摘要:

The hypermetabolic state of patients with a major burn indicates an immediate need for calories and protein. These patients are at high risk for sepsis with intravenous hyperalimentation (IVH), and enteral feedings are not attempted during the resuscitation period, usually lasting 7 to 10 days.0.001) increase in absolute lymphocytes between Day 0 and Day 14 of feeding.These data indicate that early enteral feeding of Polycose: Aminosyn is safe and well tolerated and that the small intestine will absorb nutrients readily in the early postburn period, leading to positive nitrogen balance, preventing loss of serum protein levels, assisting in the maintenance of normal carbohydrate metabolism, and restoring granulocytes and lymphocytes to normal ratios.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Formation of lipid peroxides in vivo leads to a variety of normal and pathologic consequences. For instance, peroxidation of cell membrane lipids results in altered membrane properties and increased cell destruction. Following severe thermal injury, elevated plasma levels of malondialdehyde, one product of lipid peroxidation, were detected, which suggests that an elevated level of lipid peroxidation was occurring in those patients. In vivo the major mechanisms to protect cells from lipid peroxidation are the presence of vitamin E, the fat-soluble antioxidant, and destruction of peroxides by glutathione peroxidase. In four of five patients investigated, the plasma content of vitamin E was low. The erythrocyte glutathione peroxidase activity was initially low in two patients and, by 15 days postburn, was below normal values in the other three patients. The results suggest that lipid peroxidation was occurring at elevated levels in these severely burned patients. An increased rate of lipid peroxidation could contribute to the decreased levels of phosphatidylethanolamine and essential polyunsaturated fatly acids in plasma and erythrocyte lipids and the shortened erythrocyte lifetimes previously observed in severely burned patients.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The contribution of a computer toward improving accuracy of estimate of burn size and depth and formulating treatment protocols was evaluated. Using a burn area diagram of 10 standardized representative burns, 15 raters with different levels of burn experience calculated the percentage of second-, third-degree, and total bum for major anatomical areas on a standard Lund and Browder chart. The computer was used to make comparisons between hand-calculated estimates (USCD) and those determined by the Hewlett Packard Patient Data Management System (PDMS). The inter-rater variation using the computer decreased 39% from hand-calculated estimates of previous studies. The variation in burn experience of the rater increased when evaluated by months of experience on the PDMS but was significantly less than the variation with USCD estimation. All types of raters using the computer showed a significant decrease in variability compared to hand-calculated values.Computer-assisted estimation should become more valuable, as it enables programming of priority areas for removal of eschar, grafting, and best available donor sites, as well as standardization of severity grading through increased precision in estimating burn size and depth. Comparisons between various procedures or among treatment regimens could be carried out within a burn center and presumably among burn centers.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The role of cimetidine in the treatment of acute stress erosions during the first two days following major thermal injury was evaluated. Twelve patients with burns of greater than 30% total body surface area were randomized and prospectively evaluated to determine the efficacy of two treatment regimens in the control of gastric acidity. Group A was treated with an intensive antacid regimen and cimetidine placebo; group B was treated with the same antacid protocol plus a standard regimen of parenteral cimetidine. Gastric acidity was monitored continuously by the use of an indwelling pH probe. Patients in group B experienced better pH control (P <0.01) and required fewer doses of antacid during the study period (P <0.005). Patients receiving combined therapy also required fewer interruptions in gastric decompression procedures. It was concluded that cimetidine should be part of acute stress erosion treatment regimens during the period of fluid resuscitation for burn shock until resumption of oral intake. Combined therapy with antacid and cimetidine improves gastric pH control compared to antacid alone and reduces risks of side effects associated with intensive antacid dosing and frequent interruptions of gastric decompression.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Plasma exchange therapy was used in 21 thermally injured patients not responding to conventional burn management. Major etiologic groupings included fluid resuscitation failures, massive myoglobinuria following electric injury, metabolic exhaustion (pre-sepsis syndrome), adult respiratory distress syndrome following delayed fluid resuscitation, and documented sepsis. In all patients, clinical values returned toward normal, the inadequate-resuscitation group showing the most positive effects. Plasma exchange failed to reverse the fatal outcome in patients with documented sepsis.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The Clinitron air-fluidized support system is a valuable adjunct to the care of burn patients. Used for specific indications, including posterior surface burns of all depths and posterior donor sites, this mode of therapy provides greater patient comfort, rapid healing of posterior wounds, and prevention of wound conversion and infection, as well as prevention of decubitus ulcers. Although complications, including an increased evaporative fluid loss, are a reality, awareness of these complications can prevent their occurrence.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Following intravenous administration of morphine (MS) to eight burn patients, the plasma concentration of MS, along with the analgesic effect, was determined over time. The pharmacokinetic measurements revealed rapid and extensive distribution of the morphine as well as rapid elimination. The values did not differ significantly from those found in normal controls. A plot of the mean log MS vs. mean pain relief demonstrated a relationship between the plasma concentration and the analgesic effect. The findings show that burn patients can eliminate morphine normally and can receive effective pain relief when plasma concentration is sufficient.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

For practical and economic reasons, elemental sulfur is produced and transported in a molten state. Because sulfur solidifies at 238 F and becomes viscous above 320 F, it is maintained in this temperature range for shipping. Although the industrial literature states that burns from molten sulfur are usually first or second degree and rarely third degree, a review of the medical literature has revealed no cases of or recommended care for such burns. The successful treatment of a patient with partial- and full-thickness burns to the right upper extremity from molten sulfur is to our knowledge the first of its kind to be reported to the medical community.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Calcium oxide is an industrial alkali, which forms calcium hydroxide and heat when mixed with water. The powder, solution, and heat can cause body surface burns as well as inhalation injury. This case report describes an inhalation injury secondary to a calcium oxide flameless “explosion.” Pulmonary pathology was documented by fiberoptic bronchoscopy and xenon 133 ventilation-perfusion scans. The upper-airway injury was apparent early; the diagnosis of lower-airway injury was delayed because the initial xenon 133 scan was normal. The clinical picture of poor oxygenation prompted a repeat radionuclide scan, which showed extensive pulmonary injury. Vigorous pulmonary support resulted in resolution.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The team approach to nursing care, therapy, and rehabilitation in burned children has been used at The Hospital for Sick Children, Toronto, for the past 20 years. This approach ensures that the patient's care is coordinated and that those providing the care receive appropriate support. The nine team members (plastic surgeon, head nurse, nutritionist, physical and occupational therapists, play therapist, social worker, psychiatrist, and public health nurse) communicate regularly about the medical and psychosocial aspects of the patient's care. Team members are also concerned with the entire family unit. Just as patients are encouraged to do as much for themselves as possible to sponsor independence and self-esteem, families are encouraged to assist with their child's care whenever possible. The team helps family members to work together to establish a realistic and satisfying approach to long-term rehabilitation.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID