This prospective, randomized study compared protocols of care using either AQUACEL® Ag Hydrofiber® (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL® Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL® Ag dressing protocol tended to have lower total treatment costs ($1040 vs. $1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of $1,409.06 for AQUACEL® Ag dressing and $1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL® Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.
Invasive diagnostic and therapeutic techniques such as percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), transjugular intrahepatic portosystemic shunting, and laparoscopic cholecystectomy have led to a rise in hemobilia. Most complications from hemobilia are attributable to acute blood loss; other complications are secondary to thrombus formation in the biliary tree. We present a case report of acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. The role of ERCP in the diagnosis and treatment of this exceedingly rare event is discussed.
Necrotizing fasciitis of the head and neck region is a rare but lethal complication of any head and neck infection. We present a case of cervical necrotizing fasciitis secondary to peritonsillar abscess requiring a large neck debridement and bilateral mastectomies that was treated in our institution. A 38-year-old male presented with a history of sore throat which progressed to right neck swelling and bilateral chest pain. Blood work was only significant for a white blood cell count of 22.0 × 103/μL. Computed tomographic imaging of the neck and chest demonstrated a right peritonsillar abscess involving the right masticator space and carotid space which had dissected laterally and superficially to involve the right sternocleidomastoid and bilateral pectoralis muscles. The patient was taken emergently to the operating room for wide excision resulting in a neck debridement, right total mastectomy, and left partial mastectomy. After multiple debridements, intravenous antibiotics, and dressing changes the patient underwent split thickness skin grafting to his neck and chest wounds and was subsequently discharged from the hospital 45 days after initial presentation. Necrotizing fasciitis of the head and neck demands a high index of suspicion involving a multidisciplinary team, rapid diagnostic measures and aggressive surgical and antibiotic management as the mainstay of treatment in reversing this potentially fulminant and lethal disease process. In this rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis, the infection spread across cervical fascial planes onto the anterior chest wall rather than dissecting as usual to the parapharyngeal, retropharyngeal spaces or mediastinum. Extensive and potentially disfiguring debridements may be necessary to obtain negative margins with frequent reoperations until the patient is ready for reconstruction.
Journal Article Combining AQUACEL® Hydrofiber® Dressing with Ionic Silver: AQUACEL®-Ag Get access D. M. Caruso, MD, D. M. Caruso, MD 1Maricopa Medical Center, Phoenix, AZ2ConvaTec, Killman, NJ Search for other works by this author on: Oxford Academic Google Scholar K. N. Foster, MD, K. N. Foster, MD 1Maricopa Medical Center, Phoenix, AZ2ConvaTec, Killman, NJ Search for other works by this author on: Oxford Academic Google Scholar M. H. Hermans, MD M. H. Hermans, MD 1Maricopa Medical Center, Phoenix, AZ2ConvaTec, Killman, NJ Search for other works by this author on: Oxford Academic Google Scholar The Journal of Burn Care & Rehabilitation, Volume 24, Issue suppl_2, March-April 2003, Page S89, https://doi.org/10.1097/00004630-200303002-00094 Published: 01 March 2003
Journal Article A New Strategy for Burn Patients that Fail Conventional Ventilation: High Frequency Oscillatory Ventilation Get access K. M. Whitford, RRT, K. M. Whitford, RRT 1Maricopa Medical Center, Phoenix, AZ Search for other works by this author on: Oxford Academic Google Scholar M. J. Hibbert, Rrt, Cpft, RRT, M. J. Hibbert, Rrt, Cpft, RRT 1Maricopa Medical Center, Phoenix, AZ Search for other works by this author on: Oxford Academic Google Scholar D. M. Caruso, MD, D. M. Caruso, MD 1Maricopa Medical Center, Phoenix, AZ Search for other works by this author on: Oxford Academic Google Scholar K. N. Foster, MD K. N. Foster, MD 1Maricopa Medical Center, Phoenix, AZ Search for other works by this author on: Oxford Academic Google Scholar The Journal of Burn Care & Rehabilitation, Volume 24, Issue suppl_2, March-April 2003, Page S122, https://doi.org/10.1097/00004630-200303002-00159 Published: 01 March 2003
A 14-month-old female suffered a 95% TBSA flame burn from a water heater malfunction and explosion. Her head, face, and perineum were largely spared. All other areas had full-thickness burns. She did not suffer an inhalation injury. The patient was transported to a regional burn center and standard thermal injury protocols were instituted, including endotracheal intubation and ventilator support, aggressive intravenous fluid resuscitation with crystalloid and colloid, wound management with topical antimicrobials 5% sulfamylon solution, and enteral nutrition. Our standard of care included no venous thromboembolic prophylaxis and change of all arterial and central venous catheters every 7 days. The patient required early escharotomies of all four extremities, hands, and feet. The patient underwent early burn excision with fascial excision and allograft placement to all thermal wounds on post injury days (PID) three, four, and five. These excisions were all performed at the bedside because the patient's tenuous cardiopulmonary status precluded transporting her to the operating room.
Arizona Burn Center staff observed an increasing number of pediatric scald burn admissions. Therefore, a retrospective study was conducted to identify scald demographics and etiologies. Focus groups were subsequently conducted to determine burn prevention knowledge in the target community. Arizona Burn Center scald admission variables (ages 0-5 years) reviewed included age, sex, ethnicity, TBSA, body parts burned, occurrence month and location, caregiver present, child and caregiver activities when injured, payor source, length of stay, parental language, and zip code. High-risk zip code area focus groups were then conducted. There were a total of 170 pediatric patients, aged 0 to 5 years, admitted to the burn center during 2005 to 2006. Of this total, 124 of the patients were admitted for scald burns, accounting for 59% of all pediatric burn admissions. Scald burn patient's demographics included male (52%), female (48%) with a mean age of 1.7 years. Majority ethnicity was Hispanic (63%). The mean TBSA was 8% with mean length of stay of 8 days. The remaining pediatric admissions for children aged 0 to 5 were for burns caused by fire or flame 15%, contact with a hot object 13%, friction burns 7%, chemical burns 3%, and electrical burns 3%. Demographics for the combined etiologies included an identical sex breakdown with male (52%) and female (48%). The majority ethnicity in the nonscald group was also Hispanic at 59% with a mean length of stay of 7 days and an average TBSA of 9.5%. Main etiologies of scald burns included hot water (25%), soup (24%), and coffee or tea (21%). Most common child behaviors were pulling hot substance from stove (24%), from countertop (13%), and having liquid spilled on them (13%) typically while caregiver was cooking. Mean TBSA was 8% with mean length of stay (8 days). Scalds occurred in the kitchen (83%) and mainly in child's home (94%). Mother was primary caregiver (78%). Payor source was Medicaid (86%) and the average admission cost was dollars 60,075. Only 36% of parents spoke Spanish as their primary language. Scalds (43%) usually occurred during year's first quarter (P < .001). Focus group participants (85%) reported receiving no prior burn prevention education and preferred to receive prevention instruction in small groups through established community agencies. Results suggest that culturally sensitive, bilingual scald prevention education, targeting Hispanics, is needed to create awareness of the frequency, severity, and danger associated with pediatric scalds.
