J Trauma
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An accurate estimation of burn surface area is needed to correctly calculate initial fluid resuscitation, nutritional requirements, prognosis, and comparisons of treatment protocols among burn centers. The following experiment was conducted to test the accuracy of physicians compared to a computer-assisted method. Twenty-seven physicians were asked to estimate the per cent of burned surface area from an adult patient diagram. ⋯ The average physician estimate was 42% compared to 29.6% calculated by a computer-assisted program. The degree of error between physician estimates and actual TBSA burned is significant and may critically affect patient management. Additional benefits of computer assistance include a permanent record of injury, burn wound trend analysis, and meaningful statistics involving morbidity, mortality, and comparative treatment protocols among burn centers.
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The field identification of the patients who should be taken to trauma centers is a major problem of trauma care. This study appears to be the first to use multivariate analysis to systematically design a field triage instrument and to evaluate its performance in terms of a meaningful and plausible criterion for which patients ought to be treated at trauma centers. Four new triage instruments were created and their performance compared to that of two existing measures, the Trauma Score and the CRAMS scale. ⋯ The one purely physiologic instrument tested appeared to be inferior to instruments that included anatomic and historic as well as physiologic indices. Simple checklists performed approximately as well as weighted scales. No instrument was found to be high in both sensitivity and positive accuracy.
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Case Reports
High-pressure acid injection: case report with recommended initial management and therapy.
This report represents a case of high-pressure hydrochloric acid injection of the shoulder girdle, with the resultant need for aggressive debridement in the form of extended forequarter amputation. The accelerated destructive activity of such reducing agents and the need for neutralization or removal of these agents is emphasized. Debridement, copious saline irrigation, and careful periodic monitoring are recommended.