Résumé
Background: Central Venous Catheterizations (CVC) is a standard method of intravenous access in resuscitation of acute severe burn patients, with the subclavian and internal jugular veins being preferred over the femoral vein. However the ease of placement and the decreased chance of life threatening complications make it an attractive and safe option for the burns physician. Aims: To study the efficacy femoral CVC in acute burns resuscitation. Methods: This is a prospective observational study conducted over a period of 2 years. Patients with acute severe burns were admitted, and landmark based femoral central venous catheter was placed for resuscitation. Results: A total of 300 femoral central lines were placed in 300 patients. In 84.66% patients the right femoral vein was used and 15.3% patients, left femoral vein was catheterized. In 65% patients catheterisation was done in one attempt while 34.33% patients required 2- 3 attempts. No use of ultrasound was required in any of our patients. The risk of catheter related blood stream infections due to femoral CVC was not higher when compared with CVC placement in other sites (subclavian/internal jugular). Conclusion: Landmark based femoral central venous catheterisation is a quick, reliable and safe method to attain venous access in acute severe burn patients with lesser chances of immediate life threatening complications when compared to other sites of placement.
Résumé
Background: Necrotising fasciitis is a progressive, fulminant, inflammatory infection of deep fascia with secondary necrosis of subcutaneous tissue. The present study was carried out to evaluate the usefulness of LRINEC score to differentiate Necrotising fasciitis (NF) from other soft tissue infections (STI). Methods: Ours was a prospective observational study carried out in a tertiary care setting over a period of one year from November 2013 to November 2014. 150 patients of soft tissue infections were included. Clinical evaluation was done based on the signs and symptoms which included a rapidly progressive oedema, bullae, blue-grey cyanotic lesions, erythema and necrotic patches. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score including Haemoglobin count, Total leucocyte count, C - reactive protein, Platelet count, Fasting blood sugar and Serum sodium, was calculated for all the patients. Results: Among 150 patients with soft tissue infection, 108 (72%) patients were clinically proven to be NF, rest 42(28%) were soft tissue infections. Based on LRINEC score out of 42 STI, 15 % had moderate to high risk of NF while out of the 108 confirmed NF cases 55 % had low to moderate risk of NF. Conclusion: The low sensitivity and low positive predictive value achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections
Résumé
Varicose veins have troubled mankind for thousands of years, and their various treatments and complications have been documented from the times of Hippocrates. Although thrombophlebitis is a relatively common condition in the superficial veins of the upper or lower limbs, it usually follows some intravenous intervention or trauma. Thrombosis followed by thrombophlebitis in varicose veins has seldom been reported in literature but the occurrence of spontaneous thrombosis in only the above knee perforator veins of the lower limb has been seldom mentioned. We report the case of a patient with long standing varicose veins of the left lower limb presenting with spontaneous thrombosis of only the above knee perforators and our subsequent management.