Electrical burns in adults

INTRODUCTION

Electrical burns account for up to 10% of burns admissions worldwide and are a potentially serious mechanism of injury. The aim of this study is to describe the epidemiology, presentation, management and complications of electrical burn injuries in adults.

MATERIAL AND METHODS

A retrospective study of all adult patients with electrical burns admitted to a tertiary burns centre.

RESULTS

Eighty-two cases were identified. The mean age was 40 ± 2 years, 92.7% were males. The most common activities causing the injuries were work (39%) and do-it yourself activities (32%). A low voltage (< 1,000 W) power source was involved in 78% of cases. The mean total body surface area involved was 3 ± 0.3%. The head, hands, and other upper extremities were the body parts most frequently injured. The mean hospital stay was 2 ± 1days.

CONCLUSION

Electrical injury was an infrequent but potentially serious cause of injury in adults. Minor injuries were successfully managed non-operatively. Electrical burns in adults are mainly low voltage burns contracted by manual workers resulting in a flesh burn. Although rare, the loss of digits, neurological sequelae, cardiac arrhythmias and renal failure remain serious complications in a significant number of cases.

Surgical training during the COVID-19 pandemic - a single institution's trainee survey

BACKGROUND

Few studies have assessed the impact of COVID-19 on surgical training in low- and middle-income countries. The aim of this study was to survey the effect of the COVID-19 pandemic on postgraduate surgical training, research and registrar wellbeing in South Africa.

METHODS

A cross-sectional study was conducted as an online survey from 5 October 2020 to 1 December 2020. The study population was registrars from all surgical disciplines at the Faculty of Medicine and Health Sciences of Stellenbosch University. The survey consisted of 26 multiple-choice and five open-ended qualitative questions on the impact of COVID-19 on physical and mental wellbeing, skills acquisition and postgraduate research.

RESULTS

Of 98 surgical registrars, 35 (36%) responded. Twenty-three (65.7%) reported missed planned surgical rotations, 30 (85.7%) decreased surgical training time, and 22 (62.9%) reported a perceived decrease in training quality. Simulated skills training was only available to eight (22.9%) participants. Twenty-four (68.6%) experienced burnout and/or depression symptoms during the pandemic. Twenty-seven (77.1%) reported that postgraduate research was unaffected by the pandemic.

CONCLUSION

During the COVID-19 pandemic, surgical trainees at this institution reported a decrease in the quality of surgical training and skills acquisition and a negative impact on their mental wellbeing.

Toxic Epidermal Necrolysis Syndrome: Management And Outcomes

Toxic epidermal necrolysis syndrome (TENS) is a rare medical emergency associated with high morbidity and mortality. At present, there is no agreement regarding specific treatments for this disease. The aim of this study is to determine the outcome of patients with TENS using a treatment protocol that did not include the use of intravenous immunoglobulin or systemic steroids. This is a retrospective study of all patients diagnosed with TENS admitted to a tertiary burns centre from 2015-2017. Twelve cases were identified with a mean age of 46±8 years. Mean total body surface area affected was 51±9%. The SCORTEN index was 3.4±0.3 (range 2-5) and predicted 3 deaths in this cohort. Overall mortality was 25%. This study casts no doubt on the prognostic validity of SCORTEN. No specific TENS treatment has been unequivocally proven to be effective.

Inflammatory and coagulative pathophysiology for the management of burn patients with COVID-19: systematic review of the evidence

The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19. As such, a COVID-19 positive patient sustaining burn injuries may have an amplified response to the burn insult due to their baseline hyperinflammatory and hypercoagulable states. Burn patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. The concurrent pathogenesis of COVID-19 and the inflammatory response in burn injury have serious implications on the management of burn patients.

Availability Of Covid-19 Information From National And International Burn Society Websites

National and international burn society websites are an important source of information for patients and burn care professionals. The current COVID-19 pandemic represents an unprecedented global health crisis. The aim of this study was to assess the information available on national and international burns society websites on the current pandemic of COVID-19. National and international burns society websites were assessed with regard to COVID-19 information. Five percent of nations had a burn care society website. Forty percent of these national society websites mentioned COVID-19. None provided their state's guidelines, nor advised to provide only urgent or emergent care. None recommended following WHO guidelines. One-third (33%) of the international societies documented the decision to postpone its congress and provided links to two articles describing burn care during the COVID-19 pandemic. The availability of COVID-19 clinical guidelines and information on national and international burn care society websites is lacking. Burn care society websites must develop relevant COVID-19 information to support burn care professionals on the frontline of care.

Protective Measures For Burn Care Professionals During The Coronavirus Disease 2019 Pandemic: Systematic Review

The emergence of a novel human β coronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has developed into a global pandemic and public health emergency. The management of patients with burns must be adapted to this context. The aim of this systematic review is to identify the optimal protection measures during the COVID-19 pandemic and provide guidance of protective measures for burn surgeons. A systematic search of PubMed was performed for articles about COVID-19. "Burn units", "burns", "COVID-19", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" and "telemedicine" were reviewed during the entire diagnosis and management process of burn patients. Eight articles were included, and five articles emphasized that burn care professionals should pay attention to prevent cross-infection. Only three articles reported in detail how burn care professionals should be protected during surgery in the operating room. These experiences and strategies can help burn care professionals work safely and effectively, and prevent both nosocomial infections and burn care professional infections during the global pandemic of COVID-19.

Burns from ECG leads in an MRI scanner: Case series and discussion of mechanisms

Iatrogenic burns are rare and preventable. The authors present two cases of burns from ECG leads, sustained during magnetic resonance imaging (MRI). Common features included a long duration spinal MR scan (120 and 60 minutes) and high patient body mass index (BMI >30). Both patients were discharged within 24 hours of admission, but required a period of outpatient burn care. The causation of these injuries remains unclear but there are several possible mechanisms including: electromagnetic induction heating, antenna effects and closed-loop current induction. The authors provide a description of the injuries, discuss possible mechanisms that may lead to burn injury in the MRI environment and suggest ways to reduce the risks of such injuries.

Extravasation injuries in adults

Insertion of an intravascular catheter is one of the most common invasive procedures in hospitals worldwide. These intravascular lines are crucial in resuscitation, allow vital medication to be administered, and can be used to monitor the patients' real-time vital parameters. There is, however, growing recognition of potential risks to life and limb associated with their use. Medical literature is now replete with isolated case reports of complications succinctly described by Garden and Laussen (2004) as "An unending supply of "unusual" complications from central venous catheters." This paper reviews complications of venous and arterial catheters and discusses treatment approaches and methods to prevent complications, based on current evidence and endeavours to provide information and guidance that will enable practitioners to prevent, recognise, and successfully treat extravasation injuries in adults.