Patient data monitoring system in the burn unit

Burns 3 5 S ( 2 0 0 9 ) S1–S47

S45

26%). The majority of 11th EBA congress oral presentations have not been pub-

ABSI is 5 ± 3 and the average UBS is 44% ± 68. Only 29% of burn have a admission

lished to date. The only meaningful predictor of ultimate journal publication was

in a burn center.

a clearly defined statistical method.

Conclusion: The accidents at home and industrial burn are responsible for a great

doi:10.1016/j.burns.2009.06.178

majority of the burn that the Emergency Mobile Medical Service of hospital of Besanc¸onl staff has taken care of. A action of prevention is necessary in Franche-

FRI105 Extracorporeal life support devices (ECMO, ILA) in severely burned patients: Bridging the gap?

Comté. doi:10.1016/j.burns.2009.06.180

FRI112

A.D. Niederbichler ∗ , A. Jokuszies, T. Peters, A. Steiert, K. Knobloch, K. Busch, P. Vogt Plastic, Hand and Reconstructive Surgery, Burn Center, Medizinische Hochschule Hannover, Hannover,

Patient data monitoring system in the burn unit

Germany

K. Ossmer ∗ , S. Rabel Wall Burn Unit, Department of Reconstructive Plastic Surgery, Karolinska

Rationale: Introduction: Severe burn injury is frequently accompanied by cardiopul-

University Hospital, Stockholm, Sweden

monary dysfunction. Inhalation injury may lead to adult respiratory distress

Rationale: PDMS (Patient Data Monitoring System) enables easy access to all the

syndrome (ARDS). Preexisting pulmonary or cardiac diseases are additive com-

patient data at the point of intensive care and simplifies clinical practice. The pur-

plicating factors. Organ failure, disability and death may result. Extracorporeal life

pose of our study is to describe our experience of implementing PDMS in a Burn

support techniques such as extracorporeal membrane oxygenation (ECMO) or the

Unit.

interventional lung assist devices (iLA, Novalung® ) can be used to both ensure

Methods: The PDMS was modified and designed according to local needs. Prede-

adequate tissue oxygenation and decrease cardiac stress. Depending on the clin-

fined care protocols were validated to the needs of the burn care. All medical

ical situation, various methods such as veno-venous, veno-arterial (VV-VA) ECMO

bedside devices such as monitors, ventilators and infusion pumps were validated

or the iLA can be used.

to be compatible with the system. Implementation of PDMS was started May 2008.

Methods: A systematic, retrospective chart review (2001–2009) of burn patients

At the time, previous flowsheets and most paper charts were removed. After 8-

treated in our unit as well as a literature review using evidence-based medicine

month practice, entire staff answered a questionnaire to evaluate the system. The

(EBM) criteria was performed. From 2001 to 2009, a total of n = 8 patients who

questions focused on the quality of documentation and whether the new system

underwent extracorporeal life support (ELS) after having sustained severe burn

allowed less time to be used for documentation.

injury either with or without concomitant inhalation injury were identified. Clin-

Results: The PDMS is connected to all monitors, ventilators, infusion pumps and

ical outcome was measured by various parameters such as overall survival,

also with the hospital information system for patient administration and labora-

improvement of oxygenation parameters and cardiac function parameters. Cardiac

tory results. The PDMS database allows rapid generation of reports of drugs, fluids,

function was measured by a transpulmonary thermodilution and pulse contour

material and staff expenses. Connection to external systems provides reports to

analysis system (PiCCO® ). Data analysis was done using descriptive statistical

the Swedish Intensive Care Registry. The collected experience of the PDMS; – easy

analysis.

to use – saving time – the task list with reminders are appreciated – reduced medi-

Results: The use of ELS devices improved the assessed cardiac functional and oxy-

cation errors – provide tools to better patient care – automatically continuous fluid

genation parameters in all patients. Survival was noted in n = 5 patients. Ventilator

balance optimise early adjust of fluid – no interruption in the documentation when

parameters could be decreased to the targets as outlined in the guidelines for

patients are at the operating room – the system provides tools to see the patient

protective lung ventilation in all patients.

status at a glance on the computer – after discharge, data is stored in a database

Conclusion: The use of ELS devices can be beneficial in devastating clinical situ-

that makes it easy to analyse outcomes.

ations. Their use is associated with potential complications such as bleeding in

Conclusion: After the implementation of PDMS, less time is required for documen-

case of catheter dislocation. Thromboembolism may occur when anticoagulation

tation, resulting in more time available for patient care. In addition, PDMS has

is not properly initiated and maintained. This study indicates that ELS devices can

reduced the number of medication errors. The majority of the staff prefers PDMS

be a useful and potentially life-saving treatment option in burn patients suffering

in comparison with prior flowsheets and paper charts.

from cardiopulmonary dysfunction. Clinical algorithms for the use of ELS devices

doi:10.1016/j.burns.2009.06.181

in burn patients need to be established. doi:10.1016/j.burns.2009.06.179

FRI110 Epidemiology of burn in Franche-Comté: Activity of the emergency mobile medical service of the hospital of Besanc¸on from 2002 to 2008 J.L. Fortin ∗ , J.M. Labourey, P. Valero, C. Manzon, G. Capellier Emergency Department – Samu 25, Universitary Hospital J. Minjoz, Besan, France

FRI113 Iodine toxicity as a cause of total atrioventricular block in burn patients K. Colpaert 1,∗ , F. Tromp 2 , E. Vandecasteele 2 , A. Dhondt 3 , J. De Waele 1 , E. Hoste 1 , J. Decruyenaere 1 , S. Monstrey 4 1 Intensive Care, Belgium 2 Cardiology, Belgium 3 Nephrology, Belgium 4 Plastic Surgery, Ghent University Hospital, Ghent, Belgium

Rationale: Povidone–iodine is a common used topical antimicrobial agent in burn patients. Previous case reports describe total atrioventricular (AV) block in

Rationale: The Emergency Mobile Medical Service works in Besanc¸on area as well

patients treated with povidone–iodine, although the exact mechanism is still

as three departments (Doubs, Jura and Haute-Saône) with 1,105,500 inhazbitants.

unclear.

It works also suburban and mountains area. From 2002 to 2006, the Emergency

Methods: Description of a case series of burn patients with total AV block treated

Mobile Medical unit took care of 89 burnt victims in primary evacuation and 57

with povidone–iodine, admitted during a 15-month period in our burn centre.

burnt victims in secondary evacuation.

Results: A total of 6 patients with unexplained sudden total AV block were identi-

Methods: A retrospective epidemiology burn study was made in the emergency

fied: five burn patients with a median of 53% (range 25–80%) total body surface

mobile medical service of the hospital of Besanc¸on. The study concerns only the

area (TBSA) and one patient with necrotising fasciitis requiring extensive skin

89 burnt victims in primary evacuation. The assessment of the burn area has been

debridement. None of the patients had a cardiac history or was treated with

done according to the table of Lund and Brownder. The facts that have been take

drugs interfering with cardiac conduction. All patients were topically treated

into account are: age, sex ratio, the victim’s place of residence, the circumstances

with povidone–iodine 10% gel daily and underwent several surgical interven-

and cause of injury, the surface area of burn, the depth and the final destination of

tions. A nodal rhythm developed on median day 39 (range 35–65), mostly in the

the burnt victims.

peri-operative period. In five patients total AV block appeared peri-operatively.

Results: The sex ratio is 32 female patients/57 male patients. The average age

Epinephrine could restore sinus rhythm in 3 patients temporally, placement of

is 30 ± 19 years. The circumstances of the accidents are: accidents at home: 49

a temporary pacemaker was only possible in 3 patients due to access problems.

(55.05%), fire: 15 (16.85%), suicide attempt: 8 (8.98%), industrial injury: 9 (10.11%),

Echocardiography showed no structural heart disease. The urinary iodine con-

attack: 3 (3.37%), car accident: 1 (1.12%) and unknown 1 (1.12%). The causes of injury

centration in the 3rd and 4th patient was high: 72,700 and 678 ␮g/g creatinine

are: flames: 56 (62.92%), liquid: 17 (19.10%), electrical: 14 (15.73%) and contact: 2

respectively (normal range < 222 ␮g/g creatinine). In the last 2 patients the serum

(2.24%). The average surface burn area is 21% ± 21. The depth of burn is: a super-

iodine concentration measured was high as well: 927 and 66,500 ␮g/L, respec-

ficial burn in 49 cases (first degree burn for 8 patients (8.98%), a superficial second

tively (normal range 50–80 ␮g/L). All patients had acute renal failure (ARF) at the

degree burn for 41 patients (46.06%), a intermediary burn in 20 cases (22.47%) and

time of AV-block. Continuous dialysis was efficient in restoring AV conduction in

a deep burn for 8 patients (8.98%). The average Baux index is 51 ± 31, the average

2 patients.