Treatment of Sequelae of Burn Injury with Microneedling Procedure (Dermastamp(R))

PURPOSE: Many burn patients have been suffered from sequelae of burn injury (itching, pain, heating sense, etc.). The treatment of those symptoms was not successful even though they are approached multiply. Some patients depend on folk remedies. We try to find the effectiveness of microneedling procedure (dermastamp(R)) which is used for esthetic purpose. METHODS: 25 patients were included who had been treated with the skin massage therapy from September 2008 to March 2009. They received the dermastamp(R) procedure once a week and surveyed from 2 months after procedure. The survey items were itching, pain, tightness, firmness, shape of scar, joint deformities. We divided the severity of symptoms into digit scale form 0 (no symptoms) to 10 (too severe to sleep) and the severity was estimated by patients. Statistical method was Wilcoxon signed rank test. RESULTS: The patient group consisted of 8 males and 17 females. The mean age was 22.2+/-13.8 years old. The average time that felt the effectiveness was 4.4+/-2.3 times. Statistically significant responses showed in itching, firmness (P<0.05), pain and tightness (P<0.01). Improvement of the shape of scar and joint deformities were not statistically significant. CONCLUSION: Even now, no definite treatment against the sequelae of burn injury. Multimodalities of treatment in sequelae of burn injury are using and dermastamp(R) can be an additional method for sequelae of burn injury.

Skin Graft Fixation with Histoacryl Tissue Adhesive in STSG of Burn Patients

PURPOSE: Comparing with suture and staple, skin graft fixation with Histoacryl (N-butyl-cyanoacrylate, B.Braun, Germany) has two advantages. Fixation is simple, painless and removal process is unnecessary. There are few reports that compare histoacryl with conventional methods for skin graft fixation in FTSG. However, there are no comparative studies in STSG. The purpose of this study is to show our experience of skin graft fixation with histoacryl in STSG of burn patients. METHODS: This study included those who was burned less than 10% of TBSA and needed STSG. The patients who had underlying disease (DM, hypertension, liver disease, lung disease) were excluded. 29 patients who visited Bestian burn center from January to July 2009 was enrolled in the study. In STSG, skin graft was fixed with histoacryl and authors marked the fixed points with pen. Fixation rate was checked in 7 days after STSG and take rate was checked in 14 days after STSG. RESULTS: The patient group consisted of 7 males and 22 females. The mean extent of burn area was 2.3%. The type of injury consisted of 18 contact, 8 scald, 1 flame, 2 friction. 31 STSG of 29 patients was done. STSG was done at 24th day after burn, the mean area of wound for STSG was 51 cm2. Mean numbers of fixation point with histoacryl per patients were 14.1. 430 of 436 fixation were stable and fixation rate was 98.6%. There was no infection case. Take rate was 99.1% in 14 days after STSG and it took 21 days for wound opening. CONCLUSION: Until now, suture and staple are common methods in skin graft fixation. However, it is disadvantageous that suture and staples should be removed. Histoacryl does not need those process. This study showed that take rate was 99.1% and fixation rate was 98.6% in fixation with histoacryl. In STSG, Skin graft fixation with histoacryl could be alternative methods for suture and staple.

Effects of Skin Rehabilitation Massage Therapy on Pruritus, Skin Status, and Depression in Burn Survivors / 간호학회지

PURPOSE: Hypertrophic scarring and depression are the principal problems of burn rehabilitation. This study was done to verify the effects of skin rehabilitation massage therapy (SRMT) on pruritus, skin status, and depression for Korean burn survivors. METHODS: A pretest-posttest design using a nonequivalent control group was applied to examine the effects of SRMT for 3 months in a group of 18 burn survivors. The major dependent variables-including pruritus, objective and subjective scar status, and depression-were measured at the beginning and at the end of the therapy to examine the effects of SRMT. RESULTS: Burn survivors receiving SRMT showed reduced pruritus, improved skin status, and depression. The remaining scar also showed improvement in skin pigmentation, pliability, vascularity, and height (compared to the surrounding skin) as measured on the Vancouver Scar Scale (VSS). CONCLUSIONS: The findings demonstrate that SRMT for burn survivors may improve their scars both objectively and subjectively, and also reduce pruritus and depression.

Proper Depth of Tracheal Intubation in Korean Children

PURPOSE: In pediatric intubation, it is difficult to select the correct tracheal tube size and proper depth. Children have as many different tube size as they have ages. This study was performed to evaluate the Pediatric Advanced Life Support (PALS) guideline for intubation in Korean children. METHODS: We studied pediatric patients who were admitted with intubation from 1996 to 2001 at our hospital. We selected 33 Korean patients under 15 years of age for evaluation in this study. Their medical records and chest radiographs were compared. The distance of the tracheal tube tip from the carina on the postintubation chest X-ray was determined. RESULTS: Thirty-three patients were enrolled in the study. The depth of tracheal intubation was proper in 12 patients (36.3%), too deep in 16 patients (48.4%) and too shallow in 5 patients (15.1%). The reasons for intubation were respiratory failure (24.2%), mental change (57.6%) and status epilepticus (18.1%). CONCLUSION: We conclude that the PALS guideline for tracheal intubation is not suitable for Korean children. Determination of the proper depth of tracheal intubation for Korean children is needed through further study.

Inter-rater Reliability of the Modified Emergency Severity Index as a Triage Tool

PURPOSE: Triage in the emergency departmen (ED) is the preliminary clinical sorting process before full disclosure of patients' problems so that patients with the highest acuity are treated first in the setting of resource constraints. To overcome the inter-rater variability of existing triage tools, the Emergency Severity Index (ESI) was developed and was shown to be both valid and reliable in practice. Because of the disparity in practice patterns and some inappropriate criteria in the original ESI, the authors have modified the ESI and determined its inter-rater reliability. METHODS: We applied the modified ESI to a convenient sample of adults who visited an urban academic ED between July 24, 2001, and August 5, 2001. After completion of a short, 4-hour training course on the modified ESI, an intern and emergency medicine resident pair triaged the patients independently. The inter-rater reliability was measured using a weighted kappa analysis and was categorized as excellent (>or=0.8), good (0.60-0.79), or fair (

A retrospective review of the Do-Not-Resuscitate Patients

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.

CLINICAL REVIEW OF DOXYLAMINE SUCCINATE OVERDOSE

BACKGROUND: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. METHODS: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. RESULTS : 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3 hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. CONCLUSION: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the possibility of rhabdomyolysis.

Optima Positioning of Central Venous Catheters

BACKGROUND: Catheterization of central vein may cause fetal complications such as cardiac arrhythmia, cardiac temponade, atrial perforation etc. For prevention of these complications, tip of central venous catheter should located in superior vena cava. The purpose of this study was to investigate the optimal positioning of central venous catheters. METHOD: From March 1996 to Jun 1996, a total of 50 patients who requiring central venous catheters were involved. First, we evaluate the accuracy of predetermined formula of 'Peres'. Second, we hypothesized that height of patients was correlated with optimal length of central venous catheters and we analysed relationship between height and optimal length of central venous catheters using simple regression analysis by SAS. RESULTS: 1) Predetermined formula of 'Peres' inaccurately predicted required length of central venous catheter. The accuracy was 78%. 2) There were a linear relationships between height and optimal length of central venous catheter. Their relationships was followed, Y=0.09X(Y: optimal length of central venous catheters, X: height, p=0.0001, R2=0.39). CONCLUSION: Using height of patients, we can accurately predict the optimal length of central venous catheters.

Alteration of Ionized Calcium, Magnesium and Acid-base status in Hyperventilation Syndrome

BACKGROUND: Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation far this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt. But clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hypeventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. METHOD AND MATERIAL : 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan.1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank. sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. RESULTS: 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mmo1/L, 106mmol/L each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO2 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dL, 0.16mg/dL lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. CONCLUSION: We conclude that ogler than decrement of ionized calcium, decrement of ionized magnesium could be a factor far inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.