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Acute phase protein changes
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bronchoscopy should also be carried out in patients with facial injuries affecting the perioral and perinasal regions, particularly when there is additional oropharyngeal inflammation in order to give some indication of the likelihood of subsequent acute upper airway obstruction. Clark C. J., Reid W. H., Telfer A. B. M. et al (1983) Respiratory injury in the burned patient-the role of flexible bronchoscopy. Anaesthesia 38, 35.
Acute phase protein changes Twelve patients with a mean burned area of 32 per cent (range 16-89 per cent) and 11 patients with a mean burned area of 14 per cent (range S-30 per cent) showed reductions in the levels of total protein, albumin and transferrin and early increases in the concentrations of alpha, antitrypsin and alpha,, antichymotrypsin, cortisol and glucagon which were positively related to the severity of injury. Significant correlations were found between the levels of plasma cortisol and glucagon and alpha, antichymotrypsin but not between cortisol and alpha, antitrypsin. The relationships between these acute phase reactant plasma proteins and cortisol are discussed in view of the probable dual role of the hormone which appears to aid protein breakdown in muscle, yet aids the synthesis of specific proteins in the liver. Batstone G. F., Levick P. L., Spurr E. et al (1983) Changes in acute phase reactants and disturbances in metabolism after burn injury. Burns 9,234.
Pain relief during debridement A survey of 93 burn units in the USA showed that because of the pain expected or experienced during the debridement of extensive burns in adults about two-thirds of the units used narcotics in widely varying dosages and that the assessment of pain was not statistically different regarding the type of narcotic used or the route of administration. About half the units used psychotropic drugs in conjunction with narcotics but without a reduction in the dosage of the narcotics or a reduction in the assessment of pain. For children narcotics, if used, tended to be given in larger dosage per unit of body weight. Psychotropic drugs in conjunction with narcotics were used less than with adults (24 per cent vs 52 per cent) and despite the higher percentage of units who recommended using no narcotics or no psychotropics or no analgesia at all, the general assessment of pain for children and adults was the same i.e. the pain was moderately severe. The repeated use of narcotics did not induce addiction. Perry S. and Heidrich G. (1982) Management of pain during debridement: a survey of U.S. burn units. Pain 13, 261.
Abstracts
Fibronectin administration Opsonic fibronectin aids the reticuloendothelial uptake of bacterial and non-bacterial particles. Studies in rats with burns showed an acute depletion (to 35 per cent of normal) of opsonic fibronectin within I hour of injury. This depletion was correctable by the administration of purified opsonic fibronectin when accompanied by moderate sepsis but not in the presence of severe sepsis. In those animals in whom the depletion was correctable and corrected it did not necessarily follow that impaired reticuloendothelial activity was also corrected implying that additional factors may contribute to reticuloendothelial failure after severe burn injury. Lanser M. E. and Saba T. M. (1983) Correction of serum opsonic defects after burn and sepsis by opsonic fibronectin administration. Arch. Surg. 118, 338. Reductions in burn oedema The formation of odema after burns may be partly due to superoxide radicals since removal of oxygen derived free radicals with superoxide dismutase and catalases significantly reduced the volume of oedema formed. In other studies hydrocortisone reduced the very early post burn oedema by its membrane stabilizing influence which reduced vasodilatation. Cimetidine reduced oedema formation partly through its ability to reduce mean arterial blood pressure. Differing anaesthetic agents used at the time of injury affected the volume of oedema produced by a standardized mode of injury. Bjork J. and Arturson G. (1983) Effect of cimetidine, hydrocortisone, superoxide dismutase and catalase on the development of oedema after thermal injury. Burns 9, 249. Erythrocyte calcium levels The loss of calcium from in vitro loaded erythrocytes from patients with burns was related to cell hydration, deformability and the intra-extra-cellular pH difference. Episodes of delayed calcium extrusion were evident in all patients and associated with low cell water and high intracellular calcium and sodium. The pH gradient decreased although the whole blood pH remained normal. These abnormalities were reversible. Surviving patients reverted to normal in about 7 days with only brief recurrences. Fatal injuries remained abnormal much longer and reversal to normal was only brief. Calcium extrusion and intracellular cations were always abnormal before death. Frequent extensive blood transfusions favourably affected the red cell abnormalities. Persistent delayed extrusion of calcium from in vitro erythrocytes indicated a poor prognosis. Baar S. (1982) The effect of thermal injury on the loss of calcium from calcium loaded red cells: its relationship to red cell function and patient survival. C/in. Chim. Acta. 126, 25.
bronchoscopy should also be carried out in patients with facial injuries affecting the perioral and perinasal regions, particularly when there is additional oropharyngeal inflammation in order to give some indication of the likelihood of subsequent acute upper airway obstruction. Clark C. J., Reid W. H., Telfer A. B. M. et al (1983) Respiratory injury in the burned patient-the role of flexible bronchoscopy. Anaesthesia 38, 35.
Acute phase protein changes Twelve patients with a mean burned area of 32 per cent (range 16-89 per cent) and 11 patients with a mean burned area of 14 per cent (range S-30 per cent) showed reductions in the levels of total protein, albumin and transferrin and early increases in the concentrations of alpha, antitrypsin and alpha,, antichymotrypsin, cortisol and glucagon which were positively related to the severity of injury. Significant correlations were found between the levels of plasma cortisol and glucagon and alpha, antichymotrypsin but not between cortisol and alpha, antitrypsin. The relationships between these acute phase reactant plasma proteins and cortisol are discussed in view of the probable dual role of the hormone which appears to aid protein breakdown in muscle, yet aids the synthesis of specific proteins in the liver. Batstone G. F., Levick P. L., Spurr E. et al (1983) Changes in acute phase reactants and disturbances in metabolism after burn injury. Burns 9,234.
Pain relief during debridement A survey of 93 burn units in the USA showed that because of the pain expected or experienced during the debridement of extensive burns in adults about two-thirds of the units used narcotics in widely varying dosages and that the assessment of pain was not statistically different regarding the type of narcotic used or the route of administration. About half the units used psychotropic drugs in conjunction with narcotics but without a reduction in the dosage of the narcotics or a reduction in the assessment of pain. For children narcotics, if used, tended to be given in larger dosage per unit of body weight. Psychotropic drugs in conjunction with narcotics were used less than with adults (24 per cent vs 52 per cent) and despite the higher percentage of units who recommended using no narcotics or no psychotropics or no analgesia at all, the general assessment of pain for children and adults was the same i.e. the pain was moderately severe. The repeated use of narcotics did not induce addiction. Perry S. and Heidrich G. (1982) Management of pain during debridement: a survey of U.S. burn units. Pain 13, 261.
Abstracts
Fibronectin administration Opsonic fibronectin aids the reticuloendothelial uptake of bacterial and non-bacterial particles. Studies in rats with burns showed an acute depletion (to 35 per cent of normal) of opsonic fibronectin within I hour of injury. This depletion was correctable by the administration of purified opsonic fibronectin when accompanied by moderate sepsis but not in the presence of severe sepsis. In those animals in whom the depletion was correctable and corrected it did not necessarily follow that impaired reticuloendothelial activity was also corrected implying that additional factors may contribute to reticuloendothelial failure after severe burn injury. Lanser M. E. and Saba T. M. (1983) Correction of serum opsonic defects after burn and sepsis by opsonic fibronectin administration. Arch. Surg. 118, 338. Reductions in burn oedema The formation of odema after burns may be partly due to superoxide radicals since removal of oxygen derived free radicals with superoxide dismutase and catalases significantly reduced the volume of oedema formed. In other studies hydrocortisone reduced the very early post burn oedema by its membrane stabilizing influence which reduced vasodilatation. Cimetidine reduced oedema formation partly through its ability to reduce mean arterial blood pressure. Differing anaesthetic agents used at the time of injury affected the volume of oedema produced by a standardized mode of injury. Bjork J. and Arturson G. (1983) Effect of cimetidine, hydrocortisone, superoxide dismutase and catalase on the development of oedema after thermal injury. Burns 9, 249. Erythrocyte calcium levels The loss of calcium from in vitro loaded erythrocytes from patients with burns was related to cell hydration, deformability and the intra-extra-cellular pH difference. Episodes of delayed calcium extrusion were evident in all patients and associated with low cell water and high intracellular calcium and sodium. The pH gradient decreased although the whole blood pH remained normal. These abnormalities were reversible. Surviving patients reverted to normal in about 7 days with only brief recurrences. Fatal injuries remained abnormal much longer and reversal to normal was only brief. Calcium extrusion and intracellular cations were always abnormal before death. Frequent extensive blood transfusions favourably affected the red cell abnormalities. Persistent delayed extrusion of calcium from in vitro erythrocytes indicated a poor prognosis. Baar S. (1982) The effect of thermal injury on the loss of calcium from calcium loaded red cells: its relationship to red cell function and patient survival. C/in. Chim. Acta. 126, 25.