Results of a Pilot Multicenter Genotype-based Randomized Placebo-controlled Trial of Propranolol to Reduce Pain After Major Thermal Burn Injury

Results of previous studies suggest that β-adrenoreceptor activation may augment pain, and that β-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high activity haplotype

Meningitis Secondary to Pseudomonal Endophthalmitis in a Burn Patient: A Case Report and Review of the Literature

Background: To report the case of a burn patient with meningitis secondary to pseudomonal endophthalmitis that led to death. Case Presentation: An 18-year-old female who sustained flame burns in a house fire was admitted to our burn center. She sustained burns that accounted for 68% of her total body surface area, including her face. The patient underwent multiple excision and grafting procedures. On the thirteenth post-burn day, wound cultures revealed a resistant Pseudomonas sensitive only to aminogyclosides and colistin. On the twentieth post-burn day the patient developed edema, erythema, and proptosis of the right eye. Ophthalmology was consulted and endophthalmitis was diagnosed. A lateral right canthotomy was performed. Treatment modalities including intra-vitreous antibiotic injection were discussed but not performed. Computed tomography (CT) of the head at that time showed concern for retrobulbar inflammation. There was a progressive decrease in her mental status. An additional brain CT scan showed diffuse cerebral abnormalities and edema. Clinical examination at that time demonstrated decreased cerebral activity consistent with brain death and repeat neurologic examination confirmed brain death. Conclusion: Meningitis constitutes a rare complication of endophthalmitis and its prompt diagnosis and treatment via administration of systemic antibiotics via intravenous or intrathecal routes, with intra-vitreal antibiotics could lead to a more favorable outcome. Endophthalmitis is a rare condition, usually occurring as a complication of intra-ocular surgery or penetrating injury. Rarely, endophthalmitis may follow metastatic spread of fungal or bacterial infection from a distant source and the majority of these patients suffer from an underlying disease. Pre-disposing factors are immunocompromise, intravenous drug abuse, and prolonged stay in intensive care

Western Trauma Association critical decisions in trauma: Preferred triage and initial management of the burned patient.

This is a recommended management algorithm from the Western Trauma Association addressing the management of victims of burn injury. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published retrospective studies, clinical guidelines, and the expert opinion of members of the Western Trauma Association in conjunction with partner members of the American Burn Association. The algorithm and accompanying comments represent one safe and sensible approach that can be followed at most trauma centers. We recognize that there may be patient or institutional factors that warrant deviation from the published algorithm. We would encourage institutions to use this document as a starting point toward a dialog with local burn centers to collaboratively create a patient-centered care experience for the victims of minor burn injuries arriving at local trauma centers

Catechol-O-Methyltransferase Genotype Predicts Pain Severity in Hospitalized Burn Patients

Increasing evidence suggests that stress system activation after burn injury may contribute to burn-related pain. If this is the case, then genetic variations influencing the function of important stress system components, such as the enzyme catechol-O-methyltransferase (COMT), may predict pain severity after thermal burn injury