Underlying structures

The low resistance offered to current flow by nerve, muscle, and blood vessels accounts for the severity of damage to these structures. Muscle, in particular periosseous muscle, may be non-viable although surrounding tissues, fascia, and tendons are undamaged. Swelling and edema are worst in the first 24 h after the burn. These cause compression, particularly in the forearm and calf, and decompression should be performed by fasciotomies either on clinical grounds (pain, paresthesia, anesthesia, loss of pulse, tenseness on palpation) or by demonstration of raised compartment pressures (within 30 mmHg of diastolic pressure). Swelling may be accentuated by the administration of crystalloid, a dilemma familiar to those working with burned patients. At operation non-viable tissue should be removed and amputation may be necessary. In this situation the surgeon may be in the unenviable position of not knowing from visual examination whether tissues are dead or alive. Additional exploration is often necessary, and good results have been reported after repeated exploration of deep muscle compartments in the forearm and hand.

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Sleep Apnea

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