Curtis P. Artz

Changing concepts of electrical injury

Summary If the patient with an electrical injury survives the initial shock, he will usually have more tissue damage than is generally expected. Too frequently he is treated for burn injury, although his injury is more like a crush injury and should be treated accordingly.

Clinical Importance of Emotional Problems in the Care of Patients with Burns

IN a study of victims of the Coconut Grove fire, Cobb and Lindemann1 recorded a high incidence of emotional disturbances soon after burning and concluded that both the psychiatrist and the social w...

Infection—A major unsolved problem in severe trauma

Abstract During the past few years improved resuscitative therapy in patients who were burned and in patients who experienced severe mechanical trauma has permitted longer survival; and eventually infection has caused their death. Likewise, patients who have posttraumatic renal insufficiency have been sustained by proper fluid and electrolyte therapy and multiple dialyses with an artificial kidney through diuresis and chemical recovery only to succumb to severe infection. Between 1950 and 1956, eighty-two deaths occurred among 1,000 burned patients who were hospitalized. Septicemia was associated with death in forty-six instances, and improper replacement therapy in ten instances. The total per cent of burn of patients who died averaged 56, 40 per cent being third-degree involvement. The causative microorganism was primarily a resistant form of M. pyogenes. Nine patients survived septicemia; the total per cent of burn among these patients was significantly less than those who died. The day of onset in the group that died averaged thirteen; the average was nine among the survivors. Because many of the causative microorganisms were sensitive to bacitracin, it was administered daily in large doses (300,000 units). Permanent renal damage was not seen in any of the patients who received bacitracin therapy. During the past two years, twenty-four patients with acute tubular necrosis were treated. There were seventeen deaths and seven survivors. In the seventeen patients who died, twelve deaths were complicated by a severe infection. Of these twelve patients, eight experienced a diuresis. It appears that infection following severe trauma is a major unsolved problem. Further investigation concerning the resistance of the body to infection is strongly indicated.

Disadvantages of dicumarol with special reference to therapeutic inadequacies

Abstract 1. 1. A study of the problem of venous thrombosis during the past year has disclosed several failures of dicumarol therapy, namely: (1) Too often the unpredictable response of the patient to dicumarol makes it very difficult to maintain the prothrombin level in the suggested therapeutic range of 10 to 30 per cent of normal. (2) Even when a prophylactic prothrombin depression has been maintained within the therapeutic range, thrombosis may occur. (3) Case studies have been presented of two patients with thrombosis in whom the thrombotic process extended in spite of a dicumarol-induced hypoprothrombinemia of less than 30 per cent of normal. (4) A transfusion of whole blood to rectify excessive depression of plasma prothrombin by dicumarol may increase the coagulability of the blood sufficiently to allow thromboembolism to occur. 2. 2. The dicumarol effect, as evidenced by the Quick prothrombin test, may be most inaccurate if determined on blood containing moderate amounts of heparin. This is due to the effect of heparin on the end point of the test. 3. 3. Although dicumarol has been the popular anticoagulant in this country for several years, the newer preparations of heparin in a gelatin menstruum may prove safer and more dependable.

MUCOSAL CHANGES FOLLOWING GASTRIC FREEZING.

Abstract In a study of ninety-three dogs subjected to a standard gastric freeze for one hour with outflow temperature of −13 °C., gastric mucosal damage was appreciable in 69 per cent. Endoscopic observations with the Fiberscope in twenty-one patients during the immediate postfreeze period demonstrated some mucosal damage in eleven patients. In a series of one hundred patients treated with gastric freezing, four had mucosal hemorrhage severe enough for the patient to require transfusion. This occurred between the seventh and twelfth days postfreeze, and after conservative management each experienced an uneventful recovery with complete relief of symptoms. In the clinical series, symptomatic relief from ulcer pains was striking; however, the observations reported in this paper emphasize the potential dangers in the technic.

Experiences in the management of abdominal and thoracoabdominal injuries in Korea

Abstract During the latter part of the Korean conflict a survey of patients who had abdominal injuries and were admitted to the 46th Mobile Army Surgical Hospital showed a mortality of 8.85 per cent. The average evacuation time was 3.1 hours and the time from injury until operation was 6.3 hours. In a comparable group during World War II the case fatality rate was 20.51 per cent. The fatality rate among patients who had thoracoabdominal injuries was 13.1 per cent as compared with 27 per cent in World War II. Several factors were responsible for this reduction in mortality. The surgical technics employed were essentially the same as those used in World War II but the stable tactical situation in Korea permitted better organization for surgical care and a longer period of postoperative observation. The availability of an adequate number of trained anesthesiologists and anesthestists, together with modern antibiotic therapy, was undoubtedly of assistance in decreasing the mortality. Two of the most effective factors in decreased mortality, however, seemed to be early restoration of blood volume and utilization of larger quantities of whole blood.

Practical technics in the care of the burn patient

Abstract Use of the Stryker frame in the care of the severely burned patient greatly facilitates nursing care, permits frequent change of position and increases the comfort of the patient. The use of a new burn dressing, semielastic gauze bandage, irrigating hand table and plastic intravenous needle, are worth while practical technics in the care of the burn patient.

Intravenous fat as supportive therapy after severe injuries

Abstract A total of 302 units of a commercially prepared fat emulsion was given to twenty-eight patients. During five of the infusions, reactions such as nausea, chills and urticaria occurred. These were very minor and the patients showed no untoward effects when reinfused with fat emulsion on the following day. After eighteen infusions in various patients a benign rise in temperature to above 100.6 ° f . was noted. Only one patient showed a serious response. This consisted of jaundice after twenty-four infusions. At the present time it appears that moderate quantities of fat emulsion are safe for clinical use, but large quantities may evoke a severe response. Interference with liver function and the coagulation mechanism after intravenous fat emulsion infusions over a prolonged period is the primary problem requiring further study. Metabolic balance studies were carried out on several patients. Data on six typical patients show the protein-sparing effect of intravenous fat emulsion. This preparation appears to be a useful adjunct in injured patients and other patients who are unable to take adequate calories by mouth.

Treatment of burns of difficult areas

Abstract In the management of more than 900 hospitalized burned patients certain technics have been evolved for the treatment of specific problem areas. Priority for skin coverage must be given to the face and hands. Exposure is indicated in all burns of the face and in second degree burns of the hands. Dressings are preferred for third degree burns of the hands. Ectropion and its complications can be prevented by tarsorrhaphy. Full thickness burns of the ears are treated by a fish-mouth incision, debridement and wet dressings. Tracheotomy is suggested for respiratory tract burns and all full thickness burns of the face. Kirschner wire immobilization and fusion of the involved proximal interphalangeal joints minimize flexion contractures. Early application of thick, split thickness skin to the palms of the hands and soles of the feet is usually sufficient.

Improving Oral Protein Nutrition

Because protein for rebuilding tissue cannot be given intravenously, it must be fed orally. After a serious burn, patients require 20 gm of nitrogen per square meter of body surface. Giving high-protein powder between meals or by tube feeding can help make up deficits.