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NexoBrid is a topically administered biological drug that enzymatically removes nonviable burn tissue for eschar removal in adult patients with deep partial-thickness and/or full-thickness thermal burns.

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Indication

NEXOBRID ® ( anacaulase-bcdb) is indicated for eschar removal in adults with deep partial thickness (DPT) and/or full thickness (FT) thermal burns.
Limitations of Use
The safety and effectiveness of NEXOBRID have not been established for treatment of:

Chemical or electrical burns

Burns on the face, perineum, or genitalia

Burns on the feet of patients with diabetes mellitus or on the feet of patients with occlusive vascular disease

Circumferential burns

Burns in patients with significant cardiopulmonary disease, including inhalation injury

NEXOBRID is not recommended for wounds contaminated with radioactive and other hazardous substances to avoid unforeseeable reactions with the product and an increased risk of spreading the noxious substance.

Important Safety Information

Contraindications

NEXOBRID is contraindicated in patients with: known hypersensitivity to anacaulase-bcdb, bromelain, pineapples, or to any other components; known hypersensitivity to papayas or papain because of the risk of cross-sensitivity.

Indication

NEXOBRID ® ( anacaulase-bcdb) is indicated for eschar removal in adults with deep partial thickness (DPT) and/or full thickness (FT) thermal burns.
Limitations of Use
The safety and effectiveness of NEXOBRID have not been established for treatment of:

Chemical or electrical burns

Burns on the face, perineum, or genitalia

Burns on the feet of patients with diabetes mellitus or on the feet of patients with occlusive vascular disease

Circumferential burns

Burns in patients with significant cardiopulmonary disease, including inhalation injury

NEXOBRID is not recommended for wounds contaminated with radioactive and other hazardous substances to avoid unforeseeable reactions with the product and an increased risk of spreading the noxious substance.

Important Safety Information

Contraindications

NEXOBRID is contraindicated in patients with: known hypersensitivity to anacaulase-bcdb, bromelain, pineapples, or to any other components; known hypersensitivity to papayas or papain because of the risk of cross-sensitivity.

Warnings and Precautions

Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylaxis, have been reported with postmarketing use of anacaulase-bcdb.

Pain Management

Manage pain as appropriate for an extensive dressing change of burn wounds. At least 15 minutes prior to NEXOBRID-related procedures ensure adequate pain control measures are in place.

Proteolytic Injury to Non-Target Tissues

NEXOBRID is not recommended for treatment of burn wounds where medical devices or vital structures could become exposed during eschar removal.

Coagulopathy

Avoid use of NEXOBRID in patients with uncontrolled disorders of coagulation. Use with caution in patients on anticoagulant therapy or other drugs affecting coagulation, and in patients with low platelet counts and increased risk of bleeding from other causes. Monitor patients for possible signs of coagulation abnormalities and signs of bleeding.

Adverse Reactions

The most common adverse reactions (>10%) were pruritus and pyrexia.

Use in Special Populations

Geriatric Use

Clinical studies of NEXOBRID did not include sufficient numbers of subjects 65 years of age and older to determine whether they respond differently from younger adult subjects.

To report negative side effects contact Vericel Corporation at 888-454-BURN (888-454-2876) or FDA at 1-800-FDA-1088 (1-800-332-1088) or www.fda.gov/medwatch.
Please see Full Prescribing Information.

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NexoBrid® (anacaulase-bcdb) | About NexoBrid

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Information on how NexoBrid® may provide an alternative option to surgical excision that selectively and effectively removes eschar without compromising viable tissue.

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Received FDA approval in the U.S. in December 2022.

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NexoBrid is a biologic treatment for burn wounds used to treat partial thickness burns up to 20% total burn surface area. This medication uses pineapple plant stem-derived powder mixed with hydrating gel. This mixture is applied topically on burn eschar for up to 4 hours (Shoham et al., 2023). NexoBrid has also been documented to use on different types of wounds. NexoBrid is a class of medications called Bromelin-based debridement (BBD).

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https://youtu.be/ljZ8I6BygZI

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Mediwound: Powerful voices for NexoBrid: Prof. Marcus Lehnhardt

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About NexoBrid®. NexoBrid® (anacaulase-bcdb) | About NexoBrid. (2023). NexoBrid Results [photograph]. NexoBrid https://nexobrid-us.com/img/before-nexobrid.jpg

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NexoBrid can be administered at the bedside, saving the requirement for OR staff, sophsiscaed equipment, or other expensive resources. According to Shoham et al., (2023) NexoBrid can be used with selective debridement, which preserves viable dermis and allows spontaneous epithelialization. This reduces the need for patients have autograft in surgery or allograft rejection. Shoham et al., (2023) also explains that researchers agree that it can be used for off label uses such has chronic wounds and compartment syndrome. The outcome of hypertrophic scarring is less.

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I chose this medical advancement because I have actually seen it utilized at my current place of employment. I saw it administered on a 65 year old female with a 10% burn that previously failed autografted twice. This patient also had a history terminal cancer, and an extensive health history. After the application of NexoBrid the patient's wound did heal and was subsequently discharged. It is interesting that this medication has been utilized in Europe since 2012, but not approved in the United States until 2022. Ultimately, NexoBrid can change the way burn treatment is administered through a much lesser non invasive treatment.

This treatment has the ability to save patients from surgical debridement, infection risk, possible sepsis, escheratomies, and a host of other complications from surgery. This is beneficial to me because from my experience some patients are not medically clear to have surgery, but are scheduled anyway because of the severity of their burn. I have seen patients who are under-debrided and some who were excised to aggressively, and were hemodynamically unstable afterwards. The fact that NexoBrid only removes the nonviable tissue is next level. I think that BBD treatments such as this one will continue to change the world of burn care (Shoham et al, 2023).

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About NexoBrid®. NexoBrid® (anacaulase-bcdb) | About NexoBrid. (2023). https://nexobrid-us.com/about-nexobrid/?gad_source=1&gclid=Cj0KCQjwu8uyBhC6ARIsAKwBGpS7DpDmR1g71gluysBRf2H9G1sdqTwUz2NBjJRRTKhRQK9NHsJudKAaAnAdEALw_wcB

Shoham, Y., Gasteratos, K., Singer, A. J., Krieger, Y., Silberstein, E., & Goverman, J. (2023). Bromelain‐based Enzymatic Burn Debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes. International Wound Journal, 20(10), 4364–4383. https://doi.org/10.1111/iwj.14308

Smolle, C., Wurzer, P., Tuca, A., Shoham, Y., Voigt, C. D., Branski, L. K., Lumenta, D., & Kamolz, L.-P. (2015). Low exposure levels of respirable particles during the preparation of NexoBrid® Bromelain powder. Safety in Health, 1(1). https://doi.org/10.1186/s40886-015-0012-3

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One of the most drawbacks I discovered to NexoBrid is pain. This was observed from the patient received it on my job, as well as research that I found. According to Shoham et al., (2023) the pain experienced using NexoBrid can be severe. Because of this, developers suggest using nerve blocks, moderate sedation, and opioids before adminstration.

In addition, research conducted by Smolle et al., (2015) found that there is a risk of an allergic reaction when the bromelian powder is inhaled. It is recommended that all patients who are allergic to pineapples avoid this product. Oral bromelian has also been proven to reduce platelet aggregation, plasma fibrinogen, prothrombin, and activated partial thromboplastin times (aPTT). In light of this discovery healthcare providers should avoid or exercise with caution on patients taking anticoagulants with thrombocytopenia, or in other causes of increased risk of bleeding.

NexoBrid also has limits of where it can be utilized. According to the NexoBrid (2023) this medication cannot be used of the following burns or conditions:

Burns on the face, perineum, or genitalia

Burns on the feet of patients with diabetes mellitus or on the feet of patients with occlusive vascular disease

Circumferential burns

Burns in patients with significant cardiopulmonary

disease, including inhalation injury

Electrical burns

This is significant because a large portion of the burn patients I see have comorbidites, and frequently have burns on these ares where NexoBrid cannot be used.

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5.) Photos of NexoBrid Results cont'd...

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5.) Photos of NexoBrid Results cont'd...

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Note in (A) pre NexoBrid the eschar on the wound. This is a 3rd burn which the standard of treatment is surgical intervention. In (B) post NexoBrid you can see the healthy re-vascularization of the wound as evidenced by the bleeding. What is most fascinating, is the selective debridement and release of constriction which is usually only achieved from escharotomies. From" Bromelain‐based Enzymatic Burn Debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes," by Smolle, et al, 2023, Int Wound 20(10): 4.2. Paradigm shift, selective debridement, and wound management from retroprospective studies, Figure 2 doi: 10.1111/iwj.14308

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My top 5 Clifton Strengths are:

Context

Harmoney

Consitencey

Learner

Achiever

My strengths are instrumental in achieving educational success as they allow me to learn from the past and apply those lessons to the future. I strive to create a positive work environment by avoiding conflicts and maintaining harmony. Consistency and discipline are crucial to me, whether working independently or in groups, as they are the keys to achieving goals. I have a thirst for knowledge and consider myself a lifelong learner, constantly seeking new information and data. To excel in education, one must have a natural inclination towards learning. Additionally, my ability to remain dedicated and focused on tasks makes me a valuable asset in a team setting where perseverance is essential for completing assignments that require extensive time and research.

The top 5 Strengths/People I chose:

Carter-Communication

Pablo-Positivity

Fernado-Focus

Daniel-Discipline

Sam-Self-Assurance

I carefully selected these individuals based on their strengths, which I believe complement areas where I may be lacking in my educational journey. Communication in group settings is a skill I struggle with, so having a team member who excels in this area would greatly benefit our collaboration. Positivity is crucial for me, as I believe it is essential for success in any endeavor. Discipline is a constant challenge for me, given the numerous demands on my time. Having a team member who can help keep me focused and on track would be invaluable. Self-Assurance is vital for building confidence and achieving educational goals. Having a team member with this strength would not only boost my confidence but also help alleviate any anxiety I may feel during group work.