Læknablaðið - 01.04.1943, Blaðsíða 14

LÆK NABLAÐ1Ð
118
liver oil ointment, sulphonilamide
paste, ancl scarlet red with sulphon-
ilamide have also been extensively
used. These have been used espec-
ially for the cases of burns of the
hands, face and genitals. These
have all been an effort to improve
'on the use of the escharotics.
For extensive loody burns, baths
in warm saline have lteen used.
Immersion in this bath for 4—6
hours, then placing the patient on
steriie sheets, and covering the
burned areas with warm saline
dressings is the method. It is large
ly used as a preliminary treatment
1io use of the triple dye, or other
tanning method, while combatting
shock. The basis for this is that
Naval officers have noted that
burn cases which liave been immer
sed in the saline sea water for per-
iods of time after injury have not
had as rnuch shock or pain as cases
not so immersed.
Lately, the English liave been
using the sulphonilamide, saline
and tulle gras method or treatment
with great success. Fortunately, I
have seen sonte of the results of
this type of therapy, and have been
tremendously impressed as to its
value.
Tulle gras is a meshed gauze,
which is impregnated much like
vaseline gauze, with a mixture con-
taining 98 parts of parrafin, 1 part
balsam of peru. and 1 part olive
oil.
In tliis meth'od of treatment, the
burned area its very lightly debrid-
ed of dead tissue and the blistered
skin, and the aiea sprinkled wit'h
powdered sulphonilamide. This is
then covered with gauze soaked in
normal saline. This is then, in turn,
covered with the tulle gras mesh,
more saline gauze used to cover
the tulle gras, and liandages in
place. Once daily, the bandages are
soaked off, never forcibly removed,
and a new dressing applied. This
method, whiie especially valuable
for burns of the hands and face,
has also been used for extensive
burns of the body, by the use of
large tubs of the saline solution in
the soaking off process. Of course.
careful routine sulfo levels are
taken, as a check on the use of the
sulphonilamide.
Another method, which has lieen
largely used, especially in cases
complicated by fractures, etc., is
the plaster cast therapy. This don-
sisted of applying plaster over
sterile wadding upon subsidance
of the initial edema. The cast was
left in place until healing had oc-
curred, even though the local area
became very foul smelling. Its
success was throught to l>e due to
the development of a bacterio-
jihage.
Now of all of the above ment-
ioned therapy, we have limited our-
selves to a discussion of the local
treatment entirely. This should be,
of sedondary importance, our first
principle being the treatment of
shock.
Shock is divided, for our pur-
pose into primary, sedondary and
tertiary shock. Primary shock
comes on immediately after injury
and is similar to any traumatic
shock. It is largely due to pain,
plus loss of plasma, and I believe,
fear. Secondary shock, which com-
es 011 in 12 to 24 bours after the
initial injury is probably due to
increased loss of plasma, with the
resulting lilood doncentration, plus
proliably absorbed ]>rotein factors.
If our primary treatment is ade-
quate, the nuniber of these cases
shtauld lie minimal. However, in
war time, where delay may occur.