The Burn Wound

Skin serves as a protective barrier against infection, prevents excessive fluid and electrolyte losses, performs crucial thermoregulation, and provides tactile feedback of surroundings. The skin also plays an essential role in human perception of body image, personal appearance, and self-confidence. With these many diverse functions, understanding normal anatomic composition of skin is pivotal to evaluating the extent of its disruption from burn injury. This article discusses the pathophysiology, initial evaluation, subsequent progression, and healing of burn wounds. By delineating the various microcellular and macrocellular alterations of burn injury, this review also augments providers' capacity to deliver patient-centered, evidence-based burn care.

Algorithms to Identify Nonmedical Opioid Use

The rise in nonmedical opioid overdoses over the last two decades necessitates improved detection technologies. Manual opioid screening exams can exhibit excellent sensitivity for identifying the risk of opioid misuse but can be time-consuming. Algorithms can help doctors identify at-risk people. In the past, electronic health record (EHR)-based neural networks outperformed Drug Abuse Manual Screenings in sparse studies; however, recent data shows that it may perform as well or less than manual screenings. Herein, a discussion of several different manual screenings and recommendations is contained, along with suggestions for practice. A multi-algorithm approach using EHR yielded strong predictive values of opioid use disorder (OUD) over a large sample size. A POR (Proove Opiate Risk) algorithm provided a high sensitivity for categorizing the risk of opioid abuse within a small sample size. All established screening methods and algorithms reflected high sensitivity and positive predictive values. Neural networks based on EHR also showed significant effectiveness when corroborated with Drug Abuse Manual Screenings. This review highlights the potential of algorithms for reducing provider costs and improving the quality of care by identifying nonmedical opioid use (NMOU) and OUD. These tools can be combined with traditional clinical interviewing, and neural networks can be further refined while expanding EHR.

Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift

Palliative care is intended to relieve caregivers of physical, psychological, and even spiritual elements of care. One of the most prevalent issues facing this form of care is a lack of healthcare resources and structures to deal with an aging population. This aging population is placing a strain on the healthcare system, prompting a need for a shift in system management. A potential answer to this issue may be the Multi-Agent System (MAS). This category of computerized networking system was created by programmers to gather relevant health information on a patient and allow for the system to act with other agents to decide the best course for disease management. It can also allow for a multidisciplinary healthcare team to make more informed plans of actions for their patients by providing accurate and up-to-date information resulting from a greater synergetic mesh. MASs could fulfill the demands of a rising chronic illness population and deliver high-quality care, indicating a major paradigm shift within the US. In this review, we will evaluate the aging population and contributing factors, palliative care and the need for the multi-agent system, and clinical considerations involving examples from healthcare systems both on and beyond US shores.

546 Health Disparities Among Rural Burn Patients

Introduction

Socioeconomic status is a risk factor for sustaining a burn and for burn mortality. Patients from rural areas make up a minority of the population but are frequently more isolated from life-saving care and burn centers. Lower socioeconomic status patients may delay seeking treatment of their burns for concern over medical costs, time away from work, and overall distance from accredited burn centers. We aim to explore disparities in burn outcomes at our institution based on patient socioeconomic status.

Methods

Between January 2020 and January 2021, patients presenting for management of acute burns were reviewed. Patient demographics and outcomes were collected, including time to presentation, total body surface area burned, presence of inhalational injury, and mortality. Patient socioeconomic status and rural designations were assigned based on a validated metric derived from Census endpoints, with higher scores reflecting lower socioeconomic status.

Results

A total of 524 patients were identified. Overall, 30% of our patients were from areas defined as being small towns or rural by the Census. Racial demographics did not differ between rural and urban areas (p = 0.099), but Hispanic ethnicity was less common (16% vs. 29%, p = 0.002). Rates of alcohol, tobacco, and illicit drug use did not differ between groups. Compared to the urban/suburban cohort, rural patients were from less affluent areas (63.6 vs. 58.5, p = 0.001) and traveled farther to our center (112 miles vs. 70 miles, p = 0.029). Despite these distances, rural patients did not have a higher rate of delayed presentation (35.7% vs. 43.3%, p = 0.105), or longer average time to presentation (3.4 days vs 4.4 days, p = 0.222). Flame burns were the most common mechanism overall (44.3%) and were significantly more common in the rural population (59.2% vs. 37.8%, p < 0.001), Scalds, the second most common burn mechanism (25.9%), occurred less frequently in rural patients (18.5% vs. 29.2%, p = 0.011). Controlling for age, TBSA, inhalational injury, and ventilator requirement, patients from rural areas were at a significantly higher risk of mortality (OR 24, p = 0.024).

Conclusions

Rural burn patients face many challenges receiving appropriate care following a burn. They frequently come from less affluent backgrounds, limiting their ability to access care, and they must travel greater distances to a qualified burn surgeon. Despite these barriers, our rural patient population did not present any later following a burn compared to our more urban patients. Rural patients sustained more extensive burns but were not hospitalized at a greater rate. Even when controlling for numerous factors associated with burn mortality, rural patients were still at an increased risk. Burn prevention strategies targeting rural communities should address the unique challenges facing these areas.

728 Chemical Burns and Eyebrow Tinting: An Unusual Case

Introduction

Here we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature.

Methods

A 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia.

Results

Burns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process.

The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase.

Conclusions

Eyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.

Biology of COVID-19 and related viruses: Epidemiology, signs, symptoms, diagnosis, and treatment

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.

Framework for creating an incident command center during crises

The Hospital Incident Command System (HICS) is an incident management system specific to hospitals based on the principles of Incident Command System (ICS), and it includes prevention, protection, mitigation, response, and recovery. It plays a crucial role in effective and timely response during the periods of disasters, mass casualties, and public health emergencies. In recent times, hospitals have used a customized HICS structure to coordinate effective responses to public health problems such as the Ebola outbreak in the US and SARS epidemic in Taiwan.

The current COVID-19 pandemic has placed unprecedented challenges on the healthcare system, necessitating the creation of HICS that can help in the proper allocation of resources and ineffective utilization of healthcare personnel. The key elements in managing a response to this pandemic include screening and early diagnosis, quarantining affected individuals, monitoring disease progression, delivering appropriate treatment, and ensuring an adequate supply of personal protective equipment (PPE) to healthcare staff.

HTX-011 (bupivacaine and meloxicam) for the prevention of postoperative pain - clinical considerations

HTX-011 is an extended-release, dual-acting local anesthetic consisting of bupivacaine (sodium-channel blocker) and low-dose meloxicam (non-steroidal anti-inflammatory drug [NSAID]) applied needle-free during surgery. Introducing low-dose meloxicam addresses the limited efficacy of liposomal bupivacaine in acidic inflamed tissues and allows enhanced analgesic effects over three days. It has great promise to be an extremely effective postoperative pain regimen and produce an opioid-free surgical recovery, as it has consistently significantly reduced pain scores and opioid consumption through 72 h. This manuscript provides an updated, concise narrative review of the pharmacology, clinical efficacy, safety and tolerability of this drug and its applications to prevent postoperative pain.