Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog.

CASE DESCRIPTION: A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS: The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME: The dog was hospitalized in the hospital's intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE: The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal's total body surface area.

Palliative care for critically ill older adults: dimensions of nursing advocacy.

Overall, critical care nursing and medical teams are inadequately prepared to deliver palliative care for the critically ill geriatric patient. Conversations with nursing and medical providers caring for the frail elderly within an intensive care unit often reveal feelings of concern for overtreatment of patients when hope for improvement has diminished. Decline of critically ill elders regularly results in conflicts and disagreements surrounding care directives among patient, family, nursing, and specialty service teams. Uncertainty shrouds the care goals as the patient declines within a critical care setting. Nursing and medical providers caring for the critically ill elderly population often waver anxiously between aggressive verses palliative care measures and are troubled by ethical dilemmas of "doing more harm than good." Collaborative, interdisciplinary practice in the face of such dilemmas offers an interactive and practical approach that promotes clinical excellence and improves quality of care for the critically ill. This article defines palliative care, discusses the complexities of caring for the critically ill older adult, and suggests recommendations for nursing practice.