PubMed Health⌕ Search

Biomedical subjects

G F Purdue

Publications and source records attributed to G F Purdue.

At least 19 recordsLinked to original sources
PubMed1995

Pediatric grease burn injury.

OBJECTIVES: To evaluate the incidence and severity of grease and oil burns in children and to discuss prevention. DESIGN: All pediatric patients admitted with hot grease burns were compared with the general pediatric burn population. SETTING: All admissions to a regional burn center during a 20-year period were reviewed using a computerized database. PATIENTS: Eight thousand three hundred sixteen patients with acute burn injuries were admitted. Children less than 15 years old accounted for 31.9% of this population (2651 patients). Two hundred fifteen children had burns caused by hot grease or oil. INTERVENTIONS: Sixty-nine patients (32%) in the pediatric grease burn group were admitted to the intensive care unit. Thirteen patients (6%) required intubation, and six (46%) eventually required tracheostomy. Sixty-three patients (29.3%) required operative procedures for wound care. MAIN OUTCOME MEASURES: Grease burn patients had a significantly higher incidence of full-thickness burns, wound infection, and burns involving the face, neck, chest, and arms but lower mortality compared with the general pediatric burn population. Fifty percent of grease burns were caused by home deep fryers. RESULTS: There was no difference between the groups regarding age, sex, or ethnic distribution, size of injury, length of hospitalization, number of intensive care unit admissions, pulmonary infections, operative procedures, or mechanical ventilator requirements. CONCLUSIONS: Grease burns often result in long-lasting, disfiguring, and debilitating injuries. Home deep fryers are frequently involved in these injuries. Careful use of these appliances is mandatory. Increased public awareness is vital to this effort.

Adolescent↗
PubMed1995

A double-blinded prospective evaluation of recombinant human erythropoietin in acutely burned patients.

OBJECTIVE: To evaluate the effects of recombinant human erythropoietin (r-HuEPO) in attempting to prevent anemia in acutely burned patients. DESIGN: Prospective double-blind randomized study of 40 patients. METHODS: Patients with burns from 25% to 65% total body surface were enrolled. r-HuEPO or a placebo was begun within 72 hours of admission. Cell blood count, reticulocyte counts, transfusion requirements, and blood loss were measured. Comparison was carried out by the unpaired t test. MAIN RESULTS: There was no statistically significant difference in hemoglobin, hematocrit, reticulocyte count, ferritin, serum iron, total iron blinding capacity, or transfusion requirements. In patients with burns from 25% to 35%, the reticulocyte counts were statistically significantly higher. CONCLUSION: In our work the administration of r-HuEPO in acutely burned patients did not prevent the development of postburn anemia or decrease transfusion requirements. Increased erythropoiesis in smaller burns (25% to 35%) was observed and may indicate a reason for further study.

Adolescent↗
PubMed1995

High-voltage electric injury: assessment of muscle viability with MR imaging and Tc-99m pyrophosphate scintigraphy.

PURPOSE: To evaluate use of magnetic resonance (MR) imaging and technetium-99m pyrophosphate (PYP) scintigraphy in preoperative assessment of muscle viability after high-voltage electric injury. MATERIALS AND METHODS: Twelve injured limbs were studied. Immediate, equilibrium, and delayed Tc-99m PYP scintigrams and gadolinium-enhanced and unenhanced MR images were obtained. Imaging results were compared with clinical findings. RESULTS: Scintigraphy demonstrated nonperfusion in four limbs that were subsequently amputated, but MR imaging had poor sensitivity in nonperfused regions owing to lack of edema. Tc-99m PYP uptake increased at transition zones between normal and nonperfused regions. MR imaging allowed further characterization of these zones by demonstrating edema as enhancing (perfused) or nonenhancing (nonperfused). In all nonamputated limbs, edema showed enhancement. CONCLUSION: In high-voltage electric injury, gadolinium-enhanced MR imaging appears able to demonstrate zones of potential viability within radionuclide-avid tissue but has poor perfusion sensitivity when used alone.

Amputation, Surgical↗
PubMed1992

The elderly burn patient.

During a 16-year period, 547 patients who were older than 64 years of age with a mean total body surface area (TBSA) (third-degree burns) of 25% were treated. Etiologies were flame/flash in 81% of patients, scald in 11%, solids in 7%, and electrical/chemical in 1%. Seventeen percent of patients had significant causal factors. An inhalation injury was present in 13% of patients, and the mortality in these patients was 100%. Burn excision was performed 239 times in 165 patients. The majority of excisions were for full-thickness burns. Excision did not improve overall survival in patients with third-degree burns of 0% to 10%, but the length of stay (LOS) in excised and nonexcised survivors was improved (9 versus 21 days, respectively). The LOS and survival were not significantly different in patients with burns between 11% and 20%. Postburn complications occurred in 28% of patients. Overall mortality was 50% (mean age: 77 years; TBSA: 40%). There were no survivors with over 47% TBSA burns. The leading cause of death was pulmonary sepsis. Most surviving patients returned to a satisfactory lifestyle after discharge.

Aged↗
PubMed1992

Acute trauma of the femoral artery and vein.

Between 1974 and 1991, 233 patients were treated for 321 confirmed femoral vascular injuries. There were 112 patients (48%) with isolated arterial injuries, 36 (15%) with isolated venous injuries and 85 (36%) with combined arterial and venous injuries. Injury to the concomitant superficial or common vessels occurred in 27 (8.3%) and 9 (1.7%) patients, respectively. Associated extremity injuries included bone, 15%; soft tissue and muscle, 11%; and nerve, 7%. Sixty patients (26%) had fasciotomies. Arterial thrombosis occurred in five superficial repairs. Eighteen repaired veins thrombosed--eight of 61 simple (lateral venorrhaphy) and ten of 50 complex repairs. Thirty-four percent of patients with a repaired venous injury had clinical evidence of postoperative venous morbidity--deep vein thrombosis (DVT), edema, pulmonary embolus. Six patients (2.5%) had a documented pulmonary embolus--four in the 18 patients (22%) with clotted venous repairs. Eleven patients (4.7%) underwent an amputation. Five of the amputations were in patients with either inadequate or delayed fasciotomy. An inadequate fasciotomy was equally as deleterious as a delayed fasciotomy in terms of outcome. Six of 27 limbs (22%) with a femur fracture required an amputation. There were six deaths. Acute limb morbidity was related to the extent of associated limb trauma, i.e., soft-tissue, nerve, and bone damage. Chronic morbidity was related to neurologic deficits and venous sequelae. Vascular injury to the femoral vessels was associated with a high morbidity but low mortality.

Adolescent↗
PubMed1991

Paranasal sinusitis in burn patients following nasotracheal intubation.

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.

Adolescent↗
PubMed1991

Inhalation injuries and burns in the inner city.

Burns in the urban environment present special problems. Although there generally is ready access to appropriate care and short transport times, burn injury remains a serious concern. Inhalation injuries, electrical and chemical burns, and burns as a result of abuse or assault are common problems.

Burn Units↗
PubMed1991

Placement and complications of monitoring catheters.

Vascular access is a necessary evil in critically ill patients, a population that is at high risk for complications. Appropriate planning and attention to detail minimize the associated risks while maximizing the benefits derived from catheter use.

Catheterization↗
PubMed1991

Early orthopedic intervention in burn patients with major fractures.

Surgical treatment of concurrent orthopedic trauma in burn patients is controversial. During a 10-year period, 101 patients were treated for major fractures and burn injuries. Twenty-eight patients with 34 fractures were treated with early operative fixation. The mean TBSA burned was 20%. Ten fractures were open (4 grade I, 5 grade II, and 1 grade III) and 24 were closed. Seventy-five percent of patients had a definitive orthopedic procedure within 24 hours of burn. Intramedullary nails were used in 13, ORIF in 15, external fixation in 3, and percutaneous fixation in 4. Ten patients had burns overlying the fracture site and the surgical incision was made through burned tissue. Four were associated with open fractures. Two orthopedic complications occurred: nonunion of a femoral neck fracture and angulation of a tibial plateau fracture. The goal of orthopedic management in the polytrauma burn patient is to achieve early reduction to allow optimal wound care and early patient mobility. A team approach to patient selection and management is mandatory.

Adolescent↗
PubMed1990

Adult assault as a mechanism of burn injury.

Assault by burning is an often unappreciated cause of burn injury. One hundred forty-eight of 3678 adults admitted to a major burn center with acute burn injuries sustained their burns as a result of an assault by another adult. High-risk groups included blacks and alcohol abusers. Patients were extremely reductant to describe the cause of their injury and to identify their assailant. In contrast to child abuse, very few cases go to court due to the patient's failure to press charges. There was no typical burn pattern, although the injury often did not coincide with the initial medical history. The presence of multiple trauma, occurring in 16% of these patients, must be excluded in the assaulted patient.

Adolescent↗
PubMed1990

Duplex scanning of central vascular access sites in burn patients.

Seventy-one burned patients requiring intensive care unit management underwent 570 central venous and 167 femoral arterial catheterizations. These patients were surveyed by repeated physical examinations and duplex scans for vascular-related complications. Catheter sites were rotated every 3 days. No arterial thrombi or occlusions were noted. Fourteen patients (19.6%) had 19 positive venous duplex scans. Five patients (7%) had symptomatic deep venous thrombosis (DVT) and nine (12.6%) had asymptomatic DVT. Mean number of venous cannulations before a positive scan was 4.3 (range 1 to 17). All five symptomatic patients had DVT that originated in the lower extremities. No patient had clinical evidence of a pulmonary embolus, or limb morbidity resulting from the DVT. Follow-up duplex scans in the five asymptomatic and three symptomatic patients showed complete resolution in each case. This study demonstrates the high incidence and natural history of central DVT in a group of critically ill burn patients.

Adult↗
PubMed1989

Multiple trauma and the burn patient.

Multiple trauma greatly complicates the care of the burn patient, whereas a burn often complicates the diagnosis and treatment of the trauma patient. One hundred seventy-six of 3,550 consecutive acute burn admissions received nonburn trauma. The majority of injuries were sustained in motor vehicle accidents (70), escaping fire (32), electrical burns with falls (24), scald burns associated with assault (22), and explosions (18). Eighty patients received orthopedic injuries, including major (47), minor (25), and multiple (28) fractures, 10 dislocations, and 4 open joints. Soft-tissue injury occurred in 91 patients, head injury in 30, thoracic trauma in 27, and abdominal injury in 15. Unstable orthopedic injuries were major contributors to morbidity. Early internal and external fixation permitted optimal mobilization and wound care. Awareness of the potential for multiple injuries and the team approach to these injuries are the most important factors in appropriate care.

Adolescent↗
PubMed1988

Aeromonas hydrophilia infection in burn patients.

Aeromonas hydrophilia rarely infects burn wounds. Three cases of early A. hydrophilia burn wound infection, with one death, are reported. A history of extinguishing the fire with dirty water or by rolling in dirt should alert the physician to consider A. hydrophilia as a possible infection organism.

Adolescent↗
PubMed1988

Morbidity and mortality of an endemic pathogen: methicillin-resistant Staphylococcus aureus.

Over an 8-year period, two epidemics of methicillin-resistant Staphylococcus aureus (MRSA) occurred in a burn unit. Sources of sepsis were the burn wound and lung. Fourteen percent of the patients colonized with MRSA became bacteremic. The mean postburn day of bacteremia was 19 and the mortality rate was 5 percent. MRSA was introduced to the burn unit when a patient was transferred from another unit, on readmission of a previously infected patient, or heavy burn census when MRSA was epidemic in the hospital. Although the morbidity rate associated with MRSA infections was high, the mortality rate was low. Gram-negative sepsis has continued to be more lethal.

Adolescent↗
PubMed1988

A clinical trial of i.v. tetravalent hyperimmune Pseudomonas globulin G in burned patients.

Pseudomonas aeruginosa continues to be a common lethal pathogen in burned patients. Active and passive immunization represents an important therapeutic adjunct. Ten patients with Pseudomonas sepsis, eight with bacteremia, were passively immunized with tetravalent hyperimmune Pseudomonas-intravenous immunoglobulin G. The dose was 500 mg/kg given on two successive days. The IgG levels rose after infusions and were maintained in the normal range throughout the septic course. Antibodies to the immunotype of each of the Pseudomonas responsible for the bacteremias were present in the hyperimmune globulin. Clinical improvement in the patients was associated with a 3- to 125-fold postinfusion increase in antibody titers. Seventy per cent of the patients survived, including six of the seven with bacteremia.

Adolescent↗
PubMed1988

Cyanide toxicity in burned patients.

The role of cyanide (CN) in smoke inhalation injury has been the subject of investigation for many years. Prospective evaluation of serum CN, thiocyanate (the primary metabolic product of CN), and carboxyhemoglobin (COHb) in patients suspected by history of having smoke inhalation injury was performed in 144 patients. Eight of 12 patients with "lethal" CN levels (greater than 1.0 mg/L) died. All had sublethal levels of COHb. A separate group of patients who were DOA following fatal burn injuries were also studied. Lethal CN levels were found in 12 of 14 victims with lethal COHb levels and in 14 of 20 victims with sublethal COHb levels. The results show that elevated CN levels are frequent in patients with smoke inhalation and suggest that cyanide toxicity is a contributor to severe inhalation injuries. In some cases, CN was the primary measured toxicant.

Acidosis↗
PubMed1988

Pulmonary emboli in burned patients.

The incidence of and prophylaxis against clinically important pulmonary emboli (PE) in burned patients is an often discussed problem. To study its magnitude, all patients admitted with acute burns were followed for clinical evidence of thromboembolism: 2,106 patients were evaluated (1,439 adults). No children had evidence of PE. Six adults (0.4%) sustained a PE: none died. Mean burn size was 26.8%; mean age, 35.1 years; and mean weight, 90.8 kg. Mean PBD of the PE was 16.5 days. None with PE were ICU patients and none had lower-extremity IV lines. Two patients had embolic events after discharge from the hospital. No ICU patients who died unexpectedly had a PE. Only two patients had significant risk factors; they were obese with leg burns. Three had no risk factors; normal weight and upper body burns without prolonged bed rest. The incidence of pulmonary emboli and resulting morbidity do not justify routine prophylactic heparinization of all burned patients.

Adolescent↗