Carl Jelenko

Water-Holding Lipid and Water Transmission Through Homeothermic and Poikilothermic Skins

Summary Water transmission was measured through isolated human, rabbit, marine fish, and frog skins. The water transmission rate of fish and frog skins approximates free evaporation of water, and is 6 to 20 times greater than in mammalian skins. Human and rabbit skins contain a hexane-soluble lipid which appears to be the major regulator of passive water holding. This hexane-extractable lipid was not detected in the fish or frog skin. Burned mammalian skin contained 30% or less of the normal water-holding lipid and transmitted up to 4 times more water than intact skin. Water transmission by the surfaces examined was inversely proportional to the water-holding lipid content of the surface. The postburn decrease of hexane-extractable lipid in burned mammals was associated with production of a surface which closely resembles the skin of poikilotherms in water transmissivity and thermoregulatory capability. The maintenance of homeothermia may therefore be, in part, related to the presence of water-holding lipid in the skin.

Studies in burns. XII. Evaporative water loss is related to postburn hypermetabolism

Abstract A partitional calorimetric evaluation was made of unanesthetized rabbits in the unburned, 20% burned, and burned-treated state. Treatment comprised spraying ethyl linoleate (ethyl (9–12- cis , cis -octadecadienoate) 0.01 ml/cm 2 , onto the burn at, or after, the 12th hr postburn. Evaporative water loss, increased 3- to 6-fold postburn, and metabolic heat production increased 2- to 3-fold. Within 30 min of spraying with ethyl linoleate both water-loss and heat production returned virtually to preburn control levels. Additionally, burned-untreated animals had decreased O 2 consumption, CO 2 production, and activity rates, Their body temperatures fell toward room temperature. These physiologic parameters also returned toward normal within 15–30 min of ethyl linoleate spraying. Ethyl linoleate, which appears to be the naturally occurring water-holding lipid of skin, may offer significant therapeutic effectiveness in burn treatment. It is inexpensive; seems to have minimal toxicity; and may have lower antiinfective properties. However, it remains to be determined if the agent will perform in the presence of currently used topical antibacterial agents and/or hydrotherapy; will function in man as it does in animals; will be effective over many days; and will not affect healing adversely. Finally, the mechanism of action of the agent needs more precise definition. Despite the areas in effect and mechanism of action yet to be defined, the possibility that the agent will prove a valuable adjunct in burn therapy is exhilarating.

Management of the acute burn patient--1973.

The most urgent measures in treating a burn patient include assessing the injury, with consideration of the facilities needed for proper car; assuring that the patient has an adequate airway; and initiating treatment for shock. Once these steps have been taken, the physician may direct his attention to the care of the injury itself.

The elusive artery: Found by sound

The Doppler flow probe can be used to locate blood vessels in patients with shock or severe burns. The technique, which uses an ultrasonic signal, is described.

Postburn respiratory injury

A common and frequently overlooked concommitant of burn injury is postburn pulmonary damage. The lesion may be secondary to inhalation or mechanical obstructive or toxic problems; or it may be associated with indirect damage from hypovolemia, shock, central nervous system disturbances or drugs. Therapy comprises establishing a clear airway; administration of sufficient humidity and oxygen to maintain adquate arterial pO2; sequential pO2 monitoring; surface decompression of the thorax; systemic antibiotics and sequentially increasing--and later decreasing--airway support. The diagnosis of postburn pulmonary injury is clinical. Aggressive, sequential management of the patient, supported vigorously by laboratory evaluation, is essential.

Call for help: an algorithm for burn assessment, triage, and acute care

Because of the Medical College of Georgia Burn Treatment Center frequently received patients with extensive burns who had been badly managed locally, we devised an Algorithm to provide health care professionals a logical method for assessment, triage and obtaining help. Limited experience suggests that the Algorithm does, in fact, accomplish these ends but that continued evaluation of its efficacy is necessary.

A guideline for the organization of an emergency department in the university setting

An emergency d e p a r t m e n t associated with a medical school is pa r t of a teaching ins t i tu t ion and mus t provide the atmosphere , faci l i t ies and s taff for the educat ion of s tudents , phys ic ians and al l ied hea l th professionals. I t also has the respons ib i l i ty for developing new knowledge in emergency medical care th rough research because of i ts academic set. t ing. The commi tmen t to educat ion and research is often in conflict wi th the commi tment to pa t i en t care. These must be brought into h a r m o n y if the emergency depa r tmen t is to run smoothly.

Respiratory Problems Complicating Burn Injury: Recognition, Assessment, and Treatment

Postburn pulmonary injury is a common and frequently overlooked concomitant of burn injury. The lesion may be secondary to direct damage to the respiratory apparatus from the inhalation of smoke or of toxic or superheated chemicals or from mechanical mechanisms or it may be secondary to indirect damage from hypovolemia, shock, central nervous system disturbances, or drug usage. Therapy comprises establishment of a clear airway and administration of humidity and oxygen in amounts appropriate to maintain adequate blood oxygen tension and pH. Sequential monitoring of oxygen and pH status is required. The diagnosis of postburn pulmonary injury is made on clinical grounds, and sequential management of the patient, closely supported by laboratory studies, is essential. Surface decompression of the thorax, antibiotics given systemically, and sequentially increasing respiratory support (with later de-escalation) may be needed.

“Change theory” in action: The (1972) Georgia ambulance law

Change theory is applied to the goal of obtaining an ambulance law for the state of Georgia. The governor established an Emergency Medical Services Commission that led the process through legislation, regulations, systems planning, funding and implementation. The joining of disparate individuals, groups and organizations, assessing the problem, evaluating resources, planning the change process, creating the change, and assuring self-perpetuation of the change are examined.