ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A 23-year-old Hispanic worker sustained an electrical injury to 45% of his body when a crane hit a power line. Amputations of both legs, with bilateral partial hemipelvectomies, were required. A disarticulation of the right arm at the shoulder was also preformed. Resection of necrotic bowel, debridement of 95% of the abdominal wall, and resection of the genitalia was eventually required, with later reconstruction of the abdominal wall. After wound healing was complete, the patient was fitted with Jobst garments. A customized bucket prosthesis with a temperature control, to allow sitting upright, was provided. An electric wheel chair and a myoelectronic prosthetic arm were supplied. Rehabilitation was begun early.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Lung protective ventilation strategies are recommended in acute respiratory distress syndrome to avoid ventilator associated lung injury, a recently characterized complication of mechanical ventilation. High-frequency oscillatory ventilation (HFOV) is an unconventional ventilation strategy which may achieve this goal. We reviewed our experience with HFOV in six severely burned patients with acute respiratory distress syndrome. The mean age (± SD) of the patients was 34 ± 13 years, and the mean TBSA burn was 52 ± 10%, with a mean full-thickness injury of 49 ± 12%. HFOV was initiated as “rescue therapy” in three patients with oxygenation failure (mean PaO2/FIO2ratio of 71 ± 8 and mean oxygenation index [OI] of 42 ± 3) that was unresponsive to conventional ventilation (mean FIO2, 1.0 ± 0; mean positive end expiratory pressure, 14.8 ± 2.8 cm H2O; and mean inhaled nitric oxide, 20 ± 0 ppm). In the other three cases, HFOV was initiated “prophylactically” as a lung protective ventilation strategy in an attempt to prevent further respiratory deterioration. All six patients showed a rapid and substantial improvement in oxygenation after initiation of HFOV, with significant improvements in the PaO2/FIO2and OI by 12 hours (P= 0.02). In four patients HFOV was also used during anesthesia and surgery, where a total of 10 procedures involving a mean excision and closure of 15 ± 7% TBSA burns was performed. Five of the six patients died, but none died because of oxygenation failure. In three patients death resulted from sepsis and multiple organ dysfunction syndrome; their mean PaO2/FIO2was 107 ± 31 and their mean OI was 30 ± 11 immediately before death. Two patients with multiple organ dysfunction syndrome died after withdrawal of life support; their mean PaO2/FIO2and OI were 178 ± 31 and 18 ± 2, respectively, at the time of this decision. Although HFOV had no impact on mortality, it played a useful role in the supportive management of burn patients with severe oxygenation failure unresponsive to conventional ventilation. Importantly, HFOV allowed surgery to proceed in patients who may have otherwise been too unstable to go to the operating room. As far as we are aware, this is the first report of the use of intraoperative HFOV in burn patients.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A small but significant number of adults admitted to our burn center were assaulted by burning. Eighty-five such cases were identified at our burn center. Fifteen deaths were caused by these assaults. These cases are in one sense unique in that in addition to the burn victim, society is also obliged to expend resources dealing with the assailant.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Most burn injuries are minor in nature and can be managed on an outpatient basis. Such patients are usually evaluated and treated in emergency departments (ED) rather than in specialized outpatient burn care facilities. Although many burn centers maintain such facilities for the initial care of these patients, this practice is not commonplace because of conflicting interests of the ED and burn team. We first analyzed the hospital charges for all thermally injured patients admitted for a period of ≤24 hours between April 1996 and August 1998. This was followed by an independent analysis of the hospital charges for all outpatient visits to the burn clinic and ED during calendar year 1998. Physician charges were not included in the second study. Patients admitted for ≤24 hours had mean hospital charges of $1185 when initially evaluated in the ED compared with $691 if they were directly admitted to the burn unit (P< 0.001). This difference was largely because of higher charges for medication, laboratory, radiologic studies, and the ED visit charges. In the second study the mean charge for care administered in the ED was $192 compared with $139 for treatment in the outpatient burn clinic (P< 0.0001). Patients treated in the burn clinic had significantly lower radiology and treatment charges but significantly higher pharmacy charges than patients treated in the ED. These data have supported our efforts to develop a walk-in burn treatment center. Such a program should not only result in reduced charges for care, but also enhance patient access to the expertise of the multidisciplinary burn team and help ensure optimal outcomes.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID