7-19
Bacitracin to the face and to burn areas. If burn creams are not available, a 0.5 percent solution of
silver nitrate in water is also very effective. Apply this solution to a thick layer of gauze dressings at least
once every 6 hrs (must be kept moist). Do not put silver nitrate on the face (stains the corneas black).
Other options: any antibiotic ointment, Betadine ointment or even honey.
15.Do not use prophylactic IV or oral antibiotics. A centimeter of redness surrounding a burn wound is
common, and results from local inflammation rather than true infection. If redness spreads and other
symptoms of infection appear, the patient has cellulitis and needs anti-streptococcal antibiotics
(penicillin, vancomycin, or 1st generation cephalosporin). When effective burn creams are not used,
the patient may develop invasive gram-negative burn wound infection. Look for systemic signs of sepsis
and changes in the color and odor of the burn wound. This is a life-threatening problem– give aggressive
fluid resuscitation, and two broad-spectrum IV antipseudomonal antibiotics (piperacillin, ticarcillin or a
3 rd generation cephalosporin; and an aminoglycoside).
16.Burn patients need more calories and protein. Supplement patients with burns over 30 % TBSA with
milkshakes or any similar high-calorie, high-protein food source.
- Burn patients with deep burns across most or all of the anterior and lateral chest may develop a “chest-
eschar syndrome” during the first 24 h post-burn. Full-thickness burned skin (leathery, tight, and inelastic)
may act like a straightjacket, inhibiting chest movement during inspiration or bag ventilation. Using a
scalpel or electrocautery, cut through the eschar on the chest from mid-clavicular line to anterior axillary
line down past the costal margin. Then, connect right and left across the epigastrium (see Figure 7-2,
chest escharotomy). Do this procedure immediately when it is needed. - Burn patients with circumferential deep burns of the extremities are at risk for an extremity eschar
syndrome, in which swelling beneath the inelastic eschar causes gradual constriction of the blood vessels.
This can result in nerve and muscle damage, and eventually life-threatening infection of dead muscle
and/or limb loss. This syndrome is diagnosed by loss of distal pulses in a patient with deep (full-thickness
or deep partial thickness) burns of an extremity. (Note also that low blood pressure due to severe
shock may also cause loss of peripheral pulses in burn patients.) Treat with escharotomy: incise the
tight, inelastic eschar with a scalpel or electrocautery. Place the incision in the mid-lateral and/or mid-
medial line of the extremity (see Figure 7-2). Cut all the way through the skin, but no deeper into the
subcutaneous fat than is necessary to release the tension. Low-dose IV narcotics or ketamine will help
control pain. Check distal pulses after the procedure to make sure it was successful.
Alternate: Chemical Injuries - Decontaminate the patient. Decontaminate at the site of injury as thoroughly as possible. Determine
exactly what compound caused the injury. Following decontamination, treat in the same manner as
thermal injuries. - Acids or bases: brush off any solid material, then flush with copious amounts of water—at least 30
minutes for acids, hours for bases. Test the skin with pH paper to determine when it is safe to stop
decontamination. Never attempt to neutralize a chemical by applying a basic compound to an acid burn.
Burns of the eyes should be continuously irrigated (can use IV line) at the inner canthus. Alkali burns of
the eyes may require irrigation for 8-12 hours. - White phosphorus (WP): an incendiary compound that ignites on contact with air at 32°C (89.6°F).
To prevent this, wounds containing WP fragments must be continuously immersed in water, saline
solution, or similar liquid. Remove the fragments in an operating room and place them in a container of
water. A Wood’s lamp (UV light) can be used in a dark room to identify these fluorescent fragments. - Hydrofluoric acid (HF): HF absorption can cause deep tissue damage and can deplete circulating calcium
and magnesium, resulting in lethal dysrhythmias. Topical application of calcium gluconate in a gel such
as Surgilube will chelate the fluoride anion and prevent systemic absorption. This mixture can be placed
inside a surgical glove for those patients with HF hand burns. - Tar and asphalt. Hot tar and asphalt cause a deep thermal injury. Cool the injured areas in water. Then,
apply white petrolatum (Vaseline, etc.), mineral oil, or vegetable oil to the area in order to dissolve and
soften the material. Do not apply gasoline or other petroleum-based solvents.
Alternate: Fluid Resuscitation - If LR is not available, you may use normal saline or alternate between normal saline and sodium
bicarbonate solution (mix 2 1/2 50-meq ampules of sodium bicarbonate per liter of D5W to make a