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Inhalation injury in burn victims
253
Abstracts
for the care of major injuries rather than be scattered through many ill-equipped casualty departments. The major threat to life in these patients is uncontrollable sepsis, which in the end caused the deaths of the two Moorgate victims. Leading article (1977) Crush injuries. Br. Med. J. 2, 1244.
Burns Porcine
xenograft
dressings
The pigskin was applied to partly destroyed skin, which was found to heal with a better appearance than it did under similarly burned areas that were covered by gauze impregnated with nitrofurazone. A striking advantage of the pigskin over other dressings was that pain was immediately and lastingly relieved. The authors do not consider the financial implication of the use of pigskin for the purposes they describe. Hobby J. A. E. and Levick P. L. (1978) Clinical evaluation of porcine xenograft dressings. Burns 4, 188. Lyophilized
pigskin
in burn treatment
British and American preparations were compared and were found to give comparable results. They were particularly successful in relieving the pain of superficial burns, which heal well in any case, but they were less successful than tangential excision in the treatment of deep dermal burns. With some of these injuries some areas of complete destruction of skin occurred and were liable to give rise to hypertrophic scars. Pigskin also delayed healing. The authors did not compare pigskin with human skin. Sully L. and Bailey B. N. (1978) Lyophilized pigskin in the treatment of superficial and deep dermal burns. Bwns 4, 27 I. Inhalation
injury
in burn victims
This paper from the US Army Institute of Surgical Research at Fort Sam, Houston, Texas describes 60 patients admitted with burns and inhalation injury confirmed by bronchoscopy and 133 Xenon scan. Of these, 30 were treated by dexamethasone or saline placebo for 3 days; the other 30 were treated with aerosolised gentamicin or a placebo for 10 days. Both treated groups were comparable to their controls in age and mean size of burn. Results of the steroid and gentamicin trials showed no major difference in mortality, pulmonary complications or other septic complications between the treated and control groups. Levine B. A.. Petroff P. A.. Slade C. L. et al. (1978) Prospective trial of dexameihasone and aerosblisei gentamicin in the treatment of inhalation injury in the burned patient. J. Truuma 18, 188. Hypertension
in burns
In a group of children admitted to a burns centre in Philadelphia, sustained systolic and diastolic hypertension occurred in 31.5 per cent of the children and
some 57 per cent of the children demonstrated episodic periods of hypertension. The only clinical finding which was significantly associated with the hypertension was the presence of tachycardia, which persisted into the late healing phase. Hypertension was more prevalent in the younger age groups, but bore no relation to sex, age or extent of the burn injury. The development of hypertension in itself did not adversely affect the prognosis for survival. The aetiology of the hypertension is not clear. Falkner B., Roven S., DeClement F. A. et al. (1978) Hypertension in children with burns. J. Traumn 18, 213. Burns and mechanical
injuries
Sevedty-eight cases of burning combined with other injuries are reported; 25 per cent resulted from road accidents. One of the dangers is that some of the associated injuries will be overlooked. Primary internal fixation of fractures is advisable, especially in burned limbs. Of 16 such fractures, 8 healed without complication, 3 were fixed internally, 3 were treated by &action and 2 in plaster. Eight of the fractures were complicated by delayed union or non-union, 2 patients died and 1 limb was amputated. Associated wounds require immediate toilet, but cIosure may be better deferred for a few days than carried out at once. Novlk J., Papp T. and ZBborsky 2. (1978) Burns; associated with mechanical injuries. Burns 4, 197.
Organization prevention Resuscitation
topics
and accident
ambulances
This is a review of 40 consecutive successful revivals following cessation of heartbeat outside hospital and achieved in the course of 3 years and over 3000 urgent calls for a special resuscitaiion ambulance. Resuscitation was attemoted in 356 cases and 101 were admitted to hospital. Twenty-six of the 40 survivors had no heartbeat when the ambulance arrived, 3 were still conscious when the ambulance arrived, but then developed ventricular fibrillation and 10 others also developed fibrillation while under treatment. Fifteen of the 26 were already undergoing compression of their hearts by doctors, nurses, ambulancemen and others. Of the 40 survivors, 32 were still alive 6 months to 3-5 years later. Even prolonged unconsciousness had little or no deleterious effect on mental powers. The value of the scheme should not be judged only on the number or proportion of successful revivals and it allowed the survival of a number of persons with no orevious knowledge of anv cardiac disorder. ’ Mackintosh A. F., Cradb M. E., Grainger R. et al. (1978) The Brighton resuscitation ambulances. Br. Med. J. 1, 1115. Mobile
coronary
care units
This study was carried out in Nottingham, where it was not always possible to dispatch a mobile coronary care unit in answer to an appropriate emergency call.
Abstracts
for the care of major injuries rather than be scattered through many ill-equipped casualty departments. The major threat to life in these patients is uncontrollable sepsis, which in the end caused the deaths of the two Moorgate victims. Leading article (1977) Crush injuries. Br. Med. J. 2, 1244.
Burns Porcine
xenograft
dressings
The pigskin was applied to partly destroyed skin, which was found to heal with a better appearance than it did under similarly burned areas that were covered by gauze impregnated with nitrofurazone. A striking advantage of the pigskin over other dressings was that pain was immediately and lastingly relieved. The authors do not consider the financial implication of the use of pigskin for the purposes they describe. Hobby J. A. E. and Levick P. L. (1978) Clinical evaluation of porcine xenograft dressings. Burns 4, 188. Lyophilized
pigskin
in burn treatment
British and American preparations were compared and were found to give comparable results. They were particularly successful in relieving the pain of superficial burns, which heal well in any case, but they were less successful than tangential excision in the treatment of deep dermal burns. With some of these injuries some areas of complete destruction of skin occurred and were liable to give rise to hypertrophic scars. Pigskin also delayed healing. The authors did not compare pigskin with human skin. Sully L. and Bailey B. N. (1978) Lyophilized pigskin in the treatment of superficial and deep dermal burns. Bwns 4, 27 I. Inhalation
injury
in burn victims
This paper from the US Army Institute of Surgical Research at Fort Sam, Houston, Texas describes 60 patients admitted with burns and inhalation injury confirmed by bronchoscopy and 133 Xenon scan. Of these, 30 were treated by dexamethasone or saline placebo for 3 days; the other 30 were treated with aerosolised gentamicin or a placebo for 10 days. Both treated groups were comparable to their controls in age and mean size of burn. Results of the steroid and gentamicin trials showed no major difference in mortality, pulmonary complications or other septic complications between the treated and control groups. Levine B. A.. Petroff P. A.. Slade C. L. et al. (1978) Prospective trial of dexameihasone and aerosblisei gentamicin in the treatment of inhalation injury in the burned patient. J. Truuma 18, 188. Hypertension
in burns
In a group of children admitted to a burns centre in Philadelphia, sustained systolic and diastolic hypertension occurred in 31.5 per cent of the children and
some 57 per cent of the children demonstrated episodic periods of hypertension. The only clinical finding which was significantly associated with the hypertension was the presence of tachycardia, which persisted into the late healing phase. Hypertension was more prevalent in the younger age groups, but bore no relation to sex, age or extent of the burn injury. The development of hypertension in itself did not adversely affect the prognosis for survival. The aetiology of the hypertension is not clear. Falkner B., Roven S., DeClement F. A. et al. (1978) Hypertension in children with burns. J. Traumn 18, 213. Burns and mechanical
injuries
Sevedty-eight cases of burning combined with other injuries are reported; 25 per cent resulted from road accidents. One of the dangers is that some of the associated injuries will be overlooked. Primary internal fixation of fractures is advisable, especially in burned limbs. Of 16 such fractures, 8 healed without complication, 3 were fixed internally, 3 were treated by &action and 2 in plaster. Eight of the fractures were complicated by delayed union or non-union, 2 patients died and 1 limb was amputated. Associated wounds require immediate toilet, but cIosure may be better deferred for a few days than carried out at once. Novlk J., Papp T. and ZBborsky 2. (1978) Burns; associated with mechanical injuries. Burns 4, 197.
Organization prevention Resuscitation
topics
and accident
ambulances
This is a review of 40 consecutive successful revivals following cessation of heartbeat outside hospital and achieved in the course of 3 years and over 3000 urgent calls for a special resuscitaiion ambulance. Resuscitation was attemoted in 356 cases and 101 were admitted to hospital. Twenty-six of the 40 survivors had no heartbeat when the ambulance arrived, 3 were still conscious when the ambulance arrived, but then developed ventricular fibrillation and 10 others also developed fibrillation while under treatment. Fifteen of the 26 were already undergoing compression of their hearts by doctors, nurses, ambulancemen and others. Of the 40 survivors, 32 were still alive 6 months to 3-5 years later. Even prolonged unconsciousness had little or no deleterious effect on mental powers. The value of the scheme should not be judged only on the number or proportion of successful revivals and it allowed the survival of a number of persons with no orevious knowledge of anv cardiac disorder. ’ Mackintosh A. F., Cradb M. E., Grainger R. et al. (1978) The Brighton resuscitation ambulances. Br. Med. J. 1, 1115. Mobile
coronary
care units
This study was carried out in Nottingham, where it was not always possible to dispatch a mobile coronary care unit in answer to an appropriate emergency call.