Introduction The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. Method A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant article were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. Results Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies have the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. Conclusion Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
Exposition environnementale à l'amiante et relation exposition-réponse avec le mésothéliome RÉSUMÉ Une étude épidémiologique et environnementale a été réalisée à Shubra El-Kheima, dans la banlieue du Caire, sur la relation exposition-réponse entre l'amiante et le mésothéliome pleural malin. Un dépistage radiologique a été effectué sur 487 personnes exposées à l'amiante dans le milieu professionnel, 2 913 personnes exposées à l'amiante dans l'environnement et un groupe témoin de 979 personnes n'ayant jamais été exposées. Une biopsie pleurale a été réalisée sur les cas suspects. Les concentrations de fibre d'amiante dans l'air ont été établies dans toutes les zones. Quatre-vingt-huit cas de mésothéliome ont été diagnostiqués, dont 87 dans le groupe exposé. Le risque de mésothéliome était plus élevé dans le groupe soumis à une exposition environnementale que dans les autres groupes, et plus élevé chez les femmes que chez les hommes. La prévalence du mésothéliome augmentait en même temps que l'exposition cumulée à l'amiante.
This report describes a case of ventricular tachycardia (VT) storm managed in the emergency department prior to transfer for automatic implantable cardioverter-defibrillator (AICD) placement. VT storm is associated with significant in-hospital and 6-month mortality, necessitating emergent stabilization and definitive secondary prevention. While ACLS and antiarrhythmic drugs (AAD) are the mainstays of emergency management early referral is indicated for AICD placement, catheter ablation, and/or sympathetic cardiac denervation. In the setting of sustained or recurrent VT (including VT storm), amiodarone and/or lidocaine can be administered not only as boluses but also as infusions. This strategy can stabilize the patient for transfer (if needed) and avoid escalation to intubation and sedation for central sympathetic blockade, which would necessitate admission to intensive care.
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