ABSTRACTS

was recommended that patients receiving more than eight vials of antivenin be treated with a gradually tapering dose of steroids.

Harold L Skaggs, Jr, MD

echocardiography, myocardial contusion

those patients who were already being monitored due to the severity of their injuries. It was concluded that an abnormal echocardiogram would help determine those requiring in- vasive monitoring prior to surgery and that a normal echo- cardiogram with a normal ECG may be helpful in eliminat- ing admissions solely for rule-out myocardial contusion.

Cheryl Melick, MD

The value of echocardiography in blunt chest t rauma Hiatt JR, Yeatman LA, Child JS J Trauma 28:914-922 Jul 1988

The diagnosis of cardiac contusion in blunt chest trauma is a difficult diagnosis to make clinically but is very impor- tant for the hemodynamic instability it produces. A pro- spective study using two-dimensional echocardiography in 79 consecutive patients with blunt chest trauma seen dur- ing a one-year period was performed. Six patients were elim- inated because no echocardiography was performed, three due to death, two due to aortic surgery, and one due to tech- nical difficulties. Of the 73 patients studied, all had serial CPK-MB enzymes, serial 12-lead ECGs, continuous ECG monitoring, and two-dimensional echocardiography within 24 hours of admission. Patients were divided into four groups for analysis of data. Group .A (n=35) had a normal echocardiogram and ECG, Group B (n= 16) had a normal echocardiogram and abnormal ECG, Group C (n= 14) had an "acutely abnormal" echocardiogram with five normal and nine abnormal ECGs, and Group D (n = 8} had a "chron- ically abnormal" echocardiogram with four normal and ab- normal ECGs. Group A patients had no arrhythmias or in- stability, but eight did have elevated CPK-MB fractions. In Group B, no one had elevated CPK-MB fractions and only one required antiarrhythmic therapy. In Group C, 12 had wall motion abnormalities thought to be acute, and four had pericardial effusions. Seven had elevated CPK-MBs, seven required invasive monitoring, three required dopa- mine, and one required treatment for ventricular tachycar- dia. In Group D, two had elevated CPK-MBs but none had arrhythmias or were unstable. Overall, the Group C pa- tients had higher injury severity scores (P < .01). Two-di- mensional echocardiography was helpful in determining if acute or chronic cardiac disease was present; however, acutely abnormal echocardiograms were found only in

polyetherurethane, wound healing

A clot. inducing wound covering with high vapor permeabi l i ty: Enhancing ef fects on epidermal wound in part ia l - thickness wounds in guinea pigs Jonkman MF, Bruin P, Hoeksma EA, et al Surgery t04:537-545 Sep 1988

A new experimental wound covering, polyethemrethane (PEU), was compared with control wounds and those cov- ered with the occlusive dressing OpSite ® to determine the effects on rate of reepithelialization, healed epidermal thickness, and scab thickness. Anesthetized guinea pigs had two standard 2-cm by 2-cm partial-thickness wounds made on their shaved backs with a hand dermatome. Each wound received a different treatment (PEU, OpSite ®, or air ex- posure) in a random fashion. The PEU-covered wounds showed 85% reepithelialization on day 2 as compared with 66% and 35% for the OpSite ® and air exposure-treated wounds, respectively. Scab thickness was maximal in the wounds exposed to air; however, there was no significant difference in eventual epidermal thickness regardless of treatment choice. Epidermal wound healing was clearly su- perior in PEU-covered wounds. Noninterconnected micro- pores, relatively high hydrophilicity, and good membrane elasticity make the PEU extremely water vapor permeable. However, the PEU membrane will not transport water in a liquid state and is not permeable to coagulase-negative Staphylococcus aureus. Further, the PEU adheres well to moist wound surfaces without added adhesives but does not stick to normal or healed skin. It is also easy to handle be- cause it does not stick to itself. The superiority was thought to be due to high water vapor permeability, which induced concentration of wound exudate into a jellylike clot layer.

David Rosenberg, MD

172/111 Annals of Emergency Medicine 18:1 January 1989