J Trauma
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Chemical burns account for a relatively small proportion of the patients treated within a burn center; however, certain characteristics of these injuries, particularly in the initial stages of treatment, justify their separate consideration and review. Thirty-five patients were treated in the Baltimore Regional Burn Center from July 1976 through June 1980, with 14 different agents involved. The majority of injuries were work related; however, 20% were the result of assault. ⋯ In approximately one half of the patients this was begun as a first-aid measure at the scene of the accident. Compared to the group which did not receive lavage until admission to the hospital, the patients receiving appropriate first aid showed significantly less full-thickness injury and more than twofold shorter hospital stay, indicating the importance of public and industrial medical awareness of the role of immediate copious lavage. The problems of systemic toxicity with and specific therapy for certain agents is discussed with particular attention given to an unusual case involving cutaneous absorption of dichromate.
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Injured patients whose treatment included the use of radiologic catheter techniques were reviewed to determine the clinical utility of radiologic intervention. In the past 4 years, 51 patients have undergone 53 radiologic procedures, predominantly angiographic hemostasis. ⋯ Twenty-eight of the 31 patients with shock or with life-threatening hemorrhage or sepsis, treated by the radiologist, were salvaged. Based on our results, we believe that a radiologist, knowledgeable about trauma and expert in catheter techniques, plays a vital role in improving patient survival and should be integrated into the trauma team approach.
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Complex vascular injuries of the extremities in which acute arterial insufficiency is combined with severe or prolonged shock, extended periods of ischemia, or associated fractures or soft-tissue injuries have unacceptably high limb loss rates, frequently because the allowable warm ischemia time for skeletal muscle is exceeded before adequate revascularization. In a 1-year period, ten patients with complex vascular injuries identified at our metropolitan trauma center underwent routine introduction of temporary plastic intravascular shunts at the site of vessel disruption, thus permitting immediate limb revascularization. ⋯ Following various local and distant orthopedic or general surgical procedures, arterial and venous continuity were uneventfully re-established. This experience suggests that the routine use of plastic intraluminal shunts in complex vascular injuries of the extremities has the distinct potential of reducing the excess morbidity from prolonged acute arterial insufficiency noted in such injuries.