Introduction: Nursing care for patients with severe burns involves three major challenges: management of body temperature, management of wounds, and management of pain. This study investigated the currently recommended care based on guidelines with a literature review.
Body temperature management for patients with extensive burns: Avoiding hypothermia is essential in patients with extensive burns and the following measures are advised: 1）Establish target room temperatures tailored to specific situations（shock phase, perioperative period, management in the intensive care unit, etc.）and monitor body temperature. 2）In the perioperative period, combine active rewarming（e.g., with a warm air blanket）with management of appropriate room temperature and shortening of operative time.
Management of burn wounds: The recommended treatment for third-degree burns is excision of the burn wound and early wound closure such as using skin grafts. Extensive third-degree burns require the management of large amounts of exudate until the wound closes. However, few studies have examined this issue, warranting future study.
Analgesia and sedation for patients with burns: Several guidelines related to analgesia and sedation have been published based on a large body of evidence and are applied in practice. However, studies in this area are insufficient regarding patients with burns. The current recommendations are as follows: 1）Sedation is unnecessary as long as analgesia is instituted. 2）Opioids（fentanyl, etc.）are the first-line drugs for pain management in wound care. The dose of opioids can be reduced by combining them with other analgesics and/or sedatives, including acetaminophen, nonsteroidal anti-inflammatory drugs, propofol, dexmedetomidine (Precedex®), and ketamine. 3）Pain should be regularly evaluated using pain assessment tools such as the Behavioral Pain Scale, Critical-Care Pain Observation Tool, and Numeric Rating Scale. 4）Pregabalin (Lyrica®) can be considered for neuropathic pain.
Introduction: We collected data regarding burns caused by occupational accidents that were treated at our hospital in the previous 5 years, and analyzed their recent trends. We also discuss points that medical professionals should be aware of regarding such accidents.
Methods: Data of patients who were treated at our hospital between January 1, 2014 and December 31, 2018 were reviewed. A retrospective study was conducted on 36 cases of occupational accident burns in 35 patients who were treated at our department.
The following data were analyzed: 1. Year of injury; 2. occupation; 3. situation causing the injury; 4. burn area; 5. burn depth; 6. days from injury to hospital visit; 7. treatment; 8. whether guidance was provided at work regarding measures to take at the time of a burn injury; 9. whether the injured site was immediately cooled; and 10. time required until returning to work after the injury, if described.
Results: The largest number obtained for each result is shown. 1. The number of patients in 2014 was 14. 2. Restaurant workers comprised 74% of the patients. 3. Injury from high-temperature liquid comprised 53% of the total. 4. Patients with a burn area of less than 10% comprised 89% of the total. 5. A burn depth of superficial dermal burn or deep dermal burn was observed in 80% of the patients. 6. In total, 94% of the patients visited the hospital on the day of the injury. 7. Conservative treatment was performed on 71% of the patients. 8. At work, 23 of 26 patients had not been instructed on how to manage such injuries. 9. Sixteen of 26 patients did not cool the injured area for at least 20 minutes. 10. Twelve of 25 patients returned to work more than a month after the injury.
Discussion: Even in industries with a high risk of burns, appropriate guidance regarding the initial management of an injury is not provided at the time of employment. By providing instruction on appropriate initial measures to manage burn injuries at work, it will be possible to prevent the progression of the depth of occupational burns and shorten the treatment period.
Conclusion: Doctors should be aware that if a patient returns to the same workplace, there is a risk of reinjury and that people in the same profession are also at risk of injury.
Introduction: Fever as an indicator of infection remains controversial in pediatric burn patients. In this study, the medical conditions of burn injury patients and their thermal status were investigated.
Objective and methods: Fifty-four pediatric burn patients under 15 years of age treated between 2007 and 2015 at our unit were retrospectively examined regarding age, sex, total burn surface area, and temperature.
Result: The infection group comprised 23 patients（42.6%）, including two with severe bacterial infections（3.7%）. The fever group（above 38.5℃）consisted of 21 patients（38.9%）, and a significant association was found between fever and infection（p<0.01）.
Discussion and Conclusion: Fever above 38.5℃suggests infection when low-grade fever caused by absorption is generally observed. However, the necessity of antibiotics in the case of high fever remains an issue.
We present the case of a 71-year-old man with 9% TBSA chemical injury on his right back, both buttocks, both thighs, and left leg caused by an alkali.
He lost consciousness while cleaning the floor without precautionary measures using a wax remover containing benzyl alcohol and an alkali. He then sustained third-degree chemical injury due to exposure to the alkali. On day 7 after the injury, he came to our hospital because he did not realize his injury until then. We diagnosed volatile organic compound (VOC), benzyl alcohol, poisoning as the cause of consciousness disorder after the interview and physical examination. After two rounds of skin grafting, the wound was closed and he was discharged on day 73 after the injury.
There is a risk of overlooking important details in cases of industrial accidents because of a lack of specific findings for VOC poisoning.
We report the use of the MEEK™ system to expand skin grafts in split-thickness skin grafting in 2 burn patients. One patient was a woman in her 50s. Split-thickness skin grafting was performed using 1:6 MEEK for back burns. The other patient was a man in his 50s. Split-thickness skin grafting was performed using 1:4 MEEK for abdominal burns. Engraftment was generally good and epitheliali-zation was rapid. The MEEK™ system can efficiently expand skin grafts at a high rate. In addition, grafts expanded by the MEEK™ system are resistant to infection, have a high success rate even on wound beds with a poor vascular supply, and may have a short time to epithelialization. Although the MEEK™ system has problems, such as the need to purchase a specific machine and to learn techniques, including dressing, it is an effective option for extensive burns lacking sufficient graft donor sites.