BURNS 19

 NUTRITION

Since there is Ileus in most cases there is need to insert a

nasogastric tube and remove the gastric contents and

instiantacids on return of motility. 

The NG tube is removed antacids or cimatidin are give orally to prevent ulceration.

There is always an increase in metabolic rate in these patients

and a negative Nitrogen balance lasts for months.

* The normal requirement of proteins is roughly 4 gm/kg in a

child and 1.5 gm./kg in adults. A 50% increase should be

aimed at in a child and 100% in adults in these cases

* In calories a 30% increase is desirable.The intensive

feeding should be started on the third or fourth day.

* Tube feeding may have to be resorted to if the patient does

not feed himself

Nutritional need in the burnt patient can be predicted /

estimated in a 70% burnt patients requires 2000-2200 calories and

12-18 gms of nitrogen per m2of body surface per day.

It is neccessary therefore to provide liquid through nasogastric

tube in which the lower end of the tube is positioned in the

duodenum.

 

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BURNS 18

 ANTIBIOTICS

In our country patients arrive late and some degree of

contamination may have occurred,it is necessary to give

prophylactic antibiotic therapy; and this can be provided by

giving full doses of penicillin.

- The further treatment of the burnt area, is guided by

recognition of areas of full thickness skin burn

- These will require early sloughectomy (Removal of the full

thickness skin burnt area with the scalpel under anaesthesia).

- The areas requiring this treatment will become apparent any day

after the 4th day this treatment can be undertaken, at the end

of first week or later.

- These areas will require covering with split thickness graft.

 

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BURNS 17

 SKIN GRAFT TECHNIQUE

Grafts are usually taken with a Blair or a Humby knife from the

limbs.

* An electric dermatome is used when a large amount of skin

is required.

A Padget's dermatome is most helpful for

obtaining skin from the abdomen.

* Full aseptic precautions are taken

. The donor parts are cleaned and drapped in sterile towels, and after taking the

  grafts, the parts are bandaged in an occlusive dressing

  before the burnt areas are exposed.

* The grafts are laid on tulle gauze raw surface up and cut

   into decent sized pieces.

* These are laid on the recepient area after it has been

   cleaned. Edge to edge covering is done and another layer

   of tulle gauze applied.

* The whole area is bandaged in an occlusive dressing given to

   hands, joints of the limbs, face and neck.

   Dressing is removed in seven days and the residual areas are grafted as

   soon as more skin is available.

 

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BURNS 16

Local treatment 3

Circmferential burns

A full thickness circumferential burn injury carries with it  the

risk of compression of structures underneath the wound. In the extremities the combination of increased extravascular fluid in

the wound and underlying tissues and the lack of elasticity of

the burn wound can lead to subeschar pressures.

All extremities with circumferential full thickness burns should

be elevated to minimize edema formation and should be evaluated

hourly for signs of vascular compromise.

An escharotomy is performed by making an incision through the

eschar or the lateral surface of the extremity. An additional escharotomy may need to be performed on the medial surface as

well.

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