Local treatment of burns by honey is not appropriate

According to the world health organization (WHO), management of burns should be well codified and organized such as in trauma patients. The severity of burns is determined usually by the burned surface area, the depth of burn and other considerations. Morbidity and mortality rises with increasing burned surface. Initial local treatment of burn lesions should be focused on speedy healing and prevention of infection. In our African countries and in Tunisia, we still have some strange traditional local treatment of burns. In this rare case report, a seventeen years old young teenager which had a burned leg and back of foot was treated by local administration of honey. After a week of treatment, he was admitted to the emergency department of the regional hospital of Zaghouan in Tunisia. At examination, we found a second degree burns with purple cutaneous blisters covered with white adhesions. We found also sections of dying skin. This inappropriate initial local treatment with honey application could lead to severe complications. After gentle debridement with 0.25% chlorhexidine solution, and gentle scrubbing, all necrotic tissue was removed. After daily change of dressing and systemic antibiotics, the lesions recovered totally. The teenage was discharged from hospital after five days.Pan African Medical Journal 2016; 2

A historic “open book fracture”

"Open book fracture" is rare. It is one of the most dangerous pelvic fractures. It is usually associated with abdominal, vascular and nervous injuries requiring a multidisciplinary team for its management. Itstreatment  is mainly surgical. Only some cases are published in recent literature. The mechanism is usually complex and the consequences usually dramatic. We report in this case a very rare image of an open book fracture which occurred in a young thirty old man. He was admitted to the emergency department of our hospital after a work accident. He was hit by a heavy (500 kg) charge in his back with impact to the groin in the manufactory where he works. He was transferred by a non-medical transfer to our emergency department. At initial examination, he had a deformed pelvis with moderate bleeding. We observed a large hematoma in his back. The standard pelvis radio X ray (A) revealed a disruption of the pelvic ring with a "third fragment". Pelvic CT scan showed this third fragment (B). There was a complete fracture of the right iliac wing with a sacroiliac joint disruption. The right and the left halves of the pelvis are separated at front and rear. The front was opening more than the rear. It seemed like an open book and it is called "open book" pelvic fracture. The patient was managed initially in the emergency room with fluid challenge and analgesia. He had then urgent multidisciplinary surgery with external fixation with a good outcome.Pan African Medical Journal 2016; 2

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture

Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications

Easily identified at-risk patients for extubation failure may benefit from noninvasive ventilation: a prospective before-after study

Abstract Background While studies have suggested that prophylactic noninvasive ventilation (NIV) could prevent post-extubation respiratory failure in the intensive care unit, they appear inconsistent with regard to reintubation. We assessed the impact of a prophylactic NIV protocol on reintubation in a large population of at-risk patients. Methods Prospective before-after study performed in the medical ICU of a teaching referral hospital. In the control cohort, we determined that patients older than 65 years and those with underlying cardiac or respiratory disease were at high-risk for reintubation. In the interventional cohort, we implemented a protocol using prophylactic NIV in all patients intubated at least 24 h and having one of these risk factors. NIV was immediately applied after planned extubation during at least the first 24 hours. Extubation failure was defined by the need for reintubation within seven days following extubation. Results We included 83 patients at high-risk among 132 extubated patients in the control cohort (12-month period) and 150 patients at high-risk among 225 extubated patients in the NIV cohort (18-month period). The reintubation rate was significantly decreased from 28 % in the control cohort (23/83) to 15 % (23/150) in the NIV cohort (p = 0.02 log-rank test), whereas the non-at-risk patients did not significantly differ in the two periods (10.2 % vs. 10.7 %, p = 0.93). After multivariate logistic-regression analysis, the use of prophylactic NIV protocol was independently associated with extubation success. Conclusions The implementation of prophylactic NIV after extubation may reduce the reintubation rate in a large population of patients with easily identified risk factors for extubation failure