To retrospect the development of fluid resuscitation for burn shock and to look to the future. The main achievements in burn care in the past fifty years and existing problems are summarized, and the appropriate regime of fluid resuscitation for burn shock is suggested. Numerous achievements in burn care have been made, including the estimation of burn area, fluid replenishment formula, delayed resuscitation, fluid resuscitation for burn shock complicated by inhalation injury, covert compensatory shock and research on mechanism of burn shock etc. We had established and improved fluid resuscitation formula, and we had made clear how to properly resuscitate burn shock. However how to tide over the patient form burn shock smoothly had not yet reached a consensus. Effective treatment to alleviate hypoxic injuries as a result of severe shock had not been properly defined. Although significant achievements in fluid resuscitation for burn shock have been made, there is still a long way to go to attain a perfect regime. Therefore it is still utterly necessary to carry on in-depth research on this problem both in the laboratory and bedside.
Burns ; therapy ; Fluid Therapy ; Humans ; Shock, Traumatic ; therapy

It is well known that shock is one of the main complications occurring during early stage of severe burn, and presently, ischemic/hypoxic damage of tissues and organs is still hard to be prevented by various fluid resuscitation regimens. Findings in recent years demonstrated that postburn cardiac damage occurs promptly and much earlier than any other organs. Application of measures to ameliorate cardiac damage may improve organ blood flow in liver, kidney, and intestines, and mitigate organ damage concomitant with fluid resuscitation according to Parkland formula. These facts suggest that cardiac damage occurring promptly at early stage of severe burn is one of the important factors leading to ischemia/hypoxia of tissues and organs, therefore,new resuscitation regimen including "volume replacement" plus "dynamic support" may conduct to more effective burn shock resuscitation, and reduce organ complications as a result of either insufficient or over fluid infusion.
Burns ; therapy ; Fluid Therapy ; Humans ; Resuscitation ; methods ; Shock, Traumatic ; therapy

BACKGROUND: The Sewol ferry disaster caused national shock and grief in Korea. The present study examined the prevalence and associated factors of post-traumatic stress disorder (PTSD) symptoms among the surviving students 20 months after that disaster. METHODS: This study was conducted using a cross-sectional design and a sample of 57 students (29 boys and 28 girls) who survived the Sewol ferry disaster. Data were collected using a questionnaire, including instruments that assessed psychological status. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with PTSD symptoms. RESULTS: The results showed that 26.3% of participants were classified in the clinical group by the Child Report of Post-traumatic Symptoms score. Based on a generalized linear model, Poisson distribution, and log link analyses, PTSD symptoms were positively correlated with the number of exposed traumatic events, peers and social support, peri-traumatic dissociation and post-traumatic negative beliefs, and emotional difficulties. On the other hand, PTSD symptoms were negatively correlated with psychological well-being, family cohesion, post-traumatic social support, receiving care at a psychiatry clinic, and female gender. CONCLUSION: This study uncovered risk and protective factors of PTSD in disaster-exposed adolescents. The implications of these findings are considered in relation to determining assessment and interventional strategies aimed at helping survivors following similar traumatic experiences.
Adolescent ; Child ; Disasters* ; Female ; Grief ; Hand ; Humans ; Korea* ; Linear Models ; Prevalence ; Protective Factors ; Shock ; Stress Disorders, Post-Traumatic ; Survivors

OBJECTIVETo investigate the influence of escharectomy during shock stage on plasma lipid and free fatty acid levels in scalded rats.

METHODSThirty-two adult Wistar rats inflicted with 30% TBSA III degree scalding were employed as the model and were divided into normal control (NC), scalding control (SC) and treatment groups (T), and the latter was further divided into three sub groups according to the time of escharectomy, i.e. 8 postburn hour (PBHs) (T8), 24 PBHs (T24) and 96 PBHs (T96) groups. The rats were sacrificed at 168 PBHs. The postburn changes in the rat plasma lipid and free fatty acid levels were determined.

RESULTS1) There was significant increase in serum triglyceride (TG), cholesterol (CHO), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB) and all the free fatty acids (FFAs) in the total serum FFAs excluding myristic acid (P < 0.05) at 168 PBHs in rats of all the T groups. 2) The serum levels of TG, CHO, ApoB, total FFA, lauric acid, palmitic acid, zoomaric acid, oleic acid and linoleic acid in T8 and T24 groups were evidently lower than those in SC group (P < 0.05). The plasma levels of VLDL, stearic acid and arachidonic acid in T8 were obviously lower than those in SC group (P < 0.05); 3) In T96 group, the serum levels of ApoB and lauric acid were significantly lower than those in SC group (P < 0.05), but all the other indices remained higher than those before injury.

CONCLUSIONThere was enhanced fat mobilization after severe burn injury. Escharectomy during shock stage might decrease fat mobilization, which was beneficial to the restoration of normal lipid metabolism.

Animals ; Burns ; blood ; surgery ; Fatty Acids ; blood ; Lipids ; blood ; Male ; Rats ; Rats, Wistar ; Shock, Traumatic ; blood ; surgery

PURPOSE: A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion. METHODS: On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed. RESULTS: Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p < 0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated. CONCLUSION: UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.
ABO Blood-Group System ; Bays ; Blood Pressure ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Humans ; Mortality ; Shock* ; Shock, Traumatic ; Transfusion Reaction ; Trauma Centers

We describe here a case of traumatic neuroma that developed in the pancreas head as a rare complication of pancreatic surgery for pseudocyst. A 50-year-old man presented with septic shock. The patient was a heavy drinker with history of operation for pancreatic pseudocyst 28 years ago. On the radiologic examinations, a poorly defined mass-like lesion was found in the uncinate process of pancreas, and it had features of chronic pancreatitis and a stricture of the distal common bile duct. Whipple's operation was performed due to the diagnosis of suspected pancreas head cancer. The pancreas revealed an ill-demarcated 4 cm sized firm mass with grayish white fibrotic cut surface in the head portion. On the microscopic examination, the mass was composed of haphazard proliferations of nerve fascicles in a fibrocollagenous matrix and this case was diagnosed as traumatic neuroma. Although traumatic neruoma is a rare cause of a pancreatic mass, it should be included as a differential diagnosis of pancreatic mass in patients with a history of pancreatic surgery.
Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Diagnosis, Differential ; Head and Neck Neoplasms ; Head* ; Humans ; Middle Aged ; Neoplasms, Post-Traumatic ; Neuroma* ; Pancreas* ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Shock, Septic

Body Surface Area ; Burns ; complications ; therapy ; Humans ; Multiple Organ Failure ; prevention & control ; Shock, Traumatic ; etiology ; prevention & control ; Wound Infection ; prevention & control

OBJECTIVETo study the dynamic changes in the lymphokines and the changes in tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8) levels in the lymph during shock stage of rats with major burns.

METHODSForty-two male adult Wistar rats were randomly divided into burn resuscitation group (A, n = 18), burn non-resuscitation (B, n = 18) and the control (C, n = 6) groups. The TNF-alpha, IL-6 and IL-8 levels in the lymph were determined with radioimmunoassay at 6, 24, 48 postburn hours (PBH). The lymphokines in the mesenteric lymphatic vessels was observed at 6, 24 and 48 PBH with inverted microscopy and digital image processing, and the contraction frequency of the lymphatic was calculated. The lymph was collected by cannulation of the chylous cistern, and its speed of flow was calculated.

RESULTSThe lymphatic contents of TNF-alpha and IL-6 in both A and B groups began to increase at 6PBH, reaching the peak values at 24 PBH (TNF-alpha in A and B groups were 1.61 +/- 0.27 ug/L and 1.86 +/- 0.34 ug/L, respectively; IL-6 in A and B groups were 398 +/- 67 ng/L and 572 +/- 97 ng/L, respectively), and they were significantly higher than those in C group at each time points (P < 0.01), meanwhile there was also obvious difference in them between A and B groups (P < 0.01). The lymphatic contents of IL-8 in A and B groups began to increase at 24 PBH, and continued to increase till 48PBH (540.29 +/- 0.32 ng/L in A group, 863.48 +/- 105.16 ng/L in B group), which were evidently higher than those in C group (P < 0.01). There was significant difference in IL-8 contents between A and B groups (P < 0.01). The contraction frequency of the mesenteric lymphatic vessels in A and B groups were decreased, especially so at 24 PBH (P < 0.01). The speed of lymphatic flow in A and B groups was increased at each time points (P < 0.01). The central chylous vessels in the villi of the small intestine were extremely dilated as seen under microscope.

CONCLUSIONAfter burn injury, the lymphatic vessels dilated, with its motility decreased and speed of flow increased, and the contents of TNF-alpha, IL-6 and IL-8 in lymph were increased during the shock stage of burn rats. Fluid resuscitation could improve the lymph circulation.

Animals ; Burns ; metabolism ; physiopathology ; Disease Models, Animal ; Interleukin-6 ; metabolism ; Interleukin-8 ; metabolism ; Lymph ; metabolism ; physiology ; Male ; Rats ; Rats, Wistar ; Shock, Traumatic ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo investigate the influence of escharectomy during shock stage on systemic and intestinal immune function and its mechanism in scalded rats.

METHODSNinety-six Wistar rats were employed in the study of which 8 were used as normal control group. The donor skin from the trunk in twenty-four rats were preserved in liquid nitrogen. The other 64 rats were subjected to 30% full-thickness scalding, and they were randomly divided into A (n = 24, no treatment after scalding), B (n = 24) and C (n = 16) groups. Physiological saline was intraperitoneally injected (50 ml/kg) on the 24 post-scalding hours to the rats in the B and C groups. The rats in B group underwent escharectomy during shock stage, and the excision wounds were covered with the cryo-preserved alloskin. The rats in C group received the same treatment as in B group but at 72 post-scalding hours. The change in the proliferative ability of splenic lymphocytes, the plasma and intestinal tissue content of interleukin 2 (IL-2), the contents of sIgA in intestinal mucus, and the content of DAO in the intestinal tissue were observed on 2, 4 and 8 post burn days (PBD) in A and B groups and also on 4 and 8 PBD in C group, respectively.

RESULTSThe splenocytic proliferative ability, IL-2 level in the plasma and intestinal tissue, and the sIgA content in intestinal mucus in the rats in A, B and C groups were lower than that in control group at all time points (P < 0.05). The proliferative ability of splenic lymphocytes in B group on 4 and 8 PBD and in C group on 8 PBD respectively was similar to that in control group. Whereas the IL-2 content in plasma and in intestinal tissue was higher in B and C groups than that in A group (P < 0.01). The sIgA content in intestinal mucus in B group was twice of that in C group respectively [(3.51 +/- 2.14) mg/g vs (1.40 +/- 0.64) mg/g, (3.03 +/- 0.95) mg/g vs (1.52 +/- 1.26) mg/g (P < 0.05 or P < 0.01)] on 4 and 8 PBD. The DAO activity in the intestinal tissue in A group was lower than that in control and B group (P < 0.05) on 4 and 8 PBD.

CONCLUSIONEscharectomy during shock stage might be beneficial to the recovery of the systemic and intestinal immune functions in rats with scalding injury.

Animals ; Burns ; immunology ; surgery ; Immunoglobulin A, Secretory ; immunology ; Interleukin-2 ; immunology ; Intestines ; immunology ; Male ; Rats ; Rats, Wistar ; Shock, Traumatic ; immunology ; surgery ; Skin Transplantation ; immunology ; T-Lymphocytes ; immunology

OBJECTIVETo explore new methods for the management of extensive deep partial thickness burn wounds.

METHODSFifty burn patients with extensive deep partial thickness burn wounds were randomly divided into two groups: A and B groups. The patients in A group (n = 30) were treated with dermabrasion while those in B (n = 25) with conventional tangential excision. The first operation time in A and B groups was 12.3 +/- 10.7 hours and 47.2 +/- 11.5 hours, respectively. The patients' urine output, heart rate and arterial oxygen saturation (SaO2) were monitored.

RESULTSThe mean one setting operation area in A and B groups were (65.5 +/- 19.4)% and (64.8 +/- 18.7)%, respectively. All the indices remained stable in both groups during and after the operation. Nevertheless, the burn wound healing time (20 days averagely) in A group was 10 days shorter than that in B group. The incidences of internal organ injury and bacteremia in A group were much lower than those in B group. Furthermore, the hospitalization cost in A group was decreased compared with that in B group. And the scar after wound healing was much less obvious in A group than that in B group.

CONCLUSIONDermabrasion during early postburn shock stage for the management of deep partial thickness burn wound had many advantages such as: easy manipulation, less injury to patients, lower infection rate, less complications and quicker burn wound healing.

Adolescent ; Adult ; Burns ; surgery ; Dermabrasion ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Shock, Traumatic ; surgery ; Time Factors ; Treatment Outcome ; Young Adult