Aging Begins at 30

Burns Shoud Be Avoided But Can Be Treated Part II

When the serious burn victim has fluids replaced, he or she needs nutritional support. When the fluids leak, energy leaks too. Burn patients need at least twice their usual calories. So much energy is used that 25% of the body weight is lost with a 40% or greater burn. A very warm, very moist room conserves energy.

In order to deliver fluid and nutrition, two large bore intravenous lines are set up and resuscitation fluid needs to be measured by urine collection from an indwelling Foley bladder catheter. There is gut paralysis and a nasal tube is inserted to aspirate stomach contents and prevent vomiting. A good airway is secured by an endotracheal tube. A mechanical ventilator support may be needed. Morphine is given IV and the patient is protected against tetanus.

The burn wound can be excised and covered with temporary or permanent closures such as pigskin or human cadaver skin. Skin grafts from unburned parts of the patient can be meshed and made to cover three times the original area.

The burn itself will need to have dead tissue removed (debridement). Silver sulfadiazine locally will delay invasion by environmental (20%) or the patient's intestinal bacteria (80%) until the patient is again covered by their own skin. Highly resistant organisms occur in burn units and threaten to invade unless meticulous isolation is practiced. Timely closure of the burn wound is the best defense. Selectively chosen antibiotics can be used when skin bacteria, sampled three times weekly, exceed 100,000 per gram of skin when it's known that blood stream invasion is likely. If too many antibiotics are given for too long, these invasions are made worse and are followed by hard to treat invading fungi.

Breathing hot air or smoke may cause damage to the upper breathing passages or lungs. Inhalation injury is suspected if a burn occurs in a closed space or there are burns of the head and neck. Lung involvement is suggested by a productive cough, wheezing, singed nasal hairs, coal colored sputum, or red vocal cords. Sepsis or pneumonia will cause at least 50% of burn deaths.

First, don't get burned. Second, get rushed immediately to an expert burn center and get coordinated team care.

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See related Patient Topics Burns, Fire Safety, Injuries and Wounds, Safety or Safety--General.

See related Provider Topics Burns, Injuries and Wounds or Safety.

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