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Appropriate intravenous fluid resuscitation has improved early post burn outcomes. However, clinical and pre-clinical evidence suggests that enteral or oral resuscitation may complement intravenous fluid administration. While this strategy is often discussed in the context of resource-limited settings, its implementation could reduce overall IV fluid requirements and simplify management during routine care. Conversely, concerns about this strategy have been raised over impaired gut perfusion and function leading to adverse effects. We present a case of an 82-year-old man with a total burn size of 14% who was encouraged to ingest the oral rehydration solution Drip Drop® starting 7 hours post-burn. In the ensuing 17 hours he consumed over 5 L of oral rehydration solution, which was nearly 1 L more than the total amount of IV fluids he received. There were no adverse gastrointestinal side effects. This demonstrates tolerance of a significant volume of voluntary oral fluids in combination with IV resuscitation. Clinical trials are warranted.

Freeze branding was first performed in 1966 to identify animals for agricultural purposes, and remains relevant today in veterinary medicine. In contrast, human branding for aesthetics, punishment, identification, and purported medicinal benefits is standardly performed through transfer of thermal energy via heat. Uniquely, this case report documents the first description of freeze branding as a mechanism of injury in humans resulting in a 0.25% total body surface area mixed partial thickness/full thickness forearm burn that was managed non-operatively with out-patient daily wound care over six-months without morbidity. The overall clinical management of freeze branding injuries, anticipated sequelae, and co-morbid diseases will be discussed to provide an educational foundation for future clinical encounters.

Background: Following severe burn injury, patients undergo profound metabolic changes, including insulin resistance and hyperglycemia. Hyperglycemia has been linked to impaired wound healing, increased risk of skin graft loss, increased muscle catabolism, increased infections, and mortality. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that improves glycemic control by slowing the inactivation of incretin hormones, increasing insulin synthesis and release from pancreatic beta cells and lowering glucagon secretion from pancreatic alpha cells. The objective of this study was to describe our institution’s experience with using sitagliptin to help mitigate insulin resistance after burn injury. Methods: This was a retrospective chart review that included 22 adult burn patients. Burn patients were prescribed sitagliptin regardless of their previous medical history of type 2 diabetes mellitus. Patients were included in this analysis if they were adults admitted for burn injury during a 13-month period and received at least 3 consecutive doses of sitagliptin. Patients were excluded if they did not have insulin use data 3 days pre- and 3 days post-sitagliptin initiation. The first day of sitagliptin initiation was considered day 0; data from day 0 were not included in either the pre- or post-sitagliptin analysis. Results: In the 3 days prior to sitagliptin initiation, patients received a median of 114.3 units per day (IQR 49.1, 228) in an attempt to maintain a blood glucose goal of less than 180 mg/dL. In the 3 days after sitagliptin was started, exogenous insulin requirements significantly decreased to a median to 36.3 units per day (IQR 11.7, 95) (P=0.009). Seven patients were on insulin infusions at the time of sitagliptin initiation. After sitagliptin was started, it took a median of 3 days (IQR 2, 3.25) to be liberated from the insulin infusion. In terms of safety, there were two episodes of hypoglycemia (BG

Purpose: End-tidal CO2 (eTCO2) can be used to estimate the arterial CO2 (PaCO2) under steady-state conditions, but that relationship deteriorates during hemodynamic or respiratory instability. We developed a multivariate method to improve our ability to estimate the PaCO2, by using additional information contained in the volumetric capnograph (Vcap) waveform. We tested this approach using data from a porcine model of chest trauma/hemorrhage. Methods: This experiment consisted of 3 stages: pre-injury, injury/resuscitation, and post-injury. In stage I, anesthetized pigs (n=26) underwent ventilator maneuvers (tidal volume and respiratory rate) to induce hypo-or hyper-ventilation. In stage II, pigs underwent either (A) unilateral pulmonary contusion, hemorrhage, and resuscitation (n=13); or (B) bilateral pulmonary contusion (n=13) followed by 30 min of monitoring. In stage III, the ventilator maneuvers were repeated. The following Vcap features were measured: eTCO2, phase 2 slope (p2m), phase 3 slope (p3m), and inter-breath interval. The data were fit to 2 models: (1) multivariate linear regression and (2) a machine-learning model (M5P). Results: 1750 10-breath sets were analyzed. Univariate models employing eTCO2 alone were adequate during stages I and III. During stage II, mean error for the linear model was -8.44 mmHg (R2=0.14, P

Objective: To report the use of a bovine hemoglobin-based oxygen carrier (HBOC-201) in an elderly patient sustaining extensive thermal injury unable to receive allogenic transfusion due to religious preference. Methods: Case report and literature review describing steps required for acquisition and safe infusion of HBOC-201. Results: Six units of HBOC-201 were infused in the perioperative period for anemia with signs of critically low oxygen delivery without adverse sequelae. The patient ultimately died as a result of multiple organ failure. Conclusions: Despite disappointing results of the use of HBOCs in other patient populations, there is a role for compassionate, emergency use of cell-free hemoglobin in the management of burn patients unable to receive allogenic blood products.

Collecting quality of life (QOL) data longitudinally from burn survivors is difficult; especially if they live in geographically distant areas from the burn center. Although mailed surveys can be used, response rates to these surveys may be low. The purpose of this feasibility study was to examine the use of the videophone to collect QOL data from burn patients over 5 time points after discharge from the U.S. Army Institute of Surgical Research Burn Center. Twenty-five patients agreed to participate, using the Starview 2000 Pro II videophone. Participant satisfaction with the technology was measured using the Telemedicine Perception Questionnaire. Qualitative comments from participants and the researchers conducting the videophone data collection sessions also were collected. Military participants were approximately 20 years younger than civilian participants. Most burns were from a thermal cause and civilian patients had a slightly shorter length of stay in the burn center than military participants. The majority of participants were relatively happy with the telehealth technology, rating it with a mean score of 61.84 out of a possible total score of 85. Qualitative comments also reflected a positive attitude about the use of the videophone for research data collection; 60% of the participants said they remained in the study because they were allowed to use the videophone rather than using only the telephone or a mailed survey. The researchers collecting the data also commented about the ease of using the videophone. Negative comments were related to dropped calls or lack of audio or video at certain times. Findings from this study are consistent with the two other studies that reported use of telemedicine to clinically evaluate burn patients. With the rapid advancement of technology, QOL research data could be collected longitudinally from burn patients by using laptops with high resolution, portable video cameras.