Burns vs. toxic epidermal necrolysis: A medico-legal dilemma

2020 ◽  
Vol 88 (3) ◽  
pp. 160-162
Author(s):  
Ajay Kumar ◽  
Mandar Ramchandra Sane ◽  
Amandeep Singh ◽  
Dasari Harish
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Fatal Case ◽  
Total Body Surface Area ◽  
Sudden Onset ◽  
Rapid Progression ◽  
Mucosal Involvement ◽  
Total Body

Toxic epidermal necrolysis is a rapidly progressive exfoliating dermatosis which simulates second degree burns. The authors describe a fatal case reported as due to burns. Around 95% of the deceased’s total body surface area was affected, with epidermolysis over face, chest, abdomen, limbs and associated with mucosal involvement. Histopathological findings revealed epidermal necrolysis and confirmed the autopsy suspicion. Because of its sudden onset and rapid progression, toxic epidermal necrolysis often arises suspicion of burns by investigators. We emphasise the differentiating features between toxic epidermal necrolysis and burns and its implications.

scholarly journals Cephazolin-Induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin and N-Acetylcysteine

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Carlos Saavedra ◽  
Paola Cárdenas ◽  
Héctor Castellanos ◽  
Kateir Contreras ◽  
J. R. Castro
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Intravenous Immunoglobulin ◽  
Surface Area ◽  
Skin Reaction ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Severe Form ◽  
Drug Induced ◽  
Total Body

Toxic epidermal necrolysis is the most severe form of drug-induced skin reaction and includes denudation of >30% of total body surface area. The mechanism of disease is not completely understood, but immunologic mechanisms, cytotoxic reactions, and delayed hypersensitivity seem to be involved. We report a case of cephazolin-induced toxic epidermal necrolysis treated with intravenous immunoglobulin and N-acetylcysteine with excellent response.

Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach

2020 ◽  
Author(s):  
Nikita Batra ◽  
Yinan Zheng ◽  
Emily C Alberto ◽  
Omar Z Ahmed ◽  
Megan Cheng ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Cox Regression ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Cox Regression Analysis ◽  
Treatment Type ◽  
Total Body ◽  
Hand Burns

Abstract Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1–11) had a median total body surface area per hand burn of 0.8% (range 0.1–1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15–0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01–6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.

scholarly journals The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?

2018 ◽  
Vol 6 ◽  
Author(s):  
A. K. W. Cheah ◽  
T. Kangkorn ◽  
E. H. Tan ◽  
M. L. Loo ◽  
S. J. Chong
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Validation Study ◽  
Total Body Surface Area ◽  
Three Dimensional ◽  
Smart Phone ◽  
Conventional Methods ◽  
Total Body ◽  
Smart Phone Application

Abstract Background Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart. Methods Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’ burn percentages. Results Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. Conclusions The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

Length of Stay per Total Body Surface Area Burn Relative to Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

2021 ◽  
Author(s):  
Kelli N Patterson ◽  
Amanda Onwuka ◽  
Kyle Z Horvath ◽  
Renata Fabia ◽  
Sheila Giles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Common Mechanism ◽  
Quality Improvement Collaborative ◽  
Pediatric Injury ◽  
Total Body

Abstract Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients are often limited to single institutions and are grouped in ranges of TBSA burn which lacks specific detail to counsel patients and families. A LOS to TBSA burn ratio of 1 has been widely accepted but not validated with multi-institution data. The objective of this study is to describe the current relationship of LOS per TBSA burn and LOS per TBSA burn relative to burn mechanism with the use of multi-institutional data. Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for patients across five pediatric burn centers from July 2018-September 2020. LOS per TBSA burn ratios were calculated. Descriptive statistics and generalized linear regression which modeled characteristics associated with LOS per TBSA ratio are described. Among the 1267 pediatric burn patients, the most common mechanism was scald (64%), followed by contact (17%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.2 (SD 2.1). In adjusted models, scald burns and chemical burns had similar LOS/TBSA burn ratios of 0.8 and 0.9, respectively, while all other burns had a significantly higher LOS/TBSA burn ratio (p<0.0001). LOS/TBSA burn ratios were similar across races, although Hispanics had a slightly higher ratio at 1.4 days. These data establish a multi-institution LOS per TBSA ratio across PIQIC centers and demonstrate significant variation in the LOS per TBSA burn relative to the burn mechanism sustained.

RADIOISOTOPE RENOGRAPHY IN CHILDREN. I. THE RENOGRAM IN CHILDREN WITHOUT RENAL DISEASE

PEDIATRICS ◽  
1965 ◽  
Vol 36 (1) ◽  
pp. 120-127
Author(s):  
James E. Wenzl ◽  
W. Newlon Tauxe ◽  
Edmund C. Burke ◽  
James C. Hunt ◽  
Gunnar B. Stickler
Keyword(s):  
Renal Disease ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Narrow Range ◽  
Total Body Surface Area ◽  
Radioisotope Renography ◽  
Peak Point ◽  
Total Body ◽  
Initial Peak

Isotope renograms (ortho-iodohippurate-I were obtained from 30 children who had no evidence of renal disease. Determinations were made by a standardized technique with the subjects in a state of relative dehydration; in 15 children the renogram was repeated under conditions of hydration (14 children) or further dehydration (1 child). Values for the point of initial peak (point A), point of maximal radioactivity (point B), and the differences between these points (B-A) were calculated. These values were plotted arithmetically against surface area to obtain regression lines and estimates of the variability of the observations about the line. The time from appearance of radioactivity to peak radioactivity was calculated and found to fall into a relatively narrow range. Similar attempts to correlate mathematically the height of timed segments of the decreasing slope of the renogram with surface area were successful in children with a body surface area of 1.15 m2 or greater. The state of hydration appeared to influence the excretory slope of the renogram; this effect was most pronounced in children whose total body surface area was less than 1.15 m2.

Assessment of burn surface area

2019 ◽  
pp. 67-76
Author(s):  
Rowan Pritchard-Jones ◽  
Kayvan Shokrollahi
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Gold Standard ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Injured Patient ◽  
Crucial Step ◽  
Total Body

Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.

Estimation of body surface area of extremely obese human subjects

1960 ◽  
Vol 15 (5) ◽  
pp. 781-784 ◽  
Author(s):  
Garrett R. Tucker ◽  
James K. Alexander
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Human Subjects ◽  
Total Body Surface Area ◽  
The Body ◽  
Du Bois ◽  
Linear Formula ◽  
Total Body ◽  
Obese Human

The body surface areas of one normal and four extremely obese human subjects have been estimated by three methods: a) direct measurement by a method similar to that which Du Bois described; b) calculation from the Du Bois height-weight formula; and c) calculation from the Du Bois linear formula. The values for the total body surface area of the obese subjects calculated from the height-weight formula varied up to 11% below those that were directly measured. The values for the total body surface area obtained with the linear formula ranged between 13% and 20% above the direct measurements, this being almost entirely due to discrepancies in the trunk and in the thigh estimations. It has been concluded that estimation of the body surface area oxf extremely obese subjects by the Du Bois height-weight formula is satisfactory when considered in relation to the accuracy of the physiologic measurements with which it is generally used. Because of the unusual body form the Du Bois linear formula has been found unsatisfactory for this group. Submitted on March 1, 1960

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