bluuebunny/crossref_metadata_2025_split huggingface dataset:
598 Protection Against Thermal Stress in Humans: Application of “Cooling Wear” Under Heated Conditions in Burn Centers
Authors: Luze Hanna , Holzer Judith , Nischwitz Sebastian P , Kamolz Lars-Peter 
Published: March 2020

Abstract

Introduction
Many professional groups have to work in places with high temperatures; this includes, for example, doctors and nursing staff working at burn centres. Increased ambient temperature during the care of severely burned patients in the operating theatre and intensive care unit is used to mitigate the loss of thermoregulation, prevent hypothermia, and minimize the impact of hypermetabolism. However, experimental evidence indicates, that even relatively mild thermal stress may affect human performance. Novel cooling strategies have been invented for reducing thermal stress in people, who are occupationally exposed to high temperatures and have for instance already been tested in the military field. Here, the present study investigated the effects of cooling wear on the performance under high ambient temperatures.

Methods
Effects of cooling wear on concentration and performance of surgeons were investigated in 12 subjects during a simulated burn surgery. Subjects were divided into two groups, one group wearing cooling wear and one control group with normal scrubs. Directly before the exposure to high ambient temperatures, subjects of both groups underwent standardized tests for concentration, manual dexterity and measurements of physiological parameters. After a simulated burn surgery of 1 hour, subjects underwent the same analysing procedure again.

Results
Results proved that even relatively mild thermal stress affects performance whereby complex actions, that require high concentration, are primarily affected. Initial values of both groups showed approximately homogenous values. After heat exposure, however, subjects who received cooling wear showed higher results in tests for concentration and manual dexterity. Furthermore, the comparison of physical parameters indicates the ability of cooling wear to reduce thermal stress and its’ negative effects on the human organism.

Conclusions
Decrements in vigilance, performance and endurance are well-documented effects of thermal stress. As an opportunity to withstand thermal stress and therefore improve medical care, cooling wear showed good results in many aspects.

Applicability of Research to Practice
Based on these promising results cooling strategies may be used as an important tool in medical sectors in the future. Burn medicine may particularly profit from further development and rigorous investigation of cooling strategies.
602 Managing Hypothermia in the Surgical Burn Patient
Authors: Regojo Patricia , Mohan Molly 
Published: March 2020

Abstract

Introduction
It is known, hypothermia, core body temperature at or below 36oC/96.8oF, can lead to dangerous complications for burn patients. Due to loss of their protective thermoregulation, burn patients are at an increased risk of hypothermia during surgery. Findings from a Quality Assurance audit revealed burn patients were returning from surgery hypothermic and hemodynamically unstable. There was little evidence of intra-operative temperature management in the electronic medical record (EMR) or reported to the nurse upon the patients’ return from the operating room (OR). Only 73% of patients had temperatures recorded during their surgery and of those, 40% had a drop of temperature &gt;2 degrees from their baseline. The purpose of this collaborative evidence-based quality assurance project was to improve temperature management in the operating room and prevent hypothermia in the intra and post operative periods. Our aim was to develop warming methods pre-operatively that would establish a goal for keeping the patients’s temperature within 2 degrees of their baseline preoperative temperature during surgery.

Methods
A literature search obtained from CINAHL, Cochrane, EMBASE, and MEDLINE from 2010–2018, provided current surgical guidelines and evidence-based practices for managing surgical hypothermia in burn patients (levels of evidence I, III, V, & VI). Recommendations from the burn unit staff for preoperative warming initiatives were listed and shared with the OR staff. Hemodynamic documentation, including core temperature, estimated blood loss, and intra-operative warming methods were monitored for twelve months after the Burn Unit Warming Protocol was implemented. Progress was reported quarterly in our Burn and Trauma Quality Committees.

Results
After implementing the Burn Unit Warming Protocol, temperature management of the burn patient improved. Intra-operative warming methods were initiated. Patients began returning from surgery warmer with improved hemodynamics. 96% of the patients had their temperatures recorded and managed intra-operatively. Of those patients, only 2.6% had a drop in temperature &gt; 2 degrees from their pre-operative baseline.

Conclusions
Implementing a nurse-driven warming protocol from the pre-operative stage through surgery can aid in reducing post-operative hypothermia in burn patients.

Applicability of Research to Practice
Managing hypothermia will help reduce complications that can lead to increase morbidity and mortality in burn patients.
632 Heterotopic Ossification Related Contractures: Success with Bodyweight Stretches
Authors: Tinlin Kristen E , Comstock Jill , Sood Rajiv 
Published: March 2020

Abstract

Introduction
Heterotopic Ossification (HO) occurs following a trauma and is a complication in therapy recovery following burn injuries. Burn literature reveals the incidence of HO is present in approximately 2% of the burn population. There is limited evidence supporting bodyweight stretches in the treatment of HO related contractures. When present, HO can result in a loss of range of motion (ROM), significant pain and limit independence with daily activities. This case study identifies therapeutic interventions, specifically bodyweight stretches, with associated positive outcomes that improved HO related contractures. This challenges the common practice of discontinuation of aggressive ROM with an HO diagnosis.

Methods
Two patients were identified as having been diagnosed with HO and subsequent loss of joint ROM that successfully regained motion without requiring surgical intervention. Retrospective chart reviews were completed that compared demographics, hospital course, timing of HO diagnosis, outpatient therapy frequency and duration, treatment interventions and time to resolve ROM deficits. Graphs were created that tracked rehab course and ROM progression along with therapeutic interventions to identify common factors that contributed to regaining mobility.

Results
Both patients were of similar age with an average TBSA of 64% and comparable hospital stays. At the outpatient therapy evaluation, each patient presented with approximately 50% loss of joint ROM in one upper extremity joint. The pair received occupational and physical therapy services. With different frequencies and durations, both achieved nearly normal joint ROM at the completion of their rehab. Patient 1 attended therapy 3-4x weekly over 4 months and regained 70° of active shoulder flexion motion. Patient 2 attended burn therapy once weekly for a period of 9 months and regained 60° of elbow flexion. In each case, the most significant ROM improvements were noted after initiating bodyweight exercises to maximize end range stretches and total body strengthening. Interventions included planks, modified yoga positions, push ups and pull ups. Both patients demonstrated a high pain tolerance and motivation to progress stretches to end range that resulted in maximum ROM gains.

Conclusions
Therapy guided, self administered stretches using bodyweight as an external force strongly contributed to significant ROM improvements and remediation of HO related contractures. Higher therapy dosage with a frequency of 3x weekly resulted in quicker resolution of ROM deficits as compared to 1x weekly dosage.

Applicability of Research to Practice
Rehab success following a burn injury can be strongly limited with the diagnosis of HO. This research utilizes a common therapy practice of bodyweight stretches to improve HO related contractures, leading to greater mobility gains and a quicker return to their desired lifestyle.
636 Case Report on Continuous Passive Motion (CPM) Therapy on Hand Burns in a Patient with a Large Total Body Surface Area (TBSA) Burn
Authors: Mullen Audrey , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy , Collins James , Askari Morad 
Published: March 2020

Abstract

Introduction

Methods

Results
Expectations: To lose ROM as healing progressed due to the extent of the injuries (based on prior experience) & because some contracture was assessed as early as 1 week.

Outcomes

Conclusions

Applicability of Research to Practice
That other therapists might consider this therapy and experience similar outcomes when treating deeply burned hands.
710 Use of Airway Pressure Relief Ventilation (APRV) in Burn Patients with and Without Inhalation Injury
Authors: Foster Kevin N , Buchanan Dylon , Durr Timothy , Richey Karen J 
Published: March 2020

Abstract

Introduction
Burn patients often require ventilator management because of large % TBSA injury, the presence of inhalation injury, and/or other factors. Airway pressure relief ventilation (APRV) offers several advantages over conventional ventilation modes including improved alveolar recruitment, better oxygenation and hemodynamics, preservation of spontaneous breathing, and possibly less ventilator-induced lung injury. This study reviews the use of APRV as the primary ventilator mode in burn patients with and without inhalation injury.

Methods
A retrospective chart review of patients admitted to the burn center and requiring APRV ventilation over a ten year period was performed. Data collected included demographic data, burn injury data, ventilator settings, arterial blood gas data, and development of ventilator-associated pneumonia (VAP).

Results
There were 411 patients identified over the ten year period. Mean age was 46 years, and mean % TBSA burned was 33. Seventy-three percent were male. One-half (51%) of patients had an inhalation injury. Mean hospital length of stay was 32 days with 22 mean ventilator days. Average number of surgeries was 4.4 per patient. Mean high pressure (P high) was 23 mm Hg. Mean FiO2 was 88% on post-injury day (PID) 1, 65% on day PID 2, and 45% thereafter. Mean P/F ratio was 333. Mean pH was 7.40, mean pCO2 was 40 mmHg, and mean HCO3 was 25 mm Hg. Forty-six percent of patients met criteria for diagnosis of VAP.

Conclusions
These data demonstrate that burn patients requiring mechanical ventilation can be safely and effectively managed with APRV. Oxygenation, carbon dioxide removal, normal acid-base status, and excellent P/F ratios were maintained with relatively low ventilator settings such as peak airway pressure and FiO2. Patients were able to breathe spontaneously when able and were easily liberated form the ventilator at the appropriate time.

Applicability of Research to Practice
This study defines an unconventional and potentially improved ventilator mode use in burn patients.
751 Airway Management of Patients Burned While Smoking on Oxygen: Intubation Rates and Associated Risks
Authors: Leonard Clinton D , Bennett Crystal 
Published: March 2020

Abstract

Introduction
A growing population among burn units across the country includes those burned while smoking on oxygen, occasionally resulting in resulting in complications such as full thickness burns requiring grafting, COPD exacerbations and arguably the most serious among this population, inhalation injury. First responders assess the respiratory status of these patients, occasionally choosing to intubate based on signs of respiratory distress. Due to the high proportion of intubated patients in our burn center and the risks of unnecessary intubation, this study will look at trends for patients burned while smoking on oxygen, especially regarding airway management.

Methods
A retrospective chart review was performed for all patients who were treated by referring providers prior to transfer to our Burn Center between July 2012 – August 2014. A subset analysis was performed on patients whose mechanism was injury resulting from smoking on oxygen. Demographics, airway management, and outcome data were measured.

Results
33 of 623 total patients who were treated by referring providers met the inclusion criteria for this study.
Twenty-one (64%) were intubated prior to arrival at the Burn Center. Of those intubated, twelve patients (57%) were extubated within 24 hours. Only four patients (19%) were found to have inhalation injury.
Overall mortality rate for these patients was 18%, over four times as high as our total mortality rate for transfer patients.
Length of stay (LOS) for those who survived their hospital stay without being intubated (3.45 days) was less than those who survived after being intubated (4 days).

Conclusions
The relatively low proportion of inhalation injury and high rates of extubation within 24 hours indicate the necessity of education improvements regarding risks of unnecessary intubation for regional first responders and physicians.
The low incidence of inhalation injury and high rates of extubation by hospital day 1 support previously published reports of overintubation among this patient population.
These patients have mortality rates despite small TBSA burns.
Further study is warranted to further describe the unique attributes of this high-risk patient population to develop appropriate treatment algorithms.

Applicability of Research to Practice
Dissemination of this information to first responders and pre-Burn Center hospitals will help reduce the morbidity and mortality associated with overintubation, especially in a medically fragile patient population such as those who are on supplemental oxygen.
784 Automated SIRS Alert Systems Are Ineffective at Predicting Sepsis in Burn Patients
Authors: Grigsby Melissa , Palmieri Tina L , Sen Soman , Romanowski Kathleen S , Greenhalgh David G 
Published: March 2020

Abstract

Introduction
Burn injury patients represent a population at particularly high risk for sepsis and sepsis mortality due to the severe immunological insult. Because of the unique nature of burn injury, this population has largely been excluded from studies developing protocols for identification and treatment of sepsis. In our institution, the protocolized approach to sepsis starts with an alert if two SIRS criteria are met, regardless of the patient’s diagnosis. We examined whether the SIRS alert was an effective way to identify and treat sepsis in burn patients.

Methods
Patients admitted to the burn surgery service at an academic regional burn center were identified by querying the “SIRS alert” dashboard from the hospital’s quality and safety department. The dashboard is a record of every patient whose clinical status triggered a SIRS alert during hospital admission, and whether a screening order set was opened. The SIRS alert and order set usage data were analyzed directly from the dashboard. Each patient’s chart was then reviewed to decide whether there was clinical suspicion of sepsis at the time an order set was released. We determined that there was clinical suspicion of sepsis if antibiotics were initiated or escalated within 6 hours of a SIRS screening order set being opened.

Results
From January 1, 2019 until September 14, 2019 there were 225 patients admitted to the burn surgery service at an academic regional burn center. 70 patients, specifically receiving treatment in the burn ICU, met the criteria to trigger a SIRS alert at least once in that time. Across those 70 patients, a total of 1381 SIRS alerts were acknowledged by the nursing staff. Due to a lack of clinical suspicion for sepsis, the SIRS screening order set was opened 8.5% of the time an alert was acknowledged. Only two times in the 1381 alerts was an order set opened and then followed by the initiation or escalation of antibiotics within 6 hours.

Conclusions
SIRS criteria appear to be ineffective at helping clinicians to identify and treat sepsis in the burn patient population. This is consistent with the fact that burn patients are in a virtually constant state of inflammation, making SIRS alerts futile at picking up subtle changes that could indicate early sepsis.

Applicability of Research to Practice
Hospitals should abandon the use of the standard SIRS criteria as a starting point for sepsis protocols when treating burn patients. There does not yet exist a validated criteria set to replace the standard SIRS criteria. In the meantime, the Burn Sepsis Consensus Conference definitions could be used as a guideline to modify the criteria, and future research should continue seeking to identify early predictors of sepsis in the burn population.
798 Introduction of Bedside Echocardiography by Mid-level Providers into Burn Intensive Care
Authors: Chambers Michael G , Britton Garrett W , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Point-of-care ultrasound (US) has been shown to be a useful adjunct in assessment of various shock states and has been utilized to guide both resuscitation and post-resuscitation de-escalation. We aimed to characterize the use of bedside ultrasound examinations performed by advance practice providers (APPs) and attending physicians in a burn intensive care unit (BICU).

Methods
We introduced routine US by an APP into our BICU and evaluated our experience under an approved PI project. Daily beside US exams were performed utilizing a portable US machine with a cardiac probe and tissue filter. US exams included focused transthoracic echocardiography, assessment of inferior vena cava diameter with distensibility/collapsibility indices, and pulmonary evaluation. The images were archived to a centralized repository and reviewed daily during multi-disciplinary rounds. US data were utilized in conjunction with physical exam, radiographic, and laboratory findings for medical management decision making.

Results
Thirty-four exams of 34 patients have been conducted to date. 91% of US findings corresponded to physical, laboratory, and radiographic findings, and contributed positively to medical decision making. 9% of US findings either did not contribute to medical decision making or conflicted with physical exam, radiographic, or laboratory findings.

Conclusions
Our results demonstrate the feasibility of routine US by an APP in the BICU, and indicate that bedside US helps guide both resuscitative and post-resuscitative care.

Applicability of Research to Practice
It is well known that positive fluid balance is associated with worse clinical outcomes. We believe point-of-care US is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.
808 Utilizing High Fidelity Simulation in Advanced Burn Life Support Scenarios
Authors: Hellebusch Katie , Curtis Alyson , Westlake Bethany , Siemons Kimberly 
Published: March 2020

Abstract

Introduction
Keeping staff up-to-date on required certifications has always been a gold standard for optimum care of specialty patients in our facility. We currently house a 12-bed American Burn Association(ABA) verified burn unit within this 800-bed hospital. All critical care nurses hired into the Burn Unit are required to obtain Advanced Burn Life Support(ABLS) certification within one year of hire. After the first year, all Burn Unit nurses are required to maintain ABLS certification through renewal.
Our hospital currently has seven active ABLS instructors. However, it is difficult to find volunteers willing to have moulage applied and be assessed head-to-toe. Another confounding issue is utilizing additional Burn Unit staff as “scenario patients” causing unfavorable staffing patterns. In March of 2019, we set out to investigate the functionality of high fidelity simulation during ABLS patient assessment performance test outs.

Methods
Our hospital has a simulation expert that facilitates high fidelity simulations with physician, residents and fellows. We sought out his expertise to understand the feasibility of having a mannequin follow scenario requirements. Both adult and small-child mannequins had the ability. Vital signs could be activated on the monitor screen once an ABLS candidate stated they had assessed the patient. Vital signs could then be adjusted throughout the scenario to coincide accordingly. Both mannequins had the ability to be turned and assessed head-to-toe. Both mannequins were fully dressed at the start of the each scenario, with the expectation each would be fully undressed in proper sequence during the test out.The burns were simulated using mix-and-pour skin effects silicone rubber. The moulage reflected the appropriate degree of burn for each scenario.

Results
High fidelity simulation has been utilized in our facility for two ABLS courses with great success. ABLS pass rates remain constant. A more realistic setting was obtained when utilizing simulation labs. Further improvements could be made to utilize the simulation’s highest functionality.

Conclusions
The use of simulation for a variety of burn patient scenarios that represent potential situations allowed learning to occur in a safe and realistic environment. Moving forward, improvement opportunities include utilizing the simulation mannequins and simulation-experts to their fullest capability. An additional component needs to be added prior to test-out, orienting the ABLS candidates to the simulation environment.

Applicability of Research to Practice
Mixed teaching modalities have been utilized for decades. Simulation has led to more realistic assessments and hands-on learning. There remains a need to merge scenario-based education with simulation-based education to further learners thought process and move from route memorization, to functional knowledge and application.