Biomedical subjects

D M Heimbach

Publications and source records attributed to D M Heimbach.

131 records · Page 8Linked to original sources

PubMedDate not supplied

Does early excision of burn wounds change the pattern of mortality?

Ninety-five patients died at the University of Washington Burn Center from 1980 to 1985. Fifty-seven patients (60%) survived more than 3 days. Thirty-five of these patients underwent excision and grafting. The major causes of death were pneumonia, burn wound sepsis, and sepsis from multiple sources. Thus infection was the cause of death in 26 (74%) of these 35 patients. The other 22 patients who survived longer than 3 days did not undergo excision and grafting before death. The primary cause of death was pneumonia. Infection was the cause of death in 12 patients of this group (55%) and thus was the major cause of death in 62% of all patients who survived more than 3 days. Although early wound closure may affect overall mortality, it does not appear to materially change the pattern of the causes of death in those that die after 3 days of hospitalization.

Adult↗

PubMedDate not supplied

Efficacy of continuous passive motion (CPM) devices with hand burns.

Ten patients with bilateral (deep second-degree and/or third-degree) hand burns requiring excision and grafting were included in a prospective randomized study to evaluate the efficacy of continuous passive motion (CPM) with burned hands. The purpose of the study was to evaluate: 1) if CPM is a useful alternative to supervised OT/PT for burned hands; 2) which patient populations benefit from CPM intervention; 3) if CPM use has deleterious effects on new grafts; and 4) what effect CPM has on hand pain. Eight hands in the control group and eight hands in the experimental group regained normal total active motion (TAMs) in an average of nine days (range three to 22 days). Two hands with tendon involvement in each group remained impaired at discharge. No patients suffered graft loss attributable to range of motion. Both groups reported only minimal pain during exercise.

Adult↗

PubMedDate not supplied

Therapeutic hyperbaric oxygen: help or hindrance in burn patients with carbon monoxide poisoning?

Although its efficacy is unproved, administration of hyperbaric oxygen (HBO) for the treatment of carbon monoxide poisoning is often carried out to prevent the development of acute and delayed neurologic sequelae. In burn patients with carbon monoxide poisoning the value of HBO also is unproved. This review of the clinical course of ten such patients showed major complications during the course of treatment: two patients suffered from eustachian tube occlusion, two patients had episodes of aspiration, one patient had seizure activity, and severe hypocalcemia developed in another. Progressive hypovolemia was seen in three patients; respiratory acidosis was evident in four. There were three episodes of cardiac dysrhythmia. Seven of the ten patients survived. The authors state that the efficacy of HBO in carbon monoxide poisoning must be studied further. Based on their experience and a review of the literature, they contend that important delayed neurologic sequelae are rare, and further, that they occur and resolve with or without HBO. Multicenter randomized clinical trials with controlled follow-up are needed to assess the actual incidence of neuropsychiatric sequelae and to evaluate the efficacy of HBO.

Adult↗

PubMedDate not supplied

Duodenal erosion by aortorenal dacron graft.

Fistulous communications between the bowel and arterial grafts present difficult problems in diagnosis and management. The majority of these cases exhibit retroperitoneal sepsis but in some instances communication between the bowel and the lumen of the arterial graft produces serious hemorrhage. In contrast, the current report describes a patient in whom bleeding occurred twelve years after insertion of an aortorenal graft and the source of bleeding was arterial erosion of an ulcer in the duodenal wall rather than an aortoenteric fistula. Removal of the graft, closure of the ulcer, and nephrectomy were effective in treating the bleeding ulcer and the renovascular hypertension.

Adult↗

PubMedDate not supplied

The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Arm Injuries↗