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Electrical and burn injuries
144
Burns
are fatal. Included within this total are all patients in whom thermal damage occurred at either the entry or exit point of the electricity. High voltage burns are characterized by severe tissue destruction; when muscle is involved it should be excised as soon as possible after injury. There is a high incidence of renal failure, the early symptoms of which should be looked for and appropriate treatment instituted. Sepsis and neurological complications are frequent. Relatively low voltage electrical injuries have a high incidence of cardiac involvement, which may in some patients produce irreversible cardiac arrest. Both high and low voltage electrical injuries commonly require extensive surgical procedures, including the use of skin flaps and tendon and muscle transplantation. Mtiller F. E. (1978) Die Chirurgische Behandlung der Nieder-und Hochspannungs-Verletzungen. Zeit. Plast. Chir. 2, 1.
Electrical
and burn injuries
Although electrical injury is often classified as a burn injury, it is more precisely a crush injury or vascular insufficiency accompanying the surface burn. Treatment is modified considerably from that for the usual thermal injury because tissue damage is much deeper. Electrical injury frequently requires amputation unless prudent judgement and appropriate use of debridement and skin grafting have avoided it. Fluid replacement needs to be much greater for the patient with electrical injuries due to the depth of the injury and the frequent occurrence of haemoglobinuria and myoglobinuria. The urine flow should exceed 50 ml/h to clear this pigment. Fasciotomy is more frequently needed in addition to escharotomy due to the depth of the injury and the frequent association with vascular insufficiency. Sulfamylon is used in areas of extensive, deep electrical injury because of its better penetrating action as compared with silver sulphadiazine. Large doses of penicillin prophylaxis are directed at clostridia in the tissues affected by electricity as compared with much lower doses of penicillin for prophylaxis against streptococcus spp. in thermal injury. The possibility of vascular thrombosis and rupture of blood vessels must be borne in mind during frequent clinical examination. Rouse R. G. and Dimick A. R. (1978) The treatment of electrical injury compared to burn injury: a review of pathophysiology and comparison of patient management protocols. J. Trauma 18, 43.
Prevention
and burn epidemiology
An appreciation of the causes of burn injury is essential in order to direct burn prevention. Towards this goal, 1564 patients treated in California were studied. There were 699 patients with burns severe enough to be admitted to hospital for treatment and 865 outpatients. Scalding was the most common cause of burning in both adults and children. In children, scalds accounted for 42 per cent of the total number treated, and in those under 4 years of age, scalds caused 75 per cent
Vol. ~/NO.
1
of all burn injuries, most of which occurred in kitchens. Flammable liquids were responsible for the majority of the severe burns in the adult group (I9 per cent of acute admissions). Housefires, while accounting for only 5 per cent of the adults treated, were responsible for 44 per cent of the deaths in adults. Continuing public education in safety practices at home-especially in the kitchen and bathroom-and with motor vehicles and outdoor stoves and fires is recommended, as well as planned escapes from homes and the use of smoke detectors. Jay K. M., Bartlett R. H., Danet R. et al. (1977) Burn epidemiology: a basis for burn prevention. J. Trauma
17, 943.
Dbbridement enzymes
with
proteolytic
In a search for an enzyme preparation which would successfully debride necrotic burned tissue, sutilains ointment (Travase) was used on 463 patients with burns covering more than 10 per cent of the body surface. The use of Travase combined with silver sulphadiazine was effective since it allowed earlier application of the first skin graft and resulted in a shorter stay in hospital without significantly altering mortality when compared with results obtained before the start of the trial. Comparison of survival times and the extent of burn injury causing death showed that the use of Travase in silver sulphadiazine gave a better survival rate and a quicker recovery than that reported for patients not receiving this form of treatment by the National Burn Information Exchange. Dimick A. R. (1977) Experience with the use of proteolytic enzyme (Travase) in burn patients. J. Trauma
17. 948.
Immunosuppressive
factors
in burns
An immunosuppressive factor was isolated and partially purified from a fraction of the serum of acute burns patients which contained primarily albumins. The factor was either a small protein or a peptide of molecular weight less than 10 000. It inhibited migration of peripheral blood leucocytes of burned patients and of Guinea-pig peritoneal macrophages. In the presence of the serum it caused the lysis of peripheral lymphocytes from burned patients and depressed mitogenic stimulation of normal human peripheral lymphocytes. It had no effect on migration and did not lyse peripheral blood lymphocytes of healthy subjects. Hakim A. A. (1977) An immunosuppressive factor from serum of thermally traumatized patients. J. Trauma
Water
17, 908.
losses in burns
The laminar flow principle has been applied to the treatment of burn patients for over a year in a reverse isolation burn unit. Topical antibacterial agents were also used, usually silver sulphadiazine. Careful studies
Burns
are fatal. Included within this total are all patients in whom thermal damage occurred at either the entry or exit point of the electricity. High voltage burns are characterized by severe tissue destruction; when muscle is involved it should be excised as soon as possible after injury. There is a high incidence of renal failure, the early symptoms of which should be looked for and appropriate treatment instituted. Sepsis and neurological complications are frequent. Relatively low voltage electrical injuries have a high incidence of cardiac involvement, which may in some patients produce irreversible cardiac arrest. Both high and low voltage electrical injuries commonly require extensive surgical procedures, including the use of skin flaps and tendon and muscle transplantation. Mtiller F. E. (1978) Die Chirurgische Behandlung der Nieder-und Hochspannungs-Verletzungen. Zeit. Plast. Chir. 2, 1.
Electrical
and burn injuries
Although electrical injury is often classified as a burn injury, it is more precisely a crush injury or vascular insufficiency accompanying the surface burn. Treatment is modified considerably from that for the usual thermal injury because tissue damage is much deeper. Electrical injury frequently requires amputation unless prudent judgement and appropriate use of debridement and skin grafting have avoided it. Fluid replacement needs to be much greater for the patient with electrical injuries due to the depth of the injury and the frequent occurrence of haemoglobinuria and myoglobinuria. The urine flow should exceed 50 ml/h to clear this pigment. Fasciotomy is more frequently needed in addition to escharotomy due to the depth of the injury and the frequent association with vascular insufficiency. Sulfamylon is used in areas of extensive, deep electrical injury because of its better penetrating action as compared with silver sulphadiazine. Large doses of penicillin prophylaxis are directed at clostridia in the tissues affected by electricity as compared with much lower doses of penicillin for prophylaxis against streptococcus spp. in thermal injury. The possibility of vascular thrombosis and rupture of blood vessels must be borne in mind during frequent clinical examination. Rouse R. G. and Dimick A. R. (1978) The treatment of electrical injury compared to burn injury: a review of pathophysiology and comparison of patient management protocols. J. Trauma 18, 43.
Prevention
and burn epidemiology
An appreciation of the causes of burn injury is essential in order to direct burn prevention. Towards this goal, 1564 patients treated in California were studied. There were 699 patients with burns severe enough to be admitted to hospital for treatment and 865 outpatients. Scalding was the most common cause of burning in both adults and children. In children, scalds accounted for 42 per cent of the total number treated, and in those under 4 years of age, scalds caused 75 per cent
Vol. ~/NO.
1
of all burn injuries, most of which occurred in kitchens. Flammable liquids were responsible for the majority of the severe burns in the adult group (I9 per cent of acute admissions). Housefires, while accounting for only 5 per cent of the adults treated, were responsible for 44 per cent of the deaths in adults. Continuing public education in safety practices at home-especially in the kitchen and bathroom-and with motor vehicles and outdoor stoves and fires is recommended, as well as planned escapes from homes and the use of smoke detectors. Jay K. M., Bartlett R. H., Danet R. et al. (1977) Burn epidemiology: a basis for burn prevention. J. Trauma
17, 943.
Dbbridement enzymes
with
proteolytic
In a search for an enzyme preparation which would successfully debride necrotic burned tissue, sutilains ointment (Travase) was used on 463 patients with burns covering more than 10 per cent of the body surface. The use of Travase combined with silver sulphadiazine was effective since it allowed earlier application of the first skin graft and resulted in a shorter stay in hospital without significantly altering mortality when compared with results obtained before the start of the trial. Comparison of survival times and the extent of burn injury causing death showed that the use of Travase in silver sulphadiazine gave a better survival rate and a quicker recovery than that reported for patients not receiving this form of treatment by the National Burn Information Exchange. Dimick A. R. (1977) Experience with the use of proteolytic enzyme (Travase) in burn patients. J. Trauma
17. 948.
Immunosuppressive
factors
in burns
An immunosuppressive factor was isolated and partially purified from a fraction of the serum of acute burns patients which contained primarily albumins. The factor was either a small protein or a peptide of molecular weight less than 10 000. It inhibited migration of peripheral blood leucocytes of burned patients and of Guinea-pig peritoneal macrophages. In the presence of the serum it caused the lysis of peripheral lymphocytes from burned patients and depressed mitogenic stimulation of normal human peripheral lymphocytes. It had no effect on migration and did not lyse peripheral blood lymphocytes of healthy subjects. Hakim A. A. (1977) An immunosuppressive factor from serum of thermally traumatized patients. J. Trauma
Water
17, 908.
losses in burns
The laminar flow principle has been applied to the treatment of burn patients for over a year in a reverse isolation burn unit. Topical antibacterial agents were also used, usually silver sulphadiazine. Careful studies