Ethical dilemmas in managing severe burns:Is there a place for palliative care?
1Anesthesiology Clinic, University General Hospital of Heraklion, Heraklion, Greece
2Medical School, University of Crete, Heraklion, Greece
DOI: 10.22514/sv.2021.155 Vol.17,Issue S1,September 2021 pp.8-8
Submitted: 26 August 2021 Accepted: 06 September 2021
Published: 15 September 2021
Introduction: Despite advances in treatment strategies, patients with severe burns rapidly develop complex metabolic changes and multiorgan failure, compromising survival. Severe burns are the ones complicated by major trauma or inspiratory injury, chemical or electrical ones and generally any burns in adults occupying >20% of body surface area, except for superficial burns.
Methods: The presentation of ethical dilemmas in the management of a critically ill burn patient in the emergency department (ED).
Results: A 31-year-old patient was admitted to the ED with 2nd and 3rd degree burns >80% of the total body surface after a tank explosion with hot water and chemicals. Initially presented in full awareness, without wheeze, in hypoxia, hemodynamically unstable with constant unbearable, agonizing pain. A multidisciplinary team consisting of anesthetists, emergency physicians, ENT, intensivist and plastic surgeon was immediately gathered. Some members of the team raised the issue of delayed anesthesia and endotracheal intubation so that the patient could speak to his family who were on the way, as his imminent death was considered almost certain. However, immediate intubation was performed. The patient eventually died 4 hours later in ICU after marked hemodynamic instability and multiorgan failure.
Conclusion: During management of patients with predicted high mortality, immediate decisions are often required to enhance even minimum chances of survival. These decisions often do not consider the real benefit and wishes of the patient at that moment, which raises some ethical dilemmas. Triage of patients for palliative care without transfer to a specialised burn centre is a difficult decision, especially in the absence of both legal framework and a pre-recorded “medical will” of patients, where the goals of care based on their values and wishes are clear.
Eleni Diamantaki,Vasileia Nyktari,George Papastratigakis,Georgios Stefanakis,Periklis Vasilos,Dimitrios Kouvidakis,Alexandra Papaioannou. Ethical dilemmas in managing severe burns:Is there a place for palliative care?. Signa Vitae. 2021. 17(S1);8-8.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.