Læknablaðið - 01.04.1943, Blaðsíða 16

120
LÆK N A B LAÐ 1 Ð
This will keep the load down on the
hospitals where large numbers o.f
casuals are being cared for.
Htospital treatment. First. —
Further, ntore adequate treatment
of shock. This should be similar
to that outlined for the emergency
tratment, but, of course, more
thorough. The .use of the Trende-
lenburg position, with the further
usa of p'asma, cortical hormone,
and oxygen are to be prescribed.
The ámount of plasma needed can
be determined by frequent red
blood cell counts and hemoglobiu
determinations.
Next, the use of the combined
tetanus and gas gangrene antitoxin
should be urged. Care should be
taken to not inject into those sensi-
tive to horse serum. As the eschar
formation produces an ideal locus
for the growt of anaerobic organ-
isms, the use of the antitoxin is
imperative.
As soon as possible with the
condition of shock existing, the
patient shuld be removed to the
operating room and given intra-
venous sodium pentothal anae-
sthesia. Careful, gentle, and I strese
gentle, cleansing of the burned area
is to be done. This should be done
by careful removal of dead tissue.
and irrigation with warm mormal
saline. Next, spraying of the af-
fected areas, excepting the face,
hands and genitals, with tlie triple
dye is done. Spraying every hour
for 8 hours is usually sufficient to
produce a fine eschar.
The eschar loosens in from 10 to
14 days. Where grafting is neces-
sary, it should be done as soon as
posible after removal of the eschar.
I stnongly reconnnend the sul-
phonilamide, and tulle gras method
for treatment of the hands, face
and genitals. Therfore, I propose
to use the triple dye for burns
of the torso and upper extremities,
with the sulphonilamide and tulle
gras for the hands, íace, forearms
and genitals. In case of burns of
the hands, motion should be insti-
tuted at once, and as soon as pos-
sible grafting done where needed.
One of the great deformitv jtro-
ducing conditions of the hands is
the involvement of tendbns in scar,
and early motion and graíting help
to reduce this to a minimum.
To recapitulate therefore, first
treat the shbck, adequately and
throughly, by the use of morphine,
heat, stimulants, plasma and oxv-
gen. Tlien treat the burns locally
as suggested, with the triple dye
for general body burns. and the
sulphonilamide, tulle gras and
saline fbr the burns of the hands
face and genitals. Early motion
and skin grafting are urged. I
believe that this will result in a
decreased mortality rate, a decrea-
sed morbidity, increase t’ne percen-
tage of good cbsmetic and funct-
ional results, and minimize the
necessity for plastic corrective
proceedures.