bluuebunny/crossref_metadata_2025_split huggingface dataset:
522 Perioperative Echocardiographic Assessment of Malnutrition-Related Cardiomyopathy: A Case Series
Authors: McQuitty Alexis L , Brown Frances , Ozhathil Deepak K , Sreshta Erin , Talon Mark D 
Published: April 2021

Abstract

Introduction
It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Monitoring nutritional status is an integral part of improving post-burn cardiomyopathy. Perioperative echocardiography can be used to assess the degree of cardiac dysfunction and alter treatment in these patients.

Methods
Serial echocardiographic parameters were measured (ejection fraction, fractional shortening, pericardial fluid) in 4 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting), delayed wound healing, and a late presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients up to 2 years post-injury. Acutely injured or septic patients were excluded.

Results
Echocardiographic measurements were obtained in 4 patients, ages 7–21. The TBSA ranged from 33–95% and included flame injury and electrical burns. The initial ejection fraction ranged from 12–38% in patients with a BMI range of 10–16. The mean initial albumin was 1.65g/dL; the mean prealbumin was 10.8mg/dL. Selenium deficiency was noted in 1 patient. Dobutamine was required intraoperatively in several patients.

Conclusions
Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy of varying degrees. However, the degree of systolic dysfunction varied significantly. Chronic surgical grafting was used to manage burn wounds, while slow nutritional rehabilitation normalized the patient’s BMI with careful avoidance of refeeding syndrome. As exemplified by serial echocardiography, one patient’s EF improved over 1 year from 12% to 50–55% as the nutritional status also improved, demonstrated by the normalization of his BMI. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and required only short-term inotropic agents. Intraoperative and serial echocardiography allowed for continued monitoring and alteration of the heart failure medication regimens if required. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year.
523 Retrospective Outcomes Analysis of Tracheostomy in Paediatric Burn Population
Authors: Iglesias Nicholas , Prasai Anesh , Golovko George , Ozhathil Deepak K , Wolf Steven E 
Published: April 2021

Abstract

Introduction
For decades, controversy has raged regarding the placement of tracheostomy in severe paediatric burns. Numerous variables including extent of smoke inhalation injury, % TBSA burned, age of the patient, and co-morbidities among others complicate reaching consensus. Furthermore, paediatric patients are particularly susceptible to complications including inadvertent loss of airway and long-term swallowing and other anatomic issues. Additionally, previous analysis of the efficacy of tracheostomy in paediatric burn patients appears to be hindered by a lack of nationwide analysis. The aim of this study was to explore the efficacy of tracheostomy in the general paediatric burn patient population.

Methods
De-identified patient data was obtained from the TriNetX Research Network database. Two cohorts were identified: paediatric burn patients with tracheostomy (cohort A) and paediatric burn patients without tracheostomy (cohort B). Burn patients were identified using the ICD-10 codes T20-T25 & T30-T32. Tracheostomy was identified using the ICD-10 codes 1005887, 1014613, 31600, 31601, 31603, 31604, 31610, and Z93.0. A total of 132 patients were identified in cohort A in 23 HCOs and 83,117 patients were identified in cohort B in 38 HCOs. Infection, hypovolemia, pulmonary injury, laryngeal injury, pneumonia, and death were compared between the cohorts.

Results
Cohort A had a mean age of 11 (SD=5) and Cohort B had a mean age of 9 (SD=5). Paediatric burn patients with tracheostomy had a higher risk for death, infection, hypovolemia, pulmonary injury, laryngeal injury, and pneumonia when compared to their non-tracheostomy counterparts. The risk ratios for these outcomes were 62.452, 4.713, 9.267, 26.483, 116.163, and 18.154, respectively.

Conclusions
The analysis of the longitudinal outcomes of pediatric burn patients with tracheostomy as compared to those without tracheostomy demonstrated the tracheostomy cohort suffered much worse mortality and morbidity across several metrics. The potential benefits of tracheostomy placement in pediatric burn patients should be weighed against these outcomes.
529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients
Authors: John Albin A , Anand Rohan , Frost Joshua , Griswold John A 
Published: April 2021

Abstract

Introduction
Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention.

Methods
We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter.

Results
We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (&gt;20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today.

Conclusions
ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.
544 Temporizing Matrix in the Complex Wound: A Retrospective Three-year Review
Authors: Blome-Eberwein Sigrid A , Bothwell Lydia 
Published: April 2021

Abstract

Introduction
A complex wound is a wound that will not heal spontaneously or with simple or standard closure techniques. Often functional structures (bone, tendon, fascia, joint capsule etc.) are exposed and a matrix can be used for bridging of these structures. The Temporizing Matrix is an entirely synthetic matrix made from polyurethane open-cell foam. This matrix was used in the burn center for three years for the indication “complex wound” with good success. The study objective was to evaluate success rate (leading to wound closure after STSG, duration of treatment) and complications (infection, failure, scarring) on this patient cohort. IRB approval was obtained.

Methods
All charts of patients receiving the Matrix between June 2017 through May 2020 were reviewed. Data collected were demographics, surgery dates, wound descriptions, healing, infection, failure, reapplication, time from application to STSG, time to healing, post discharge complications and scar quality.

Results
33 patients with 37 complex wounds were identified to meet inclusion criteria, 61% male, 39% female, age ranging from 3 months to 72 years. The wounds were caused by Burns, necrotizing infections, trauma or amputation post burn. The Matrix was placed for widely exposed structures (70%), failed STSG(3%), thin subcutaneous tissue coverage over amputation stumps (15%) and other reasons (12%). Primary graft success was 97%. Infection rate was 15% with 8% reapplication. Most infections were treated locally. The average Vancouver scar scale rating after discharge was 9/15.

Conclusions
This temporizing Matrix in preparation to STSG led to successful wound closure in 97% of these complex wounds with low complication rates and an acceptable long-term scar.
559 Benzocaine-Lidocaine-Tetracaine (BLT) Cream Adverse Effects in Burn Patients: A Case Report and Literature Review
Authors: Walroth Todd A , Brown Michelle E , Gordon Katelyn , Martinez Moises , Grooms Cortni , Hartman Brett C 
Published: April 2021

Abstract

Introduction
Historically, BLT cream has been used at our burn center in laser procedures and tattoo removal with 6–8% lidocaine to improve tolerance of outpatient procedures. Recently, the laser BLT formulation (8%) has been trialed as an opioid-sparing alternative for managing pain during inpatient microneedling procedures. When utilizing this formulation for microneedling, the high percentage of lidocaine absorption may correlate with adverse central nervous system (CNS) effects.

Methods
A literature evaluation and retrospective chart review of burn patients receiving BLT cream for inpatient microneedling was performed.

Results
From January to June 2020, two elderly females (77 and 78 years old) received several doses of BLT cream during inpatient microneedling procedures with no documented adverse events attributed to the medication. A 68 year old male with a total body surface area (TBSA) of 8% reported dizziness shortly after he received BLT cream. Vitals were normal, but the patient was unable to focus his eyes or communicate clearly. Neurological exam revealed sluggish, pinpoint pupils. Patient remained disoriented with gargling and tongue thrusting though vitals remained stable. At this time, the remainder of the BLT cream was removed from the wound and his mentation returned to baseline within 90 minutes. No residual neurologic deficits occurred. No other potential causes were identified. Literature review revealed topical lidocaine can be absorbed systemically and cause CNS depression, confusion, and disorientation. Based on limited published data in healthy patients, it is recommended to use no more than 5% of topical lidocaine in large quantities, especially over raw surfaces or blistered areas. The amount of lidocaine systemically absorbed is linked to both the duration of application and the surface area over which it is applied. Using study data from lidocaine/prilocaine 2.5% cream and lidocaine patches, we explored a safer BLT formulation for burn patients as published data do not exist for this group.

Conclusions
Based on our review, we determined 2% to be the maximum lidocaine concentration to apply to a burn wound, 5% TBSA as the maximum surface area involved, and total exposure time limited to 30 minutes or less to reduce incidence of adverse effects. Specifically, formulations with a higher lidocaine concentration applied to a burn wound have the potential to result in untoward neurological deficits.
561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report
Authors: Khalifa Andrew , Sarfraz Anzar , Avraham Jacob B , Archie Ronnie , Kaminsky Matthew , Poulakidas Stathis , Bokhari Faran , Bajani Francesco 
Published: April 2021

Abstract

Introduction
Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for &gt;500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes.

Methods
This case-report was conducted via retrospective chart review of the case presented.

Results
A 43-year-old male sustained a HVEI (&gt;10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK &gt;40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital.

Conclusions
Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.
565 Pandemia Experience in Pediatric Minor to Moderate Burns and the Role of Telemedicine in Treatment
Authors: Abali Ayse Ebru , Aydogan Cem , Turkmen Nigar , Haberal Mehmet 
Published: April 2021

Abstract

Introduction
A huge number of pediatric burn injuries are minor to moderate burns. During covid-19 pandemia, these cases have continued to require medical attention. Aim of the present study was to share our burn center’s pandemia experience in minor to moderate burns in children.

Methods
Records of 117 victims (age:0 to 17yrs) were documented {study period: 3/11/2020(pandemia decleration by WHO)-9/11/2020}. Data were classified according to treatment modalities (outpatient/inpatient/telemedicine). Age; sex; extent of burns; burn cause; environment in which injury occured; referral history (time interval between injury and referral; other hospitals before arriving at our center) were noted for each case. Thereafter, subjects were divided into two subgroups according to pandemia calender: GroupIconsisted of referrals in march+april+may (national ‘lock-down’ period for children n=60) and GroupIIconsisted of referrals in june+july+august+september (‘new normal’ period with limited social life n=57) (mean±SE,p˂.05).
Results:
Outpatients comprised 82,1% of all referrals(n=96) with 361 in-person visits. Mean age was 4,2yrs±0,4(min:0 max:17); male/female ratio was 1,04/1. Mean total body surface area(TBSA) burned was 2,6%±0,6(min:0,2 max:20). The most common burn causes were scalds(n=79; 82,3%) and contact burns (n=11;11,5%). Number of referrals on the same day with injury was 41 (42,7%) and 65 referrals were unmediated(67,7%).
Inpatients comprised of 11,1% of all referrals (n=13). Mean age was 3,9yrs ± 1,7 (min:1 max: 16). Male/female ratio was 0,9/1. Mean TBSA burned was 9,3%±1,8 (min:1 max:18). The most common burn cause was scalds(92,3%;n=12). Nine patients were hospitalized on the same day with injury (69,2%). Ten patients were referred from other hospitals (76,9%). Mean lenght of hospital stay was 6,77days±1,4 (min:1 max:14).
Telemedicine visits (n=33) which were carried out for 23 children via e-mail and phone/video calls included photographic follow up visits for scars, treatment of contact dermatitis and controls of wound-dressings. Comparison of ‘lock-down’ period (groupI) with ‘new normal’ period (groupII) revealed that almost whole telemedicine service was carried out in groupI except two interurban visits in groupII. Findings were similar in both groups except the significant increase of outdoor burns and remarkable presence of sun burns in groupII(p&lt; .05).

Conclusions
Covid pandemia has created extraordinary conditions; however present data suggests that minor to moderate burns in childhood continue to occur anyway. Telemedicine is an advantageous method under pandemia conditions. Therefore, attempts for basic burn-care guidelines including telemedicine facilities should be supported.
567 Results from a Survey About the Ethical Challenges of Treating a Medically and Socially Complicated Patient
Authors: Gerrek Monica L , Lambrix Marcie A , Schirokauer Oliver , Coffee Tammy , Yowler Charles J 
Published: April 2021

Abstract

Introduction
Medically complicated burn patients can present with complex social situations that lead to difficult ethical decision. While the four principles of biomedical ethics, viz., respect for autonomy, nonmaleficence, beneficence, and justice, offer guidance, they may not lead to a clear resolution. Instead, providers may be faced with making a recommendation that is ethically uncomfortable.

Methods
At the 2109 ABA Annual Meeting, we presented a poster of the following real-life case:
Patient is a 47-year-old male who has an 81% TBSA burn, is intubated, and is unable to participate in medical decision making. He needs four limb amputations. His chance of long-term survival with amputation is less than 20%, and the best case scenario is a vent-dependent life with tetraplegia. His complicated family, which include his wife, ex-wife, children, and siblings, is unable to agree on what interventions should be provided.
The poster included a QR code and a link, both of which took respondents to a 10-item survey. Later in 2019, we asked the organizers of our regional burn conference to email a case summary and a link to the same survey to registered participants.
The survey addressed medical appropriateness and various factors that might affect decision making.

Results
We received responses from 12 attendees at the ABA Annual Meeting and 18 regional conference registrants.
On the 8 questions for which only a single response was permitted, 64% of respondents on average chose the same answer. This number goes up to 72% if we restrict to the 5 questions with only two options. Though these numbers indicate a degree of consensus, they also reflect a notable lack of agreement. In fact, less than 77% of respondents agreed about the medical appropriateness of not amputating, the roles that quality of life and justice (resource allocation) should play in decision making, whether the level of evidence needed to withdraw treatment is the same as is needed to continue, how to handle the conflicting claims of family members, and the level of importance that should be attached to the team’s comfort. In the case of the last two issues, none of the 5 available responses for each question received more than a third of the votes. The only position unanimously endorsed on the survey was that comfort care should be an option for the patient/family.

Conclusions
Our data suggest that there is substantial disagreement among those involved in burn care regarding important aspects of decision making for a patient who is medically, socially, and ethically complicated.
576 Striving for Excellence: Beacon Application Submission and Achievement
Authors: Ha Aemilio W , Thomas Mini , Henderson Tammy L 
Published: April 2021

Abstract

Introduction
The American Association of Critical-Care Nurses (AACN) Beacon Award (BA) recognizes individual nursing units with Gold, Silver, or Bronze level for excellence. The BA signifies an effective and systematic approach to policies, procedures and processes that include engagement of staff and key stakeholders; fact-based evaluation strategies for continuous process improvement; and performance measures that meet or exceed relevant benchmarks. Units designated with BA show an overall higher morale and lower turnover rate. Being a verified burn unit and Magnet designated facility, the unit practice council (upc) began the application process for Beacon.

Methods
The application process started in 2017 through a core group of UPC members. Different sections of the application were written through the guidance of the team leader and with support of the unit management. Data was gathered from various hospital departments and dashboards which included: leadership structures and systems, appropriate staffing and staff engagement, effective communication, knowledge management and learning development, evidence-based practice and processes, and outcome measurements. After data collection/synthesis, small group meetings were conducted to complete the application. The application was reviewed and edited by the unit management prior to submission.
Highlights included: low infection rates in the unit exceeding national benchmarks, peer supporter events for burn survivors, team bonding, community outreach, multiple abstract submission/presentations from nursing at local/national conferences, high patient satisfaction scores, implementing new burn care practices based on evidence, and interdisciplinary rounds.

Results
Burn unit was designated as a Beacon Gold Award Recipient in 2019. This designation lasts for three years. Our burn unit became one of seven units in the nation with BA and is the second one to achieve Gold designation. During and after this process, there was an increase in staff engagement, teamwork, and exceptional quality metrics.

Conclusions
Persistent effort combined with teamwork and leadership can help a unit achieve Gold BA designation. This award requires ongoing work to refine processes and promote evidence-based practices.