Clinical Challenges in Burn Surgery: Global Burn Surgery

The percent surface area burn for which half of patients survive, known as lethal area 50, or LA50 depends on where in the world the injury occurs. Calling all surgeons and trainees with an interest in providing more equitable delivery of global injury care - Join our Burn Surgery team as we welcome Dr. Manish Yadav, Plastic and Burn Surgeon at Kirtipur Hospital in Kathmandu, Nepal to discuss several recent challenging cases. We’ll discuss the global burden of burn injuries, how emergency burn care systems reduce preventable morbidity and mortality, innovations in resuscitation of burn shock, use of checklists for critical care and safe early excision, and application of palliative care in different cultural contexts. (Co-hosts: Dr. Barclay Stewart, Burn and Trauma Surgeon at Harborview Medical Center and Paul Herman, UWMC/HMC Surgery Resident)

Hosts: (affiliation and SM handles)
1. Manish Yadav, Kirtipur Hospital, Nepal
2. Barclay Stewart, Harborview Medical Center
3. Paul Herman, UW/Harborview General Surgery Resident, @paul_herm
4. Tam Pham, Harborview Medical Center (Editor)

Learning Objectives
1. Describe the global epidemiology of burn injury, disparities in burn injury and care, and highlight efforts to improve burn care in low and middle-income countries
2. Discuss two cases at a burn center in Kirtipur, Nepal, highlighting challenges in burn care in LMICs and innovations to address these challenges and provide high level care
a. Highlight enteral resuscitation as an innovative strategy with advantages for treating burn shock in low resource settings
b. Discuss the key burn concept of early excision and steps to ensure safe application in low resource settings

1. References

a. Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank.

b. Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am. 2023 Jun;103(3):551-563. doi: 10.1016/j.suc.2023.01.014. Epub 2023 Apr 4. PMID: 37149390.
https://pubmed.ncbi.nlm.nih.gov/37149390/

c. Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744.
https://pubmed.ncbi.nlm.nih.gov/29475744/

d. Hebron C, Mehta K, Stewart B, Price P, Potokar T. Implementation of the World Health Organization Global Burn Registry: Lessons Learned. Annals of Global Health. 2022; 88(1): 34, 1–10. DOI: https://doi. Org/10.5334/aogh.3669
https://pubmed.ncbi.nlm.nih.gov/35646613/

e. Jordan KC, Di Gennaro JL, von Saint André-von Arnim A and Stewart BT (2022) Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front. Pediatr. 10:954995. doi: 10.3389/fped.2022.954995
https://pubmed.ncbi.nlm.nih.gov/35928690/

f. Mehta K, Thrikutam N, Hoyte-Williams PE, Falk H, Nakarmi K, Stewart B. Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report. J Burn Care Res. 2023 May 2;44(3):508-516. doi: 10.1093/jbcr/irab166. PMID: 34850021; PMCID: PMC10413420.
https://pubmed.ncbi.nlm.nih.gov/34850021/

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