摘要:

We have recently developed a new burn-specific equation that satisfactorily estimates initial caloric requirements for thermally injured patients. In the present study, we compared these estimates with resting energy expenditures (REE) (n = 141) measured weekly by indirect calorimetry in 20 patients between postburn days 3 and 348. In this group, mean initial burn size was 46.7% (range, 21–88) and mean age 31.3 years (range, 19–61). Serial measurements were continued until the burn wounds were closed or the patient was discharged. Multiple regression analysis indicated a relationship between REE, initial burn size, and postburn day in these patients (r= 0.65). This analysis indicated a general trend of decline in REE toward normal values 100 to 150 days postburn in patients with smaller burns (20%-40%) and roughly 250 days postinjury in those with larger burns (> 75%). The initial predictive equation appeared adequate for estimating caloric needs during the first postburn month, but beyond 30 days postburn indirect calorimetric measurements became necessary for accurate estimation of caloric requirements.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The use of preventive antibiotics has become the standard of care in the management of patients with multiple trauma who have injuries at risk for infection. In many areas of surgical practice, preventive antibiotic utilization has been restricted to the perioperative period only. In this study we reviewed a series of trauma patients with combined blunt chest injuries and extremity fractures to determine whether the duration of postoperative antibiotic administration would have adverse effects upon nosocomial pneumonia rates and severity.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We recently treated two patient with engine block-muffler contact burns and greatly underestimated the devastating injuries to bone, deep fascia, and muscle. As a result, each patient required multiple procedures to close their burn wounds. Ten-year data from the University of Washington Burn Unit confirmed our observation that these burns tend to be considerably deeper than suspected. Eighteen patients with contact burns from engine parts were identified from 1980 through 1990. Nine (50%) of these were initially recognized to be fourth-degree and five (28%) were third-degree thermal injuries, showing that these are deep burns. Eight patients required fascial excisions and four required debridement of devascularized bone. The mean burn size was only 6% total body surface area; however, the patients with fourth-degree burns had an average graft take of only 56% and required a mean hospital stay of 44 days. Patients with third-degree burns also had suboptimal graft take and some required prolonged hospitalization. Thirty-six percent of patients required flaps either as the initial procedure or as a second procedure following an autograft. The four patients with partial-thickness burns healed without surgery and their average length of hospital stay was 3 days. Of the entire group, only four healed without surgery and only five healed with a single operation. Our 10-year data indicate that engine block contact burns are usually small, but most are deceptively deep, involving tendon, muscle, or bone. If the burn appears full thickness, suspicion must be very high at the initial surgical procedure that there is deep tissue destruction. We propose that burns from engine block or muffler contact are the fourth, fifth, and sixth-degree injuries described by Dupuytren in 1832. They behave like and should be handled more like electrical burns than other contact injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Power mower trauma remains an alarmingly frequent cause of serious injury in young children. The patterns of mower-related injuries in children <15 years old (n = 130) were compared with those of adults aged 15–64 (n = 16) and elderly victims ≤65 years old (n = 6), who were similarly injured over the past 5 years. Children were more likely to be injured in accidents involving high-energy riding mowers. Of those children injured, 69% (9 of 13) were playing in the yard while 31% (4 of 13) were riding on the mower with a guardian when the injury occurred. Amputations in children were more frequent and more extensive than in the adults and includes one forearm, two Symes, and three below-knee amputations. The need for transfusion was also significantly increased in children (62% vs. 6% adults,p< 0.005), who were also more likely to require prolonged hospitalization (11.8 days vs. 5 days in adults,p< 0.005). Aggressive efforts to increase public awareness regarding the cause and nature of power mower injuries are warranted to decrease the incidence of this debilitating but preventable trauma in young children.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study Objective:To ascertain the nature and extent of motorboat propeller injuries in Wisconsin.DesignRetrospective study of deaths and injuries from outboard motor propellers reported to the Wisconsin Division of Health, Vital Statistics, and reported by a statewide retrospective survey of emergency departments.ResultsFor the study period 1987 through 1989, three fatalities were found in Vital Statistics and Emergency Department records and 14 nonfatal injuries reported by respondents to the Wisconsin emergency department survey. Thirty-six percent (5 of 14) of the nonfatal injuries occurred in water skiers. Injuries involved the lower extremities in 10 of 14 nonfatal cases (71%), frequently in association with other anatomic areas. At least three cases involved very severe injuries, with mean acute care medical charges of more than $100,000 per case.ConclusionsWhere boating is common, fatal and severe injuries from propellers occur with regularity. These injuries are often severe, requiring complicated and expensive treatment. The authors urge improved documentation of the incidence of propeller injuries, and an active exploration of prevention strategies including fitting motorboat propellers with guards.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

During the era before seatbelts and air bags, extensive injury was common after motor vehicle collisions (MVCs). Yet upper extremity peripheral nerve problems, other than the brachial plexus injury, have not been ascribed previously to MVCs. Seven hundred twenty-five patients with the diagnosis of carpal tunnel syndrome (CTS), cubital tunnel syndrome (CT), and radial sensory nerve (RSN) entrapment in the forearm were reviewed. The number of MVC-caused nerve entrapments was 157 (68 for CTS, 64 for CT, and 25 for RSN). In 25% of the patients, the nerve entrapment was bilateral. This paper discussed the causal relationship between MVCs and subsequent nerve compressions in the upper extremity and discusses a suggested pathomechanism of injury. This most common pattern was for the injured person to be the driver, to have the injured hand or hands on the steering wheel, to be hit from the front or rear, and to develop a sudden onset of nerve compression symptoms within 1 week. Awareness of this causal relationship may allow early recongition and treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although electrical burns account for a small portion of all thermal injuries, their treatment becomes more complex when associated with injuries of other organs. From July 1987 through December 1991, 8 of 249 burned patients sustained electrical burns associated with head injuries. The mean total body surface area burned was 19% (range, 2%-45%). Computed tomographic (CT) scans of the brain revealed that six patients with moderate to severe head injuries had intracranial hemorrhage including three cases of intracerebral hematoma and another three cases of epidural hematoma. Half of these patients underwent surgical intervention for removal of intracranial hematomas and a compound depressed fracture segments of the skull, and the others were treated conservatively. All the patients progressively recovered consciousness with Glasgow Coma Scale scores of 14 or more and minimal neurologic sequelae. The combination of early detection and prompt removal of life-threatening intracranial hematomas with aggressive support of electrical victims who appear dead would minimize the morbidity and mortality in patients with electrical burns and head injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In a series of 61 trauma cases, 35 liver injuries (Moore's classes 2 to 5) were repaired using a polyglactin 910 perihepatic prosthesis. Two deaths (one coma, one avulsion of the inferior vena cava) were observed. Two centrohepatic hematomas were successfully treated by percutaneous needle aspiration. No hemobilia and no abscess of the liver occurred. Rapidly obtained hemostasis and cholestasis result in a large savings of blood. Progressive disappearance of the lesions was observed with repeat CT scanning until full recovery of the parenchyma was achieved. This was verified by biopsy and histologic examination and also by means of specific hepatic function tests.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism. Bilateral lower extremity technetium venoscans and ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SCIU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days following trauma. Twenty-five patients had normal or low probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary arteriograms (PAGs) at 12.5 ± 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, Injury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patient with DVT or PE. All but one patient with DVT or PE underwent placement of a vena caval filter. Multiple trauma patients with severe head injury (GCS score ≤8) are at high risk for thromboembolism. The available means of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To examine functional limitations, recovery rtes, and association with Injury Severity Scores (ISSs), we followed 92 children with severe trauma and 59 control subjects with appendicitis at 6 months and 1 year after discharge. Physical health status was assessed by the Rand Health Insurance Study instrument. Overall, 73% and 55% of trauma patients had one or more functional limitations at 6 months and 1 year, respectively, in contrast to 14% and 9% of the controls. Overall functional status of the trauma patients improved by 22% in the first 6 months and care. Although ISS did not correlate with overall functional status, higher ISSs were related to impairment in patients whose principal injury was to the head or extremity. This study shows that many children with severe trauma are left with disabilities. Recovery rates are not uniform but depend on type of limitation. Functional impairment and recovery are related more to the body parts involved than to ISS.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID