Critical care of thermally injured patient

Berger, Mette M.; Shahrokhi, Shahriar; Jeschke, Marc G.

doi:10.1007/978-3-7091-0348-7_14

Cited by 1 publication

(2 citation statements)

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“…Patients were aggregated in two groups based on a 20% TBSA cut-off, which distinguishes large burns (≥ 20%) from smaller ones (< 20%). This cut-off is a recognized threshold for beginning an aggressive reanimation and orienting patients in specialized centres [4,21]. The separation into two subgroups was based on the prehospital TBSA estimation, except in the case of a missing value (5), where the hospital TBSA estimation was considered.…”

Section: Data Collectionmentioning

confidence: 99%

“…However, despite prevention efforts, the social and economic costs remain high and individual consequences are serious [2,3]. Severe burns require specific expertise and significant resources throughout the course of care [4]. Evidence-based medicine literature supporting prehospital recommendations or guidelines is scarce, although critical issues are shared by many, if not all, emergency services [5].…”

Section: Introductionmentioning

confidence: 99%

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Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Maudet

Pasquier

Pantet

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Emergency medical services regularly encounter severe burns. As standards of care are relatively wellestablished regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). Methods: All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. Results: We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were − 5.3, 4.4 and − 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. Conclusions: We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.

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Section: Data Collectionmentioning

confidence: 99%