Parkland formula role in treatment of severe burn – Case report

Cilj je ovog rada prikaz bolesnika s iznimno opsežnim opeklinama svih dijelova tijela. Muškarac srednjih godina 12-ak sati prije početka bolničkog liječenja u KBC-u Split pokušao je suicid paljenjem plinske boce u zatvorenom prostoru, oko 150 kilometara od ustanove gdje je započeto liječenje. Eksplozija i požar kojima je pacijent bio izložen uzrokovali su opekline visokog stupnja na velikoj tjelesnoj površini. U trenutku prijma na bolničko liječenje pacijent je bio ekstremno agresivan i nesuradljiv. Važno je naglasiti da pacijent u trenutku prijma na bolničko liječenje nije imao uspostavljen venski put. U bolnicu je primljen sa znatnom odgodom (12 sati +/- 1 sat), koja je produbila dehidraciju i pogoršala njegovo, već ionako životno ugroženo stanje. Dubina opeklina procijenjena je na stupnjeve II. b i III., a zahvaćale su 70% ukupne površine tijela (engl. Body surface area – BSA). Prvi cilj prije volumne nadoknade bila je uspostava odgovarajućega venskog puta, koji pacijent u trenutku prijma u bolnicu nije imao. Zbog agitiranosti i agresivnosti intramuskularno se injicirala kombinacija midazolama, ketamina i atropina, a središnji venski pristup uspostavio se tek kad je pacijent bio anesteziran. Obilna nadoknada kristaloidima za vrijeme inicijalnoga trosatnog zbrinjavanja privremeno je stabilizirala bolesnika, a agresivna nadoknada kristaloidima i koloidima nastavljena je u jedinici intenzivnog liječenja. Potrebe za kristaloidima u prva 24 sata izračunane su s pomoću Parklandske formule i iznosile su 25.200 mL kristaloida. Tijekom liječenja pacijent je šest puta podvrgnut kirurškim zahvatima uz svakodnevna previjanja u općoj anesteziji. Boravak se zakomplicirao zbog infekcije multirezistentnim Acinetobacter baumannii. Zaključno, Parklandska formula ostaje okosnica volumne nadoknade pacijenata s opeklinama II. i III. stupnja. Odgoda liječenja, prisutna u ovom slučaju, rezultirala je enormnom dehidracijom i gubitkom intravaskularnog volumena sa svim patofiziološkim poremećajima pridruženima takvom stanju. Zbrinjavanje pacijenta bilo je dodatno otežano zbog njegove agresivnosti pri prijmu, nedostatka venskog puta i nemogućnosti započinjanja liječenja odmah ili vrlo brzo nakon nastalih opeklina.In this case report a rarely seen and a fairly demanding patient is presented. A middle-aged male with severe and extensive burns sustained after attempted suicide with ignited propane butane containing gas bottle was transported to the emergency department of University Hospital Centre Split after more than 12 hours since initial injury. Explosion and fire caused the second and third degree burns to the patient on a very large body surface area (70 percent). At the moment of admission, he was extremely aggressive, combative and uncooperative. Also, it is important to emphasize that the patient had no intravenous access. Due to the absence of intravenous access, and due to the patients’ condition, the author decided to apply midazolam, ketamine and atropine intramuscularly. After the patient was in general anaesthesia, central venous access was established via left subclavian vein, and immediate crystalloid infusion therapy was initiated. According Parkland formula, volume of crystalloid replacement should be 25200 mL during the first 24 hours. Since more than eight hours passed from the time of the injury, fluid deficit was theoretically more than 8400 mL. During the initial treatment and three hour surgery, the patient received 5500 mL of Plasma-Lyte solution. He was treated in the intensive care unit for a prolonged period of time, and complicated with multiresistant Acinetobacter baumannii infection. Finally, Parkland formula remains the basic tool in burn fluid resuscitation. Our intention was to present an interesting case of a middle-aged patient with extensive burns, whose care was complicated with aggression at admission, lack of intravenous access, and a prolonged period between the initial injury and the start of hospital treatment. These greatly complicate the treatment, patients’ recovery and overall morbidity and mortality

Breaking Stereotypes in American Popular Culture: Proceedings of the 10th Annual Conference of the Croatian Association for American Studies

This volume is the proceedings of the 10th Annual Conference of the Croatian Association for American Studies: Breaking Stereotypes in American Popular Culture, which was hosted by the Faculty of Humanities and Social Sciences, University of Osijek, on September 9–10, 2022. The conference, which brought together twenty-two early-career and senior scholars from across Europe, was co-organized by the Croatian Association for American Studies and two research centers affiliated with the Faculty of Humanities and Social Sciences at the University of Osijek—Centre for Popular Culture and Center for North American Studies. The keynote lecture, Challenging “Karen” Stereotypes, was delivered by Kamilla Elliott, Professor of Literature and Media at Lancaster University. A rich variety of the contributions, in addition to the interdisciplinary scope and the relevance and appeal of the conference theme, provided an excellent forum for a productive exchange of ideas on the construction and persistence of stereotypes and stereotypical representations in the context of both global popular culture and the American cultural space. The eight chapters contained in this volume aim to continue this conversation by exploring how the dynamics of making and breaking of stereotypes has been addressed in American cultural industries while illuminating a range of stereotypical tropes and processes of their production and dissemination as well as their wider (cross)cultural resonances, both historical and contemporary. Focusing on diverse cultural and semiotic practices and mediascapes—from fiction, drama, film, and music to social-media blog, podcast, and memoir—and approaching the subject matter from various theoretical and disciplinary angles, this volume explores not only the patterns inherent to the mobilization, cultural apprehension, and reinforcement of stereotypes but also mechanisms through which stereotypical attitudes, expectations, and representations can be circumvented, contested, and upended.This volume is the proceedings of the 10th Annual Conference of the Croatian Association for American Studies: Breaking Stereotypes in American Popular Culture, which was hosted by the Faculty of Humanities and Social Sciences, University of Osijek, on September 9–10, 2022. The conference, which brought together twenty-two early-career and senior scholars from across Europe, was co-organized by the Croatian Association for American Studies and two research centers affiliated with the Faculty of Humanities and Social Sciences at the University of Osijek—Centre for Popular Culture and Center for North American Studies. The keynote lecture, Challenging “Karen” Stereotypes, was delivered by Kamilla Elliott, Professor of Literature and Media at Lancaster University. A rich variety of the contributions, in addition to the interdisciplinary scope and the relevance and appeal of the conference theme, provided an excellent forum for a productive exchange of ideas on the construction and persistence of stereotypes and stereotypical representations in the context of both global popular culture and the American cultural space. The eight chapters contained in this volume aim to continue this conversation by exploring how the dynamics of making and breaking of stereotypes has been addressed in American cultural industries while illuminating a range of stereotypical tropes and processes of their production and dissemination as well as their wider (cross)cultural resonances, both historical and contemporary. Focusing on diverse cultural and semiotic practices and mediascapes—from fiction, drama, film, and music to social-media blog, podcast, and memoir—and approaching the subject matter from various theoretical and disciplinary angles, this volume explores not only the patterns inherent to the mobilization, cultural apprehension, and reinforcement of stereotypes but also mechanisms through which stereotypical attitudes, expectations, and representations can be circumvented, contested, and upended

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave : the global UNITE-COVID study

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality