprehensive overview for the value and impact of certification on professional development, nurse satisfaction, and patient outcomes.

Burn Injuries Associated with At-Home Hair Braiding.

Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. As part of the styling process, the ends of the braid are commonly dipped in scalding water; an increasing number of patients have presented to our center after containers of recently boiled water are accidentally tipped over and spilled onto patients. A retrospective chart review was performed of all patients who sustained burn injuries related to at-home hair braiding presenting to an ABA-verified burn center between January 1, 2006 and July 31, 2020. A total of 41 patients presented over the study period, and the frequency of this type of burn increased over time, with 54% of injuries occurring in the past 3 years (2018-2020). The mean patient age was 7.5 years, and the majority of patients were under 18 years of age (97%), female (95%), and African-American (98%). Seventy-three percent of injuries occurred in the home and 88% involved another person in the hair braiding process. The mean TBSA burned was 5% (range 1-20%). The most commonly involved areas were the back (54%), thigh/leg (37%), and neck (24%). Ninety percent were partial-thickness injuries only, with 10% having some degree of full-thickness injury. Ninety percent of patients required inpatient admission, and 34% of patients required at least one operative procedure. Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to burn injuries that require hospitalization and the need for surgical intervention.

Urban Frostbite: Strategies for Limb Salvage.

Under ideal circumstances, severely frostbitten extremities are rapidly rewarmed and treated with thrombolytic therapy within 6 to 24 hours. In an "inner city," urban environment, most patients who suffer frostbite injuries present in a delayed fashion, sustain repeated injuries further complicated by psychological issues or intoxication, and are rarely ideal candidates for thrombolytic therapy within the prescribed timeframe. We describe our experience with the treatment of urban frostbite injuries. A retrospective review of patients with cold injuries sustained between November 2013 and March 2014 treated at a verified burn center in an urban setting was performed. Fifty-three patients were treated (42 males, 11 females). Average patient age was 41.8 years (range 2-84 years). No patients met criteria for thrombolytic therapy due to multiple freeze-thaw cycles or presentation greater than 24 hours after rewarming. Deep frostbite was seen in 10 patients. Of these patients, nine underwent debridement, resulting in partial limb amputations at levels guided by Tri-phasic technetium (Tc-99m) bone scans. Wound closure and limb-length salvage was then achieved by: free flap coverage (n = 2), local flaps (n = 8), split-thickness skin grafting (n = 22), and secondary intention healing (n = 6). While tissue plasminogen activator has been successful in reducing the need for digital amputation following frostbite injuries, in our experience, this treatment modality is not applicable to the urban patient population who often present late and after cycles of reinjury. Therefore, our approach focused on salvaging limb length with durable coverage, as the injuries were unable to be reversed.

Toxic Epidermal Necrolysis with Gastrointestinal Involvement: A Case Report and Review of the Literature.

Gastrointestinal involvement is a rare complication of toxic epidermal necrolysis syndrome (TENS) that results in sloughing of the intestinal epithelium. Prior case reports have noted the potential susceptibility of the entire gastrointestinal tract, from oropharynx and esophagus to sigmoid colon and rectum. Given its infrequency, the effect of gastrointestinal involvement on the treatment and prognosis of TENS is poorly understood. Here, the authors report a case of gastrointestinal symptoms in a patient diagnosed with toxic epidermal necrolysis, likely representing gastrointestinal involvement. In addition, the authors describe the histopathologic and endoscopic characteristics of the involved mucosa, clinical course, and present a review of the literature of this rare but potentially impactful complication of TENS.

The Utility and Versatility of Perforator-Based Propeller Flaps in Burn Care.

The majority of surgical burn care involves the use of skin grafts. However, there are cases when flaps are required or provide superior outcomes both in the acute setting and for postburn reconstruction. Rarely discussed in the context of burn care, the perforator-based propeller flap is an important option to consider. We describe our experience with perforator-based propeller flaps in the acute and reconstructive phases of burn care. We reviewed demographics, indications, operative details, and outcomes for patients whose burn care included the use of a perforator-based propeller flap at our institution from May 2007 to April 2015. Details of the surgical technique and individual cases are also discussed. Twenty-one perforator-based propeller flaps were used in the care of 17 burn patients. Six flaps (29%) were used in the acute phase for coverage of exposed joints, tendons, cartilage, and bone; coverage of open wounds; and preservation of range of motion (ROM) by minimizing scar contracture. Fifteen flaps (71%) were used for reconstruction of postburn deformities including coverage of chronic wounds, for coverage after scar contracture release, and to improve ROM. The majority of flaps (94% at follow-up) exhibited stable soft tissue coverage and good or improved ROM of adjacent joints. Three cases of partial flap loss and one case of total flap loss occurred. Perforator-based propeller flaps provide reliable vascularized soft tissue for coverage of vital structures and wounds, contracture release, and preservation of ROM across joints. Despite a relatively significant risk of minor complications particularly in the coverage of chronic wounds, our study supports their utility in both the acute and reconstructive phases of burn care.

Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: vacuum-assisted closure and gauze suction.

Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.

Is palmar surface area a reliable tool to estimate burn surface areas in obese patients?

Estimating TBSA burned is critical to the initial management and fluid resuscitation of patients who have sustained burn injuries. TBSA of scattered burn injuries are frequently estimated using the patient's percentage palmar surface area (%PSA), which is taught as being 1% of the TBSA. This study investigates the relationship of %PSA to TBSA as the body mass index (BMI) increases. Age, sex, race, weight, height, and PSA was collected from obese and nonobese volunteers. TBSA was calculated using the Mosteller, DuBois-DuBois, Livingston and Scott, and Yu formulas. The %PSA relative to TBSA was calculated in obese and nonobese volunteers. Data from 100 subjects were collected. Fifty subjects had a BMI >30 and 50 had a BMI <30. The average age was 41 years (22-77 years old). There were 68 women and 32 men. The %PSA ranged from 0.49% of TBSA with a BMI of 58.7 to 1.15% of TBSA with a BMI of 22.6. This correlation of %PSA to BMI was statistically significant with all of the formulas. We should not assume that the %PSA is always 1% of TBSA, especially in obese patients.

Association of lower limb injury with boot cleat design and playing surface in elite soccer.

Reducing external injury risk factors associated with the boot-surface interaction is important in reducing the incidence and severity of foot and ankle injury. A review of prospective football (soccer) injury epidemiology studies determined that the incidence of noncontact ankle sprain injury is relatively high. Research on the impact of cleat shape and configuration and boot design on the boot-surface interaction is providing new understanding of the impact on player biomechanics and injury risk but is not keeping pace with commercial advances in boot design and innovation in natural and synthetic turf surface technology.

Behaviors of young children around microwave ovens.

BACKGROUND: Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. A portion of these injuries occur when children are removing items from microwave ovens. This study assessed the ability of typically developing children aged 15 months to 5 years to operate, open, and remove the contents from a microwave oven. METHODS: The Denver Developmental Screening Test II was administered to confirm typical development of the 40 subjects recruited. All children recruited and enrolled in this study showed no developmental delays in any domain in the Denver Developmental Screening Test II. Children were observed for the ability to open both a push and pull microwave oven door, to start the microwave oven, and to remove a cup from the microwave oven. RESULTS: All children aged 4 years were able to open the microwaves, turn on the microwave, and remove the contents. Of the children aged 3 years, 87.5% were able to perform all study tasks. For children aged 2 years, 90% were able to open both microwaves, turn on the microwave, and remove the contents. In this study, children as young as 17 months could start a microwave oven, open the door, and remove the contents putting them at significant risk for scald burn injury. CONCLUSIONS: Prevention efforts to improve supervision and caregiver education have not lead to a significant reduction in scald injuries in young children. A redesign of microwave ovens might prevent young children from being able to open them thereby reducing risk of scald injury by this mechanism.

Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach.

BACKGROUND: Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system. METHODS: Records of 48 patients with a histopathologic diagnosis of toxic epidermal necrolysis syndrome treated with burn equivalent critical care and antishear wound care from September of 1985 to April of 2004 were reviewed. Observed mortality data were compared with those expected using the SCORTEN, and the standardized mortality ratio was calculated. RESULTS: The overall mortality rate was 27 percent. Factors affecting mortality were advancing age, time to burn unit admission, multisystem organ failure, and presence of comorbidities (p = 0.02, p = 0.02, p < 0.001, and p = 0.003, respectively). Chronic renal insufficiency and malignancy were two independent risk factors for nonsurvival (p = 0.04 and p = 0.004, respectively). Patients with a SCORTEN score of 2 or less had no mortality rate in this series. Observed and predicted mortality rates were comparable for patients with SCORTEN scores of 3 or greater. Patients with combined scores of 3 or less had a standardized mortality ratio score of 0.58 (42 percent mortality reduction). Overall, the standardized mortality ratio was 0.89 (11 percent mortality reduction). CONCLUSIONS: Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.

Disruption to social dyadic interactions but not emotional/anxiety-related behaviour in mice with heterozygous 'knockout' of the schizophrenia risk gene neuregulin-1.

Clinical genetic studies have implicated neuregulin-1 [NRG1] as a leading susceptibility gene for schizophrenia. NRG1 is known to play a significant role in the developing brain, which is consistent with the prevailing neurodevelopmental model of schizophrenia. Thus, the emotional and social phenotype of adult mice with heterozygous 'knockout' of transmembrane [TM]-domain NRG1 was examined further in both sexes. Emotional/anxiety-related behaviour was assessed using the elevated plus-maze and the light-dark test. Social behaviour was examined in terms of dyadic interactions between NRG1 mutants and an unfamiliar C57BL6 conspecific in a novel environment. There was no effect of NRG1 genotype on performance in either test of emotionality/anxiety. However, previous reports of hyperactivity in NRG1 mutants were confirmed in both paradigms. In the test of social interaction, aggressive following was increased in NRG1 mutants of both sexes, together with an increase in walkovers in female mutants. These findings elaborate the specificity of the NRG1 phenotype for the social rather than the emotional/anxiety-related domain. They indicate that NRG1 is involved in the regulation of reciprocal social interaction behaviour and thus suggest a putative role for NRG1 in a schizophrenia-related endophenotype.

Prehospital and emergency department burn care.

Burn-injured patients have special needs in the prehospital and emergency department settings. This article addresses the nursing priorities in prehospital and emergency department care.