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

Any questions be sent to drmmkapur@gmail.com  

All olderposts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com  

www.otmanage.blogspot.com  

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.

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for accrss and review.

Visitors that follow may post contributions.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com

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.

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors thay follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot,com

www.otmanage.blogspot.com   

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.

 

ANY questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com 

www.otmanage.blogspot.com  

BURNS 11

MANAGEMENT 3

   *  In the second 24 hours the fluid requirement is half of the

      first day.

   *  The colloid is administered in the form of plasma or plasma

      replacement depending on the depth of the burn.

   *  If a large percentage of burn area is full thickness than

      the colloids are increased and the electrolytes

      correspondingly decreased.The rate is adjusted so as to

      give half of the first day's requirement in the first 8

      hours.

   *  It must be stressed, however, that the time is calculated

      from the moment the burns are sustained, and that the fluid

      calculated as above and the daily metabolic requirement

      (2000 ml.) must be administered to the patient.

   *  Assessment of progress is best obtained by catheterizing

      the patient and if the urine output is near 50 ml per hour,

      it can be presumed that the fluid requirements are being

      met.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com  

www.otmanage.blogspot.com  

BURNS 10

MANAGEMENT 2

.

Major  burns  of 15% or 10% in children need to  be  admitted  to

hospital  for  their  proper  care  and  treatment  and  may   be

considered under the following heads:

 

       1.  Check clear airway

       2.  Treatment of neuro-genic and olig-aemic shock

       3.  Tetanus Prophylaxis

       4.  Prevention and treatment of infection

       5.  Skin cover for the full thickness loss at the earliest

           opportunity

 

 PAIN

Adequate  sedation  in  the  form of  pethidine  for  adults  and

children is employed.

 FLUID

Wallace's  Rule  of nine" is used to estimate the  percentage  of

area burnt and fluid requirement is calculated.

 

                            

Detect  the  depth of burns - this is represented  by  the  three

degrees  depth  of skin burnt,  clinical  appearances,the  layers

affected.

   *  As a general rule 0.5 ml. of colloid and 1.5 ml. of

      electrolyte are prescribed for every 1% of burn per

      kilogram of weight per 24 hours.

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.drmmkapur.blogspot.com

BURNS 9

2.3 MANAGEMENT

There are a couple of "Dont's" that need to be impressed upon for

those first coming in contact with these patients outside hospitals.

   *  Do not remove clothing

   *  Do not apply emolients or pastes of any description

   *  Put out the flames(burning clothes)

In the case of acid burns a weak solution of Soda Bicarb and  for

alkali burns a 1% solution of acetic acid should be used.

- Burnt area should be wrapped in clean sterile towels,if these

are available.

 

If  transport  to  hospital will take an hour a  drip  should  be

started.

In the hospital, minor burns of 10% or less may be dealt with  in

the out-patients department and discharged.

   *   The wound is cleaned and dressed with wide mesh veseline

       gauze and reinforcement with a lot of cottonwool to act as

       a pressure dressing.

   *   Necessary  analgesics and fluids are prescribed and the

       dressings are changed at 3-4 days interval.

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com