BURNS 15

Local treatment 2

* Indications for immediate removal of dressings may be:

Signs of excessive pressure

Soaking of the dressing due to discharge

Unexplained pain or fever

Slipped dressings

* Otherwise the dressing can be left on for several days

* Infection is dealt in the usual manner,by antibiotics, saline

or eusol dressings.
The areas of known full thickness burns

which should be obvious by now are desloughed by taking the

patient to the theatre and under anaesthesia removing the

eshcar with a knife in the second or third week.

* Cover with split thickness graft is undertaken, when the

sloughed areas cleared shows a healthy granulation

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BURNS 14

 

MANAGEMENT 4

2.3.3 LOCAL TREATMENT

* Light anaesthetic may be required for the the procedure in the

operation theater.

Under strict aseptic conditions the burns are cleaned with 1% cetrimide,loose tags removed and blisters punctured.

* The burns are now dressed with tulle gauze covering the entire

area

* If cotton wool is available in abundance, it is used in long

pads. These are placed in the long axis of the limb and extra

pads are reinforced in front and behind joints

* The limb is now encircled in crepe or ordinary bandage with

considerable cross garter using adhesive Elastoplast to

prevent slipping of the dressing.

* Hands are kept in position of maximum function,lightly elevated

to prevent swelling

* Exposure method is an equally good technique of treatment, if

the ward is dust proof.

* Flies can be kept away by using a mosquito net.

* This method may be useful in our country where hyper pyrexia is

a problem particularly during the summer.

 

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BURNS 13

MANAGEMENT 3

Patients who have sustained a major burns injury should have a

nasogastric tube placed to decompress the dilated stomach.

During transport and resuscitation every effort should be made to

maintain body temperature.

Patients are draped in clean sheets or blankets and in the

initial phase in the emergency care area the room is armed.

Resuscitation fluid should be warmed when fluid are given at

rates of greater than 200ml/h. burn injured extremities should be

elevated above the level of the heart.

Every guideline that has been developed carries with it the

mandate that the patient's response to resuscitation be used as

the actual determinant of fluid administration, not the formula!

The goal of resuscitation is to maintain adequate tissue

perfusion and therefore preserve organ function.

The traditional assessment of adequacy of resuscitation in burn

injury has been based on observation of blood pressure, heart

rate and urine output.

In this approach the patients is "titrated" with fluid to

maintain a normal blood pressure and heart rate and a urine

output of 1 ml/kg per hours or 30 to 60 ml/h in an adult patient.

 

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BURNS 12

MANAGEMENT (CONT)

General Principles

Because intravascularfluid loss beginstooccur immediately

after burn injury.

Peripheralvenous cannulation is preferred overcentral venous

access through noninjured sites is not available.

Patients withgreater than 20% total body surfaceareainjury

(15% inchildren) require intravenous fluidresuscitationand

should have a catheter placed in the urinary bladder.

* The treatment of the burnt area overlaps the above

measures. At any time, as soon as the condition of the

patient improves, local treatment is undertaken.

* Calculation for the record of 24 hours. 0.3-0.5 ml per kg

per% burnt area of celloid or plasma equivalent 5% dextrose

to maintain 30-50 (1 hr.) urine output.

* Invasive monitoring is for those where the response to

resusitive fluids is not adequate. SWAN-Ganz catheter will

reveal the need for improving myocardial function by the

use of dobutamine and other ionotrpic drugs.

 

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