Characteristics of and strategies for patients with severe burn-blast combined injury.
BACKGROUND
Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.


METHODS
Five patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6% +/- 7.2%) of TBSA (full-thickness burns 75% - 92% (83.4% +/- 7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.


RESULTS
One patient died of septic shock 23 hours after admission (four days after injury), the others survived. Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.


CONCLUSIONS
Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients' condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.
Chai
Jia-ke
JK
Burns Institute, First Hospital Affiliated to the General Hospital of People's Liberation Army, Beijing 100037, China. cjk304@sohu.com
Sheng
Zhi-yong
ZY
Lu
Jiang-yang
JY
Wen
Zhong-guang
ZG
Yang
Hong-ming
HM
Jia
Xiao-ming
XM
Li
Li-gen
LG
Cao
Wei-hong
WH
Hao
Dai-feng
DF
Shen
Chuan-an
CA
Tuo
Xiao-ye
XY
Liang
Li-ming
LM
Wang
Shu-jun
SJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001753:Blast Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002056:Burns / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D044623:Nutrition Therapy; D011613:Psychotherapy; D012119:Respiration
D000900:Anti-Bacterial Agents