J Trauma
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Even though metal refineries require workers to wear safety boots, molten metal splash causes serious burns to the feet and ankles of these employees. Twenty cases are reported which illustrate the need for safety boot top protection. In analyzing these cases, it was found that these molten aluminum and brass alloy burns were not full-thickness, and dermis could be preserved. The technique of dermabrasion-debridement was found to be a valuable tool for accurate debridement of such wounds in this location.
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A period of aggressive surgical treatment of early identification of fungal infection of the burn wound was compared with the previous 5 years' experience with patients suffering from fungal infection of burn wounds. The portion of those patients with Candida infections diagnosed and treated premortem increased from 48.0% to 63.6% and of patients with noncandidal infections from 40.8% to 67.0% in the more recent period. ⋯ Local surgical control of the infected portion of burn wounds is an effective way of improving the survival in noncandidal burn wound infections. Surgical excision of burn wounds does not alter the poor prognosis of patients with Candida invasion of the burn wound.
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Reduction of liver ATP in proportion to the severity of shock and hypoxia is well known. We have studied the interrelationships among arterial oxygenation, arterial pH, and liver ATP in experimental hypoxia and in hemorrhagic shock in rats. No significant correlation was found between liver ATP and arterial pH in both hemorrhagic shock and hypoxia and between liver ATP and arterial PO2 in hypoxia. Induction of experimental observations suggest that in this form of hemorrhagic shock, arterial pH may be a sensitive indicator of decreased hepatic perfusion and impaired liver ATP production.
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Post-trauma patients have an oxygen consumption which is proportional to oxygen delivery, suggesting that tissue oxygen consumption is limited by diffusion. Transfusion of packed red blood cells (RBC), which increases the oxygen-carrying capacity of blood, would be expected to increase mixed venous PO2, thereby improving tissue oxygenation. However, the low P50 of stored blood may increase the affinity of hemoglobin for oxygen and reduce oxygen consumption. ⋯ Standard P50 decreased by 4.2 +/- 2.4 Torr following transfusion of two units of RBC (p less than 0.05). Red blood cell transfusion thus failed to increase oxygen consumption in these patients, despite an increase in oxygen content. Thus, RBC transfusion may not improve tissue oxygenation.
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We report a retrospective study of 198 trauma patients brought directly to a trauma operating room by an air ambulance system. Despite rapid transport, expert prehospital resuscitation, and the capability of early surgical intervention, the overall mortality was high (57%). ⋯ Optimal trauma care failed to show encouraging results in this preselected group of patients with predominantly blunt and multisystem injury. The justification and cost effectiveness of this system of trauma care is discussed.