Indications of hospitalization:
- 15% total body burns,
- 10% burns in children or old adults,
- 5% full thickness burns,
- Burns of hands, feet, face, eyes, ears or perineum,
- Suspected inhalation injury,
- All electric and chemical burns,
- Any associated injury,
- Any pre- existing illness.
- Remove the person from further danger.
- Neutralize chemicals- water in copious amounts is good.
- Specific agents:
- For acid – 3% sodium bicarbonate.
- For alkali – 1% acetic acid (vinegar).
- Phosphorous burns – keep wet at all times, irrigate with 1% copper sulphate.
- Hydrofluoric acid – apply calcium gluconate get.
- Wound – cover with a clean wet towel.
- Fluids – major burns – nil by mouth; start an i/v line by 18 g cannula.
- Analgesia – narcotic analgesics best suited for burn patients.
Evaluation of the abs’s:
Airway – breathing – circulation
Indication for referral to a burn specialist:
- 20% second degree burns,
- All deep burn,
- Respiratory burn,
- Electric burn,
- Chemical burns,
- Associated injuries.
Aims of treatment:
Prevention & treatment of shock,
Prevention of complications,
Closure of wounds.
Other important considerations:
aintain and preserve body function and appearance as far as possible,
Healing in least possible time with minimal scarring,
Mental and emotional stability of patient and family members.
In the field of burn management focus has been on development of techniques so as to achieve complete healing of injuries and return
of the patient to his/her schedule in possible time so as to save the valuable time &money and to avoid the psychological trauma and agony to patient and his/her
family members. All this has been possible because of the better understanding of –
- Avoidable causes of infections,
- Factors responsible for delay in wound healing,
- Factors leading to fibrosis & scarring,
- Importance of early provision of healthy skin cover &
- Importance of early mobilization.
Trend now a day is of management of deep burn injuries by
early excision of burn wound and skin grafting
The superficial burns almost always (unless infected) heal without any significant scarring in two to three weeks time. Deep burns need specialized
management so as to treat the deep burns by dressing & dressings & dressings … until the granulation tissue is fit to accept skin graft. Granulation
tissue gradually matures into fibrous tissue that is the precursor of the most of the ill effects of burns. This can largely be avoided by early excision
of deep burn areas and at the same time by providing cover by split skin graft. This should always be considered for deep burns on hands, neck, and face& across flexor aspect of joint surfaces.
Post burn scars, contractures, other deformities and disfigurements,