[Treatment of the burned patient: a review of the literature]

Nursing care directed to burned patients: a scoping review

OBJECTIVES

to identify in the literature and summarize nursing care in a hospital environment directed to patients who suffered burns.

METHODS

a scoping review, according to the JBI Reviewers' Manual recommendations, with a search in the MEDLINE, CINAHL, Web of Science, Scopus databases and in the Virtual Health Library portal, through articles published between 2016 and December 2021.

RESULTS

of the total 419 articles found, nine were selected for analysis. The main care measures identified were changing dressings and types of coverage, vital sign control, non-pharmacological techniques for pain relief and opioid reduction.

CONCLUSIONS

the complexity of burn care requires constant updating by the nursing team. Keeping it prepared to carry out the best nursing care practices for burn patients will promote adequate care, patient recovery and reduction of possible harm.

Expression of fibroblast cells after extraction of wistar rat teeth after topical application of okra fruit (Abelmoschus esculentus) gel

Background

Tooth extraction is a dental procedure for removing a teeth from the alveolar bone socket. The tooth extraction process causes damage to hard tissue and soft tissue, so the body will respond physiologically to heal the wound. The wound healing process is divided into several phases, one of which is the proliferation phase of fibroblasts, which is one of the most important phases in the process of wound healing. Okra fruit contains saponins, tannins, flavonoids and alkaloids that have antiinflammatory, antibacterial, antioxidant effects, and can stimulate angiogenesis so to accelerate the process of wound healing.

Objective

to prove that the administration of okra fruit extract can accelerate the process of wound healing after extraction in the teeth of Wistar rats through increased expression of fibroblast cells.

Methods

18 Wistar rats were divided into 2 groups; control group and treatment group. The treatment group received a 30% okra fruit extract. The number of fibroblasts was calculated statistically using One Way ANOVA and Tukey HSD.

Results

The results showed that the expression of control group fibroblast cells on day 3 (19.00±2.0), day 5 (21.67±2.08), day 7 (24.00±2.00), whereas in the treatment group on day 3 (24.00±1.00), day 5 (29.00±2.00), day 7 (30.00±1.53). Anova test between groups showed a significant difference with P-value 0.006.

Conclusion

30% okra fruit extract can increase fibroblast expression in wound healing process after extraction of Wistar rat teeth.

Therapy for patients with burns - an integrating review

OBJECTIVE

to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns.

METHODS

integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns.

RESULTS

ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited.

CONCLUSION

the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.

Development of Chitosan/Silver Sulfadiazine/Zeolite Composite Films for Wound Dressing

Biopolymeric films with silver sulfadiazine (AgSD) are proposed as an alternative to the occlusive AgSD-containing creams and gauzes, which are commonly used in the treatment of conventional burns. While the recognized cytotoxicity of AgSD has been reported to compromise its use as an antimicrobial drug in pharmaceuticals, this limitation can be overcome by developing sustained-release formulations. Microporous materials as zeolites can be used as drug delivery systems for sustained release of AgSD. The purpose of this work was the development and characterization of chitosan/zeolite composite films to be used as wound dressings. Zeolite was impregnated with AgSD before the production of the composite films. The physicochemical properties of zeolites and the films were evaluated, as well as the antimicrobial activity of the polymeric films and the cytotoxicity of the films in fibroblasts Balb 3T3/c. Impregnated zeolite exhibited changes in FTIR spectra and XRD diffraction patterns, in comparison to non-impregnated composites, which corroborate the results obtained with EDX-SEM. The pure chitosan film was compact and without noticeable defects and macropores, while the film with zeolite was opaquer, more rigid, and efficient against Candida albicans and some gram-negative bacteria. The safety evaluation showed that although the AgSD films present cytotoxicity, they could be used in a concentration-dependent fashion.

Skin Wound Healing Potential and Mechanisms of the Hydroalcoholic Extract of Leaves and Oleoresin of Copaifera langsdorffii Desf. Kuntze in Rats

The wound healing is a complex process which, sometimes, can be a problem in public health because of the possibility of physical disability or even death. Due to the lack of a gold standard drug in skin wound treatment and aiming at the discovery of new treatments in skin repair and the mechanisms involved in the process, we used oleoresin (OR) from Copaifera langsdorffii and hydroalcoholic extract of the leaves (EH) to treat rat skin wounds. For that, male Wistar rats were divided into groups (n = 8): Lanette, Collagenase, 10% EH, or 10% OR and, after anesthesia, one wound of 2 cm was made in the back of animals. The wounds were treated once a day for 3, 7, or 14 days and the wound areas were measured. The rats were euthanized and skin samples destined to biochemical, molecular, and immunohistochemical analysis. The results showed a macroscopic retraction of the wounds of 10% EH and 10% OR creams and both treatments showed anti-inflammatory activity. Molecular and immunohistochemical results demonstrated the activity of Copaifera langsdorffii creams in angiogenesis, reepithelialization, wound retraction, and remodeling mechanisms.

Atendimentos decorrentes de queimaduras em serviços públicos de emergência no Brasil, 2009

O objetivo foi analisar os atendimentos por queimaduras em serviços de emergência, e fatores associados. Estudo transversal de 761 atendimentos coletados pelo Sistema de Vigilância de Violências e Acidentes em 2009. A maioria foi do sexo masculino (58,6%); adultos de 30 a 49 anos (23,1%) e crianças de 0 a 9 anos (23%). A residência foi o local de ocorrência mais frequente (62,1%), especialmente para crianças e mulheres; em seguida comércio, serviços, indústria e construção (19,1%), especialmente entre homens de 20 a 49 anos. Queimaduras no trabalho foram 29,1% do total. Uso de álcool chegou a 5,1%. Agentes causadores em todas as idades: substância quente (43,6%) e fogo/chama (24,2%); na faixa produtiva: substâncias químicas. As queimaduras entre 0 e 14 anos foram associadas com residência, substância e objeto quente e internação hospitalar; entre os de 15 a 49 anos associaram-se com fogo/chama e choque elétrico, via pública e alta da emergência. Estratégias de prevenção para crianças e trabalhadores devem ser implantadas.

Development of animal model for studying deep second-degree thermal burns

Thermal lesions were produced in 12 male Wistar rats, positioning a massive aluminum bar 10 mm in diameter (51 g), preheated to 99°C ± 2°C/10 min. on the back of each animal for 15 sec. After 7, 14, 21, and 28 days, animals were euthanized. The edema intensity was mild, with no bubble and formation of a thick and dry crust from the 3rd day. The percentage of tissue shrinkage at 28 days was 66.67 ± 1.66%. There was no sign of infection, bleeding, or secretion. Within 28 days reepithelialization was incomplete, with fibroblastic proliferation and moderate fibrosis and presence of modeled dense collagen fibers. It is concluded that the model established is applicable in obtaining deep second-degree thermal burns in order to evaluate the healing action of therapeutic agents of topical use.

[Clinical and epidemiological aspects of burned patients hospitalized in a teaching hospital]

The objectives of this study were to characterize burned patients according to epidemiological and clinical variables and identify the treatments, invasive procedures and complications. This is a retrospective, descriptive and quantitative study. The sample consisted of 138 burned patients hospitalized in a teaching hospital from January 2003 to December 2007, in Uberaba-MG. Of the 138 hospitalized patients, 98 (71.0%) were male, and the average age was 26.1 years. The average length of stay was 16.2 days; 93 (67.4%) of the burns were caused by accidents and the main cause (68; 49.3%) was an open flame. The average burned body surface was 20.8% and most (122; 88.4%) had second degree burns. The most common topic treatment (93; 67.4%) was silver sulfadiazine. Forty-seven (34.0%) patients had indwelling catheters; 30 (21.7%) underwent tissue transplantation, and 28 (20.3%) underwent debridement; the lesions in 14 (10.1%) patients became infected.

[The importance of nursing care in managing complications related to fully-implantable catheters]

This is an experience report of a thirty-year-old female patient, diagnosed with recurrence of Acute Myeloid Leukemia, submitted to catheter implantation and presenting surgical wound necrosis. The following were used with success: collagenase, calcium alginate and oil lotion with essential fatty acids. It was found that the complications related to catheters are a great challenge in oncology nursing besides implying a delay in the oncological treatment. Making a correct decision as soon as possible is extremely important and avoids removing the catheter too soon.

Primeiro atendimento em queimaduras: a abordagem do dermatologista

Apesar dos crescentes progressos obtidos ultimamente no tratamento dos grandes queimados, ainda são consideráveis as taxas de mortalidade e morbidade. As estratégias preventivas implementadas ainda não foram capazes de alterar significativamente o dramático quadro epidemiológico das queimaduras. Os sobreviventes de queimaduras graves ainda carregam um pesado fardo de seqüelas físicas e psicossociais que geram grande sofrimento a ser superado. Não há dúvida de que o prognóstico final de uma queimadura depende essencialmente de um pronto e adequado primeiro atendimento. Daí a importância de todo médico, inclusive o dermatologista, estar habilitado a orientar os primeiros socorros e a prestar o primeiro atendimento médico à vítima de queimadura. Este artigo procura fazer uma revisão das bases fisiopatológicas das queimaduras e dos princípios de avaliação do queimado, além de discutir de forma simples e objetiva a abordagem médica de urgência até a remoção da vítima para uma unidade de queimados, se houver indicação.