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- Title
Management of Concomitant Severe Thermal Injury and ST-Elevation Myocardial Infarction.
- Authors
Beveridge, Julie; Budden, Curtis; Medina, Abelardo; Faccenda, Kathryne; Dodd, Shawn X.; Tredget, Edward
- Abstract
Acute coronary thrombosis is a known, but rare, contributor to morbidity and mortality in patients with thermal and electrical injuries. The overall incidence of myocardial infarction among burn patients is 1%, with an in-hospital post-infarction mortality of approximately 67%, whereas the overall mortality rate of the general burn patient population is from 1.4% to 18%. As such, early detection and effective peri-operative management are essential to optimize patient outcomes. Here, we report the details of the management of an adult male patient with a 65% total body surface area severe thermal injury, who developed an ST-elevation myocardial infarction (STEMI) in the resuscitation period. The patient was found to have 100% occlusion of his left anterior descending coronary artery, for which prompt coronary artery stent placement with a drug-eluting stent (DES) was performed. Following stent placement, the patient required dual antiplatelet therapy. The ongoing dual antiplatelet therapy required the development of a detailed peri-operative protocol involving pooled platelets, packed red blood cells, desmopressin (DDAVP™) and intraoperative monitoring of the patient's coagulation parameters with thromboelastography for three staged operative interventions to achieve complete debridement and skin grafting of his burn wounds.
- Subjects
ALBERTA; BURNS &; scalds complications; RISK assessment; BURN care units; COMBINATION drug therapy; SKIN grafting; BURNS &; scalds; ACADEMIC medical centers; ACUTE diseases; ERYTHROCYTES; THROMBELASTOGRAPHY; FLUID therapy; THERMOTHERAPY; CORONARY thrombosis; SEVERITY of illness index; HOMOGRAFTS; TREATMENT effectiveness; BURN patients; ELECTROCARDIOGRAPHY; BLOOD platelets; DESMOPRESSIN; INTRAOPERATIVE monitoring; PLATELET aggregation inhibitors; DEBRIDEMENT; ST elevation myocardial infarction; CARDIAC catheterization; DRUG-eluting stents; PERIOPERATIVE care; DISEASE risk factors; MIDDLE age
- Publication
European Burn Journal (EBJ), 2024, Vol 5, Issue 2, p169
- ISSN
2673-1991
- Publication type
Article
- DOI
10.3390/ebj5020015