Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.

Access to high quality acute trauma care is well established across parts of Canada but a clear urban/rural divide persists. Regional efforts to improve short- and long-term outcomes after severe trauma should focus on the optimization of access to pre-hospital care and acute trauma care in rural communities using locally relevant strategies or novel care delivery options.

Serious nonfatal physical injuries and burns are common occurrences that can have substantial implications for personal, social, and occupational functioning. Such injuries are frequently associated with significant mental health issues, and compromised quality of life and well-being. The purpose of this review is to summarize the current literature on physical, psychological, and social risk factors for mental health issues post-injury and to contextualize findings using Engel's biopsychosocial framework. We distinguish between pre-injury, injury-related, and post-injury risk factors for mental health problems. Female sex, history of mental health problems or trauma, type of injury, and level of pain are among the strong risk factors for mental health problems post-injury. We highlight inconsistent findings in the literature, identify directions for future research, and explore the implications of the risk factors identified for treatment and prevention.

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In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers.

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Simultaneous monitoring and treatment of wound infection is of great importance in the biomedical field. The present work describes the development of a theranostic wound dressing (TH-WD) that can monitor and inhibit wound infection simultaneously. The main component of TH-WD is a polyurethane (PU) scaffold loaded with a ciprofloxacin-based prodrug (Pro-Cip) and a chromogenic probe (H-Cy). In vitro studies demonstrated that TH-WD displayed efficient inactivation (100 ± 4% reduction) of Pseudomonas aeruginosa (ATCC 27853) within 4 h of contact while providing a visual detection of wound infection via a simple color change from yellow to green to red. These results are attributed to the activation of H-Cy and Pro-Cip via hydrolysis of their ester linkages catalyzed by lipase, an extracellular enzyme secreted by bacteria. Moreover, TH-WD is highly selective as it only changes color and releases the active drug (ciprofloxacin) in the presence of certain lipase-secreting pathogenic bacteria such as P. aeruginosa ATCC 27853, and no color change and cytotoxicity were observed when TH-WD was incubated with no- or low-lipase-producing bacteria (e.g., E. coli TOP 10) or skin cell fibroblast. This hence can minimize the emergence of bacterial resistance associated with the overuse of antibiotics and avoid unnecessary cytotoxicity to skin cells. The present system not only provides a visible and noninvasive method to monitor the wound status but also allows the timely administration of antibacterial agents to inactivate bacteria in the wound.

Combining both N-chloramine and quaternary ammonium moieties in one molecule results in a new biocide with better antibacterial activity.