The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1994
Case ReportsInfluence of head and neck position on endotracheal tube tip position on chest x-ray examination: a potential problem in the infant undergoing intubation.
Complications related to endotracheal tubes are frequent in small children and infants. We report a case of a burned 12-month-old child in whom frequent manipulation of the endotracheal tube was required because of recurrent atelectasis and changing position of the endotracheal tube on chest x-ray film. It was then determined that because of variations in head and neck position while chest x-ray films were obtained, the endotracheal tip changed position in the trachea greater than 2.7 cm (greater than 1 inch), although endotracheal tube position was maintained at the level of the teeth. Airway care and gas exchange were subsequently improved by ensuring that patient care and chest x-ray films were performed with the head and neck in similar (neck slightly flexed, head neutral) position.
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J Burn Care Rehabil · Sep 1994
Current trends in the use of allograft skin for patients with burns and reflections on the future of skin banking in the United States.
Cadaveric allograft skin can play a critical role in the care of patients with massive burns. It is difficult, however, to estimate current use and levels of enthusiasm for allograft skin in the United States. We report on a survey of 40 skin banks and 140 United States burn center medical directors as listed in the American Burn Association's Directory of Burn Care Resources for North America 1991-1992. ⋯ Overall, 12% of admitted patients were treated with allograft skin at the responding burn centers. Sixty-nine percent of burn center directors preferred to use fresh skin, although only 47% of skin banks were able to supply fresh cadaver skin. Tabulated survey results and a review and discussion of future directions in skin banking and replacement research are discussed in this paper and were presented to the Tissue Bank Special Interest group at the 1993 American Burn Association annual meeting.
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Between July 1, 1984, and December 31, 1991, 27 consecutive patients required admission to the Grady Memorial Hospital Burn Unit for care of hot tar burns. This group represented 1.4% of all admissions to this burn unit. Injuries occurred at the workplace and occurred mostly during the summer. ⋯ The survival rate was 92.6%. Both of the patients who died had large burns and/or preexisting medical problems. Hot tar burns occur under predictable circumstances, appear to be preventable, and have accounted for only a small fraction of all admissions to this burn unit.
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J Burn Care Rehabil · Jul 1994
Comparative StudyA biochemical and histologic rationale for the treatment of hydrofluoric acid burns with calcium gluconate.
Hydrofluoric acid has unique properties that make it attractive for a variety of industrial and household uses. Exposure to dilute and concentrated solutions of hydrofluoric acid can lead to severe pain and tissue necrosis. Local treatment with topical calcium gluconate and subdermal injections of 0.5 ml 10% solution of calcium gluconate per cm2 of affected tissue has been advocated but frequently fails to relieve the patient of pain. ⋯ The purpose of this study was to show what, if any, were the microscopic effects on the distal arterial tree of intraarterial infusion of calcium gluconate. By studying 1 micron-thick cuts of distal rat aortas after proximal infusion of concentrated (10%) and dilute (2%) calcium gluconate, we were able to show that the incidence of microperforations in the intima and media of the rat aorta increased with the concentration of calcium gluconate. We conclude that intraarterial infusions should be reserved for only the most severe cases of hydrofluoric acid burns unresponsive to local therapy.
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J Burn Care Rehabil · Jul 1994
Investigation of the presence and role of calmodulin and other mitogens in human burn blister fluid.
It is unclear whether burn blister fluid is beneficial or deleterious to the healing of the underlying wound. We investigated the calcium binding protein calmodulin in human burn blister fluid and its role in the mitogenicity of this fluid in the culture of human keratinocytes, fibroblasts, and mouse 3T3 fibroblasts. Calmodulin levels in blister fluid were three times greater than in serum (p < 0.005), whereas epidermal growth factor and platelet-derived growth factor concentrations were significantly lower (p < 0.001). ⋯ Inhibiting calmodulin with either an antagonist or antibody to calmodulin reduced the mitogenic activity of blister fluid in three cell types by 26% to 80%. These in vitro studies suggest that burn blister fluid may promote wound healing, and locally released calmodulin contributes to this effect. In appropriate cases it may be beneficial to leave burn blisters intact.