The Journal of burn care & rehabilitation
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J Burn Care Rehabil · May 1988
Therapeutic hyperbaric oxygen: help or hindrance in burn patients with carbon monoxide poisoning?
Although its efficacy is unproved, administration of hyperbaric oxygen (HBO) for the treatment of carbon monoxide poisoning is often carried out to prevent the development of acute and delayed neurologic sequelae. In burn patients with carbon monoxide poisoning the value of HBO also is unproved. This review of the clinical course of ten such patients showed major complications during the course of treatment: two patients suffered from eustachian tube occlusion, two patients had episodes of aspiration, one patient had seizure activity, and severe hypocalcemia developed in another. ⋯ The authors state that the efficacy of HBO in carbon monoxide poisoning must be studied further. Based on their experience and a review of the literature, they contend that important delayed neurologic sequelae are rare, and further, that they occur and resolve with or without HBO. Multicenter randomized clinical trials with controlled follow-up are needed to assess the actual incidence of neuropsychiatric sequelae and to evaluate the efficacy of HBO.
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Two brief cases are presented describing burns resulting from exposure to cement and its components. Of particular interest is the etiology of such burns. Do they result from a high pH solution in contact with the skin under abrasive conditions for an undetermined period of time, or are they a consequence of possible allergic reactions to chromium or chromates? Another possible factor that has been largely unexplored is the role of the calcium ion--the other principal ionic species with which the skin is in contact. Much has been written about its role in membrane transport and other physiologic processes.
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Suicide by self-inflicted burns is uncommon in Western cultures. The majority of patients who attempt suicide in this manner have preexisting psychiatric illness, including a history of prior suicide attempts. A history of previous self-inflicted burn is rare, however, as are further suicide attempts in survivors. In this series of 33 patients, a cultural trend can be identified, with an increased incidence among Latin women.