Biomedical subjects

Charles J Yowler

Publications and source records attributed to Charles J Yowler.

3 recordsLinked to original sources

PubMed2002

Burns with multiple trauma.

The purpose of this study was to determine the incidence, mechanisms, and outcomes of management in patients with multisystem trauma and associated burn injury. A retrospective review was performed of patients admitted with combined burns and trauma from 1990 through 1999. Mechanism of injury, extent of burns, associated injuries, Injury Severity Score (ISS), and patient outcomes were identified. There were 2,845 burn and 19,418 trauma admissions. Fifty-six patients (2.0% and 0.29% respectively) had combined burns and trauma. Mean ISS was 21.7 and average percentage total body surface area was 16.2. Associated injuries included fractures in 32, complex soft-tissue injury in 20, head injury in 11, and abdominal trauma in seven. Mechanism of injury was industrial in 19, motor vehicle accident in 16, house fire in 13, high voltage in six, and other in three. Skin grafting was required in 33 of 56 patients (59%). Six of 56 patients died. Mean ISS was 19.0 in survivors compared with 46.2 in nonsurvivors. The combination of burns with multiple system trauma is uncommon. Fractures are the most frequent associated injury, and the majority of patients will require skin grafting in their burn treatment. Outcomes with appropriate management are favorable and are primarily dependent on the degree of associated trauma.

Adolescent↗

PubMed2002

Early and late outcome of bedside percutaneous tracheostomy in the intensive care unit.

To simplify long-term airway management in critically ill patients the feasibility of performing percutaneous tracheostomy (PT) in the intensive care unit (ICU) was investigated from August of 1997 to March of 2000. Bedside PT was considered for patients with positive end-expiratory pressure <10 cm H20, no previous tracheostomy, no anatomic distortion of the tracheal region, and no other indication to go to the operating room. Indication for tracheostomy, duration of endotracheal intubation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, morbidity, and mortality were determined. Patients were prospectively followed until decannulation or for a minimum of 3 months. PT was performed in the ICU in 71 patients. Indications for PT were: acute respiratory failure (41), airway protection (26), and maxillofacial trauma (four). Mean duration of intubation before PT was 14 days (range 5-35 days). Average APACHE II score was 14 (range 3-28). Morbidity from PT included: early (two) and late (one) bleeding from the tracheostomy, early cuff leak (one), and self-decannulation (one). Sixteen patients died of causes unrelated to PT. Forty-five patients were decannulated after an average of 57 days (range 9-170 days); two noted a minor voice change. PT can be performed in the ICU with minimal morbidity eliminating the need for an operating room, the risks of patient transport, and the costs associated with each.

Adolescent↗

PubMedDate not supplied

Comparative study of two systems of delivering supplemental protein with standardized tube feedings.

Burn patients often require protein supplementation for their nutritional support. Although these are often added to a commercial formula, published standards recommend a 4-hr hang time for manipulated open-system formulas in comparison with 24 hr for unopened closed systems. We hypothesized that use of standard closed-system formulas with the addition of protein flushes via the feeding tube twice daily would reduce nursing time and increase satisfaction. A pilot study included a time study comparing the two methods and a nursing satisfaction questionnaire. Management of an open system consistent with national standards took almost twice as much nursing time daily as the closed system with supplemental protein flushes (36.6 +/- 17.1 min vs 18.6 +/- 3.6 min; P =.051). Sixteen of 17 nurses preferred the closed system with protein flush. The results of this study were used to support expansion of the protocol change throughout the hospital.

Bacterial Infections↗