The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1993
Effects of fluid resuscitation, burn eschar excision, and blockade of afferent pain responses on bacterial translocation and acid-base balance after murine burn injury.
We tested effects of fluid resuscitation, early burn excision/grafting, and blockade of afferent stimuli from the burn wound on bacterial translocation and acid-base balance after murine burn injury. Burn excisions were performed with patients either 15 minutes or 2 hours after burn injury under anesthesia, and excised wounds were immediately closed with murine allograft skin. Twenty-four hours after 25% total body surface area (TBSA) burn injury and 48 hours after 32% TBSA injury, mesenteric lymph nodes were cultured. ⋯ Rates of bacterial translocation in mice receiving anesthesia or excision/grafting without burn injury were 15.0% and 20%, respectively (p = NS compared with normal mice). Subcutaneous implantation of normal or burned skin into normal animals neither elicited shock nor increased the incidence of bacterial translocation. Increasing amounts of fluid resuscitation in the 25% TBSA burn model provided only delayed improvement of acid-base balance; increased amounts of fluid did not decrease bacterial translocation.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Burn Care Rehabil · Sep 1993
Preliminary evaluation of vibriolysin, a novel proteolytic enzyme composition suitable for the debridement of burn wound eschar.
Vibriolysin, a proteolytic enzyme secreted by the marine microorganism Vibrio proteolyticus, was evaluated for its efficacy as an enzymatic debridement agent. Initial in vitro experiments revealed that the protease readily hydrolyzed proteinaceous components of eschar (e.g., fibrin, elastin, and in particular, collagen). ⋯ The full-thickness wound eschar was rapidly hydrolyzed by a hydrophilic vibriolysin composition with a resultant wound bed that appeared pink and viable. Vibriolysin exhibited desirable properties heretofore not described for the enzymatic debridement agents, in particular, its selective hydrolysis of dead but not viable tissue, debridement in the absence of bleeding, compatibility with adjunct therapies, and its unique shelf-life stability in a hydrophilic composition at ambient temperature.
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Successful programs in injury prevention can focus on changing an individual's attitude and behavior or on creating and amending the environment to reduce the likelihood of injury. To investigate the latter approach as it pertains to burn prevention, the American Burn Association Burn Prevention Committee catalogued statewide legislation (as opposted to county or municipal ordinances) in major areas of burn and fire prevention. ⋯ Sprinkler systems have generally not been addressed by state legislation. The committee concludes that pursuing statewide legislative agendas as an area of burn and injury prevention is open to further initiatives.
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J Burn Care Rehabil · Jul 1993
Clinical TrialEffect of triglycyl-lysine-vasopressin on skin blood flow and blood loss during wound excision in patients with burns.
Excisional therapy often results in large-volume blood loss. Triglycyl-lysine-vasopressin selectively decreases dermal blood flow and therefore was tested for efficacy in limiting intraoperative blood loss in a series of patients undergoing excisional therapy. ⋯ Blood loss, which was quantified by weighing sponges used to absorb shed blood, was significantly decreased after treatment. Triglycyl-lysine-vasopressin treatment was safe and effective and should be considered in cases when large-volume blood loss is expected.
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J Burn Care Rehabil · Jul 1993
Comparative StudyTemperature changes during exercise stress testing in children with burns.
It has been postulated that because of the extensive destruction of the skin and appendages after thermal injury, the thermoregulatory control mechanism would be impaired, and these patients would be intolerant to prolonged work. Preview studies demonstrate evidence that during work in a hot climate, patients with an extensively healed burn react with an excessive rise in body temperature. This study was designed to investigate the thermoregulatory response to exercise in pediatric patients with burns and to study changes in body temperature during exercise testing. ⋯ Values were measured at baseline during and at maximum exercise. Our data indicate all patients reached the same endurance level regardless of the size of the total body surface area burn. Additionally, in a temperature-controlled environment, adequate heat dissipation in children with burns can be maintained during exercise testing without an excessive rise in body temperature.