Pavement temperature and burns: streets of fire.

STUDY OBJECTIVE: To measure pavement temperatures over a 24-hour period to determine when patients are at risk for burns and to report cases of pavement burns with predisposing factors. DESIGN: Descriptive study of pavement temperatures and retrospective case series of 23 patients with pavement burns admitted to the Maricopa Medical Center during the years 1986 to 1992. PARTICIPANTS: Twenty-three patients with pavement burns serious enough for them to be admitted to the burn center. RESULTS: We measured the temperatures of asphalt, cement, and other outdoor materials hourly for one 24-hour period using a thermocouple thermometer. Asphalt pavement was hot enough to cause burns from 9 AM to 7 PM during the summer months. It was hot enough to cause a second-degree burn within 35 seconds from 10 AM to 5 PM. The group of burned patients could be divided into three categories: incapacitated, restrained, and sensory deficient. All burns involved less than 13% of the total body surface area. CONCLUSION: During summer days in the desert, pavement is often hot enough to cause burns and does so with regularity in the southwestern United States. No one should be allowed to remain in contact with hot pavement, even transiently.

Continuous venovenous hemodialysis.

Hemodialysis and peritoneal dialysis are the main renal replacement therapies for patients with acute renal failure. These patients are often unable to tolerate drastic fluid shifts and other complications of conventional dialysis. Continuous hemodialysis, however, provides protection from the hemodynamic consequences and osmotic stressors of conventional dialysis and is rapidly becoming the treatment of choice for critically ill patients. We present a case in which a patient with a spontaneous cerebellar hemorrhage developed acute renal failure. Surgical evacuation was not an option. Clinical management included the use of continuous venovenous hemodialysis, which is described in the setting of a patient with a posterior fossa mass. The risks of anticoagulation, hemodynamic instability, and development of dialysis disequilibrium syndrome are discussed.