Treatment

Initial treatment of burn casualties will be resuscitative.

When such casualties are first seen, a simple plan of treatment must include: maintenance of airway with ventilating support as needed, adequate fluid therapy, and careful records of input and output.

• Maintenance of Airway
  This is of particular importance in head and neck burns or in unconscious casualties. If large numbers of casualties are seen requiring transportation over long distances early in the post-burn period, tracheotomies may have to be done on a routine basis.
  
  Tracheotomies done prior to the onset of edema are much easier to perform than when they are done after edema has resulted in respiratory obstruction. When only small numbers of casualties require treatment, tracheotomies are rarely required.
• Fluid Therapy
  The shock that is associated with an extensive burn will be severe, and survival of these casualties depends upon adequate, balanced fluid replacement therapy.
  
  The military uses a standardized formulae for determining the fluid requirements of burn casualties. The basic principle in these formulae is that the amount of fluid required is proportional to the percent of body surface burned and body weight.
  
  The type of fluid used includes colloidal materials to replace the plasma constituents lost as well as electrolytes.
• Fluid Requirements for First 24 Hours
  
  1. Colloid solutions: 0.5 ml x body weight in kilos x percent of body surface burned.
  2. Electrolyte solutions: 1.5 x body weight in kilos x percent of body surface burned.
  3. Additional fluids: 2000 ml 5-10% dextran in water.
• Restrictions
  Certain restrictions on the application of this formula are required since it is only a guide.
1. Fluid requirements for an injury involving more than 50% of the body surface should be calculated as if the burn were no more than 50%.
2. 10,000 ml of fluid should be the maximum given in the first 24 hours.
3. The first half of the fluid should be given more rapidly than the second; and the actual rate of administration should be adjusted according to urinary output.
4. During the second 24 hours, the colloid and electrolyte given should be about one-half of that given during the fi rst 24 hours. Again, the actual rate should be adjusted to maintain a reasonable urinary output. This is the single best clinical guide to use in determining the casualty's actual fluid requirements.
5. After the 3rd or 4th day, the casualties will begin to resorb fluid from the edematous areas and will excrete it in large quantities. Administration of fl uids to replace this loss is contraindicated.
   
   Excessive administration of fluids must be avoided during this time, and fluid intake can generally be reduced to that normally required for metabolic needs.
• Input and Output Records
  It is extremely important to accurately follow the input and output of fluids in burn casualties.
  
  It would be impossible to modify fluid therapy according to individual needs without accurate records. Most burn casualties will require urinary catheterization, and this can aid considerably in recording urinary output rates accurately.

Care of Burn Wound

Although first priority in casualty care is resuscitation, proper care of the burn wound is essential both for survival as well as for optimum healing and preservation of function.

In that regard, as soon as the casualty's overall condition permits, after hospitalization, initial debridement and cleaning of the burn should be done. The main purpose of this treatment is to remove foreign material and dead tissue to minimize infection. Thorough irrigation and the application of topical antimicrobial creams such as argentic sulfadiazine and sterile dressings should complete the initial procedures.

Special attention should be given to critical areas such as the hands and surfaces over joints.

Apply a Dressing to the Burn

• Hold the dressing in place with one hand and use the other hand to wrap the bandages around the limbs or the body.
• Wrap the bandages in the opposite directions until the dressing is completely covered.
• Tie the tails into a knot over the outer edge of the dressing. The dressing should be applied lightly over the burn. Ensure that dressing is applied firmly enough to prevent it from slipping.
• Use the cleanest improvised dressing material available if a dressing is not available or if it is not large enough for the entire wound.

Take the Following Precautions:

• DO NOT place the dressing over the face or genital area.
• DO NOT break the blisters.
• DO NOT apply grease or ointments to the burns.
• DO NOT attempt to decontaminate skin where blisters have formed.

Electrical Burns

Check for both an entry and exit burn from the passage of electricity through the body. Exit burns may appear on any area of the body despite location of entry burn.

Chemical Burns

Flush the burns with large amounts of water and cover with a dry dressing.