Thirty-one-year review of medical education.
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Biomedical subjects
Publications and source records attributed to H G Bingham.
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A four-year update is reported on the Eugene Tubbs Burn Intensive Care Unit at the University of Florida Shands Hospital. Flame (68%) and scald (18%) burns have remained fairly constant over the period. There were 123 inpatients and 356 outpatient visits this past year with an infection rate of 21%. Seventeen patients were age 50 or older and the average body surface area involved of the 9% mortality group was 57.4%. The advantage of a burn team working in a specially designed unit is emphasized.
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We report a series of 10 congenital hemangiomas which have been followed by serial examinations with the Doppler apparatus, to determine persistence of and increase in A--V fistulae, or a decrease in same. We believe the data on the A--V fistulae correlate inversely with the likelihood of spontaneous regression and involution.
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The Doppler ultrasonic flowmeter has been used as an aid in locating blood vessels that supply axial flaps in several different clinical situations. It has also been of value in microvascular surgery in which axial vessels of island flaps can be located and continuous patency monitored after their transfer and anastomosis.
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Various problems, involving money, space, personnel, and their relationship to the hospital administration, can be associated with the establishment of a Burn Unit. However, these problems can be overcome. During the creation of a Burn Unit, consultation regarding the design features of the unit is particularly important.
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A CO2 laser fire in the laryngotracheobronchial tree occurred because of an increase in fraction of inspired oxygen to greater than 40%. An endotracheal tube was ignited and caused a severe burn of respiratory mucosa that required treatment in a burn intensive care unit. The patient had surprisingly few immediate respiratory complications and was discharged from the hospital 25 days after the burn.
An anesthetic technique, involving nasotracheal intubation, after mask induction with halothane, nitrous oxide, and oxygen, is described for use during fabrication of a contoured facial pressure mask. Rationale and benefits are discussed, and particular emphasis is placed on the potential problems of the commonly used ketamine-based technique.
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Forty-two patients who were to undergo plastic surgical procedures were asked whether they would accept acupuncture as a substitute for local anesthesia. Eight patients agreed to acupuncture; one of these had 2 operative procedures with acupuncture. Five of the 9 procedures were successful; the remaining 4 required conversion to local anesthesia. After interviewing the patients, we felt that the success of "acupuncture anesthesia" was largely dependent on patient motivation, and that a patient may experience pain during surgical procedures without any change in facial expression or vital signs. We concluded that "acupuncture anesthesia" is of little value in our patient population at present. Its results are unpredictable; therefore, we anticipate that patient acceptance will be small.